Clinical workforce shortages generally, and nursing workforce shortages specifically, remain the number one issue facing provider C-suites across the country. While multiple studies have focused on frontline RNs’ concerns about acute care employment, few have looked at how nurse leaders are thinking about RN workforce stabilization. Uniquely positioned to offer executive teams insight into workforce investment strategies, Advisory Board conducted a national survey of nurse leaders from member organizations to gauge their top concerns and perceived ability to influence the latest workforce issues. We then analyzed nurse leaders’ concerns in concert with key data from the 2023 NSI Nursing Solutions (NSI) National Health Care Retention & RN Staffing Report. Read on to learn about select findings from our upcoming publication, “Survey report: 2023 priorities for RN workforce stabilization.”

First, some promising trends have just been reported. Not only is overall hospital turnover down from 25.9% in 2021 to 22.7% in 2022, but overall RN turnover has decreased by nearly 5%, from 27.1% in 2021 to 22.5% in 2022. These data suggest that several retention tactics — such as upping compensation, offering greater scheduling flexibility, and creating internal staffing agencies — are starting to make a difference.  

But the data also show that some workforce problems remain and are getting worse. First-year turnover has increased to 28.7% in 2022, up from 27.7% just one year earlier. The average time needed to fill vacant RN positions in acute care has increased to 95 days in 2022 (up from 87 days in 2021). Nurse leaders report that their #1 workforce concern is lack of available RNs in their markets to fill vacancies.  Yet, NSI reports that nearly 70% of surveyed providers plan to increase their RN workforce in 2023; which is unrealistic. Additionally, NSI reports that 78.9% of providers plan to continue using travel nurses at the same level as in 2022, and RN turnover costs have increased by 13%. Amid margin shortfalls, this is financially unsustainable. This sobering picture suggests the need to implement more aggressive workforce strategies, building upon all the work that has already been done.  

In response, Advisory Board has developed data-driven insights to help executive teams determine which workforce investments will be most impactful in 2023. Highlighted here is the first of five insights and a summary of our guidance:

Surveyed nurse leaders’ top concerns include a lack of available RN applicants in their market, continued escalation of RN labor costs, and unresolved RN burnout. At the same time, NSI reports that top recruitment and retention strategies include asking RNs to volunteer for overtime, authorizing critical staffing pay, flexing part-time or per diem RNs, increasing the RN salary scale, as well as continuing to use travelers — all of which actually add to total labor spend.

Remarkably, the NSI reports that only 17% of providers have changed their RN care delivery model as a recruitment and retention strategy. We think staffing model innovation should be the rule, not the exception. Given the scarcity of RNs in local markets and documented pipeline shortages, we must move past care model pilots and scale staffing model changes as safely and efficiently as is possible.

Further, we believe that the potential for clinical technology to support nursing work is grossly underestimated, including options to streamline manual work and augment clinical decision-making. In this regard, nurse leader concerns regarding limited technology investments currently allocated for non-physician workflows need to be elevated. Strategic technology discussions between CNOs, CIOs, and chief strategy officers are essential to ensure technology investments are allocated to the most pressing workforce needs.

Beyond optimizing technology to streamline manual work, key areas to consider when accelerating staffing model change include the following:

1. Redesign the role of the bedside nurse in sync with scope of practice to embrace meaningful nursing work.
2. Address dysfunctional operational processes that overwhelm nurses and waste time.
3. Support your care teams with virtual care technology to extend RN bandwidth, add coaching support for novice staff, and perform select patient-care tasks.
4. Develop an aggressive entry-level and unlicensed worker strategy for non-RN care team roles.

Staffing model changes require leaders to tolerate early ambiguity and risk. That’s why outcome tracking is critical. Likewise, staff themselves will need substantial support to successfully transition into new models of care with redefined roles. Accelerating model redesign at the pace needed will require sufficient resources for staff development, training, change management, and ongoing monitoring.

“Survey report: 2023 priorities for RN workforce stabilization” will soon be available on advisory.com. It will include a detailed analysis of leader concerns, perceived ability to influence, and key market and positional differences. The report will also outline implications for workforce investments. 

In the interim, if you have any questions or interest in follow-up discussion, our experts are available to assist you at AskAdvisory.com