How Franciscan Health Tackled Their Nursing Shortages

The 12-hospital, Mishawaka, Ind.-based Franciscan Health system designed an in-house travel nurse program to solve their nurse shortage challenges without using an external staffing agency. Like many hospitals, Franciscan Health struggled with staffing shortages and rising costs during and after the COVID-19 pandemic. Franciscan projected increasing external nurse spending from 2022 to 2023 by 36 percent. After relying on outside staffing agencies, Franciscan launched its travel nurse program in the summer of 2022. Since then, 300 nurses signed on. Now, Franciscan expects external nurse spending to decrease by 22 percent year-over-year.

Healthcare Innovation recently spoke with Franciscan’s Ellen Page, director of talent acquisition.

What made you decide to use this travel program?

In early 2022, we were grasping at any innovative ideas to bring more nurses in. We have twelve hospitals, so we have significant staffing. We put a committee together to brainstorm different ideas that would engage nurses. As many nurses as we hired were leaving as well. As you know, this was the era of great resignation. We came up with different ideas, and one of them was the travel program.

Was this program based on an existing model?

No, it’s brand new.

What are the mechanics of the program?

We were going to bring in nurses from outside Indiana and Illinois, and then we realized we were starting to become a staffing agency, and we didn’t want to do that. We paired it down a little bit to regional travel. We have hospitals in the northwest part of the state, the central part of the state, and the southern part in Indiana. We decided just to recruit local nurses into this program, but they had to commit that they would travel between facilities in that particular region. Then, we didn't have to worry about housing, stipends, or other travel incentives that outside agencies were using. They're at a higher rate of pay, without benefits. We made the plan very flexible. We were like, pick your shift, pick your assignment, pick your length of assignment, and let's go. We were astonished by all these experienced nurses applying - experienced nurses, which we were not seeing in other ways. They may just want to work Friday and Saturday or work for thirteen weeks and then take six weeks off. The flexibility of it was so attractive that it just exploded. We have a great team that's managing these nurses. They move the nurses around as needed. They may have a four-week assignment in one facility and a thirteen-week assignment in another.

I think it’s key to be at the forefront of meeting the needs of the nurses in the labor market, not how we did it ten years ago. I think that’s been the hardest thing for our management teams to get used to because healthcare is very conservative. You may have someone who works from 7 am to 7 pm and who has a partner who works from 7 pm to 7 am. We’re pushing the managers to think outside the box and be innovative in the scheduling because that’s what these nurses want.

We have converted some from the travel program to a regular position. There’s satisfaction, both for the manager and the nurse.

Did you do a pilot program?

We did, and I have to admit, I was the person saying we're never going to get nurses to come here. Other healthcare systems’ programs in Indiana were not successful. But at that time, travel nurses were making a lot of money. They could go anywhere they wanted. We did a pilot in Indianapolis. We could hire 40 nurses, and we did that within six weeks.

We had just gone live with Phenom at the same time, which is our recruiting marketing platform, and the two together were wonderful. With Phenom, we got the word out that we had this program. Nurses could apply very easily, and then we could take it from there and hire them. The program was so successful, I think, before we even finished the pilot, we could move on to another region. Then, we went to our Western region, which is Lafayette, Ind. Then, we moved up to the north part of the state, close to Chicago. We’ve added respiratory, central sterile processing, and imaging technicians. We're not getting the same volume from those tech positions because they're so needed that they're getting the incentives to stay in their hospitals.

Was the pilot program for one department, for example, the ICU?

Any; we have different tiers. When you apply based on your skill set, we put you in a certain tier, for example, ICU, acute care, or procedural. That's kind of grown as we've taken off on this journey.

Did you have internal staff nurses applying for the travel program?

If you want to ask about an obstacle, that would probably be one of them. We have a policy that if you leave Franciscan, you cannot come back to work for us as an outside agency nurse for a year. When the pandemic started, people wanted to go to New York to earn $5000 a week and then come back. We were left hanging during our critical shortages as well. We made the policy that you can’t transfer into this program if you’re an active employee. If you resign, you have to wait a minimum of six months to come back. We had to really craft our communication when we sent it out so everybody understood what the program was.

How many nurses are involved in the program?

We're almost at 300. The total number of nurses at Franciscan is around 4,000.

Do you have any metrics on cost savings and satisfaction rates from the nurses?

I don't have true metrics on the satisfaction rates, but the nurses seem to love it. What's not to love; you don't get in the department's drama.

Overall, it has impacted at least $3 million in savings, if not more. We've reduced our outside agency costs by 22 percent over last year. This is a big piece of it because we can release an outside agency nurse that we pay between $100 and $120.00 an hour and replace them with our own employees. We did rate reductions. We did a lot to impact that number because spending over $100 million in labor costs is not sustainable. All the hospitals are in the same boat. Everybody did what they had to do when they had to do it, but it's just not sustainable. We're very pleased with the impact of the program.

Do you use data analytics to track hours to ensure nurses are efficient?

Nurses track their hours because that's part of their ROI that they're constantly reporting on. Efficiency comes from the manager because they evaluate those nurses. Some of them previously worked for us, so they’re all experienced and know Franciscan. There’s less training needed.

Who presides over the program?

I’m over it as far as the HR piece of recruitment, onboarding, offboarding, and any issues that we run into with nurses. We have a clinical team that schedules them, orientates them, and makes sure that they meet the requirements for the unit they’re going to. We have a huddle weekly because there are so many people in the program.

What would you say your biggest hurdle was?

I would say the managers’ acceptance of it. We didn't do a lot of communication about it. In those first few months, even sometimes now, you feel like a used car salesman, like you're trying to sell them this agency person. And they’re like, I’m good, I’m fully staffed. But they’re fully staffed with outside agency people. It’s taken a lot for them to understand. Some of these outside agency nurses have been with us for more than a year. They feel like part of the family. That’s been the hardest part for managers, to let go of some of these agency nurses because they then have to retrain. But when we give them an experienced nurse as a replacement, then we’re winning in many areas.

What would be your advice for other hospitals that want to implement a similar program?

I would say that when you’re going to develop this program, you have to be innovative. You have to do something different to attract nurses. Some don’t need benefits and may just want to work two days a week. I think what surprised us the most was the quality of the nurses. Some of them had left nursing because of burnout. Some had left because of childcare and didn’t think they could come back. But if we work around their schedule, then that’s a win-win. Once we figured out that piece of it, it changed the whole way we did things. Some of my peers reposted the same staff job and called it a travel position. They just didn’t get any traction. I’d love to say we were smart and knew exactly what we were doing, but we weren’t holding anybody to that kind of constrictive scheduling. We have nurses who are going to have babies, or we have male nurses whose wives are going to have babies, and they can work up to the date. Then, they can take thirteen weeks off and come right back.

We’ve heard a lot about how much nurses learn by floating between hospitals and different units and acuity levels. It would take years for them to get that kind of on-the-job learning. We haven't had too many negative things about it once we got through some of the kinks in the beginning. Now, it's all everybody's talking about because they can see its impact across the system.