The social contract of work in health care is evolving—it’s time for a new approach to nurse staffing

The social contract of work in health care is evolving—it’s time for a new approach to nurse staffing

The social contract of work in health care is evolving—it’s time for a new approach to nurse staffing

ane reached a point in her nursing career where she could no longer withstand the physical demands of hospital-based nursing.

In her 10 years as a nurse, Jane worked in the neuroscience and trauma, post-anesthesia care, and same-day surgery units for a Salt Lake City children’s hospital and in the lung cancer clinic for a cancer hospital. She cared for patients at multiple points in the care journey, from inpatient care to surgery to outpatient care and follow-up. “Understanding the full experience for patients was really valuable for me and my career,” she says.

But early in her career, when Jane worked as a shift-based nurse—half days and half nights—“It was hard on my body, and I became really sick,” she says. “Most people believe nurses have an ideal work schedule, only having to work three days a week. What they don’t realize is that the amount of time spent prepping for and recovering from those shifts is significant, especially for night shifts. And because day shifts extend late into the evening, I often had to miss out on important events with friends and family. I ended up transitioning to a clinic. 

“It was hard for me to admit that to myself and to leave a specialty, patients and coworkers I loved,” Jane says. “I wanted to practice bedside nursing in acute care, but opportunities to do so with a schedule that didn’t impact my physical health were slim to none.” 

Over time, Jane recognized that her experience was not unique as she saw nursing colleagues struggle to find a hospital nursing job with scheduling requirements that were sustainable for their well-being, personal goals and family life.

Jane’s experience reflects the desire for a new social contract of work among nurses—one that incorporates innovative ways to meet nurses’ economic, physical and mental health needs. It’s a mindset shift that hospitals must acknowledge and respond to if they are to keep nursing talent in the workforce and protect quality and continuity of care.

What nurses want from hospital employers

The prolonged stresses of the pandemic prompted nurses to reevaluate whether traditional staffing models in hospitals meet their needs. 

The statistics are familiar to hospital leaders. Just seven out of 10 nurses are satisfied with their work, which sounds like a pretty good percentage until you consider that nurse satisfaction hovered between 80 percent and 85 percent for more than a decade. Nearly one out of five newly licensed registered nurses quit within their first year, and 81 percent of nurses under the age of 35 don’t feel like their organization cares about their well-being. 

There’s so much talk in the health care industry about the level of burnout that nurses faced during the pandemic and that continues to reverberate as we adjust to a new normal. But the truth is one of the biggest stressors nurses endure is a feeling of lack of power—over their working conditions and schedules. They have one of the most emotionally demanding jobs in any industry, yet they are denied the ability to manage their time, energy and emotions.

Reimagining nurse staffing models to better meet nurses’ needs could help keep nurses engaged in providing in-person patient care in hospitals and health systems. But delivering on this vision of work will take a different mindset than we’ve seen incorporated in decades past. It will also demand more effective use of technologies that empower nurses to take an active role in directing their care delivery experience and provide the resources for mental and physical recovery.

One approach that is taking hold puts the power of staffing in the hands of nurses through tech-enabled platforms that provide the ability for nurses to choose when they work and where they work. For the facility, it’s less expensive and more flexible than relying on a staffing agency to fill a specific number of shifts with a single nurse. It also holds strong appeal for nurses at every life stage, from certified nursing assistants who take on shifts to help pay for nursing school to nurses whose children’s activities necessitate a more flexible schedule to nurses who are caring for their parents. I’ve even seen nurses devote greater time to creative pursuits like playing in a rock band or spending summers as a river guide thanks to diem staffing models like this.

For Jane, who now serves as head of clinical for a tech-enabled nurse staffing platform, “It feels like all the dots in my life have connected and led me to this point,” she says. “I love knowing that I’m creating opportunities for nurses to solve complex challenges in health care and make a difference in patients’ lives simply through more flexible options in staffing. Even better, I’m helping to bring optimism back to nurses’ careers by illuminating a path for them to be able to stay in bedside nursing.”

Reaching a state where hospitals can attract top nursing talent—whether full-time or on a per diem basis—also requires organizations to consider how to make nurses’ workloads more manageable. One of the top reasons nurses leave their jobs is because they struggle to keep up with their daily workload, a McKinsey & Co. survey found. There is another factor fueling high quit rates: Nurses feel unappreciated and undervalued by health care organizations—feelings that can fester when heavy workloads put undue stress on nurses for too long.

This, too, is an area where tech enablement could strengthen a nurse’s resilience and satisfaction with hospital-based work. A McKinsey analysis found 15 percent of nurses’ time could be saved through tech-augmented or automated work and improved delegation of tasks, with a focus on empowering nurses to work at the top of their license. Such time savings would allow nurses to focus more of their time doing what they’ve been trained to do—caring for complex patients. It would also provide time to coach fellow nurses and invest in professional growth activities, two areas where nurses want to devote greater attention. 

Decreasing the administrative burden nurses carry each shift also holds strong potential to make work more meaningful for nurses while easing the mental stress of care. Today, 92 percent of nurses say administrative workload contributes to burnout, an Accenture survey shows. By leaning into digital solutions and AI-powered technologies like ambient listening, half of clinicians believe hospitals could improve clinical diagnosis, while one out of three believe it could increase time with patients—a major component of satisfaction for both nurses and patients.

Complex challenges demand new ideas

Nursing shortages didn’t start with the pandemic. In fact, they existed before World War II. That’s what makes the need for new solutions so critical. By designing new models of care delivery and support that reflect nurses’ needs, hospitals can more effectively reignite nurses’ passion for bedside care and retain top talent.

Curtis Anderson is CEO and founder of Nursa and serves on the Board of Directors of the Utah Chapter of the Healthcare Information and Management Systems Society.