Description: The COVID-19 pandemic brought forth a flurry of rapid change and a greater need for nurses across the country. Pre-existing staffing challenges compounded with higher acuity patients warranted the need for creative staffing approaches to meet pressing demands. The temporary employment of traveler registered nurses (AKA travelers) became an immediate and viable solution to a complex situation but posed unique challenges. Therefore, this strategy was further enhanced with the creation of internal and community nurse labor pools to further support the organization’s needs. Nurse leaders at an acute care hospital in Texas worked collaboratively with key hospital personnel to create new nursing jobs and implement a condensed onboarding process to employ over 250 new nurses within the past two years. Flexibility, an organization-specific “culture of ownership” mentality, and a “proceed until apprehended” nursing framework were vital in this process, which allowed for shared decision-making and ongoing revisions. A designated leader oversaw staffing practices and lead the medical surgical travelers to create consistency. Traveler and labor pool nursing practice related to performance, quality, and patient safety were led at the unit level by clinical managers. This created a greater sense of ownership and shared accountability for the new staffing strategies amongst the division clinical managers. These roles were supported administratively by the director of the medical surgical division and the chief nursing officer.
Orientation for these nurses was led by the nurse fellowship manager and focused on high-risk, low-volume interventions to promote safety and quality. This included live didactic and web-based learning modules, along with a condensed unit orientation approach. Additionally, team huddles, weekly updates, and frequent in-the-moment education offerings were shared with the travelers to streamline communication and promote transparency and accountability amongst all nurses. A designated nurse educator was also assigned to support the travelers and labor pool nurses to provide unit-based rounding, peer support, and ongoing education.
Evaluation/outcome: As a result of mixed staffing models and innovative leadership strategies, diverse patient care needs were met with temporary nurses with varied backgrounds and experience. Collectively, these strategies led to greater consistency in staffing at the unit level and allowed for positive relationships to develop amongst the temporary nurses, clinical managers, and core hospital staff. Quality and patient safety were not sacrificed as a result of collaboration and innovation. Hiring for such temporary roles allowed for flexible cost containment with a varying census. While the current health care environment no longer warrants the need for mass hiring of nurses, tradition staffing structures have been left with gaps and uncertainty. An ongoing need to employ temporary nurses will likely continue and should be expected. The willingness of nurse leaders to embrace travelers and labor pool nurses at this hospital paved the way to integrate unique alternatives into the existing staffing plan, while still promoting a safe and high-quality environment.
Evidence-based references
1. Faller, M., Dent, B., & Gogek, J. (2017). A Single-Hospital Study of Travel Nurses and Quality: What Is Their Impact on the Patient Experience? Nurse Leader, 15(4), 271–275. https://doi-org.lopes.idm.oclc.org/10.1016/j.mnl.2017.03.016
2. Raso, R., & Fitzpatrick, J. J. (2022). Travel Nurse Perceptions of Work Environment, Authentic Leadership, WellBeing, and Pandemic Impact. Nurse Leader. https://doi-org.lopes.idm.oclc.org/10.1016/j.mnl.2022.03.007
Gina Desrosiers
9/30/22 11:11 am
This is a great model. it's good to see that you took advantage of COVID surge to make administrative changes. It's a good use of resources.