Grant Regional Health Center, Lancaster, 2023 Workforce Report

Flexible Staffing

As part of Grant Regional Health Center's ongoing effort to monitor and evaluate our staffing model, we redesigned our inpatient model to include a 7 RN model that replaced the current 5 RN model.  We also assisted with recruitment efforts and was able to recruit eight nurses plus the three nurse interns in June 2022. Part of that effort included to brainstorm and create a recruitment plan for May graduates.  

The second element is to restructure the charge nurse role. Our current nursing structure includes six nurses on each day and night shift. Currently, the charge nurse is part of the six nurses, meaning the charge nurse often takes a patient load in addition to their charge nurse responsibilities. Therefore, the second request includes removing the charge nurse from the core of the six nurses on each shift. The charge nurse would technically be the seventh nurse. They would, however, serve as the charge nurse and would take a patient load if needed based on staffing needs. This would allow built-in backup for staffing needs in case there is a sick call or if patient acuity warrants additional nurses.  

Other important tactics centered around ensuring adequate staffing and staff satisfaction. We implemented a nurse intern (NI) program and launched in 2021. This concept was a win/win because it offered invaluable experience for the students and at the same time, created a pipeline of important extra help for our staff and caring for our patients. Since that time, we successfully hired all three NI after graduation. We also implemented a NCLEX review course payment to set up new graduates we hired for boards. 

Another creative idea that helped us navigate through challenging times was the development of an internal nursing agency. It was important to explore ways to address our inpatient nursing staff needs. In February, the nurse managers presented the idea of creating an internal agency program for nurses to help fill the nursing shift openings. At the time of developing this program, there were three 0.9 FTE flex position vacancies, which equals 18 open night shifts every pay period (every two weeks). To alleviate the burden of last-minute messages asking people to fill these holes, we decided to launch an internal agency program starting March 15. We completed a six-week pilot and it continued successfully until July. The internal agency was much appreciated by staff and worked very well to proactively fill shifts during our time of need.  We also brought back time and a half at schedule posting for holes to cover core of six nurses in September 2022. 

Another important key element to staff satisfaction was reviewing the scheduling process. Our goal was to increase efficiency and consistency across several departments. We gained approval and launched Ability Smartforce online scheduling system for MS, OB and ER nurses.