The 12 hospital, based in Mishawaka, Indiana Franciscan health system designed an in-house travel nursing program to solve its nursing shortage challenges without using an outside staffing agency. Like many hospitals, Franciscan Health struggled with staffing shortages and rising costs during and after the COVID-19 pandemic. Franciscan projected an increase in outside nursing spending from 2022 to 2023 by 36 percent. After relying on outside staffing agencies, Franciscan launched its travel nursing program in summer 2022. Since then, 300 nurses have enrolled. northNow, Franciscan expects spending on outside nursing to decrease by 22 percent year over year.
Healthcare innovation I recently spoke with Ellen Page, director of talent acquisition at Franciscan.
What made you decide to use this travel program?
At the beginning of 2022, we were exploring innovative ideas to add more nurses. We have twelve hospitals, so we have significant staffing. We created a committee to brainstorm different ideas that would involve nurses. All the nurses we hired were also leaving. As you know, this was the time 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?
It is not new.
What are the mechanics of the program?
We were going to bring in nurses from outside of Indiana and Illinois, and then we realized we were starting to become a staffing agency and we didn’t want to do that. We link it a little with regional travel. We have hospitals in the northwest part of the state, the central part of the state and the southern part of Indiana. We decided to simply recruit local nurses for this program, but they had to commit to traveling between facilities in that particular region. So, we didn’t have to worry about accommodations, stipends, or other travel incentives using outside agencies. They have a higher salary and no benefits. We made the plan very flexible. We thought, pick your turn, pick your task, pick the duration of your task, and let’s go. We were amazed by all of these experienced nurses who applied, experienced nurses that we didn’t see in other ways. They may only want to work Fridays and Saturdays or work for thirteen weeks and then take six weeks off. His flexibility was so attractive that he simply exploded. We have a great team that manages these nurses. They move nurses around as needed. They may have a four-week assignment at one facility and a thirteen-week assignment at another.
I think it is key to be at the forefront of meeting the needs of nurses in the labor market, not like we did ten years ago. I think that has been the hardest thing for our management teams to get used to because healthcare is very conservative. You may have someone who works from 7am to 7pm and you may have a partner who works from 7pm to 7am. We’re pushing managers to think outside the box and be innovative in scheduling because that’s what these nurses want.
We have converted some of the travel program into regular positions. There is satisfaction, both for the manager and the nurse.
Did you do a pilot program?
We did, and I have to admit that I was the one who said we would never get nurses to come here. Programs by other health systems in Indiana were not successful. But in those days traveling nurses made a lot of money. They could go wherever they wanted. We did a pilot in Indianapolis. We were able to hire 40 nurses and we did it in six weeks.
We had just gone to live with Freak at the same time, which is our recruiting marketing platform, and the two of them together were wonderful. With Phenom, we spread the word that we had this program. Nurses could apply very easily and then we could go from there and hire them. I think the program was so successful that before we even finished the pilot, we were able to move on to another region. Then we went to our western region, which is Lafayette, Indiana. Then we moved to the northern part of the state, near Chicago. We have added respiratory, sterile central processing and imaging technicians. We don’t get the same volume of those tech jobs because they are so needed that they are incentivized to stay in their hospitals.
Was the pilot program for one department, for example the UCI?
Any; we have different levels. When you apply based on your skill set, we place you at a certain level, for example ICU, critical care, or procedure. That has grown as we have taken this journey.
Did you have live-in nursing staff applying for the travel program?
If you want to ask about an obstacle, that’s probably one of them. We have a policy that if he leaves Franciscan, he will not be able to work for us again as an outside agency nurse for one year. When the pandemic started, people wanted to go to New York to make $5,000 a week and then come back. We were also left hanging during our critical shortages. We have established a policy that you cannot transfer to this program if you are an active employee. If you quit, you will have to wait a minimum of six months to return. We had to really craft our communication when we sent it out so that everyone understood what the program was.
How many nurses participate in the program?
There are now almost 300 of us. The total number of nurses at Franciscan is about 4,000.
Do you have any metrics on cost savings and nurse satisfaction rates?
I don’t have any real metrics on satisfaction rates, but nurses seem to love it. What could not be loved; You don’t get involved in the department drama.
Overall, it has impacted at least $3 million in savings, if not more. We have reduced our external agency costs by 22 percent compared to last year. This is a great part because we can free up a nurse from an outside agency that we pay $100-$120.00 an hour and replace them with our own employees. We made rate reductions. We did a lot to impact that number because spending more than $100 million on labor costs is not sustainable. All hospitals are in the same boat. Everyone did what they had to do when they had to do it, but it’s just not sustainable. We are very satisfied with the impact of the program.
Do you use data analytics to track hours and ensure nurses are efficient?
Nurses track their hours because that is part of their return on investment (ROI) that they constantly report on. The efficiency comes from the manager because they evaluate those nurses. Some of them previously worked for us, so they all have experience and know Franciscan. Less training is needed.
Who chairs the program?
I’m already over it when it comes to the HR part of recruiting, onboarding, offboarding, and any issues we have with nurses. We have a clinical team that programs them, guides them and makes sure they meet the requirements of the unit they go to. We meet weekly because there are a lot of people in the program.
What would you say was your biggest obstacle?
I would say that the acceptance by the managers. We didn’t do much communication about it. In those first few months, even sometimes now, you feel like a used car salesman, like you’re trying to sell to this person at the dealership. And they say, I’m fine, I’m fully staffed. But they have staff from external agencies. It took them a lot to understand it. Some of these nurses from outside agencies have been with us for over a year. They feel part of the family. That’s been the hardest part for managers: firing some of these nurses from the agency because then they have to retrain. But when we replaced them with an experienced nurse, we gained in many areas.
What would be your advice to other hospitals looking to implement a similar program?
I would say that when you are 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 only 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 due to exhaustion. Some had left for childcare reasons and did not believe they would be able to return. But if we stick to their schedule, we’ll all win. Once we figured that part out, it changed the whole way we did things. Some of my colleagues 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 didn’t force anyone into that kind of restrictive programming. We have nurses who are having babies, or we have nurses whose wives are having babies, and they can work to 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 over some of the early problems. Now, it’s the only thing everyone talks about because they can see its impact on the entire system.
