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If hospitals want to keep nurses, it’s time for more flexible scheduling, leaders say


Health system leaders need to get creative to retain younger nurses and veteran nurses. Hospital leaders around the country have bemoaned a shortage of nurses.

If hospital executives want to avoid losing more nurses, they need to think about scheduling differently, nursing leaders say.

Some nurses are leaving hospitals because they’re weary of long hours. Beyond the long hours, some are also walking away from hospitals because of rigid schedules, says Beth Ulrich, the lead author of a study on nursing released earlier this month by the American Association of Critical-Care Nurses.

Flexible scheduling can help hospitals retain younger nurses, and veteran nurses who may be weary of 12-hour shifts.

Hospital executives need to employ “some creativity” when it comes to scheduling, Ulrich told Chief Healthcare Executive in an interview.

“This has got to be everybody coming together on this one,” Ulrich said. “This is not just a nursing problem, by any wide stretch of the imagination. This is a healthcare problem. It’s how we deliver care.”

“There’s a whole lot of healthcare that’s not going on in hospitals,” she said. “More and more we’re moving to community settings, the local drugstore, whatever. A lot of this, we have to look in the community also. The community starts to look pretty attractive when they work the hours they can work sometimes in the community, compared to what we do to nurses in hospitals with their time. We have to think about that.” (See excerpts of our interview with Beth Ulrich in this video. The story continues below the video.)

Nursing leaders have said the profession can be very difficult when nurses begin having children. Many nurses leave hospitals when they start their families.

Hospital executives should look at devising more flexible schedules to help keep some of those younger nurses, she said.

“If you look at young nurses, younger nurses who have children in school, what if you get them to come in during some of the school hours when they’re free,” Ulrich said. “They have to get kids to school and they got to get kids from school and you need to be respectful of that.”

Engaging longtime nurses

Some of the challenges in the nursing profession began well before the arrival of COVID-19, but the pandemic has made it worse, Ulrich and other nursing leaders said.

Less than half of nurses (40%) said they were satisfied with being a nurse, according to the AACN study. That’s significant because nurses aren’t just unhappy with their employers or positions, Ulrich said. They’re unhappy being nurses.

Two out of three nurses (67%) said they plan to leave their positions within three years. Among those who are thinking of walking away, 36% said they would leave in the next year, the survey found.

Hospital leaders around the country have said they are dealing with shortages of nurses. Some have left hospital settings for other areas of care, including more lucrative positions as traveling nurses with staffing agencies.

With those shortages, hospitals should be doing more to keep nurses with decades of experience, Ulrich said.

Veteran nurses would benefit from moving to more flexible schedules, she said. Nearly half of all registered nurses are more than 50 years old, according to a federal report.

Hospital leaders should also reach out to nurses who recently left to see what it would take to get them to return, she said.

“I think some that left probably will want to come back,” Ulrich said. “I’m confident that’s going to happen. We have to find ways to engage them and re-engage them. There are a lot of nurses my age who still want to be nurses but, you don’t have the physical capacity, when you have this white hair, to flip the 300-pound guy in the bed when you’re trying to turn him over.”

Some nurses “in the third act of their career” may be open to working in hospitals if they are given the right roles, she said.

Perhaps that involves looking at times of the day with peak workflows to get additional help, even if the shifts involve shorter blocks of time.

“That’s something we can do also, not just look for brand new nurses, although they’re real important, but I think we can look for experienced nurses and see what we can do to re-engage them,” Ulrich said.

Some nursing leaders have said it’s time for hospitals to move away from 12-hour shifts for nurses.

Vicki Good, a past president of the American Association of Critical-Care Nurses board of directors, told Chief Healthcare Executive earlier this year that 12-hour shifts pose a lot of problems. “It’s the worst thing from a safety perspective and from a long-term workforce perspective that we could have ever done in nursing,” Good said.

“We have to look at alternative staffing models,” said Good, executive director of nursing for Mercy Hospital in Springfield, Missouri. “The traditional staffing models aren’t going to cut it in the future, unless we can look at an alternative way to get more nurses.”

‘We’ve got to listen’

Most nurses who are thinking of leaving said the top factor that would get them to stay is better compensation. Nearly two-thirds (63%) cited better pay and benefits would prompt them to stick around. However, nearly as many (57%) said they would stay if their employer had better staffing.

Long hours and the lack of staffing weigh heavily on nurses, and nurses say their mental health is suffering. The AACN survey found 40% of nurses said they weren’t emotionally healthy.

“Nurses care about nursing,” Ulrich said. “They care about taking care of patients.”

But nurses take it personally when the lack of staffing prevents them from doing all they wanted for their paritnes.

“Think about the nurse who goes home on any given day and realizes all the things she didn’t get done for her patient, because we didn’t have enough staff …. Sometimes you don’t get to discharge planning and I want to teach you about this medication you’re on, and that’s part of nursing to nurses. That’s what we’re supposed to do for people," Ulrich said.

Nurses are more prone to experience moral distress, when circumstances prevent nurses from providing the care they know is needed. Roughly one in five nurses (22%) said they experienced moral distress in the recent AACN survey, which is twice as many as a previous study in 2018 (11%).

“We’re seeing much higher incidences of moral distress, and much higher incidences where nurses say, ‘I am not emotionally healthy.’ They’re telling you that straight up. And we’ve got to listen to them,” Ulrich said.

Hospital nurses are seeing more workplace violence, and that’s adding to their stress. Only 47% of the nurses surveyed by AACN said they felt that their organization values their health and safety, a sharp drop from 68% in 2018.

Hospital leaders can fix that problem at no cost by simply doing a better job of expressing that they care about their nurses, Ulrich said.

As healthcare leaders grapple with finding and retaining nurses, Ulrich said it’s critically important to look beyond the number of nurses they have on staff. Healthcare leaders must gauge the skills and experience of those nurses.

“A nurse is not a nurse is not a nurse,” Ulrich said. “We’re not counting nurse bodies when we talk about ratios and we talk about minimum ratios and minimum staffing and all those things. We cannot rely solely on how many nurse bodies do we have in a unit. We have to know what knowledge they have, what skills they have, what support they have.”

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