CEO Roundtable 

By Caroline Hudson and Alex Kacik

Nationwide labor shortages have continued to hinder the healthcare industry. In response, organizations have boosted worker pipelines, looked to technological solutions and altered their practice patterns to try and maximize efficiency while minimizing burnout.

In the first part of a two-part CEO roundtable (read the second part here), Modern Healthcare asked the CEOs of Nashville, Tennessee-based Ardent Health Services; Marlton, New Jersey-based Virtua Health; and Rapid City, South Dakota-based Monument Health to share their workforce strategies moving into 2023. The interviews have been edited for length and clarity.

How will the staffing disruptions in both clinical and nonclinical roles change your health system’s long-term strategy toward recruitment and retention?

Marty Bonick, president and CEO, Ardent: This is the most acute I’ve ever seen the healthcare staffing challenge. We’ve always said we’ve had a nursing and physician shortage, and it’s always been out in the distance, but it’s here right now. We’re all feeling it, and it’s impacting our ability to care for our patients in the manner that we would like.

We’re looking at technological solutions to bring nurses to the bedside and help with some of the more routine tasks. Instead of having nurses and caregivers take vitals, they can react to what the machines are telling them and clearly determine when somebody might be deteriorating and needing intervention.

On a longer-term basis, we’re continuing to look at how we can mold our staffing patterns to conform with what the patients need. If there aren’t enough nurses, we have to look at how we get nurses to act and perform at the top of their license. Doing so requires changes in practice patterns—how we can have other ancillary providers supporting our nurses to do some of those tasks that may require licensure changes or regulatory changes down the line.

Dennis Pullin, president and CEO, Virtua: We’re dealing with a tremendous amount of folks who are leaving the industry as a result of burnout—demand is much greater than the supply. So, we are having to sort of rethink some of our strategies.

We have to make our current workforce a priority, looking at how we address the overall well-being of our existing employees and doing the things that we need to do to retain them. In terms of recruitment, you have to be competitive in the market that you’re in. Unfortunately, salaries right now play a big part of that competitive edge, which is something that we’re having to deal with. But we’re looking at other vehicles, particularly from a long-term perspective.

We recently partnered with Rowan University here in South Jersey to create an academic medical center, which is the Virtua Health College of Medicine and Life Sciences at Rowan University. One of the reasons we did that is so we could take a more active role in training our future clinicians. We’re creating our own pipeline by being part of that educational process.

Paulette Davidson, president and CEO, Monument: We’re the largest employer in the region. We currently have around 500 open clinical roles that we’re recruiting for, and we’re recruiting regionally, we’re recruiting nationally. We’re all looking for the same people. It’s probably more challenging to recruit to a rural setting than an urban setting.

We’re having a difficult time absorbing the cost impact in our organization. When you look at the makeup of our patient profile, 72% of our patients have some form of government payer. When 72% of your payer mix is fixed, meaning you can’t change your rates to absorb these higher expenses, it’s requiring us to look carefully at our clinical programs.

We recently had to close one of our long-term care facilities because we couldn’t staff it. We were to the point where the staff that we did have were tired, managers were working the night shifts, and we came to a place where we realized in order to ensure safety of those residents, we would have to close that long-term care [location].

We’re seeing that across the region. Long-term care organizations that we don’t own or operate are reducing the number of resident beds because they don’t have the staff. In one of our hospitals in Rapid City, our tertiary-level hospital, one whole floor of that hospital is occupied by patients who we have not been able to discharge. They can’t go home. They need more support, but the long-term care organizations in our community just can’t accommodate them.

What is your plan to reduce contract labor in 2023, and what cost savings could you potentially glean from that?

Bonick: We have seen the rates for contract labor come down from the peak of the pandemic and they’ve come down significantly, but they’re still probably about 50%-plus higher from where they were pre-pandemic.

Our focus is on recruitment and retention in our markets. Nurses are coming back into permanent roles. We’re really focusing on welcome-back programs to bring nurses who might have left our facilities back and honor their years of service.

Pullin: The rates have come down a little bit since the height of the pandemic, but our need for contract labor is still pretty high. Long term, is that sustainable? I don’t believe it is.

We have to be very active in our recruiting efforts and making sure that we can compete with those agencies. People want to work at a place where they feel valued in their field, where they can make a difference. Salary obviously is a big part of it. But as we look at people in the workforce today, they’re wanting to be something that’s a little bigger than just themselves. They want to know that they’re working for an organization that is committed to the community and where they’re allowed to be heard.

Davidson: Eighteen percent of our acute-care nurses were contract nurses [in late October]. I would say, three months ago, four months ago, it was probably 24%, almost 25%. They’re wonderfully trained. They do a great job. But given the cost of that contract labor, it’s expenses that were unbudgeted.

In South Dakota, we have a Board of Regents that is responsible for six universities across the state, and we have two of those universities in our region. We sat down with the legislature, we sat down with our Board of Regents, and said, “How do we train more nurses and give them a clinical experience in one of our hospitals [or] clinics, and hopefully, help them remain in our area?” We’re building … a new simulation center [at one of the universities], and we’re going to attempt to nearly double the size of [the pool of] registered nurse graduates, from 72 nurses a year to 120. Now, how long does it take to get your bachelor’s-level nursing degree? Probably four years. So, if you think about it, this is not a near-term solution. But in the long term, it could generate many more registered nurses every year for the region.