Bill Klaproth (Host): This podcast is brought to you by PRS Global. PRS Global offers an end-to-end staffing solution for hospitals to cost effectively tap well-qualified and experienced nurses from international markets and to personally ensure that these nurses are capable, productive, and engaged from day one. To learn more, visit prsglobal.com

This is a special episode of Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, recorded live at the AONL 2024 Conference. I'm Bill Klaproth, as we talk about How International Direct-Hire Can Enable A Return To Growth for Hospital Systems.

With me today is Caitlyn Obrock, Manager of the Clinical Recruitment Team at SSM Health. We also have Kara Murphy, President of PRS Global, and Seth Levell, System Vice President of Nursing Transformation and Innovation at SSM Health. I want to welcome you all to our podcast booth at AONL 2024. Seth, welcome.

Seth Lovell: Thanks, Bill. Appreciate it.

Host: You betcha, Caitlyn.

Caitlyn Obrock: Thank you. We're excited to be here.

Host: Yeah, Kara?

Kara Murphy: Bill, thanks so much for having us today.

Host: Of course. Are you kidding me? It's going to be fun talking about this. So Seth, let me start with you. So here at AONL 2024, one of the topics getting an enormous amount of attention is how to stabilize the nursing workforce. How significant a problem has the nursing shortage been for SSM health and what strategies have been tried in the past?

Seth Lovell: Yeah, that's a great question. I'll tell you SSM Health is not unique in the fact that our workforce has been one of the largest challenges. I would say even pre-COVID, but certainly exacerbated through the challenges that we saw through the pandemic. So from an approach perspective, we've really, I feel like, tried everything. It's been really multifaceted. So, some maybe familiar things that we've done, you know, tried and true for years and years such as addressing pay scales, raising our average hourly rate, increasing sign-on bonuses. But really, I think a couple of unique things. We started looking at this through the lens of the employee value proposition. So, specifically, who are we, what do we offer, and how does that separate us from our competition? And we were able to come out with a couple of unique things. One of those being earned wage access, or otherwise known as the ability for a nurse to work a shift and then walk out to their car and get paid same day. So, a couple of those things, I think, really built on top of some standard things that we've seen that have really enhanced our value proposition that we're offering to our prospective workforce.

Host: I like how you say, we tried everything.

Seth Lovell: Everything.

Host: We did it all.

Seth Lovell: Every stone unturned.

Host: I love it. You said pay scales, bonuses, and then earned wage access, which I think is really cool. And now, you're also emphasizing clinical pipeline diversification to create a sustainable workforce. Can you tell us more about that, Seth?

Seth Lovell: Absolutely. So, when we look at workforce planning, which a lot of organizations engage in, right? In short, it's understanding how many nurses are leaving your organization or transitioning within, which is a win for us. Nurses decide to grow their career within our healthcare system. The loss and the impact on the home unit is still felt the same as if the person's leaving the organization. So, we wanted to understand how many are leaving the organization. And then when we attempt to backfill, where are those pipelines coming from? So, those specific things that obviously healthcare systems have been engaged in for a long time, which is we love to hire graduate nurses. We love to recruit and hire experienced nurses. But as you look at all national workforce statistics and studies, especially those that really are indicating how nursing is going to look five, ten years from now, there's not one that says there's not going to be a shortage. And so for us, it was an ability and a time for us to reevaluate how do we diversify the clinical pipelines? How do we not just rely on the traditional pre-licensure into a graduate nursing school into the workforce? How do we really diversify that outside of our respective markets? And that's actually where a lot of our international workforce, specifically recruiting international nurses in a direct-hire fashion, really began.

Host: So when you talk about backfilling, right? Filling that pipeline, that's very interesting. You talked about international, so it seems like international direct hire is a cornerstone of SSM's health strategy going forward. So, why is that and what are the benefits that you expect see out of that?

Seth Lovell: Yeah. Well, something that's a little bit unique for SSM Health is we were founded by Catholic sisters that came from Germany about 150 years ago. So really, kind of in a layman's terms, like they are kind of the original travel nurses, right? International nurses. They really came from a different country, landed on the banks of the Mississippi and St. Louis, and really just started taking care of the underserved.

So, I think rooted in that mission and in our origin story, we've noticed that the strength of our workforce really comes through diversity. So, we're doing everything we can, I would say, locally, right? Especially in our underserved communities, but we've realized that there's really strong talent internationally as well. And we've heard from our workforce. They just cannot continue to come in and work understaffed. So when we were really trying to evaluate all the options we had available to us, this really actually helped strengthen our workforce because we're able to access talent that we didn't have otherwise, and really feel like it's a major strategy for us to actually stabilize our workforce.

Host: So, is that a large pool internationally that you're able to draw from?

Seth Lovell: It is. I think had high expectations going into it from a pool perspective, and I think our partners with PRS global have done just an incredible job and we're absolutely amazed at how good the talent pool is and how large it is as well.

Host: That's interesting. And Caitlyn, Seth was just saying how large it is and how good it is. So, what are the critical success factors for international direct-hire and how have you addressed them?

Caitlyn Obrock: Yeah, absolutely. We're pretty early in the process still, so it takes about 12-18 months for our nurses to arrive. So, I think importance and understanding how many nurses are coming in and out as Seth had mentioned for those projections. But also, a lot of learnings from our partners at PRS Global and good partnership as we do the interview process and pivot And, you know, I think relationships are really important, as well as aligning with our mission, vision, and values. And so, building those relationships in that waiting period, but also really excited as our nurses come and arrive.

Host: Yeah, that's really interesting. And Kara, being the president PRS Global, how do you intertwine in this? Where do you come into this puzzle?

Kara Murphy: One of the things, we work with hospital systems across the United States and many strategic partners that we have. SSM Health is extremely strategic and very intentional about the program that they're building. So where PRS comes into place, obviously the recruiting. We do have a strong pipeline of nurses in many different specialties, but I would say what's most important to our company is that we actually create a very strong partnership in creating a program, because it's not just the recruiting.

Really, the bigger impact is how do you prepare as an organization, as a hospital system, to be ready for the nurses. We take it very seriously that the nurses and their families are trusting us in their journey to the United States. And so, you know, we really look at how do we make this a win-win for the hospitals that we serve and then also for the nurses. So, we do things like workshops to prepare, like what does it actually look like to do international recruiting from the time you meet the nurse, all the way to they're here at the airport, we're welcoming them, we're making them thrive. And that really is the piece that SSM Health has been very strategic. They have a vision. I mean, you heard it. Seth and Caitlyn have a strong vision on what they are creating. And at the end of the day, they want their nurses coming in and feeling a sense of belonging. It's really important and their success has come from having a champion, having a task force group, creating that, it's been really wonderful to watch that grow. And they don't wait until the nurses arrive to connect with them, they're connecting with them after they're interviewing, and they hire the nurses. They have nurses in town halls talking about SSM Health, talking about the community. But you start building that sense of belonging even before the nurses start.

So, it sounds like

Host: like the onboarding process is really critical. Caitlyn, can you talk about that a little bit?

Caitlyn Obrock: Yeah. So as you can imagine, planning to move your entire family, I can't imagine what that's like. I don't even like moving across the city. But as Kara mentioned, beginning to be engaged, you can imagine things like housing, social security, schools, work, transportation, doctors. I don't like to register my son for school, so can you imagine someone from internationally learning all that process? And so, really getting granular in what will make them successful. Of course, we want to stabilize our workforce, but we also want them to be successful upon their arrival for now and many years to come. It's really moving if you think about the impact that we are able to have for those nurses and their families for many years.

And so, I'd say relationship-building is really important in that waiting process. As Kara mentioned, town halls, getting engaged, answering their questions. And then as for the arrivals, we're working closely with PRS Global to provide a really great integration service. So, all those things mentioned that it's seamless for them, that they have a wrapped-around support, not just that they're filling a need at our hospital.

Kara Murphy: Bill, one thing that I would just add is that vision of supporting them and making sure that they can transition is so important. And sometimes during the process, you're not even thinking about, but once they come over, you know, I get pictures of, "I just had my first baby," "I just bought my first house," "I have my first car," "I just went to New York." I mean, it's really great to hear these stories of how they're impacting. You know, we have nurses that win DAISY awards, right? So, impacting clinically, but also just them getting into their groove in the United States.

And one of the other things I would add is their spouses are also able to work. So many hospitals have spouses working there as well, and that's just another perk. You're building your community.

Host: Yeah, that makes sense. So, Caitlyn, for anyone thinking about doing this, what advice do you have for hospital leaders who are considering international direct-hire?

Caitlyn Obrock: I would say I have a good, strong partner. First, there's a lot of diversity of profile that you need to be aware of, of the immigration process and legal, but also just kind of getting started and you'll be able to figure it out. But no reason to rework the wheel. If someone else has already done it, learning from each other, but also kind of putting your own flair and personality into what your program's going to look like. I think we still should have a strong vision, but figuring it out, but excited to work with other hospitals that are on this endeavor as well.

Host: Yeah, thank you for your time. This has been a great podcast and a great idea to help backfill and fill that pipeline as do have a nursing shortage. So, I think this really an interesting concept. So, thanks for your time today. I'd love to get your final thoughts before we wrap up from each of you. Seth, anything you want to add?

Seth Lovell: So Bill, I would probably just add on to what Caitlyn had shared. I think my recommendation for peers across the country evaluating how to stabilize their workforce, don't let the sheer logistics and the challenges of attempting to hire directly prevent you from going down this path. It is an investment. It does take time. But as Caitlyn mentioned, if you find the right partner, it really drastically reduces the amount of challenges that you're having to endure to really get to that endpoint of stabilizing, having a robust clinical pipeline. So, that would be my recommendation, final thoughts, is you should do this.

Host: Just do this. I love it. I like how you say, don't let the challenge deter you. So, great message. Caitlyn, how about you? Final thoughts.

Caitlyn Obrock: Yeah, along those lines, there's a huge nursing shortage projected in the next 10 years that we're already facing. And so, really challenge yourselves to figure out what is our pipeline and is it strong enough? Is it diverse enough? And really, just get started because it can take a while, but it's well worth the time and investment.

Host: Yeah, for sure. And Kara, how about you? Anything you want to add?

Kara Murphy: So, I don't know if I can beat the just do it.

Host: They set the bar high for you. The bar is set very high.

Kara Murphy: They really did.

Caitlyn Obrock: It like, "But we're here if you're ready."

Host: The pressure is on. Yeah.

Kara Murphy: They really did. You know, I always go back to the planning, being very intentional. Really look at how do you create belonging and inclusion with the international nurses as they come in. They are direct-hire, so they are part of your team. And planning that out is just really important, and the support when they arrive as well.

Host: Very well said. I want to thank you all for your time today. Thank you.

Seth Lovell: Thanks, Bill.

Kara Murphy: Thanks so much, Bill. And thank you, Seth and Caitlyn, for joining. You guys are just incredible partners. Thank you.

Host: Absolutely. All right. Thank you. Once again, that's Caitlyn Obrock, Kara Murphy, and Seth Levell. And once again, we want to thank PRS Global for sponsoring this podcast. And if you found this podcast helpful, please share this on your social channels. We would appreciate it. And check out the full podcast library at aonl.org for topics of interest to you, just like this one. This is Today in Nursing Leadership. Thanks for listening.