Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. This episode brought to you by Healthcare Workforce Logistics. You can visit them at hwlworks.com. With me is Amanda Wheeler, as we talk about cultivating a proactive approach to nursing workforce in healthcare, landmines, pitfalls, and lessons learned. Amanda's going to bring the fun stuff on this podcast. Amanda, welcome.

Amanda Wheeler: Hi, Bill. It's great to be here. Thank you for having me.

Host: Yeah. Thank you for being here, interested to talking with you about this. So when we talk about a proactive approach to nursing workforce and healthcare, you're going to talk about landmines, pitfalls, lesson learned. So, what are some of those? What are the problems that we're facing right now?

Amanda Wheeler: Well, the problem as it stands post-pandemic is that there is an epidemic of burnout, and just a lack of resiliency in the nursing workforce that we need to address and we really need to get in front of. And one of the things that always resonated with me in any of the data is that, if you can provide some scheduling flexibility and some agility, so that nurses can cultivate a sense of work-life balance that's meaningful to them, not just what you think it should be, then, man, you maybe have something there that can help you with overcoming a lot of those issues that we're seeing today.

Host: Yeah. So if you address what's happening out there and make nurses' work-life better, that helps them and also helps you get better patient outcomes.

Amanda Wheeler: It does. It does. And, you know, from a retention perspective, now more than ever is the time to start thinking about how we retain as much of the nursing workforce as we can. It's estimated between now and 2030, that about 600,000 nurses are going to exit the workforce through retirement, or they're just leaving the profession altogether related to some of this burnout. So, we've got to get creative and get flexible with how we let those people that want to stay in the workforce longer, but maybe don't work full-time or three twelves at the bedside just in the same unit. We've got to figure out how to make room for that and create space.

Host: Yeah. Six hundred thousand, holy cow. So part of that, we have to recoup that. We've got to fill those spaces in making the nursing something that people aspire to, but making this profession something people really want to get into and know that they're going to be taken care of once they get into this space. Is that right?

Amanda Wheeler: That's correct.

Host: Yeah. Because there are issues. And of course, we've heard a lot since the pandemic, burnout, stress, all of those things. So, making sure that we take care of those things. So when somebody does get into the profession, they feel supported, heard, cared for. That's really important.

Amanda Wheeler: Absolutely. And I think that the other part of that too is that you also have to look at what you're backfilling with. New nurses and new generations, there's this study out there that says something like 18% of new grad nurses leave within the first two years of practice related to some of these environments of work that they find themselves in and the lack of, flexibility. So, how do we retain those people that are coming in to backfill some of those people that inevitably will retire?

Host: Yeah, absolutely. Okay. So, now that we know the problem, tell us how do we do this? What have you put in place? How do we solve or address this issue? What have you done at HWL?

Amanda Wheeler: So, at HWL and in my former lives before HWL, working inside of healthcare organizations, one of the main tactics that we implemented was float pools, and internal resource pools is probably a better term for it. And we layered them. We would have a facility pool, and then we would have an enterprise pool. And there would be full-time, part-time, PRN positions in these pools. Keep it simple. Start small. Find your cheerleaders and your change agents in the organization. Engage them in the conversation, but start building that internal contingent workforce.

Because the way that healthcare system staff, you really have to make room for the nurses to use their PTO, to be able to take LOAs. It's a largely female-driven, profession. So, having babies, they're going to take an LOA for that. So instead of that becoming something that you need to react to or that is a stressor for your nurse leaders, if you have that internal contingent workforce and that internal bench strength before you have to go outside for external contract labor, it does so many things for the organization in terms of resilience and work environment and creating flexibility, but it's also a really big cost savings for the organization to have that, because then you're not behooved to the supply demand curve that is in the external travel nurse marketplace.

Host: Yeah. So, you call them internal resource pools?

Amanda Wheeler: Correct.

Host: Yeah. So, tell us a little bit more about how you build these. How do these come about? Are there different strategic internal resource pools for different things? Would that be right?

Amanda Wheeler: That's correct. I think that that's where the landmines and the pitfalls come in. And having built three of these so far, I think the things that you have to focus on early on is you got to have a governance structure for it. You need to understand how to implement this in the culture that you're in, and in the time that you're in in your workforce.

You've also got to have some pretty solid focus and investment on some workforce analytics and technology. If you don't have transparency on what your needs are in the organization from a staffing perspective, it's really hard to strategically cultivate one of these pools that is going to be able to respond in the right way in the right time. If you don't have that, then you're taking more of a shotgun approach. And you're just kind of throwing things at the wall to see what sticks. So if I could encourage anyone that's thinking about this, to start somewhere, start with those things. Do an internal assessment first of what your transparency around staffing and scheduling looks like, and what kind of governance structures do you have. Because if this is a top-down-led thing, it's not going to stick. It's not going to take. And that's one of the things that it's so mission-critical to it that I've seen organizations try to start these pools, they don't do that. And then, it's throwing the baby out with the bath water, right? Well, this didn't work for us.

Host: Yep. So, you've got to have the plan, the structure, as you call it, a governance structure. You also said focus, analytics, and then technology all support these internal resource pools. Okay. Can I ask you about technology?

Amanda Wheeler: Sure.

Host: How about AI? Are you able to incorporate AI into any of this at all?

Amanda Wheeler: You can. And I think that's the hat trick here is how do you create efficiencies and integrations into existing staffing and scheduling software that could potentially pull into another software that then can create blasts of recruitment messages to your existing internal contingent workforce and tell them, "Hey, we have a need here."

The other thing that's great about the AI is the element of being able to integrate predictive analytics in with AI. So that once you're underway, you can really start looking at things through the lens of not just what do I need in the next week to two weeks, it's what am I going to need in the next month to two months to six months based on the trends of what my historical utilization has been?

And then, if you pull the AI element into it from your HR information systems and start feeding it information like who's at retirement age? Who is in the military? Who's a military spouse and is on an active deployment and may get redeployed, so they have to leave, right? Who's in nurse practitioner school and therefore may leave the bedside? So if you can anticipate that turnover and you can anticipate those types of things, then your staffing becomes something that is more of a proactive approach as opposed to something that you have to react to. And that's important given the fact that it takes on average right now anywhere from 60 to 90 days to replace a nurse once she gives her notice.

Host: Yeah. So, you're always looking ahead.

Amanda Wheeler: Yes.

Host: Which is really important. So at HWL, this is really fascinating, how do you work with your clients or people or nurse leaders? How do you install this? Or how do you do this?

Amanda Wheeler: So, the differentiator for HWL is that we're a tech firm and that is a true statement, but we are a service-led and a mission-driven tech firm in that we believe that you have to have subject matter experts and that technology should never replace the critical thinking and the human element for those of us who have done this. So, we have a full bench of subject matter experts that can come and help implement this internal to your organization in a consultative fashion, and you don't have to use our software. Or if you want to use our software, that's great. And if you want to use versions of our technology and our service to where we administer your program on your behalf, those are all options. It really is meant to be a bespoke model based on what your organization needs. We really try hard to meet our clients where they are, not where we think they should be.

Host: Got it. Yep. That makes sense. So, let's talk about results, successes. So, tell us, we've talked about the internal resource pools. What have the outcomes been?

Amanda Wheeler: You know, my favorite two stories. One is recent and one is in sort of the first program that I built, because I keep up with all of my programs that I've helped with. The first is the most recent. And we just stood up a program in the last 18 months for a health system up in New York. And year over year, when you looked at their travel spend, we saved them 13% in the first year in terms of their travel spend versus what this or this program costs them. And that's including startup costs. And that one is probably one of my favorites because I think a lot of the naysayers of these types of models will say, "Well, the reason that some of these were successful is because the rates from a traveler's perspective were so high in the pandemic. They're coming down, they're normalizing." So, we've been able to have a proof of concept that's post-pandemic, the rates have normalized, and this will still save you money.

Host: And we're all looking to save money.

Amanda Wheeler: Absolutely.

Host: Especially hospital CEOs and nurse leaders, every little bit helps.

Amanda Wheeler: That's I think what the business is looking for. But the cool thing about this one too is it's almost its own safety net for retention as well. So, you've got these people who are thinking about going to travel, "Hang on, I've got a solution internally for you." Why don't we think about that first, because then you retain them for your organization and you've given them the flexibility to work like a travel nurse could, or work a couple of weeks and then take a couple of weeks off. It really just depends. So, that's the other cool thing-- it's very intentional-- is that you create that room for that flexibility and for that resilience in the workforce of them just wanting to try something different. So, that's the first one.

The second one is from my first program, and we built that one before the pandemic. And when we tracked the dollar savings between travel nursing rates and the pandemic and the float team. We called it the Enterprise Support Team. it was something akin to $52 million in one year, which was pretty great, especially with everything that was going on. But the more important thing is, is in the middle of that, that float team was so invested and so dug in and so committed to that organization, the critical care arm of that team also got a Silver Beacon Award in the middle of everything. So, I'm sure everybody in the nursing world knows about Beacon. And so, it was just kind of unheard of and for a float team to get it. But we leveraged the outcomes of the organization. In our Beacon application, it said, "Look, this team impacts outcomes in every unit across the organization because they go everywhere."

So, this is our value proposition in how we impact quality positively, how we impact morbidity and mortality positively. So, that one was just the coolest, is that these nurses decided to do this and they built it from within the float team, and they had their own shared governance structure that this came from. So, they almost became like a voice or an ambassadorship for the brand of the organization.

Host: Yeah, I think that is great. Thank you for sharing those stories with us. So before we wrap up, and thank you so much for being here, Amanda. I really appreciate it. Anything else you want us to know about HWL?

Amanda Wheeler: Just that our mission is a little bit counterintuitive in that, historically, I think we're known in the market as providing MSP services and helping people procure travel nurses, and it takes a minute for people to wrap their head around the fact that no, our job is to come in and help you use less of that. If you're happy with your utilization, we can still create efficiencies, we can streamline. But our end goal is to make sure that you are adequately leveraged in that space. And so, that's why we have all of this suite of services around building internal resource pools, consulting advisory services. We want you to be healthy and resilient because we understand if you're not and you're not financially sustainable, then we don't have a partner.

Host: Right. And I think you've also touched on the retention part of this, which is really important too. This really sounds like it really helps with retention, which is a big struggle. So, this can really help with that as well.

Amanda Wheeler: Yeah, I think that that's the thing from a retention perspective, you've got to be able to figure out. And one of the things we haven't touched on that I think is important to kind of add here as like an end note, it's not just about retaining bodies, it's about retaining experience. Because these nurses that are retiring have 20, 30 years of clinical expertise. So, how do you retain some of that, even if they're not actively functioning at the bedside so that they can impart some of that wisdom to the incoming generations and you don't have that massive skills gap between or experience gap between the new nurses and the people who are exiting the profession.

Host: Wow. I like how you said that, that's really interesting. It's not just about retaining bodies, it's retaining experience. Really important when you think about that wisdom and wealth of knowledge. That nurses accumulate over their years and then passing that down to the next generation, how important that is.

Amanda Wheeler: Absolutely.

Host: And I would imagine how new nurses entering the profession find that insight valuable, coupled with new things that they learn and new technologies from their generation really can help as well, provide a really cool work environment, which everybody is working toward.

Amanda Wheeler: Absolutely.

Host: Yeah. Amanda, thank you so much. This has really been great. I've enjoyed talking with you.

Amanda Wheeler: Same here. Thank you for having me.

Host: Yeah. Thank you, Amanda. And once again, that is Amanda Wheeler. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. And once again, we want to thank Healthcare Workforce Logistics. You can visit them at hwlworks.com. That's hwlworks.com. This is Today in Nursing Leadership. Thanks for listening.