1. Richie, Kevin
  2. Peeler, Cindy RN, BSN, HSA

Article Content

After Mercy Medical Center, Des Moines, Iowa, established a centralized flex staffing office, the 973-bed hospital achieved significant reduction in its external nurse agency expenses. This reduction positively impacted turnover, staff nurse satisfaction, and overall patient care quality.

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Exploring agencies

The use of registered nurses (RNs) from external staffing agencies-and the accompanying costs-surged at Mercy. Each department head autonomously decided when to use agency nurses to fill open positions or to substitute for absent employees. No less than 11 nurse staffing agencies served various parts of the Mercy campus.


Like any hospital, Mercy paid a premium for the use of agency nurses. Another concern was its impact on care quality and employee satisfaction. Though these elements are difficult to measure, patient care can suffer when agency nurses need time to learn department-specific procedures. Anecdotal evidence and the results of focus group studies show that the job satisfaction of Mercy's staff nurses diminished when agency nurses didn't share their mission-based commitment to patient care.


To reverse the negative effect of agency nurse usage, Mercy set two integrated objectives: to reduce dependence on external nurse staffing agencies and to build an internal team of nurses to fill in as needed throughout the medical center.


To that end, Mercy created a centralized flex staffing (CFS) office. The four-person CFS department developed an internal pool of more than 80 RNs who now fill the vast majority of Mercy's nursing vacancies. CFS clearly impacted the bottom line, saving Mercy more than $1 million during its first year.


Concurrent with the reduction in agency utilization, administrators revised the agency contracting process to improve quality, cost efficiency, and compliance. Revisions included negotiating discounted rates, instituting unannounced agency spot audits to ensure contract compliance, and assigning a single person to process all billing.


Filling resources

To ensure a high-quality CFS pool, applicants must have at least 2 years of nursing experience. Administrators also set baseline pay for CFS nurses high enough to be competitive in the local market, but not so high that it attracts Mercy's staff nurses away from their floors, leaving hard-to-fill vacancies.


The CFS office organizes its RNs into three pods, or groups of nurses with similar skills: critical care nurses, medical/surgical/telemetry nurses, and pediatric nurses. Flex nurses must work a minimum of 48 hours every 6 weeks, including 3 holidays a year. Because they're Mercy employees, they share fully in the mission, vision, and values of their co-workers.


The CFS team establishes schedules for the flex nurses every 6 weeks. Department managers provide flex nurse staffing requirements via standard online forms. The CFS team carefully matches flex nurse availability to department needs. While small adjustments are made daily, and flex nurses sometimes move to different floors within the medical center, their hours remain as scheduled during each 6-week period.


If the available flex nurses can't fully meet the needs of all departments, the CFS team posts the unfilled hours. The flex nurses can sign up for these hours at their discretion. If hours are still open a week before the schedule goes into effect, the CFS team will call in nurses from nurse staffing agencies that still work with Mercy.


Stellar results

In less than 2 years, the CFS team reduced the nursing vacancy rate at Mercy from 10% to about 2%. The medical center decreased the number of nurse staffing agencies it works with from 11 to 3. In addition, nurse turnover is currently 10.7%.


As a result of the success of the CFS nursing team, Mercy has begun to use the flex staffing concept in other skill areas. In addition to RNs, the CFS team manages a pool of 60 nursing students who work as patient care technicians, a pool of more than a dozen clerical workers, and a pool of patient companions. These pools show similar positive effects on quality and costs.