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With health systems exploring many viable labor strategies including telehealth, upskilling/cross-training team members, utilizing part-time or per diem resources, moving patients and/or staff around within a system, we felt compelled to go deeper into the topic of how to procure and maximize the use of agency labor to help meet COVID-19 demand by offering ten specific strategies.


1. The Health System paying the highest rates does not necessarily get the most, or the best, talent

In response to the demand for travel clinicians, hourly rates for travel nurses currently on assignment are up ~15% on average. However, as COVID-19-driven demand increases across the country, the hourly rates for currently open positions are, in some cases, at 200% of the regular rate.

When elective surgeries ceased and demand for travel clinicians dropped this spring, many health systems canceled travel clinician contracts, starting with those clinicians booked at the highest rates. Staffing agencies and clinicians are aware of this, and while they will only consider positions with competitive market rates, many are reticent to fill the highest bill rate positions for fear of them being canceled and having to incur the opportunity costs of re-acquiring work elsewhere.


2. Lower the friction to conduct interviews and hire-offers in four hours or less

The demand for travel nurses, as measured by the number of open positions across the country, has increased by more than 230% since Q1 of this year. The speed with which a health system can interview and offer is one of the most important factors for securing a temporary team member. In order to have the best chance at securing an RN, candidates should be vetted and interviewed within two to four hours of being submitted by their agency.

Available candidates are often working with multiple agencies and are being submitted to eight or more jobs, so the health system that moves the quickest to interview the candidate can often secure the clinician, even if they are not offering the highest hourly rate in the market.

If your Managed Service Provider (MSP) or staffing partner has a team of clinicians who understand the requirements of the units, then allow them to conduct the interviews on behalf of the hiring manager in order to accelerate the speed to interview.

At SimpliFi, we complete a 42-point clinical evaluation on each unit of the health systems we serve, have a detailed conversation with the hiring manager, and then utilize RNs from our Clinical team to conduct the interviews. This service is saving nurse managers thousands of hours which is then being re-deployed into leadership and patient care on the unit.


3. Continuity of patient care is key, so extend, extend, extend the talent on-hand

At normal times, there are ~40,000 nurses working as travelers in the United States. This spring, staffing agencies could direct this universe of available talent to hot spots like Seattle, New York, and New Orleans as COVID-19 surged in those communities. The talent pool could meet the demand, as there were a relatively limited number of geographies surging at one time.

However, the large geographic distribution of this second surge is making it much more difficult to secure new clinical talent because there simply are not enough clinicians to meet the demand. Therefore, a key strategy for health systems must be to extend the contracts of all travel clinicians currently on-site.

We are seeing health systems extend any clinician with a contract that expires in 2020, and they are generally extending at hourly bill rates higher than the original contract. It is in everyone’s best interest, especially the patient’s, for the clinician to stay-in-place, so maximizing the rate to the level it takes to attract new talent is often not necessary.


4. Start securing clinicians for January starts and beyond, now

While the patient care demands of this moment are certainly urgent and help is needed right away, it simply may not be possible to secure a travel clinician to start in the next few days or even weeks. Clinicians typically travel for 13-weeks at a time, and there is a rhythm around when the majority of clinicians start and end travel assignments, with the largest single start period occurring in the middle of January.

On average, clinicians contract for their next assignment approximately six-weeks in advance, so health systems that are only evaluating clinicians for November or December start dates are missing out on the supply of candidates who are available now for January.

Another way to think about this is that the window of time for contracting the travel clinicians needed for patient care in January is rapidly closing.


5. Offer 48-hour contracts to travelers

Increasing hourly rates are not the only tool available to help a health system attract travel clinicians. While hourly rates need to be competitive in today’s market, increasing the number of guaranteed hours from 36 to 48 can help health systems differentiate and fill their open positions.

Typically, travel clinicians work on 36-hour contracts. Out of these 36 hours, staffing companies compensate the clinician, pay housing and travel stipends, and cover their fixed costs and margin. When the guaranteed hours in a travel contract increase from 36 to 48, staffing agencies have already accounted for some of the costs and will pass this benefit on to the health system by charging overtime after the 48th hour, instead of the 40th. The agency still pays the clinician for overtime over 40 hours, but they are not billing the health system at the overtime rate.

The 48-hour guarantee represents a win-win-win as the health system has increased continuity of care and less overtime costs, the travel clinician has more guaranteed pay, and there are more billable hours for the staffing agency before having to incur the costs of placing and moving the clinician elsewhere.


6. Supplement an existing float pool, or create a new pool, by using travelers

One way to utilize and redeploy travel clinicians is through a regional float pool strategy. This contingent workforce is mobile and able to be deployed or redeployed prior to the start of a shift.

When deploying a nurse for primary care, it is very important to make sure the experience of the clinician matches the area of float. A good practice is to utilize the nurse to the full spectrum of their skill while also taking into consideration their individual experience and comfort level. For example, a PCU experienced nurse could float to all PCUs, telemetry units, and med-surg units, if they have that experience. However, there are many specialties that are specific in nature, such as cardiac care units, so the clinician’s experience should match the areas they float to.

“If the nurse’s skill set is not a match with the areas of need, health systems are utilizing nurses as ‘helping hands’ to assist with tasks on the units when staffing is short.” – @Bambi Gore, SimpliFi Chief Clinical Officer


7. Evaluate and streamline the on-boarding process

A travel clinician is a clinician with experience. If they have traveled before or had a long career before traveling, they can easily get up-to-speed on new environments and cross-train quickly. Travelers are adaptable, and this is why they are often tapped as preceptors to onboard new nurse graduates based on their ability to quickly acclimate to new health systems.

For this reason, it may be necessary for health systems to review and relax certain on-boarding measures, such as learning modules that may unnecessarily delay securing a clinician for your health system.

In addition to evaluating the content of on-boarding, it is also important to ensure the frequency and availability of orientations do not turn away or delay the start dates of clinicians considering a travel assignment. With the current rate climate, delaying a start date by a few days or a week could serve as a meaningful enough financial dissuader for a clinician, which can prompt them to work elsewhere.


8. Use exclusivity to create more focus from top staffing agency partners

With the country currently has an all-time high in terms of the number of open travel nurse jobs, staffing agencies have an overwhelming number of options to present to available clinicians. The question then is, besides offering the highest hourly rate in the country, how does your health system stand out in this sea of opportunities?    

A strategy health systems can use to drive better engagement amongst their staffing agency partners is to pinpoint their existing top agencies and ask each to commit to filling an exclusive number of open jobs. An agency’s ability to focus and fill these exclusive positions could be tied to future exclusive opportunities.

Most staffing agencies have existing mechanisms for highlighting and emphasizing certain jobs. These could include how open jobs are listed on their websites, what recruiters are trained to highlight when speaking with clinicians, or even how recruiters are compensated. With a manageable number of exclusive job requisitions to fill and existing knowledge of your health system, your top staffing agencies will increase focus and decrease your open positions.


9. Overcome or minimize licensure challenges

There are over 30 states designated as Nurse Licensure Compact states, with several more pending acceptance. During the pandemic, the non-compact states have taken varying approaches to licensure, with some making little to no change. Compact states have access to a much greater pool of talent than non-compact states where clinicians must hold a license in that state in order to work on a travel assignment.

SimpliFi tracks and keeps clients well-informed of the changing licensure requirements. Currently, we are assisting a client in a non-compact state to make a market-based case to their state about temporarily changing the licensure requirement.


10. Caring for permanent clinicians could limit or reduce the number of travelers needed

Healthcare workers on the front lines, whether travel or full-time clinicians, are mentally and physically exhausted. The drive to meet rising patient demand is further exacerbated by existing staff members contracting COVID-19. According to a recent report from The Atlantic, almost a quarter of US hospitals are anticipating a staffing shortage.

Proactively taking measures to ensure the safety, retention, and satisfaction amongst permanent staff is at an all-time high right now. While the focus of this article has been strategies for securing and utilizing travel clinicians, combating burnout, fatigue and positively impacting the emotional health of full-time clinicians may limit the number of travelers needed.

In SimpliFi’s recent RED2020 Labor Summit, Nursing and HR executives representing five leading health systems from across the country spoke about the strategies they are using to maximize core staff retention during this time. Some of the strategies discussed include Hero Fund bonuses, providing opportunities to cross-train and maintain hours, Code Lavenders, and promoting and encouraging the use of PTO.


With so many opportunities out there for travelers, it is important to find ways for your health system to stand out. Making use of exclusive jobs through your staffing agency partners can be a useful way to do so without having to drastically raise your hourly rates. Additionally, using a MSP to understand licensure implications in your state can help you recognize what steps need to be taken compared to other states. Finally, taking steps to avoid burnout of permanent staff will both help reduce the number of travelers needed while also creating a positive work environment that will further help set your health system apart from others.