Navigating PECOS: A Comprehensive Guide

Nurses are in higher demand now than ever before. Every year, the need for these critical healthcare personnel has increased, a trend that is expected to continue long into the future.

According to the United States Bureau of Labor Statistics, we will require an extra 177,400 registered nurses by 2032, bringing the total RN workforce up from 3,172,500 in 2022 to a forecasted 3,349,900. The employment market for registered nurses is predicted to grow by around 6% this decade, exceeding the median rate for all other jobs by 3%.

As we dive into the data and narratives that shape the nursing environment, this piece hopes to offer light on the persistent nursing shortage, the growing importance of contract nursing, and creative techniques for managing nurse credentials. Let's look at how the health care industry is addressing these formidable problems.

The Current State of Nursing

The landscape shifted dramatically post-2021, with RN turnover and vacancy rates almost returned to pre-pandemic levels by 2023—18% and 10%, respectively. Healthcare providers have responded by boosting salaries; hospital-employed RNs enjoyed a near 22% wage increase from 2019 to 2023, thereby raising the baseline for hospital labor expenses. Interestingly, despite more RNs being employed in hospital settings in 2023 than in 2019, a whopping 84% of the net employment gains for RNs have migrated to non-hospital settings. This trend is likely fueled by the pandemic's push towards outpatient care. Although RN shortages persist in some hospitals and regions, the focus is gradually shifting from immediate staffing fixes to more sustainable long-term labor strategies.

Nurse practitioners (NPs) are seeing a remarkable surge in job opportunities. The growth forecast here is impressive: a 45% rise in employment from 2022 to 2032, introducing 118,600 new positions, which eclipses the general occupational growth rate by 42%. This upswing underscores the necessity for medical institutions nationwide to actively engage and retain their nursing staff, particularly the fresh wave of RN graduates.

In a recent survey focusing on what nurses value most in their workplace for 2024, compensation topped the list. An overwhelming 75% of nurses highlighted that better pay is crucial, with 68% emphasizing the need for a higher nurse-to-patient ratio, and 58% pointing to the importance of more favorable work schedules. Additionally, 47% of nurses felt that increased recognition in the workplace is vital, and 42% prioritized the importance of wellness programs. These findings underscore the broader concerns within the nursing community about workplace conditions and overall job satisfaction.

When asked about their perceived impact on patient health and well-being in 2024, the responses were mixed. Only 37% felt their impact was extremely positive, whereas a majority, 74%, viewed their contribution as moderately to somewhat positive. However, a small fraction, 9%, felt their impact was minimal or non-existent.

This survey, gathering insights from 1,155 nurses across the country with a 3% margin of error, sheds light on the current state of nursing satisfaction and the critical areas in need of attention to enhance their work environment and professional fulfillment.

Aging Nurse and Patient Populations

As the U.S. population ages, the demand for healthcare services is intensifying. By 2030, the U.S. Census Bureau projects that over 20 percent of the population will be 65 or older, up from 9.8 percent in 1970. This demographic shift means approximately 78 million Americans will be seniors, outnumbering those under 18 years old. As chronic conditions like diabetes and obesity become more prevalent in this aging group, the need for skilled nurses to deliver preventive and ongoing care is expanding dramatically.

The nursing workforce itself is not immune to the effects of aging. The average age of registered nurses has risen from 42.7 in 2000 to 47.9 in 2022, with over half of all RNs now over the age of 45. A significant wave of retirements is on the horizon, with projections suggesting that more than one million RNs will exit the workforce by 2030. This looming wave of retirements is set to deepen the existing nursing shortage, pressing the healthcare sector to find solutions to manage an increasingly elderly population with a diminishing pool of experienced nurses.

Nursing Shortage Over Time

The nursing shortage has deepened over the last decade, with a significant surge in recent years exacerbated by the COVID-19 pandemic. Although the situation has shown signs of improvement since its peak in 2021, it remains a pressing issue. Back in 2021, the RN turnover rate hit an all-time high of 27.1%. Fortunately, these figures have started to recede, falling to 22.5% in 2022 and further to 18.4% in 2023. Particularly hard-hit areas such as Telemetry, Step Down, and Emergency departments experienced the highest turnover rates over the past five years.

By 2023, the average vacancy rate for RN positions declined significantly to 9.9%, down from 17% in 2022. Despite this improvement, nearly half of the hospitals in 2024 still reported a vacancy rate exceeding 10%, which is a stark decrease from the 81.3% reported in 2022. The time it takes to fill these vacancies has also reduced slightly, with recruitment times ranging from 59 to 109 days, marking a decrease of over nine days compared to 2021.

These persistently high turnover and vacancy rates not only disrupt hospital operations but also impose considerable stress on the nurses who manage these understaffed units, impacting their mental health and job satisfaction.

Looking ahead, the prognosis for 2036 is daunting. Predictions indicate that several states will face severe nurse shortages, with Georgia, California, Washington, New Jersey, and North Carolina among the top regions expected to experience the most acute deficits. This anticipated shortage underscores the need for proactive measures to address the ongoing challenges in nursing recruitment and retention.

The Cost of Nursing Turnover

When a nursing position remains unfilled, the repercussions are costly, not only in terms of financial outlay but also in terms of staff morale and burnout. The financial toll is stark: the average cost to replace a bedside RN hovers around $56,300, with the broader range spanning from $45,100 to $67,500. For hospitals, RN turnover can lead to a staggering annual loss ranging from $3.87 million to $5.79 million, with the average hospital losing about $4.8 million in 2023 alone. Intriguingly, each 1% increase in turnover costs a hospital approximately $262,500 annually. Notably, while the average cost of replacing an RN has risen since 2021, the total financial loss per hospital has decreased by $2.3 million as turnover rates began to stabilize.

Hospitals and healthcare organizations have the opportunity to mitigate these costs by investing in retention strategies that make nurses want to stay. Gathering feedback from staff and conducting exit interviews can provide critical insights into the factors that contribute to nurse satisfaction and retention. Understanding what drives nurse engagement and job satisfaction is far more cost-effective than the continual cycle of replacing skilled professionals.

Turnover data underscores that the majority of nurse attrition occurs within the first year of employment. Approximately one-third of newly hired RNs leave their positions within a year. However, turnover rates tend to decrease as nurses remain with an organization longer, dropping to 11.9% after five years and to 9.9% for those with over ten years of service. Despite the current stabilization, turnover rates are expected to climb as the most experienced nurses approach retirement.

The past few years have seen a significant influx of new nurses into the workforce, replacing many seasoned professionals. From March 2021 to March 2022, the median nursing tenure dropped by 19.5% to just under three years, and the proportion of shifts filled by newly hired nurses surged by 55%. While tenure has since stabilized at an average of 5.7 years, challenges persist. New nurses often feel pressured to refrain from asking questions and report a lack of mentoring from more experienced colleagues. Training and orientation issues, undesirable shifts, high stress levels, and inadequate staffing are frequently cited reasons for leaving a position within the first few months, all contributing to lower job satisfaction and high turnover rates.

Impact on Quality of Patient Care

The quality of patient care is profoundly affected by high turnover rates and nursing vacancies. Studies highlight a clear link between the adequacy of RN staffing levels, patient safety, and mortality rates. A pivotal study published in the New England Journal of Medicine analyzed nearly 200,000 nursing shifts and discovered that insufficient staffing levels were directly linked to higher patient mortality rates. Specifically, the risk of death increased by 2% for patients who experienced shifts with staffing below the targeted levels. On average, a patient exposed to three such understaffed shifts faced a 6% greater risk of dying during their hospital stay.

Moreover, increased nurse-to-patient ratios have been shown to compromise safety and elevate mortality rates. Research indicates that each additional patient assigned to a nurse beyond the recommended 1:4 ratio raises the likelihood of patient death within 30 days by 7%. The looming retirement of a significant number of experienced RNs is expected to exacerbate these challenges, leading to staffing imbalances. Further research demonstrates that the amount of experience an RN brings to the table inversely correlates with patient mortality rates. In units where nurses had more years of experience, there were notably fewer deaths—between 4 to 6 fewer fatalities per 1,000 patients treated. This underscores the critical impact that experienced nurses have on patient outcomes and the potential risks as more nurses approach retirement.

Addressing the Nursing Crisis: The Role and Impact of Contract Nurses

As the nursing crisis intensifies, healthcare facilities are increasingly relying on contract nurses to fill the gap. This trend has seen hospitals and healthcare settings leverage temporary staffing solutions like traveling nurses to ensure patient care isn't compromised. For instance, in January 2022, travel nurses made up 23% of total nursing hours and accounted for nearly 40% of the labor costs for nursing staff. A report from the American Hospital Association highlights a sharp 213% surge in the hourly rates charged by staffing companies for travel nurses compared to pre-pandemic levels.

The reliance on contract nurses isn't without its challenges, particularly when it comes to the administrative burdens it places on Medical Staff Services Departments (MSSD). These departments are grappling with significant increases in credentialing workloads, necessary to ensure these nurses can start providing care quickly and efficiently. Many facilities have turned to outsourcing this credentialing process to specialized agencies to manage the workload better.

Credentialing, at its core, is a critical component of patient safety. It involves rigorous checks to confirm that all contract nurses are fully qualified and competent to provide care. Well-defined credentialing policies and procedures are essential, not just for mitigating risks but also for ensuring that contract nurses can be integrated smoothly into the healthcare team. These processes help in managing clinical privileges, linking to billing codes, and ensuring that every aspect of patient care handled by contract nurses is up to standard.

Contract Nurse Credentialing

Contract nurse credentialing is an essential safeguard in healthcare that ensures nurses and physicians meet all the required standards before they practice in a hospital. This process involves a thorough background check through primary source verification, including licenses, education, references, certifications, and more. Credentialing is the first step, followed by privileging, which evaluates a practitioner's experience and competence to perform specific roles within a healthcare setting.

States have their own specific rules for nursing licensure and practice, leading to differences in how nurses are credentialed and privileged. For instance, a certified nurse (CN) generally provides basic care under the supervision of registered nurses (RNs), who themselves deliver more complex patient care and coordination under physicians.

Advanced Practice Registered Nurses (APRNs), like nurse-midwives, nurse practitioners, clinical nurse specialists, and nurse anesthetists, provide a medical level of care and may perform surgical procedures, thus requiring both credentialing and privileging. The Greeley Company notes that the standards applied in the privileging process are essential, regardless of the employment status of the APRNs.

Who Credentials Contract Nurses?

Contract nurses typically come through contract companies or locum tenens agencies that conduct their own credentialing. However, agencies may not be fully aware of a hospital's specific bylaws, medical staff policies, and what is considered a red or pink flag during the verification process. Different types of nurses require different levels of privileges, and the tasks assigned to contract nurses can vary significantly from one hospital to another.

Regardless of the source of the nursing staff, the responsibility for the actions of contract nurses within a healthcare facility ultimately lies with the hospital. Inadequate credentialing can expose hospitals to significant risks, including legal liabilities if a contract nurse's inadequate care results in patient harm. This makes robust credentialing practices essential, not just to mitigate risks but also to ensure that all healthcare providers within the facility meet the required standards of care.

The complexity of nurse credentialing has grown with the increase in contract nurse companies. Recognizing this, The Joint Commission has developed a certification program to help hospitals identify staffing services that provide qualified nursing contractors. Similarly, the National Committee for Quality Assurance (NCQA) offers certifications that promote industry best practices in credential verification, enhancing the quality of healthcare services.

Contract nurses often have diverse backgrounds and qualifications, which adds another layer of complexity to the credentialing process. For instance, many contract nurses hold licenses in multiple states and have varied educational backgrounds, from bachelor's degrees to diplomas, reflecting the broad scope of their qualifications. The transient nature of their work, typically involving 13-week contracts, requires a dynamic and thorough approach to credentialing to ensure they meet each hospital's specific needs.

Given these challenges, it's imperative for healthcare facilities to establish rigorous, standardized procedures for credentialing contract nurses to maintain high standards of patient care and safety.

The Future of Contract Nurse Credentialing

For healthcare organizations that rely on temporary nursing staff, managing credentialing processes efficiently is paramount. The complexities of credentialing, particularly for locum tenens nurses, demand a streamlined and error-free system. This is where Credsy's advanced credentialing platform comes into play, transforming the traditional, labor-intensive process into a dynamic, automated solution.

Credsy leverages cutting-edge technology to minimize the time and effort required for credentialing. By automating key steps such as verification checks with primary sources, enabling electronic signatures, and sending automated alerts, Credsy significantly accelerates the credentialing timeline. This efficiency not only simplifies the hiring process for contract nurses but also enhances the overall satisfaction of both the healthcare providers and the temporary staff.

Moreover, Credsy's intuitive platform offers transparent status updates and easy access to credentials, ensuring that healthcare facilities can quickly onboard qualified locum tenens nurses. This seamless integration of technology and service helps maintain high standards of patient care while meeting urgent staffing needs.

Here’s how Credsy enhances the credentialing landscape:

• Streamlined Processes: By automating routine credentialing tasks, Credsy reduces manual input and potential errors, ensuring a smoother, faster process.
• Centralized Credential Management: All credentials are stored in one accessible location, making it easy for nurses to manage their documents and for facilities to verify qualifications instantaneously.
• Regulatory Compliance: Credsy ensures that all credentialing activities comply with state and organizational regulations, safeguarding against legal or professional risks.
• Enhanced Efficiency: The platform's ability to manage and store credentials centrally eliminates redundant tasks, allowing healthcare professionals to focus more on patient care rather than administrative duties.

For healthcare facilities aiming to optimize their use of contract nurses without compromising safety or quality, Credsy offers a robust, reliable solution. It not only meets the immediate staffing needs but also builds a foundation for long-term operational excellence in healthcare staffing.