How an internal travel pool for nurses is helping one health system address the staffing challenges that will linger after the pandemic

Novant Health was among the first health systems to set up a travel pool for staff nurses, and the organization expects to be in a stronger position coming out of the pandemic as a result.

As the person in charge of clinical staffing for Novant Health, Stacy Byram has been spending ample time negotiating with the system’s travel-nurse contractor.

“I’ve been working with the agency weekly to say, ‘All right, how much can we drop our rates? We’ve got to get back to normal,’” said Byram, senior director for clinical staffing and scheduling at Novant Health, a three-state, 15-hospital system based in North Carolina.

Stacy Byram, senior director for clinical staffing and scheduling, oversees Novant’s Health internal travel pool for nurses.

The circumstances of the COVID-19 pandemic haven’t allowed for much leverage during those discussions, given the organization’s fivefold increase in outside travel nurses. But having implemented an internal travel pool for nurses in 2013, Novant Health is in a stronger position than it would have been.

The model gives staff nurses the opportunity to travel among the organization’s facilities as needed. It hasn’t made a big dent in the demand for agency nurses during the pandemic’s various surges, but it has helped the system meet at least some needs.

As Novant Health looks to emerge from the pandemic and get back to something approaching standard operations, the model should help the organization fill persistent vacancies without continually requiring influxes of agency nurses.

“It’s allowed us to really have that central look at where things are,” Byram said. “We have to have an exit strategy.”

From a compensation standpoint, the model has allowed Novant Health to stick with its ongoing rate-reduction strategy for contract nurses instead of remaining at the mercy of the agency’s terms.

The need for ‘bold’ solutions

Even before the pandemic, the U.S. Bureau of Labor Statistics projected that 500,000 nurses would leave their jobs due to retirement and other factors in 2022. That would leave a nationwide shortage of 1.1 million nurses.

The pandemic has made the deficit worse. While employment of RNs across healthcare dropped by 1% between February 2020 and January 2022, reductions were significantly greater for licensed practical nurses (20%) and nursing assistants (10%), according to data presented by Peter Buerhaus, PhD, director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, during a recent webinar hosted by the Bipartisan Policy Center.

In tandem with that trend, hospital wages rose by 2.5% for RNs, 18.6% for LPNs and 11.3% for nursing assistants during the first 15 months of the pandemic, Buerhaus and co-authors recently wrote in Health Affairs (login required). The demand for agency nursing has played a significant role in such increases.

With burnout and pandemic-related turnover potentially continuing to constrain the number of nurses available in a given market at a given time, hospitals and health systems are considering how they can shore up their reserves. Some are taking a close look at Novant Health’s type of approach.

UPMC in Pittsburgh is one organization with such a model in the works.

“It’s a bold move,” Tami Minnier, senior vice president of health services and chief quality officer with UPMC, told the Pittsburgh Business Times (login required) in December. “It will have what we believe are positive and far-reaching implications and look to solve the problems in different ways. The same answers aren’t going to work now.”

Evolving the model

Even with the travel pool in place for more than five years prior, Novant Health lost a number of nurses who decided to either step away from nursing or take advantage of higher pay rates for traveling externally during the pandemic. As the organization seeks to further establish its internal pool as a viable option, the following changes have been implemented, are underway or are under consideration.

Scope. The model to date has had local teams that each serve three locations and regional teams that each are available across five locations.

The plan now is to add a third level — an enterprise tier that will be available to help distressed units across the system during future COVID-19 waves or any other widespread emergency, Byram said.

Experience. To accommodate more nurses, Novant Health recently reduced the level of experience required to join the traveling pool from two years to one year. The impetus was to both increase the size of the pool and retain staff nurses who otherwise might choose to travel externally, with contract agencies generally requiring only six months of experience.

At the same time, with help from the system’s professional practice and development team, Novant Health has set out to increase proficiency standards for pool nurses.

“We’re setting higher expectations so that we get to more of an expertise level versus just a float pool nurse filling a hole,” Byram said.

Pay. Nurses who move from a staff role to the travel pool receive a payment premium. Recently, payment rates have risen in response to turnover.

Nurses in the regional travel pool receive a higher premium than those in the local pool. With the systemwide pool being added, the organization is considering how to set a rate that would apply across levels.

In the name of affordability, Byram and her team strive to ensure the travel pool costs the organization less than using staff nurses who work overtime.

Automation. Novant Health is looking at ways to simplify enrollment and participation in the travel pool. The primary obstacles to implementing something akin to a gig-employment app or platform are interoperability-related.

 “The more we can automate and be more innovative, that will definitely attract people, increase the satisfaction of our internal team and help us grow,” Byram said.

6 health systems tackle the challenge together

Just as Novant Health’s internal travel pool for nurses seems like an idea whose time has come, a new initiative could serve as a blueprint for efforts that rely on intersystem collaboration.

On March 10, six prominent health systems announced the formation of a “strategic alliance” to boost HR operations across their systems.

AdventHealth (Altamonte Springs, Florida), Atrium Health (Charlotte), Henry Ford Health System (Detroit), Intermountain Healthcare (Salt Lake City), Northwell Health (New Hyde Park, New York) and OhioHealth (Columbus) have established the Evolve Health Alliance, described as an effort to ensure “each is better positioned to take on some of the most pressing issues facing their workforce today and into the future.”

Among the components of the alliance’s first phase are “ad hoc reciprocal agreements to help address staffing needs,” according to a news release.

“Collaboration is key for healthcare systems to successfully adapt to changing conditions,” Heather Brace, senior vice president and chief people officer at Intermountain Healthcare and co-chair of the new alliance, said in the release.