Mental health and SUD have reached epidemic proportions. Prior to COVID-19 one in 10 adults reported symptoms of an anxiety and/or a depressive disorder; however, during the pandemic, that number rose to four in 10 adults, the report says. According to the latest Substance Abuse and Mental Health Services Administration (SAMHSA) data:
52.9 million American adults are experiencing any mental illness.
14.2 million are experiencing serious mental illness, with percentages highest among adults younger than age 49.
40.3 million Americans aged 12 or older experienced a substance use disorder in the past year.
5.1 million adolescents aged 12 to 17 had either a SUD or a major depressive episode (MDE) in the past year, while 644,000 adolescents had both an MDE and an SUD in the past year.
Indeed, the pandemic affected nearly every aspect of the lives of youth, and the U.S. Surgeon General reports that the most vulnerable youth populations— those with disabilities, racial and ethnic minorities, LGBTQ+, low-income, rural residents, those in immigrant households, those in child welfare or juvenile justice systems, and homeless—were affected most severely, the report says.
Lack of treatment
The National Institute of Mental Health (NIMH) reports that in 2021, fewer than half of American adults with a mental illness (47.2%) were able to receive the mental health services they needed. Getting treatment for mental health and SUD is difficult for several reasons:
41 states are reported to meet less than 40% of the mental health need in their state.
27 states are reported to need more than 100 additional mental healthcare providers just to reach a ratio of 30,000 patients to 1 mental health provider in those communities.
25 states have more than 100 designated mental health professional shortage areas in their state.
Health insurance does not cover most treatment: Those who can find a mental health professional for treatment are often forced to go out-of-network, which can be costly. A 2019 report found that a mental health office visit is more than five times more likely to be out-of-network than a primary care appointment.
High out-of-pocket costs: Many available providers rarely accept Medicare, Medicaid, or private insurance.
The solution: psychiatric-mental health nurses
Numbering more than 148,000, psychiatric-mental health RNs (PMH-RNs) and advanced practice RNs (PMH-APRNs) represent the second-largest group of mental health professionals in the United States and play pivotal roles in providing access to professional mental health and substance use services to diverse patients across the nation, the report says.
But more than half a million additional PMH nurses are needed to reach “merely adequate access” to mental health and substance use disorder care, according to SAMHSA.
Roadblocks exist, however. “The lack of understanding of PMH nursing among policymakers and stakeholders has hampered the profession from making its full impact on the state of mental healthcare,” the report says. “While PMH-RNs and PMH-APRNs have the skills and qualifications to expand access and equity in mental healthcare all across the U.S., more practicing PMH nurses are needed, and they must be utilized to the full extent of their education and training.”
Two key challenges must be addressed to boost the numbers and effectiveness of psychiatric nurses, the report notes.
1. Nursing education has not kept pace with the demand for PMH nurses.
Despite strong expansion of psychiatric nurse programs, few undergraduate nursing schools can offer students exposure to PMH nursing-specific education delivered by an expert in the field, PMH nursing mentors, or opportunities to learn about the profession, the report says.
This ongoing shortage of PMH nursing faculty at the undergraduate and graduate levels blocks the development of a pipeline of PMH nurses needed to expand the workforce.
Additionally, PMH-RNs report that nursing school faculty members misrepresented the experience required prior to becoming a PMH-RN. These findings are consistent with research that suggests there is a stigma with specializing in PMH nursing and a negative view of PMH nursing within nursing schools.
2. Many states still restrict the scope of practice of PMH nurses.
With Utah’s adoption of full practice authority (FPA) last week, 27 states and the District of Columbia fully allow PMH-APRNs to diagnose, treat, order diagnostic tests, and prescribe medications to patients without physician oversight. The remaining states, however, continue to limit PMH nurses’ scope of practice.
“PMH nurses must be permitted to work to the full extent and authority of their education and training,” the report advises. “If the goal is increasing patient access to quality mental health and substance use care, the important role of PMH nurses must be fully employed in both education and in practice.”
The Future of Healthcare Work Report is Vivian Health’s annual study to provide timely and relevant data and information for its clients’ recruitment and retention efforts. Vivian Health, a healthcare hiring marketplace, surveyed nearly 1,700 clinical and clinical-support staff from across the country to better understand travel versus employed clinicians’ current perceptions about wages and their work environment.
Clinicians who have been on long- and short-term travel contracts are more willing to explore permanent employment in 2023 are a likely result of the decrease in average travel wages, the report says. U.S. travel nurse pay as of March 21, 2023, averaged $2,330 a week, which is a decrease of 33.27% from the average wage of $3,492 during March 2022, according to Vivian Health.
While this comes as welcome news for employers who lost RNs over the past two years to more lucrative travel positions, they must also realize that attracting clinicians back to permanent employment will require investments in wages, improved workloads (better staffing, for example), flexible schedules, and healthier work environments, the report says.
Show me the money
Salary ranks at the top of the list of considerations for travel clinicians to return to permanent employment. The report breaks down the average hourly wages they seek:
Advance practice (majority NP): $100
RN: $61.04
Allied health and therapies: $47.27
LPN/LVN: $37.67
CNA: $27.56
CMA: $20.67
Job satisfaction
Healthy work environments are becoming increasingly important in a competitive job market.
For the first time, responding clinicians indicate greater consideration for their work-life balance and safety. For example, interest in flexible work arrangements that fit into busy lives are important, as well as a safe and secure work environment free from rising incivility and violence, according to the report. Support for mental health and well-being, and burnout are crucial in retaining current staff and recruiting travel clinicians back to permanent positions, the report says.
While this year’s survey revealed mixed levels of satisfaction with employers related to having a healthy work environment, valuing clinician input, supporting mental health, and receiving adequate time off, there are indications that attitudes have improved from last year where less than 1% of respondents reported adequate staffing, compared to this year where 13% of clinicians reported having staff to ensure patient care 100% of the time.
When respondents were asked, “What could your employer do to increase your overall job satisfaction?” the top five answers were:
Increase number of support staff
Increase number of nurses
Allow adequate time for meals and breaks
Offer more PTO
Offer flex scheduling
Workable solutions
While negative feelings related to healthcare careers are less intense in this year’s study, there remains work to do to improve healthcare work environments, according to the report, which recommends:
Increase salaries: RNs are seeking $61 per hour, but as one option, consider offering higher hourly rates in lieu of statutory benefits.
Flexible scheduling: Offer a variety of shift lengths (4, 6, 8, 10 and 12 hours) and scheduling options (full- and part-time, per diem, travel, weekend, etc.).
Balance workload: Improve nursing workload by hiring additional nursing and clinical-support staff so RNs provide the patient care that requires a professional license. Explore different patient care delivery models.
Seek input: Continue to gather nurses’ input into decision-making; use shared-leadership and a participatory leadership style.
Support mental health: One simple strategy is to ensure staff have adequate time off. Monitor the number of consecutive shifts worked, time off between shifts, and the use of PTO to mitigate fatigue, stress, and burnout.
Feds have filed a lawsuit to stop a staffing provider from using workers to ‘unconditionally guarantee future profit streams.’
The U.S. Department of Labor is seeking to stop a Brooklyn, New York, healthcare staffing provider from allegedly requiring employees to sign ironclad three-year contracts or repay rightfully earned wages.
ACS is a staffing agency that recruits and places healthcare workers in patient care positions in New York, New Jersey, and Connecticut nursing and healthcare facilities, including at facilities owned or partly owned by one or more of ACS’s part owners.
“Federal law forbids employers from clawing back wages earned by employees, for employers’ own benefit,” said Seema Nanda, solicitor of labor. “Employers cannot use workers as insurance policies to unconditionally guarantee future profit streams. Nor can employers use arbitration agreements to shield unlawful practices.”
The department’s complaint seeks an injunction forbidding ACS and Klein from reducing employees’ wages below federal minimums, whether by demanding employees enter into contracts requiring them to cover ACS’ future profits, attorneys’ fees or costs associated with arbitration, or by enforcing such contracts.
In addition, the department is seeking back wages and liquidated damages for affected employees.
One employee’s story
One of those affected employees is an RN whom ACS recruited from the Philippines. On January 4, 2022, shortly before the RN was to move to the U.S. to work for ACS, Klein sent a letter presenting him with a new contract that superseded an earlier contract that contained a $20,000 liquidated damages clause in the event the RN stopped working for ACS prior to the end of a three-year contract term.
“On information and belief, ACS amended its prior form contract because it understood there was a significant risk that a court would determine the liquidated damages clause to be unenforceable, including under the Trafficking Victim Protections Act,” the lawsuit states.
The RN had been waiting since 2019 to begin working for ACS and at the time he received Klein’s new contract, he had recently left his job in anticipation of soon moving to the United States. Believing that he had no choice, the RN signed the 2022 contract, which stated that ACS intended to recover “loss of anticipated profits” from the RN if he left prior to the end of a three-year contract term, subject to an exception for a departure for “Good Reason.”
ACS, however, defined “Good Reason” only as a material failure by ACS of its contractual obligation to pursue an employment-based visa or failure to pay required wages. An employee’s good-faith concern that working conditions presented a risk of serious harm to patients or employees was not a “Good Reason” for resignation.
The contract also stated that as “a condition of” employment, nearly any dispute between ACS and the RN “shall be resolved by arbitration,” and stated that the RN waived his right to sue in court and have a jury trial.
The RN began to work for ACS at Downtown Brooklyn Nursing and Rehabilitation Center, which is owned in part by one of Advanced Care’s managing members, about the first week of March 2022.
The RN registered complaints about safety, both to ACS and to Downtown Brooklyn Nursing and Rehabilitation Center and soon “grew deeply concerned that he could not meet his ethical and professional responsibilities under ACS’s working conditions,” including a heavy patient load that he believed did not permit him to provide adequate patient care, according to the lawsuit.
Following repeated bouts of illness working under grueling conditions, the RN notified ACS on June 15, 2022 of his intent to resign effective June 29 because of working conditions and adverse physical and mental health effects he believed he suffered from working under those conditions.
ACS’s outside legal counsel responded by sending a letter to the RN demanding that he continue to work for ACS so “they could continue profiting from his labor,” the lawsuit says. The letter also threatened that if the RN stopped working, ACS would initiate an arbitration, begin to incur arbitration costs and attorneys’ fees, and seek to recover these amounts, and more, from the RN.
ACS’s letter warned that it would seek, in future profits alone, more than $9,000 per year from the RN through March 2026—a total of more than $24,000.
Disregarding federal law
The complaint details how Advanced Care Staffing entered into contracts that disregarded federal law by requiring employees to complete at least three years of full-time employment to keep their earned wages. The contracts would—and allegedly did—force employees who left before the contracts expired into private arbitrations, and require them to pay ACS’ future profits, plus attorneys’ fees and arbitration costs. These demands allegedly led to employees being paid less than the federal minimum wage, the complaint said.
The complaint also alleges that the employer violated the FLSA by pursuing arbitration to demand that the RN pay the company more than he ever earned to subsidize ACS’ future profits. The complaint further alleges that ACS’s contracts and arbitration demands have a chilling effect on employees’ ability to exercise their rights, including the protection to be free from an unsafe or hazardous workplace, and to obtain the wages they are owed.
'It's never wrong to think about all the stakeholders,' says CNO Cori Loescher.
The COVID-19 pandemic certainly re-engineered patient care, but numerous other factors can precipitate change in the way care is delivered.
For Brigham and Women’s Faulkner Hospital overcrowding in the emergency department (ED) and patient boarding last year necessitated a practice redesign.
Cori Loescher, BSN, MM, RN, NEA-BC, the Boston hospital’s chief nursing officer and vice president for patient care services, spoke with HealthLeaders about how she and her colleagues from all levels collaborated to solve the overcrowding problem while continuing to provide high-quality care.
Cori Loescher, CNO, Brigham and Women's Faulkner Hospital
This transcript has been lightly edited for clarity and brevity.
HealthLeaders: What is your definition of practice redesign?
Cori Loescher: I see practice redesign as looking at, depending on your healthcare environment, how you deliver care and what care needs to be delivered based on the population. Then, evaluating the structures in which you are providing that care and deciding that it is time to make a change and using that structure of putting the patient in the center and saying, “Things are not going as we had hoped. We have a new population, we have a change in service, we have challenges, we're not getting the outcomes we want, and we need to change the work and how we deliver it.”
HL: At what point is it necessary to re-engineer the way patients receive care?
Loescher: Certainly, the pandemic was one of them, but also when you are faced with a new clinical situation, a new patient population, or a new technology of change in what the industry is saying you should do for care. For example, you're looking at surgical patients who used to get their care in an inpatient setting and now insurers are saying this can be done outpatient, so you're going to change how you deliver or where you're delivering the care and the speed and time with which you do it.
We have looked at efficiencies, and we've needed to redesign care here because directly related to the pandemic is an explosion in inpatient population, and patients needing care. We have excess patients—we're boarding in our EDs, which everyone hears about—and we've needed to say, “How are we going to deliver care in nontraditional settings or with nontraditional providers in those areas?”
We’ve also needed to look at the work and see that this isn't the most efficient way for us to deliver care because it is taking us more time or is not allowing technology to support the clinicians who do the work, so we may be required to do redesign there.
We’ve redesigned it based on our team structures. We are delivering care with a much higher number of advanced practice providers—both PAs and nurse practitioners—but with having a much larger number of mid-level providers, we've had to redesign care and how we deliver that within our care delivery teams.
There are lots of reasons why you decide to re-engineer care, and each of them may be something that is foisted upon you: an increasing number of patients in the emergency department; failure to have behavioral health patient areas in which to discharge behavioral health patients; money and expense; and the Great Resignation, which leaves a scarcity of resources and a need to rethink how else and whom else can help us deliver care when we can't secure clinicians in many areas across the organization.
HL: How has Brigham and Women’s Faulkner Hospital addressed all these challenges?
Loescher: When we've done practice reorganization, it really involves bringing an interdisciplinary collaborative team together to talk about where's the problem and what is it that we're trying to solve? I'll use the most recent: we spent last year related to our overcrowding in our emergency department and patient boarding. We needed to redesign delivering care to patients in, potentially, hallways, because we had run out of beds. So, I put together a multidisciplinary team of clinicians—providers from our emergency department, inpatient, nursing, physicians, advanced persons in care management—to look at how we were going to develop these areas.
And then as we continued to dig deeper into this, we brought in additional stakeholders, realizing this is going to need to involve clinicians across the organization from other clinical care stakeholders who would be treating these patients to nontraditional service areas—for example, we need environmental services to clean.
It is bringing stakeholders together first at the highest level with senior leadership to conceptualize the problem and put that forward to the team, brainstorm ideas, and start to come to consensus through collaboration around what we're going to settle on. After we've evaluated and weighed out options, we need to say, “Now, who else needs to be at the table to talk about this?”
HL: What didBrigham and Women’s Faulkner Hospital settle on?
Loescher: We started with the fact that we have too many patients and they have to come up from the emergency department when we're overwhelmed and can't provide care. And we started weighing in: Can they go in many different arenas? And we decided it would be hallway spaces, but what hallways? Can we use conference rooms? Can we use vacant office spaces? We had to look at what was there and what met potential code opportunities for necessary requirements: Can beds fit into them? Can we get suction and oxygen, etc., available to those patients? Once we said, “No, it has to be in these hallways in these areas,” then we asked, “Will this fit for all of our units?” And the answer even at that was no. We needed to, again, be innovative and go back to redesign. So, on one unit, we have larger rooms, so we knew we could double up rooms, and we did. We’ve also put potential hallways under certain criteria meeting certain trigger points, so we could bring up beds, put them in halls, and decide which patients are appropriate to be put there.
HL: What are key tips you would suggest in implementing practice redesign?
Loescher: It’s never wrong to think about all the stakeholders and in this example, the immediate problem was the emergency department. If we had put just the emergency department together with that, it would have been a one-focused orientation to that group who are making choices for another person's areas, so you need to ask, “Who are the key stakeholders that need to be at the table to start to talk about this?”
At that table, it’s important to build an open mindset and a strong ability to listen to each other's issues, brainstorm things that may be completely outrageous, and listen without judgment. Then you systematically go through and vet those choices.
Another key tip is it’s important to realize testing and piloting a redesign and being willing to iterate as you learn more. And even once you've tested it and implemented it, to be willing to go back to the table and continue to improve on what you've done or what you perhaps did not anticipate was going to come forward.
Beehive State becomes the 27th state to adopt Full Practice Authority.
Utah lawmakers' adoption of Full Practice Authority (FPA) eliminates hurdles for the Beehive State’s nurse practitioners (NPs) to set up their own practices.
When Utah Gov. Spencer Cox signed Senate Bill 36 into law Thursday, capping a strong bipartisan effort to modernize outdated licensure laws for multiple professions, including NPs, Utah became the 27th state in the nation, along with the District of Columbia and two U.S. territories, to adopt FPA.
"In the last two-and-a-half years, four other states have taken similar action. These changes will help Utah attract and retain nurse practitioners, and provide patients access to high-quality care,” Kapu said. “We thank Gov. Cox and the legislature for prioritizing patients and taking action to improve healthcare."
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing.
This regulatory framework eliminates requirements for NPs to hold a state-mandated contract with a physician as a condition of state licensure and to provide patient care.
Momentum for FPA increased during the pandemic, when states temporarily suspended practice agreements and allowed NPs to practice at the top of their education, giving patients direct access to care.
FPA makes a difference in the health of a state’s residents, Kapu noted.
“The states that have the healthiest outcome are states that have full practice authority,” Kapu said.
“Many of the states that have the lowest healthcare outcomes are states that still have restricted, outdated laws in place that are completely unnecessary, such as retrospective chart review or collaborative contracts where you have to pay fees,” she said. “Those fees can be a barrier to an NP being able to practice in the community.”
The National Academy of Medicine's The Future of Nursing 2020-2030 report recommends that nurses be allowed to "practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value."
Utah is now part of an expanding list of states retiring outdated laws that have constrained their healthcare workforce and limited patient access to care, said Jon Fanning, MS, CAE, CNED, chief executive officer of AANP.
"Modernizing licensure laws is a no-cost, no-delay solution to strengthening the health of the nation,” Fanning said. “Decades of research show that states with Full Practice Authority are better positioned to improve access to care, grow their workforce, and address healthcare disparities, while delivering quality health outcomes for patients. We look forward to more states following suit."
NPs again take No. 1 spot in U.S. News & World Report job ranking.
Nurse practitioners (NPs) have once again garnered a top spot on a U.S. News & World Report job ranking, coming in first on its 2023 Best Jobs That Help People list.
The annual rankings noted that these jobs "enhance people's well-being and help them accomplish their personal goals, big or small."
"This top ranking for the tireless work of NPs in helping others lead better lives is yet another well-deserved testament to the outstanding care delivered by more than 355,000 licensed NPs to patients in more than 1 billion visits each year," Kapu added.
Growing demand
NPs are the providers of choice for millions of Americans, and that is expected to grow because of an aging U.S. population, increasing infectious diseases, and rising chronic disease, according to Kapu.
“We are in high demand and that is because we have 99 million Americans today that are lacking access to primary care and wait times are longer than ever before,” she told HealthLeaders.
“NPs are stepping up to meet those needs in terms of access,” she said. “You’re seeing the rise in NPs because we're helping to meet that demand and that's across all settings—rural settings, urban settings, in the hospital, the clinic, through telehealth, mobile sites, skilled nursing facilities, and schools.”
NPs’ focus on preventive healthcare is another reason that it ranks highly in helping people.
“Nurse practitioners are focused on meeting the patient where they are and engaging people in healthcare. We're very focused on the reduction of healthcare disparities, increasing access to care, and healthcare equity,” Kapu said. “The reason for that is, if we have high-quality healthcare immediately available where we're working with individuals and families on a regular basis, and providing screenings, immunizations, and regular chronic disease management, this helps to prevent urgent care visits and emergency department visits.”
With the decline of physicians in rural areas, NPs are purposefully stepping into those underserved areas.
"The nurse practitioner role is more than a job—it's a calling," said Jon Fanning, MS, CAE, CNED, chief executive officer of AANP.
"With nearly 100 million people living in primary care health professional shortage areas, NPs are leading the way to expand access to care across the nation,” Fanning said. “They are inspiring a new generation of providers heeding that special call to serve and build healthier lives."
Emergency medicine's unique nature makes noncompete agreements particularly ill-suited to the specialty.
Emergency physicians are clearly negatively affected—personally and professionally—by noncompete clauses, as revealed in a new questionnaire by members of the American College of Emergency Physicians (ACEP).
As such, ACEP is urging the Federal Trade Commission (FTC) to finalize its proposed rule to ban noncompete clauses in employment contracts. Doctors and other healthcare workers who work under noncompete clauses would be freed of those hiring restrictions under the FTC’s proposed rule.
“ACEP carefully monitors the emergency medicine labor market in pursuit of our overall goal to support emergency physicians and ensure that they are treated fairly by their employer and practice in an environment where they can best care for their patients,” Christopher S. Kang, MD, FACEP ACEP, president of ACEP, said in a letter to Lina M. Khan, FTC chair.
“Therefore, ACEP supports the commission’s proposal to categorially ban noncompete clauses and we urge it to finalize the regulation as proposed to help address the current anticompetitive conditions faced by many emergency physicians that limit their right to freely practice medicine in their communities,” he wrote.
Indeed, emergency medicine’s unique nature makes noncompete agreements particularly ill-suited to the specialty; emergency physicians do not have a “book of business” of existing patients with whom they have established and ongoing relationships. If they leave for another group or hospital, no patients will follow them to their new practice, so their departure does not lose their previous employer any business, Kang explained.
Professional consequences
Some 90% of the 75 emergency physician respondents to the ACEP survey said noncompete clauses make it harder for emergency physicians to switch employers, and more than half—59%—said they would seek a different job locally if they were not subject to the clause.
“This has without a doubt caused an impact on fair market value of our compensation as we have not received a raise in over five years and because leaving the company would cause all of the emergency physicians a hardship of moving, we all accept the bad conditions under which we are working,” one emergency doctor said.
Another worried about patient care: “I feel trapped, and worry every shift that this noncompete limits my ability to advocate for my patients—since a core part of the job of a good emergency doctor is advocating for patients even when it causes work for more ‘powerful’ specialists within the hospital,” the physician wrote.
Noncompetes can particularly affect rural and underserved areas that are struggling to keep doctors.
“As I am working in an area of the country that is in dire need of emergency physicians, if I leave my current job, I would be depriving this high-need area of a physician, as I would be forced to find work outside this area,” a rural physician responded. “Moreover, this area would be losing someone who has been actively putting down roots and becoming a member of the community, with a knowledge base of the local resources and culture.”
Personal consequences
Other emergency physicians revealed how noncompete clauses—being “chained to a single employer,” as one put it—had affected their personal and family life.
“My noncompete is geographically quite broad, and basically means that if I leave my current employer, I will have to move my special-needs kids out of the school system we moved here for,” one physician responded.
Said another: “I recently moved away from my hometown and my wife’s family due to a noncompete clause. This was a very trying time for my family and my children. I had to tear them away from their school, friends, and sports. After the move my children experienced bullying at school, lack of sports options, and one child developed severe anxiety requiring treatment. I then lost significant income and equity selling my house.”
Noncompete clauses also prohibit emergency physicians from “moonlighting” at other health facilities, an opportunity that can allow physicians to expand their skills, enhance job flexibility, and help them earn additional income. Of respondents who have had a noncompete clause in their contract in the past five years, 12% felt limited by their inability to moonlight.
“As a fellow in my late 30s and the only physician in my family, I have been the one to provide when my family needs money,” one ACEP member responded to the survey. “Not being able to leverage a contract or even moonlight at a nearby facility over a holiday weekend forces me into continued financial strain. No one should get to say what I do or where I work in my free, unscheduled time.”
Giving more control
“Restricting an emergency physician’s ability to choose a job can stall or upend their career, contribute to workplace dissatisfaction, and accelerate currently high rates of burnout, especially in rural or underserved communities where it is already challenging to attract and retain physicians,” Kang wrote.
“Finalizing this ban would be a fundamental step that can empower emergency physicians,” he wrote, “to take more control over their careers.”
After less than a year, the special team has improved nurse staffing, patient care, and health system finances.
Much like the U.S. Navy SEALS go to where their services are necessary, Jefferson Health’s S.E.A.L. RN team deploys to areas of greatest need.
The Jefferson Health S.E.A.L. (Service, Excellence, Advocacy, Leadership) RN Team, which launched in May 2022 with an initial cohort of 25 nurses, is a flexible staffing resource of nurses who care for patients across Jefferson Health’s 18 hospitals in southeastern Pennsylvania and southern New Jersey.
And, yes, the name is patterned after the Navy SEALS elite special operations forces.
“The name ‘S.E.A.L.’ team certainly draws on the concept that these nurses are meant to operate as a special workforce team deployed to hospitals where the staffing need is greatest on a weekly basis,” Andrew Thum, MSN, ML, RN, NE-BC, director of Nursing Workforce Operations for Jefferson Health, told HealthLeaders.
“S.E.A.L. nurses serve as leaders and ambassadors for Jefferson nursing as they work with different patient populations, nursing teams, providers, and leaders across our health system,” Thum said.
“This change is imperative in evolving how organizations balance valuing their people with meeting operational needs,” Thum wrote. “Now is the time to engage and think differently in order to recruit and retain the best talent.”
How it works
“Our SEAL nurses work primarily in one of three specialties which they select upon hire based on their experience: Medical-Surgical/Telemetry; Critical Care/Intermediate; or Emergency Services (ED),” Thum said.
Jefferson Health is exploring adding other specialties such as surgical services and respiratory therapy, according to Daniel Hudson, MSN, RN, CENP, vice president, Nursing Administration & Operations.
S.E.A.L. Team nurses are hired into one of three tiers:
Tier 1: deployed to two divisions within Jefferson Health
Tier 2: deployed to three divisions within Jefferson Health
Tier 3: deployed to all divisions across Jefferson Health
At the time of hiring, Tier 1 and Tier 2 S.E.A.L. nurses choose the divisions in which they wish to work and receive a base hourly salary that is incentivized depending on their tier selection. They also are eligible for shift differentials.
The S.E.A.L. nurses, who self-schedule in six-week periods, are required to work four weekend shifts per schedule and rotate in several holidays annually. Divisional staffing offices consult weekly with the S.E.A.L. Team leader to identify locations of greatest need and nurses are deployed divisionally based on these needs.
S.E.A.L. nurses also have full-time benefits including medical, paid time off, tuition reimbursement, and employer-matched retirement contributions.
“We offer S.E.A.L. nurses—like all Jefferson nurses—opportunities for ongoing continuing education,” Thum said. “We are in the process of launching a health system nursing clinical ladder program, which the S.E.A.L. team will be eligible for, that includes opportunities to engage nurses in their professional growth and development.”
The impact
The S.E.A.L. RN Team has positively affected staffing, patient care, and finances.
“The nature of the S.E.A.L. role—working across so many different practice environments—is naturally intellectually stimulating, or so our S.E.A.L.s tell us,” Thum said.
On a weekly basis, the S.E.A.L. Team is meeting anywhere from 12%-16% of the health system’s proactively identified staffing needs, according to Thum’s article. Prior to the team’s implementation, these needs either went unfilled or were staffed with core staff overtime, premium paid shifts, and agency staff.
“The benefit of using our own S.E.A.L. nurses in lieu of external agency nurses to meet staffing needs has not only had a positive financial impact but it has also allowed us to ensure more consistent, higher-quality care for our patients as S.E.A.L. nurses are Jefferson nurses trained to our standards of excellent nursing practice,” Thum told HealthLeaders.
Indeed, “we are projecting to save millions of dollars annually by replacing agency RNs with S.E.A.L. RNs,” Hudson noted.
As the program grows, so will those cost savings. The initial plan was to have 100 S.E.A.L. RNs, but the new program has been so successful that Jefferson Health already has plans to boost that number.
“We have identified the benefit of this flexible type of nursing workforce for staff, patients, and hospital operations and, as such, we have begun an initiative to expand the team to 150 nurses over the next several fiscal year quarters,” Thum said. “We hope to have most of these nurses hired by the end of June 2023. At present, we have hired a total of 51 S.E.A.L. nurses.”
Reaching that staffing goal appears to easily be in reach, given the program’s popularity, Thum noted.
“The overwhelming interest in this program among internal and external partners has been very encouraging,” he said. “While we expected the program would be successful to some degree, we did not expect it to receive such intense interest and praise from patients, nurses, leaders, and professional colleagues across local and national healthcare organizations.”
Inventor saw a gap in available and effective airway management tools for patients who suffer breathing complications.
A nurse anesthetist who leads a team that developed a device she invented, the McMurray Enhanced Airway (MEA), is the Nurse-led Team Award winner of the 2023 ANA Innovation Awards given by the American Nurses Association (ANA).
The ANA Innovation Awards highlight, recognize, and celebrate exemplary nurse innovators who improve patient safety and health outcomes. The award includes a $50,000 prize earmarked for further product advancements.
Roxanne McMurray, DNP, APRN, CRNA, and her team with McMurray Medical, in Saint Paul, Minnesota, developed the breathing tool to maintain adequate ventilation for surgery or other medical procedures.
Unlike other airway devices, the MEA’s longer flexible tubing reaches beyond the tongue to quickly stent open a patient’s airway, easing ventilation and oxygenation. It can be inserted quickly and easily without requiring special patient positioning or accessories.
The MEA also can be attached to an anesthesia circuit or resuscitator bag.
“New airway management tools are needed to help today’s patients breathe better during and after anesthesia is administered, especially in ambulatory and outpatient surgery centers and non-operating room procedures,” McMurray said. “The McMurray Enhanced Airway meets these needs and more in a significant way.”
Today’s patients, particularly those who are older, obese, or have sleep apnea, often have an increased risk of upper airway obstruction, according to McMurray Medical.
McMurray and her team saw a gap in available and effective airway management tools for patients who suffered from breathing complications, which led to the creation of the first-of-its-kind MEA.
“The 2023 ANA Innovation Award winners have built clinical solutions for complex healthcare challenges. Roxanne … advanced care and the resources being delivered, while simultaneously improving health quality for patients,” said Oriana Beaudet, DNP, RN, PHN, the ANA’s vice president of nursing innovation. “Advancing nurse-led solutions that create sustainable cost-effective solutions across healthcare is good business, driven by purpose and mission.”
“Nurses advance health through their work as clinicians, scientists, entrepreneurs, researchers, product designers, policy leaders, in advanced practice, as community organizers, and by providing direct care across our country in hospitals, long term care, hospice, ambulatory settings, schools, and numerous public health settings,” Beaudet said. “It’s time the innovative work of nurses is recognized.”
Violence prevention plans, wage increases, and sufficient PPE are among some of the RNs' wins.
RNs at Alta Bates Summit Medical Center (ABSMC) have voted overwhelmingly—87%—to ratify their collective bargaining agreement, concluding a systemwide contract fight with Northern California's Sutter Health that began in June 2021.
"We didn't get everything we wanted, but we made important gains to retain staff, and stop them from fleeing to other facilities," said Ann Gaebler, a neonatal ICU RN at ABSMC. "We will continue to address staffing at our hospital and fight for quality patient care."
While nurses approved contracts specific to their facility, highlights applicable across all 16 Sutter facilities include:
Patient and nurse safety protections: new workplace violence language to ensure the hospitals maintain sufficient security systems and violence prevention plans; maintenance of a three-month stockpile of PPE; and presumptive eligibility for workers' compensation during a state-declared pandemic or epidemic.
Recruitment and retention strategies: improved meal and break assurances; wage increases ranging from 21-32% over the life of the agreements, with Sutter hospitals bargaining their first contract receiving as much as 25-55% increases, with additional step increases; differentials for weekends and charge nurse duties; and tuition reimbursements.
RNS from across 16 Northern California health facilities have been bargaining with Sutter Health management for 21 months for safer staffing, pandemic readiness protections, and workplace violence protections, according to California Nurses Association/National Nurses United (CNA/NNU).
More than 8,000 nurses staged a one-day strike last April to call attention to Sutter Health's "refusal to accept nurses' common-sense proposals for improved nurse and patient safety," said the CNA/NNU.
"We have been on the front lines before and during this pandemic," Amy Erb, a critical care RN at California Pacific Medical Center of San Francisco, said shortly before last year's one-day strike. "Throughout this time, we have witnesses Sutter Health become profitable while they refuse to invest in the resources we need in order for us to provide safe and effective care to our patients and community."
The agreement at ABSMC is effective through November 2027, while the agreements at the other Sutter hospitals run through December 2026.
"I am so happy that ABSMC members have a contract," said Paula Lyn, RN and a CNA board member. "All Sutter nurses deserve our congratulations."
