Catholic health systems, facilities innovate to answer nurses' call for more flexibility

September 15, 2022


Large numbers of nurses have been leaving their jobs at hospitals, long-term care campuses and other health care facilities to accept high-dollar positions with nurse staffing agencies or to transition to other jobs that have better schedule flexibility and pay.

A Mercy staffer uses the Mercy Works on Demand app, which allows nurses to pick up extra shifts at Mercy hospitals.

The pandemic exodus has left health care facilities short-staffed and overly reliant on the same outside labor contractors that recruited away their nurses.

To help restore staffing equilibrium and sanity, health care facilities have been seeking to understand more about why nurses are leaving. And they are using that intelligence to develop new programs and offerings that incentivize nurses to stay, and that attract new recruits.


"We are listening to the voice of nurses and creating programs to respond," says Robin Johnson, chief nursing officer at Bon Secours Memorial Regional Medical Center in Richmond, Virginia.

Schedule flexibility
Many staffing models launched during the pandemic mimic what travel agencies offer nurses, in terms of geographic and schedule flexibility. In most programs, nurses can self-schedule for shifts at hospitals in multiple geographic areas, but within the same health system.


Dina Bush is vice president and chief nursing officer of the Intermountain Healthcare Peaks Region. It takes in parts of Colorado and Montana and includes eight hospitals. Bush says nurses who are interested in flexible postings participate in cross training so they can move fluidly among care sites in the service area. The program is called Internal Traveler.


Trinity Health, which operates mainly in the midwest and northeastern U.S., created a mobile workforce program called FirstChoice. Gay Landstrom, Trinity Health senior vice president and chief nursing officer, says nurses can apply to move to a position equivalent to the one they are in, but in another Trinity Health facility. The system has 88 hospitals, 131 continuing care locations and a network of other sites in 25 states.

Bon Secours Mercy Health's Nursing Flex Team operates as an internal travel agency for its nurses who opt to move within more than 30 hospitals in four of the states where the system operates. There are three tiers: in the first, nurses stay in one facility or community, moving between units or specialties; in the second tier, they can move within their region; and in the third, they can travel to any Bon Secours Mercy Health facility.


Stacie Call is chief nursing officer for Mercy Health in the Lorain and Youngstown, Ohio, markets of Bon Secours Mercy Health. She explains that once accepted into one of the tiers in the flex team, nurses can self-schedule using an app on their smartphone or other device. The local and regional assignments last six weeks and the systemwide assignments last 12 weeks. For the system-level tier, Bon Secours Mercy Health provides resources for housing and travel.

CommonSpirit Health also has created an internal nationwide staffing agency to enable its nurses to work at CommonSpirit facilities in the 21 states where the system operates, according to Aug. 22 reporting in Modern Healthcare. The company has 140 hospitals.

Chesterfield, Missouri-based Mercy has more than 40 acute care, managed and specialty hospitals in four midwestern states. This spring it began offering Mercy Works on Demand. This platform allows Mercy's full- and part-time nurses to self-schedule for extra shifts before they are opened up a week later to nurses not part of Mercy's core staff.

Nurses see only slots they are qualified for. The harder a shift is to fill, the more money Mercy offers from the outset to find a taker. It posts open shifts 14 days in advance.

To gain entry to the gig-work nurse scheduling platform, nurses apply to Mercy and go through a screening process which includes an interview.

Developed by a company called Trusted Health, the app and online platform allow nurses to slot themselves for up to 30 hours per week at the Mercy facilities that are on the platform. Mercy piloted Works on Demand in its Springfield, Missouri, market and has rolled it out to its other markets.

Outside nurses who use Works on Demand do not earn paid time off, nor do they qualify for health insurance or other benefits, but they can pick the shifts they want, when and where they want.

Meeting individuals' needs
Betty Jo Rocchio, Mercy senior vice president and chief nursing officer, says of Works on Demand, "Nurses are telling us what they want and need, and we are doing something about it. They want flexibility, a schedule that lets them meet their personal obligations and a work setting that matches their skills and interests."

Madysen Feeney had worked at Mercy Hospital Lebanon in Missouri as a night shift nurse but after returning to that shift from maternity leave in late 2021 she found the full-time hours to be overly taxing. She heard about gig nursing and applied to be on the Works on Demand roster. Since early this year, she's been filling one or two 12-hour shifts per week, usually on weekends.

Nurses can only sign up for shifts in departments they have experience in. Feeney has found an abundance of emergency room shifts on weekends. Gig nursing has enabled her to supplement her family's income, maintain connections at two Mercy hospitals, continue to practice her skills and return to the bedside nursing she loves. "It's been a blessing," she says.

Dollars and cents
While these nursing executives say their systems have not been able to match the salaries for-profit travel nursing companies may pay, they are able to sweeten the pay for staff nurses in their internal travel nursing programs to stay competitive.

As a new mom, registered nurse Madysen Feeney gave up full-time night shifts at a Mercy hospital in favor of "gig" nursing work. Using an app, she slots herself for one or two 12-hour emergency room shifts each week that fit with her family's schedule. Here, Feeney and her husband Luke pose with baby Ellie.
Photo credit: Justine Owsley

According to information from Intermountain, the salary rate for the Internal Traveler positions is "competitive and fixed across all of our markets."

Rave reviews
The nurse executives all say nurses have responded enthusiastically to the ability to control their own schedules in whole or in part and it's helped their systems hold onto nurses who'd considered leaving during the pandemic.

Landstrom says Trinity Health "retained a good number of nurses with these flexible options. And contract workers learned about the program from our (in-house) nurses. A growing number (of contract nurses) have been talking with our nurses and learning how much they like our FirstChoice program. The best marketing is the nurses already in the program."

Now some ministry systems are reporting they have been able to hire nurses who had worked at nurse staffing companies. They attribute this slight boost in part to flexible scheduling options. Mission and culture also attract nurses to Catholic hospitals, the executives say.

The flexible scheduling is a hit with nurse managers too. Karla VanHorn, nurse manager at Mercy Hospital Springfield, says, "I used to spend so much time calling our nurses during their free time and asking them to pick up shifts so I could get the schedule filled." Now, nurses are viewing the open shifts on their apps and applying on their own for the ones they are interested in.

The nursing executives say these flexible options, so rare in the past, are here to stay.

Landstrom says, "There has been a big shift. Though I'm not sure that we have a good understanding of the new workforce dynamics, we do know nurses' needs have shifted. They need more flexibility."

"We can't keep doing things like we did them before," she says.

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