Hospitals are having a difficult time filling their empty physician and nurse slots.
Hospital executives indicated a 17.6 percent vacancy rate for physicians and a 17 percent vacancy rate for nurses in 2013 — up from rates of 10.7 percent and 5.5 percent, respectively, in 2009 — according to AMN Healthcare's 2013 Clinical Workforce Survey.
There are several reasons for the drastic rise in clinician vacancies in hospitals, according to Susan Salka, president and CEO of AMN Healthcare. One of the main causes is the improved economy.
"As things continue to improve from an employment standpoint, people have more options and are more empowered to make changes in their professional lives," Ms. Salka explains. This especially affects vacancies on the nursing side, as many nurses are the second wage earners in a household, according to Ms. Salka.
The improved economy can create turnover, and the resulting vacancy rate is exacerbated by the shortage of experienced nurses. "Hospitals can get all of the new [nursing school] grads they want, but they need to make sure the staff is balanced out by experienced nurses," Ms. Salka says. The shortage of experienced nurses, especially in specialties like operating room or labor of delivery, leads to extended nurse vacancies.
Physician vacancies are also driven by the changing economy. "In the recession, many physicians remained in their current roles because of the economic uncertainty," Ms. Salka says. "A lot of that has improved, and those doctors have felt more empowered to change jobs. It takes a long time to replace a physician," she says.
Though hospital executives may feel as though the rise of clinician vacancies is out of their control, there are some things hospital leaders can do to lower the rate in their own facility.
Focus on retention
One of the best ways to lower vacancy rates is to keep employees in their positions. "In a corporate office environment or a hospital, retaining engaged, quality employees is the best way" to combat high vacancy rates, Ms. Salka says.
So, how do hospitals retain quality clinicians? Many clinicians want to work for hospitals where they feel they have appropriate resources and are equipped to provide quality patient care. Another important aspect of clinician retention is having a strong, positive culture where clinicians feel they are part of a team. "If they don't have quality coworkers around them…they're going to get frustrated and burned out," Ms. Salka says, which makes providers more likely to leave.
A good way to prevent clinician burnout and retain high-quality providers is to maintain proper staffing levels. That may be easier said than done, as hospitals "can't always predict when they're going to need additional staff," Ms. Salka points out, especially with the current high rate of vacancies. She suggests forming relationships with workforce solutions companies to fill in the empty positions so the remaining physicians or nurses do not experience burnout.
Don't look for more than is needed
A common refrain heard in healthcare is the push for providers to work at the top of their skill set and licensure. "Physicians should not be doing work that a nurse practitioner or physician assistant can do," Ms. Salka says. Keeping that mindset when searching for new clinicians can help keep vacancy rates low, she says.
"It's easier to attract a nurse than a nurse practitioner," she says. "As you move up the clinical skill set, vacancy rates will likely be higher, and it's harder to replace the level of skill quickly." So, hospitals' hiring professionals should make sure they are not searching for a nurse practitioner when a nurse can deliver the needed care, and they should look at the care delivery model, to make sure it maximizes every clinician's ability.
Support the training of clinicians
Obviously, one way to lower the overall rate of clinician vacancies would be to increase the supply of physicians and nurses — that way, hospitals would have more choices when attempting to fill an empty position.
Hospitals can play an important role in increasing the supply of specialized nurses, according to Ms. Salka. Many hospitals used to have specialty training programs for their nurses, for instance, which were dropped over the years for financial reasons.
The shortage of specialty nurses is likely to worsen as new clinician roles develop. "There are types of specialties and new kinds of roles that are becoming more and more needed in the new care environment," Ms. Salka says, like case managers. If hospitals develop and maintain training programs for their nurses to gain experience in those specialties, the overall vacancy rate for nurses will likely drop.
Since vacancy rates will likely go no where but up without action, hospitals need to start thinking five to 10 years down the road, because, as Ms. Salka emphasizes, cutting vacancy rates "doesn't happen overnight. You really need to be making investments today and partnering to provide innovative solutions that are going to address not only the issues today, but the increasing shortages in the future."