Conduct at the Core: Engaging Contract Nurses

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Conduct at the Core: Engaging Contract Nurses

Brooke Hickman, MBA, BSN, RN - CRMH 11 West Unit Director

The evolution of healthcare will never cease. Many who came into the world of medicine have spoken to its everchanging platforms. Change can be seen as forward progress if those in leadership can adapt to the momentum. Since the start of the COVID pandemic, unit-level nursing leaders have seen fluctuations in staffing. Leaders may have thought their areas were immune to the “Great Resignation,” only to see it hit later. 11 West went from a functional vacancy of 31% in October 2020 to 56.19% in December 2021. There continues to be limited applicants to backfill needs.

Nurse leaders must adapt to the current market. Leaders must explore strategies of how to best manage contract staff. Seasonally, we have found it harder to obtain contract staff, leaving our hospitals without resources to care for the community. Our overreaching goal needs to be the provision of necessary resources for the community the organization serves.

The organization must switch from seeing contract staff as short-term support and resolve to retain them as long as possible. This may involve determining how to include contract staff and engage them on their assigned unit. Contract staff can be a valuable resource due to their experiences within various organizations.

On 11 West, unit-level leadership has identified several strategies to better engage contract staff that may be useful to leaders of other units. For instance, nurse leaders meet one-on-one with core staff to discuss growth, expectations on both sides, and to obtain suggestions toward forward progress. This can be expanded to include leadership one-on-one meetings with contract staff. Some questions for contract staff that could be included are:

• How long have you been traveling? • Why do you travel? • What do you look for when you are deciding on an assignment? • What makes you re-sign on this or any assignment? • What are things you have seen in the workflow or on the unit, in general, that could be improved based on your previous experiences?

During one-on-one sessions, contract staff on 11 West have been open and honest with their suggestions and feedback. Their feedback can help the personal growth of leaders and the critical thinking skills of core staff, in addition to improving unit functionality. Setting unit expectations should occur just as one would when onboarding permanent core staff.

The culture of the unit is an essential driver of contract staff satisfaction. Including contract staff in one-onone sessions, unit activities, and recognition is paramount. They want to be on a unit that is welcoming and inclusive. They want a comparable acuity assignment with available resources. Unit culture can and will determine the length of time a contract nurse is retained.

Of the eleven nurses that 11 West has contracted, 72% (8 out of 11) renewed their contract, some several times. Currently, seven of those eight remain working on the unit. Consistency of unit staff can ensure maintenance and improvement in quality scores. The first contract nurse was added to the unit approximately July of 2021. Since that time the unit has maintained zero CLASBIs and zero HAPIs.

ARTICLES/NOTIFICATIONS

1 Conduct at the Core: Engaging Contract Nurses

Brook Hickman, MBA, BSN, RN

4 Nursing Work Related Stress in the ICU and Aromatherapy

Sandra Hubbard, BSN, RN, TCRN

8 Summary of Proposed National Legislation: Workplace Violence Prevention for Healthcare and Social Services Workers Act

Raymart Gerena, BSN, RN

10 Improving Work Environment and Retention in a Progressive Care Unit (Part 1)

Suzanne Beels, MSN, RN, AGCNS-BC, CCRN; Susan Blankenship, MS, BSN, RN, PCCN

RECOGNITION/EVENTS

13 Brandon Jones - Virginia Board of Nurses - New President 14 Time is Brain - Celebration of Door-to-Needle Time

Pam Flinchum, BS, RT(R)(CT), RN, SCRN

15 Citations & Recognitions 16 Additional Recognition 18 Virtual Healthcare Hot Topics Journal Club 19 Classes & Events 20 See Where Our Nurses Have Presented Their Work 21 External Conference information

Carilion Nursing Research Editorial Board: Deirdre Rea, DNP, RN-BC, PMH-CNS - Interim Editor-in-Chief

Reviewers

Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCNS, CCRN-K Ann Beheler, ADN, RN Sarah Browning, DNP, RN-BC Charles Bullins, DNP, RN, AGACNP-BC Monica Coles, DNP, RN-BC, ACNS -BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, PhD, RN, CNE Cindy W. Hodges, BSHS, RNC, FCN James Ingrassia, MSN, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Laura Reiter, DNP, RN, CCRN, CNRN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC

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In the same time span, 2 CAUTIs were called on the unit and were remediated with staff education. In effort to decrease CAUTIs, feedback from contract and permanent staff was solicited and a goal of foley removal prior to 11 am was identified. At this point in the fiscal year,11 West has not had a CAUTI.

Leadership Takeaways

• Round as a leader:  Many organizations have set expectations for leaders to round on patients. Use that time in between patient rounds to focus on individual staff members. Hear what they are saying and see how you can support them in the moment. There may be tangible action items in the moment but providing time to listen to staff increases trust and rapport. Both contract and core nurses need this support. • Unit-based shared governance restructure:  Shared governance has always given staff nurses a voice into how the unit operates and allows shared decision making.  With fewer core staff many councils have dissolved. Shared governance and decision making is directly tied to employee engagement and with creativity by the leader these councils can remain active and effective. Leaders should seek out the change agents on the unit whether core or contract. Using combinations of formal and informal meeting options provides various forums for staff to provide feedback and ideas. When the council chair or change agent is scheduled clinically, give them the support to seek out suggestions/answers from others, encourage resolutions to council goals.

Core staff are valuable. Hospitals need contract staff to ensure we can care for our communities. Unit leaders must find the balance and flexibility to manage both. The answer is to foster a positive culture and engage them all with the same level of accountability.