For most nurses, the decision to become a nurse is almost always driven by something intimate: a loved one lost to sickness or tragedy, a family tradition, a desire to heal their community. Nobody becomes a nurse to work grueling marathon shifts. Yet, the 12-hour “three-on, four-off” schedule is standard for the profession, and for many, it’s the only avenue to realizing their personal passion. It’s viable for some nurses, but for others, like me, it is a rapid route to burnout.
The current nursing shortage is a crisis, and it is being fueled by the confinement of healthcare professionals to this supremely rigid structure of work. According to recent studies, as many as 67% of nurses are planning to leave the field within the next three years. They’re citing burnout, stress, and a desire to reduce the number of hours they’re working as reasons for leaving the industry.
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I understand these reasons on a deeply personal level. Ten years ago, I was trying – and failing – to make full-time nursing accommodate the life I wanted to live. After a few months at one ICU, I’d jump to another in the next town over, always in pursuit of the ability to be a nurse and have a life outside of the hospital. By my fifth facility, I was exhausted. I loved nursing, but it was clear the nursing profession did not love me back.
The following spring, I left my full-time nursing job and found contract work as a critical care transport nurse with an ambulance company in San Diego. My expectation was to work a few shifts, put my education to use and pay the bills while I contemplated my next career move. My first shift thrust me into a new world as we raced through the city at 4:00 a.m. to get to a man who was having a heart attack. Once the rush of stabilizing the patient had dwindled, I found myself overcome with joy. I had helped save patients in the ICU before. This was different. For the first time in a long time, I actually loved my work – because I was working on my own terms, picking up shifts that worked best for my and my family’s schedules, without the obligations that accompany a full-time job.
Nurses are currently staging a great exodus from the profession, and the only way they’ll re-enter is on their own terms. Nurses and other healthcare professionals want more control over when, where, and how many hours they work. Many still love their full-time roles, and they are absolutely critical to the prosperity of healthcare’s workforce. But there are others who don’t want the traditional constraints of minimum shift requirements, nor do they want forced overtime or holidays. They want a level of autonomy and flexibility in their schedules that can’t be found working full-time or with a staffing agency.
One hundred years ago, however, that kind of flexibility was inherent to the profession.
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Taking an age-old workforce model into the 21st century
In the first few decades of the 20th century, most nurses worked as independent contractors, relying on their own resourcefulness to seek out work. Studies of the nurse labor market during this period show private duty nurses made up approximately 80% of practicing nurses. Many belonged to registries that connected nurses with private individuals and healthcare facilities needing nursing services.
Nurses would sign up with a registry and indicate when and where they were available for work, as well as the types of patients they would accept. This is exactly the flexibility, autonomy, and control many nurses seek today. What happened?
As healthcare transformed over the past century, these registries were replaced with the staffing conglomerates we know today. By the 1990s, big staffing businesses dominated healthcare’s labor market, and in recent years, they’ve begun exploiting it by charging three times the hourly rate of staff nurses and retaining as much as 40% of that amount for themselves. As the nursing shortage intensifies, many facilities feel all they can do is attempt to hire their way out.
Attracted by large bonuses and upfront payments, nurses are leaving their local positions to become a travel nurse at agencies. Those who left their full-time positions for staffing agencies during the pandemic are now beginning to realize that the structure of working as a travel nurse is no different than working full-time and is often more restrictive. It is abundantly clear that something needs to change. The system no longer works for either nurses or facilities needing temporary staff.
Healthcare facilities need workforce models that are dynamic, local, flexible, and that ultimately allow them to reduce labor costs. Nurses want a system of work that respects their autonomy and desire to have a life outside of the hospital. The private duty registry model of the early 20th century provides an early and critical historical illustration of the realization of nurse power, entrepreneurship, and control over professional practice that we still learn from today.
Many physicians, podiatrists, psychologists, and occupational and physical therapists are able to take advantage of the ability to be an independent contractor with little scrutiny. Historically, nurses have been entitled to the same opportunities of the flexibility of independent contracting. When patient demand is high, facilities are able tap local independent contractors to staff up quickly. When facilities have fewer patients, they are not stuck with costly agency contracts.
Independent contracting, of course, has its fair share of opposition. Those who oppose it fail to see nurses as anything but a tax classification; they don’t understand that trying to corral nurses back into a system of work that does not work for them will only intensify the nursing shortage by exacerbating the flight from the workforce. Offering a means of work outside the constraints of the current structure opens up access to a bevy of nurses who have left the field – nurses who are qualified, passionate about caregiving, and ready to work.
The chaos of the pandemic has driven hundreds of thousands of nurses to the brink of leaving the profession. Healthcare professionals are ready to get back to their lives – but that doesn’t mean they’re ready to abandon their passion for caregiving. They just want to do it on their terms, like I did.
Will Patterson is CareRev’s CEO and founder. Having been a nurse himself, Will experienced frustrations with the healthcare system and nurse staffing firsthand – it wasn’t until he began working as an independent contractor for an ambulance company that he realized he’d been craving the ability to build his own schedule. He founded CareRev back in 2015 with the goal of fundamentally upending the traditional healthcare workforce model with flexible staffing. Will is laser-focused on bringing local, part-time workers into the fold in ways healthcare staffing has traditionally overlooked. Once part of the very same industry he now hopes to disrupt, Will has a unique perspective on truly supporting the healthcare workforce and bringing forth a solution that mitigates today’s overwhelming staffing shortages.
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