An ongoing shortage in nurses nationwide has led Centra to increasingly rely on traveling nurses to supplement its staff.
Centra’s December 2017 end-of-year financials show it spent approximately $17.5 million on contract labor, which includes travel nurses, at the same time it was “engaged in robust nursing recruiting efforts with the intent of eliminating the need for contract nurses by the end of 2018.”
In 2018, Centra’s "continued reliance on travel nurses to meet demands for services drove an increase of $11.7 million" — a full 67% — in contract labor expenses to $29.2 million total over 2017, according to financial disclosure documents.
Centra revealed in December 2018 it would end the year with a negative operating margin for the first time in more than a decade. Officials pointed to the unforeseen costs of implementing the new electronic medical record system Cerner as the main driver, and the nursing shortage as a contributor.
“Regional and national nursing shortages have materially impacted” Centra’s operations, financial disclosure documents filed with the Municipal Securities Rulemaking Board show. The board promotes a fair and efficient municipal market, regulates firms that engage in municipal security and advisory activities and promotes market transparency.
While the nursing shortages are cyclical, according to Centra, the U.S.Bureau of Labor Statistics is forecasting 1,182,000 vacancies in nursing nationwide between 2014 and 2024.
Most hospitals in the country seek contracts with traveling nurses to supplement their staffs.
“Will we have traveling nurses next year? Yes. We would like to have less. However we will have as many as we need to provide the quality of care at the bedside that is demanded by our population,” Michael Elliott, Centra’s senior vice president and chief operating officer said in December when he was acting as interim president.
“You will not speak with any health care organization across the nation, and perhaps the world, that won’t talk about workforce being a big deal and the spearhead of that is the nursing workforce.”
A 2015 study on the costs of supplemental travel nurses published in the Journal of Nursing Care Quality showed “the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient.”
Centra’s Senior Vice President and Chief Nursing Officer Curt Baker said Centra is “better off than most health systems.”
Centra pays its staff nurses about two-thirds what it pays a travel nurse, according to Baker. Because the salaries of travel nurses are determined through a competitive bidding process, Baker would not reveal the salaries of employee nurses or contract nurses.
Virginia Baptist and Lynchburg General hospitals employ about 1,230 acute-care nurses currently and of those, 160 are contract nurses, down from 184 in March, Baker said.
He projects Centra’s travel nursing ranks will be below 100 by September, thanks in part to an influx of May graduates.
Many of those will be from the Centra College of Nursing, according to Melody Sharp, dean of the college. Sharp said 92% of CCN graduates join Centra. This May, 42 students graduated from its RN program and in December Centra anticipates seeing another 148 graduate from its RN, LPN and RN-BSN programs combined.
Centra also hires grads from Liberty University and University of Lynchburg, but in much smaller numbers.
Tiffany Lyttle, who has been a nurse for six years and joined Centra four years ago, is grateful for traveling nurses. They decrease Centra’s nurse-to-patient ratio and give her more time to be better at her job.
“We are full all the time,” said Lyttle, who lives in Forest. While there is no national nurse-to-patient standard Virginia’s hospitals must maintain, Baker said patient safety drives nurse staffing decisions, and thus how many travelers are brought in. In critical care, for example, Centra aims to have a one-to-one nurse-to-patient ratio.
Lyttle said the appeal of becoming a traveling nurse is the money and paying off student loans, but personally she found it even more appealing to be able to work at her hometown hospital.
“The work is so much more meaningful because here is where I live,” Lyttle said, adding that many traveling nurses have stayed in Lynchburg after a stint at Centra.
“I got a friend to stay because she loved working alongside the other nurses in our group,” Lyttle said. “… I would love to see some of our travel nurses, which are very talented, stay.”
To that end, Centra is tweaking recruitment and retention efforts. There are numerous scheduling options, a focus on keeping nurse-to-patient ratios low and most notably, mandatory overtime — which Centra called “mandatory flex” — has been eliminated.
“We’ve done a lot of things to improve our retention,” Baker said. “We have to make sure our salaries are competitive, our benefits are competitive, that we have attractive schedules.”
Centra now offers a residency program for new grads and a paid nurse externship program for those in their last year of school, and it continues to offer retention bonuses to new hires that are paid out over time. Its College of Nursing offers countless financial assistance programs and customizable education plans to attract and keep students.
“Acute-care nursing is hard … we don’t ever close, we don’t have snow days, we work holidays, weekends, nights, so it’s a hard job,” Baker said.