Critical need for nurses

Our "Snap Back Plan" to address a long-standing nursing shortage exacerbated by the ongoing pandemic.

Nurses are the backbone of the healthcare delivery system, but a nation- wide shortage of nurses that began in 2012 has left healthcare systems across the country crippled. The stress of two years of fighting the COVID-19 pandemic has only exacerbated the issue, with many nurses choosing to leave the field or retire.

“The last two years have spotlighted the vital role nurses play in quality healthcare,” says Janice Walker, DHA, MBA-HCM, BSN, RN, NEA-BC, executive vice president and chief nursing officer for Baylor Scott & White Health. “That focus has also shed light on the challenges nurses face, and how much we depend on their knowledge, abilities, and compassion.”

Nurses often spend more time with each patient than physicians do, and insufficient nurse staffing levels can negatively affect patient care as nurses’ time and energy are stretched thinner among more patients. National studies have shown higher patient to nurse ratios are associated with errors in care, more preventable infections and falls, longer hospital stays, higher readmission rates, and higher mortality rates. While Baylor Scott & White has taken extraordinary steps to address our nursing shortage and provide quality patient care, further action is needed to rebuild the nursing workforce.

Supply and Demand

Although nursing is one of the fastest growing occupations in the nation, demand is quickly outpacing supply for a variety of reasons, including:

Changing demographics

Between 2010 and 2030, the population over the age of 65 will increase by 75 percent. One in five Americans will be a senior citizen. As the population ages, demand for quality healthcare will skyrocket. The nursing crisis in Texas is also partially driven by a dramatic increase in population, with four million people moving into the state over the past decade.

An aging workforce and limited nursing school enrollment

 Like the patients they serve, the nursing workforce is also aging. An estimated one- third of the nation’s nurses will reach retirement age in the next 10 to 15 years. This figure includes nursing school faculty, leading to enrollment limitations and too few new nurses entering the field.

Cycle of insufficient staffing and burnout

It’s no secret that healthcare workers have faced incredible challenges and pressure over the past two years—through not one or even two, but four surges of the COVID-19 pandemic. Understandably, many healthcare workers are exhausted and overwhelmed. The shortage of staffing only increases the stress on nurses, leading to burnout and even more nurses choosing to leave the field.

Our “Snap Back Plan”

Texas is estimated to have the second highest need for nurses in the nation, and Baylor Scott & White is no exception. Thanks to our reputation for excellence in patient care, Baylor Scott & White has historically enjoyed a very low average nurse vacancy rate of just 5 percent. However, we are currently facing an 18 percent nursing vacancy.

“It’s unusual for a system like Baylor Scott & White Health—known for quality patient care and excellence in nursing—to have such a high nurse vacancy rate,” Dr. Walker says. “Until now, attracting talented nurses has not been a concern. The last two surges of the COVID-19 pandemic have certainly pushed us into a critical situation.”

To meet our staffing needs in the short-term, Baylor Scott & White has contracted more than 1,300 travel nurses whose services come at a premium— an average of $19.6 million per month over the last six months. Beyond the additional costs incurred, travel nurses cycling through departments do not provide an ideal long- term solution since they are less familiar with our System, providers, and practices.

Baylor Scott & White is also investing heavily in our current nurses, with more than $125 million in retention bonuses and incentive pay since the start of the pandemic.

While these extraordinary steps and expenditures are necessary to provide quality patient care, the situation is not sustainable. Our goal is to hire as many new nurses as possible, as soon as possible, to address the current crisis in nursing. Hiring newly graduated registered nurses (GNs) will be a crucial part of this “Snap Back Plan.”

However, GNs face a unique and often overwhelming learning curve when entering the complex and high-stakes field of nursing. They replace retiring nurses with decades of experience. In addition, stress can weigh heavily on new nurses whose daily work may involve matters of life or death, leading to frequent burnout.

“Being a nurse is not easy, and that first year can be especially difficult,” Dr. Walker says. “But Baylor Scott & White doesn’t just provide graduate nurses with their first jobs—we equip them with the resources they need to succeed in a complex career.”

To ensure the success of these new nurses, Baylor Scott & White plans to expand its Graduate Nurse Residency Program (GNRP). This transition-to-practice program, accredited by the American Nurses Credentialing Center, provides additional education and mentorship opportunities that promote quality and safety while significantly reducing turnover rates for first-year nurses.

"Baylor Scott & White doesn't just provide graduate nurses with their first jobs—we equip them with the resources they need to succeed in a complex career." Dr. Janice Walker, EVP and CNO for Baylor Scott & White Health

Graduate Nurse Residency Program (GNRP)

In the same way physicians complete a residency program before beginning their own practice, all newly hired GNs at Baylor Scott & White complete the GNRP. The one-year program provides GNs with the knowledge, skills, and support they need to confidently fulfill their expanding roles in the ever- evolving healthcare industry.

Established in 2018, the program has previously enrolled 500 GNs per year. To address the nursing shortage and rebuild a strong healthcare workforce, Baylor Scott & White will expand the program to include 2,250 newly hired GNs per year. With this aggressive plan, we anticipate we will have our nursing workforce rebuilt by 2024.

Some benefits of the program include:

• Transition from entry-level to experienced nurse
• Development of effective clinical judgment
• Ability to provide bedside clinical leadership
• Ability to incorporate research-based evidence into practice
• Guidance on an evidence- based practice project
• Mentorship and guidance on real-life challenges, including stress management
• Support from peer group of GNs facing similar challenges
• Strengthening of commitment to nursing
• Formulating individual career development plans