The Nursing Staffing Shortage and International Talent Mobility

The US is in the midst of a record breaking nursing shortage that is expected to continue through 2030 and nursing recruitment and retention is at the center of the national spotlight. In this post we assess the complexities of the problem, current solutions in the market today, and a fresh, cost-effective approach that connects high quality international talent to hospitals through the US education system.

The NSI National Health Care Retention and RN Staffing Report released this week includes input from 273 hospitals nationwide to demonstrate the impact of nurse turnover, vacancy rates, recruitment metrics, and staffing strategies. The results are staggering:

  • Fifty-one percent of respondents said the RN vacancy rate in their hospital tops 15 percent

  • The turnover rate for RNs is 22.5% nation wide with emergency services, behavioral health and other departments averaging turnover greater than 100%, indicating entire departments turning over within a 5 year window

  • The survey found that the turnover for a staff nurse costs a hospital roughly $52,350 with each percent fluctuation of nurse turnover resulting in an average spend of $380,600.

  • Moreover, the results show that hospitals that are reducing their reliance on short term travel nursing by eliminating 20 travel positions yields an average savings of $3,140,000; every full time RN hired saves a hospital $157,000.

These results illustrate that hospitals must establish sustainable, innovative longer-term staffing initiatives as the cornerstone of their recruitment and retention efforts to control cost and improve patient outcomes.

The temp, short-term, or contract labor staffing industries have experienced an exponential growth in recent years as hospitals look to curb the effects of the nationwide nursing shortage. As hospital executives face mounting pressure to contain costs, the financial stresses associated with a reliance on short term staffing solutions are unsustainable and risk negatively impacting patient outcomes long-term.

Short-term Placements

Pre-pandemic, most hospitals relied on short-term staffing solutions such as travel nursing and PRN staffing to fill gaps in their clinical areas. During the pandemic, hospitals struggled with long-standing workforce issues coupled with a focus on high-cost staffing solutions that provided immediate relief with no long-term sustainability.

  • Travel Nursing: Travel nursing agencies offer a temporary solution to the ongoing nursing shortage. Travel nurses are skilled professionals who undertake 13-week assignments in areas that have a high demand for nurses. Many healthcare organizations renew these short-term contracts over several years which is financially unsustainable due to the inflated wages charged by travel companies. The average annual conversion rate of a travel nurse to a hospital is less than <1% leading to high turnover and low staff retention. As a direct result of the pandemic, travel nursing rates have exploded with an average hourly rate reaching well over $100/hour depending on the specialty. Inflated hourly rates are pushing hospitals to the brink of financial collapse with no clear path forward.

  • PRN Healthcare Staffing: PRN is an acronym for the Latin phrase “Pro Re Nata”, which means “for the existing occasion” or “as needed.” Healthcare organizations use this form of staffing to fill in daily stop gaps to cover sick employees or an unexpected spike in the census. PRN staffing is useful in maintaining day to day staffing ratios; however, some organizations have become reliant on this form of staffing as a longer-term initiative. Due to the rising costs charged by PRN staffing firms, this strategy is unsustainable and offers a cost-ineffective temporary solution.   

Long-term Placements

Healthcare organizations are beginning to shift their focus to long-term nurse and allied staffing coverage as an essential solution for maintaining operational viability. As a result, direct placement and Recruitment Process Outsourcing (RPO) firms have attempted to offer a more cost-effective approach by sourcing local talent for permanent roles. The underlying challenge with this approach is that companies in this space are all vying for the same depleted domestic pool of nursing talent which is a direct result of the pandemic exacerbated labor shortage.

  • Direct Placement: Direct placement staffing, or direct hire staffing is a service offered by staffing agencies to hospitals looking for specialized assistance in recruiting a full-time nurse. These staffing agencies handle the entire recruitment/screening process when sourcing domestic candidates for hospitals. Direct hire firms often charge hospitals 25%-30% of the projected first year annual of each nurse placed. The major challenge with this form of staffing is that organizations rely on a limited pool of domestic candidates in an increasingly competitive market.

  • RPO Staffing: Recruitment process outsourcing (RPO) is a form of staffing where an employer transfer all or part of its recruitment processes to an external service provider. RPO firms assume ownership of the design and management of the recruitment process and the responsibility of results. This type of staffing is typically a 6-month, 12-month, or multi year commitment where hospitals pay an hourly rate for external recruiters and account managers assigned by the RPO company who function as an extension of their internal recruitment efforts. This form of staffing is very expensive and offers no guarantee to hospitals on the exact number of nurses that could be potentially sourced.

  • International Nurse Staffing: In recent years, hospitals have begun considering an untapped pool of international nursing candidates. Staffing companies offering these services have grown exponentially over the past several years as they are unconstrained by domestic labor shortages allowing them to meet the needs of their clients with a larger pool of diverse nursing applicants. One of the challenges posed by this form of staffing is that the pipeline of nursing applicants presented to hospitals require some form of visa sponsorship to be eligible to work in the U.S. In addition, these candidates have received a foreign nursing education which requires them to go through an equivalency credentialing process to ensure that their work/educational history is in-line with U.S. standards.

The inSpring Model

inSpring goes beyond the industry standard offerings listed above with a primary focus on lowering overall staffing related costs by almost 90% while providing hospitals with U.S educated international talent to build and stabilize their core staff. inSpring offers a unique approach to addressing the nationwide staffing shortages in healthcare by specifically focusing on diversifying and growing the nursing talent pool culturally, linguistically, and geographically through a new type of pipeline. inSpring partners with academic/healthcare institutions across the U.S to provide international students with an opportunity to obtain their nursing degree through an ABSN program. International students are an integral part of the healthcare sector in the U.S. and inSpring helps bridge the gap between academia and job placements nationwide with our end-to-end training & service model.

About inSpring

With job openings in tech and nursing outpacing an available workforce, inSpring curates a pipeline of high-quality, culturally diverse candidates with advanced degrees and workforce readiness training aligned with the hiring needs of a wide network of employers. inSpring also manages the entirety of the international worker visa process – eliminating a major burden in the hiring process of this underleveraged talent pool – and continues to partner with employers and the candidate long after job placement to ensure a smooth, sustainable transition in their new career.

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