“I am in desperate need of staff! “ “If we don’t get staff I will be forced reduce services”. “My team is burnt out.” “I am unable to approve vacation or educational leave."
Does this sound familiar to you? Well this was the dire situation that Alberta Health Services (AHS) was facing in the North Zone just three years ago.
Human Recourses Professionals are often faced with the dilemma of not being able to recruit the talent that is necessary to sustain operations and turn a profit. In health care, our bottom line is not share holder profit it is quality patient care - when and where it is needed. Registered Nurses and Registered Psychiatric Nurses provide front line care to patients. When AHS is unable to recruit and retain these clinical professionals, there is a direct impact to patient care services.
The North Zone of Alberta Health Services encompases more than 70% of the land mass of the province of Alberta. This zone has 9987 employees and 477 physicians. Facilitiies include 2 Ambulatory Care Centres, 1 Family Care Centre, 37 Public Health Centres, 7 Addictions facilities, 2 stand alone Community Mental Health facilities1; 34 Hospitals, 6 Cancer Centres and 53 Long Term Care facilities, serving a population of 474,235.
With the exception Grande Prairie and Ft. McMurray most communities are considered to be rural and remote. Recruitment is a constant struggle and it is mission critical to have the right human resourcess to provide quality health care to those who live and visit this area.
The northern most reaches of our North Zone were an area of critical concern for our Human Resources team. The North Zone, specifically north of the 57th parallel, experienced chronic staff shortages for several years. The number of Registered Nurse / Registered Psychiatric Nurse (RN/RPN) vacancies averaged 13.8% with a high of 22%. The North Zone accounted for nearly 10% of all terminations from AHS each year, even though the overall employee count was fewer than 11% of total AHS headcount. There were very few casual RN/RPN employees available to provide coverage when temporary vacancies occurred. For these reasons, North Zone managers had become reliant on external nursing agencies to fill in the staffing gaps. In reviewing the situation we found that utilization and cost of agency nursing resources was increasing year over year. 50% of agency costs were associated with inability to recruit talent to the area north of the 57th parallel.
The situation was unsustainable. Patient care was at risk, employee burnout was imminent and budgets were over-stretched.
What We Knew
Things had to change. From experience we knew that nurses working for private agencies were willing to work in remote locations on a time limited basis, we knew that there had to me a monetary incentive for them to take the assignment, we knew that AHS was spending a lot of money on these contingent workers, and that private agencies were making a profit from our business. We also knew that our union wanted a solution.
What if AHS operated its own staffing agency?
This idea was socialized within the North Zone HR team and caught on immediately. The team was energized by the idea.. A new approach to staffing that would eliminate our heavy reliance on costly external resources. This really could work! Next step was to get the buy in of our clients – the North Zone Clinical Leaders. Armed with their full support the HR team sought the sponsorship of the AHS senior leaders in Human Resources to move forward. . With all on board we established two conditions that had to be met::
- The program had to be, at minimum, cost neutral.
- The approach had to be in collaboration with the union.
We conducted a literature review of strategies across the country and in particular studied the College of Physician and Surgeons of Alberta’s Physician Locum Program. We were intrigued by the concept of a short term placement to provide specific clinical services.
A Locum is a person who temporarily fills the duties of another2. In health care a locum generally would be used to cover an employee absence or a vacancy.
In 2011 AHS engaged the union and formal discussions began.. By August 2012 both parties has agreed in principle to the concept of a “North Zone RN Locum Program” and collaboratively negotiated an agreement to pilot a program. The North Zone RN Locum Program is designed to provide an internal, cost effective alternative to the utilization of agency nurses, preserve the level and quality of services to patients in the area, to relieve the strain on our staff and budgets for direct patient care. The program required Human Resources to establish new procedures for everything from the application process and payroll processes to booking accommodations and travel.
The Nurse Locum Program:
- Is an option to address challenges in terms of recruitment and retention of employees for communities in the North Zone
- Can assist with maintaining health care services in communities
- Can assist with other staffing needs such as education, training, mentorship
- Improves quality and continuity of patient/client/resident care
- Reduces costs
- Improves employee morale and engagement
- Over 200 locum assignments have occurred since the program launch.
- AHS management and HR staff were able to successfully utilize the program to create a locum roster peaking in size of 107 registered nurses.
- Four locum nurses have accepted permanent positions in the pilot location.
After a successful 2 year pilot north of the 57th parallel, AHS and the union reached an agreement to expand the program across the entire North Zone April 2015. The Program seems to meet the employment needs of a number of nurses. In the first 2 weeks of the expanded program, 35 nurses applied to be part of the program; 16 of those coming from within Alberta.
Alberta Health Services measures performance against six dimensions of quality: Acceptability, Accessibility, Appropriateness, Effectiveness, Efficiency and Safety. The Nurse Locum program contributes positively to each of these dimensions by ensuring that the nurses are available to provide safe, high quality services, when and where they are needed, in a cost effective framework.
Melissa Guimond, Registered Nurse
“A large reason in my choosing locum work with AHS was the flexibility of work. I worked full-time permanent in the maritimes for 3 years, long hours, much overtime, working short-staffed, and often fighting to get vacation time we were entitled to, I got burned out. Locum work allows me a more flexible schedule and in the last year, I have work 9 of 12 months, and believe me, I enjoyed every bit of that 3 months off!”
“The most important reason I chose locum work was to travel, see other parts of this country and how other communities function. As well, many small communities rely on locum nurses and I am glad to help where and when I can. In doing so I have broadened my practice and become a more versatile nurse. I've gained invaluable experience especially in rural/remote areas.”
“It's made me the nurse I am. And changed me as a person. My most recent locum in La Crete was an eye opening experience and a positive one as well. I learned a lot from my colleagues and clients which allowed me to be a more well-rounded Nurse.”
“I'm a firm believer in working to live and quality of life. Locum/travel nursing has improved my quality of life drastically.”
Mary Ellen Hoogers, Director HR Business Partnerships, North Zone, Alberta Health Services
Sandra Jardine, Director, Talent Acquisitions - Talent Management Strategies, Alberta Health Services