Author: Meredith Kenyon
Vice President of Workforce and Education
MHA has been collecting vacancy and turnover rates of hospital-based professions since 2001. Throughout the last 16 years, if you feel like you have been on a workforce shortage roller coaster ride, you are probably right. Historical turnover and vacancy graphs look about as high and low as the screamin’ eagle roller coaster at Six Flags. There is a good chance you may have wanted to throw your hands in the air in search of innovative ways to recruit and retain employees during this time. Recruiting and retaining qualified health care workers in a highly competitive labor market continues to be a major challenge facing Missouri hospitals. As the health care industry continues to evolve, the health care workforce is critical, making this wild ride one we all would like to get off sooner rather than later.
MHA’s newly released 2017 workforce report found for the first time that staff registered nurses had a historic high vacancy level of near 16 percent. Among all 36 categories of staff surveyed, staff R.N.s led in vacancy. In addition, turnover for staff nurses remains high at 14.3 percent. A high nurse vacancy rate is consequential because it can signal difficulty in finding trained professionals. Turnover, which exceeded vacancy in last year’s report, often reflects movement within the workforce.
The report includes data from 142 hospitals and identifies trends among 36 hospital-based positions, and five clinic and physician practice positions. Complete turnover and vacancy information for surveyed positions is available on the workforce webpage.
Hospital staff nurses serve an essential role in care delivery and make up 60 percent of the hospital workforce. Last year’s report found staff nurse turnover at an all-time high of 17.9 percent. However, the 2017 report indicated turnover among staff R.N.s has decreased to 14.3 percent.
An improved economy and older workers departing the workforce have created an environment favorable to employee vacancy and turnover. The cost of turnover is high — the turnover of each bedside nurse is estimated to cost a hospital between $37,700 and $58,400. Vacancies create management challenges by limiting staffing options throughout the organization.
Because health professionals are in high demand, competition is local, regional and national. Missouri has limits on scope of practice for some clinical professionals such as advanced practice registered nurses and physician assistants. Limits on scope of practices makes Missouri a less attractive state to these highly skilled caregivers. APRNs and P.A.s are among the top 10 positions for vacancies.
In addition, nurse practitioners and physician assistants extend access to primary care; limits on the scope of practice exacerbates physician shortages, especially in rural areas. Practice-related policy changes could mitigate some of Missouri's disadvantage in attracting and retaining these high-skill health care workers.
John Locke once said, “As people are walking all the time, in the same spot, a path appears.” Missouri hospitals face a universal challenge in insuring that people with the right skills are doing the right work within an effective operating model. People can, by collective action and innovation of some, change the course of the future for Missouri’s health care workforce.
Every Missourian has a stake in the strength of the hospital and health care workforce. Important investments are being made at the local, regional and national level. Because many hospital professions require years of training before they are prepared to deliver or support care, long-term investments and ongoing partnerships are vital to deliver the workforce Missourians require.