By Marcia Faller, MSN, RN, executive vice president and chief clinical officer, AMN Healthcare 

Dec. 2, 2009 - Everyone seems to be talking about changes in health care these days, from casual observers to the highest government officials. Some of the most compelling evidence about current trends, however, may come from the chief executive officers of our nation's hospitals. CEOs have a unique, first-hand perspective on the challenges of providing quality patient care in an era of staffing shortages, economic recession and impending health care reform.

So what do these hospital leaders see in regards to clinical staffing trends?

Have their staff vacancy rates changed?  Has recruitment gotten harder, or easier? Are there enough clinicians to handle the influx of new patients that would occur with universal access to care? 

Working with the nonprofit Council on Physician and Nurse Supply, AMN Healthcare set out to find the answers to these and other questions. We conducted a staffing survey of hospital chief executive officers around the country, inviting 5,000 for-profit and non-profit acute care facilities to participate.  From the nearly 300 completed surveys (6% response rate), a number of key findings emerged. Here are a few of the highlights:

The Staffing—Money Link

Hospital chief executive officers acknowledge that clinical professionals are important revenue drivers, with a 99% vote for physicians, 91% for allied professionals, 90% for nurses and 83% for pharmacists.

As we know, clinicians can act as revenue drivers in several ways. Physicians drive revenue by admitting patients, ordering tests and performing surgeries and other procedures. Nurses and allied professionals can drive revenue by keeping beds open, performing tests and reducing costly medical errors, including "never events" that are no longer reimbursed by Medicare. 

And reimbursement issues are a top strategic priority, according to 81% of the CEOs who answered the survey.

Nurse staffing has also been shown as a key factor in improving quality of care -- ranked as the "most important" concern by these CEOs -- and patients' satisfaction, which, in turn, drives more business (see related Staffing Matters column).

Recruitment Trends for Clinical Professionals

In the context of the current recession and impending reform, these hospital CEOs reported the following recruitment trends:

Physicians.  Physician recruiting was clearly seen as the most challenging area among clinical professionals, as 41% of CEOs reported that recruiting physicians is "very difficult" and another 43% rated it as "somewhat difficult." Close to one-third (31%) of CEOs indicated that physicians have also become more difficult to recruit in the last six months, and 54% expect their recruitment of physicians to increase over the next six months. More than half (52%) rate the shortage of physicians as a "serious concern."

A recent Modern Healthcare article on physician recruitment reinforces these statistics, including a quote from Rusty Holman, chief operating officer for Cogent Healthcare and the 2007-08 president of the Society of Hospital Medicine, "It is a fiercely competitive environment."

Nurses.  Thirty-six percent (36%) of hospital CEOs indicate that recruiting nurses has become easier over the last six months although 48% still rate it as "somewhat difficult."  One-quarter (24%) of the survey respondents said that they have decreased their nurse recruitment efforts due to the economic downturn. This data reinforces the anecdotal evidence that we've been hearing from around the country: more nurses are going back to work or increasing their hours to make up for shrinking retirement funds, a spouse's loss of income and other fallouts from the recession.

Despite the trend toward easier recruitment, two-thirds (67%) of the CEOs reported that they do not think their service areas have enough nurses to meet the demands that universal access to healthcare would require.

Allied Health Professionals.   Half (51%) of the CEOs reported that recruiting allied professionals to their facility is currently "somewhat difficult" and 8% reported that it is "very difficult."  Recruitment efforts have remained fairly steady in this area, with three-quarters (75%) of the respondents saying that they have made no change in their recruitment of allied professionals due to the recession, and 76% see no change in the coming six months.  Allied professionals were reported to have the lowest vacancy rates among the four clinical areas surveyed, averaging 4.6%.

Pharmacists.  Pharmacists had the second-lowest vacancy rate (5.1%) and little change due to economic pressures: in fact, 85% of the CEOs reported "no change" in recruitment due to the recession.  In the coming six months, 83% expect pharmacist recruitment to remain steady at their facility, while 10% predict an increase.  Pharmacists are still seen as difficult to recruit, with 25% of the survey respondents rating them as "very difficult" (second-most difficult behind physicians) and 48% calling them "somewhat difficult" to recruit.

To read the full results of the survey, go to: Clinical Staffing: 2009 Survey of Hospital Chief Executive Officers to download a copy.