Authentic Leadership: Developing an Internal Staffing Agency

Apr 19, 2023

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It’s the best of both worlds. It offers me the opportunity to grow and learn and be more well-rounded. It offers all of the rewards of a full-time employee, but the benefits of being a traveler, too.

Heather Laskey, Cardiac Nurse

As the travel nursing industry becomes a more common partial solution for adequate healthcare staffing, the need for consistent training and adequate competency is also increasing.

As their solution to these challenges, CommonSpirit Health recently launched a national travel program - essentially its own internal travel agency, where qualified nurses can travel within the system’s 139 hospitals across 21 states. Heather Laskey, a cardiac nurse and program participant, and Travis Gesell, the program’s director, spoke with AACN Clinical Practice Specialist Sarah Delgado about this staffing strategy.

Sarah Delgado: Perhaps you could give us some background on the program and how it was identified as a need in CommonSpirit’s strategic plan.

Travis Gesell: In 2019, there was a merger between Dignity Health and Catholic Health Initiatives, and that merger provided us with a very large presence across the nation. Given our size, we came together and thought, “Why not make our own internal agency staffed with our own nurses who we can train in the CommonSpirit way? Then, we can provide our own nurses to our own facilities, which would allow them to easily transition from one facility to another.”

This program offers our current employees who are interested in traveling an option to travel within their own healthcare system, allowing them to retain their benefits and seniority. It also provides them with the ability to return to their home unit or hospital after they’ve traveled for a while without the hassle of going through the external application process all over again.

You were one of the first nurse participants in the program. Can you share what made this offer attractive to you?

Heather Laskey: It’s the best of both worlds. I describe it as stable instability. I can travel within the system and I’m not always in the same place. I have that opportunity to go and travel and see different areas and become a more well-rounded nurse through this program. But also, when my children are in school, I’m able to stay at my home hospital and have that flexibility to be able to travel with my kids during their time off in the summers.

How has it worked out using this in-house versus the more traditional sort of travel agency?

Travis: We went for an in-house agency over traditional travel agencies, because we really wanted to invest in our own nurses first before investing in premium labor costs to our external travel agencies. It’s no surprise that external labor comes at a premium, so investing in an in-house agency just made sense for us. We’re able to compensate our nurses at a higher rate, while also providing cost savings by eliminating agency fees that they charge on top of the nurse’s base rate.

Can you tell us a little bit about one of your experiences and how that went?

Heather: So far, I’ve been able to travel within my hospital. Besides just helping out on other units, I am excited to start cross-training in other departments and get back to procedural nursing. Because CommonSpirit has [this program], I’m a permanent, forever, full-time employee of CommonSpirit. They’re able to actually invest more in me and be able to cross-train me to do the things that support my career goals. I can continually learn and be able to grow myself and hopefully be able to grow this program. So while I haven't been able to go to our other CommonSpirit locations yet, I am able to go throughout the hospital, and that’s important to me.

Can you share a few of the different kinds of units or specialties you’ve had experience with?

Heather: I’m a cardiac nurse, and I was in the cath lab before I started traveling. Right now I work on an open-heart step-down unit and I also work at a post-PCI unit, which I’m very familiar with. But the open hearts are new for me, so I’ve been able to learn about that. And then, I also have learned neuro (from spending time on the neuro unit).

It’s interesting, because one of the complications from PCI is a stroke, or CVA. So it’s interesting to be able to kind of get from the very beginning of that patient what’s happening and then be able to follow them or just theoretically follow everything that can happen throughout their hospital stay. You might start in a heart unit and you’re going to end up in neuro if they throw a clot or something happens. So it’s interesting to be able to see and be able to nurse the complications that can arise from what my original specialty is.

Can you tell us a little bit about how people get into this program?

Travis: To qualify for the program, nurses have to come with at least two years of recent experience in the specialty that they’re applying to.

What was onboarding like for you?

Heather: Onboarding is very easy, because now I’m able to completely switch departments and switch hospitals, and I don’t have to start over. Therefore, it's just this continual flowing process that I don’t ever have to start over. We are very well-supported and we do support each other. I feel like this company has my back and really is invested in me, which is unique to find in a large hospital system, much less a hospital system at all.

Can you tell us how you match nurse competencies with the needs of different settings in your health system?

Travis: Having a nurse oversee the program operations really provides a level of clinical competency when interviewing candidates and deciding placements. There’s a reason we have specialties in healthcare, and recognizing these specialties really sets up that nurse, unit and patients for quality outcomes.

Once I hire, I will send a resume of the nurse to a facility. I say, “Hey, this is who I have coming. They come with many years of experience. Primarily, they’re most comfortable within this specialty. Please let me know where you would like them placed.” I work collaboratively with the facility to find the best placement for that nurse.

Do you feel like having this opportunity has affected your decision about staying with CommonSpirit longer term?

Heather: Yes, it provides me the opportunity to travel and see different parts of the country. I was in the military for a few years and my husband was, too. He just got off active duty. So, my kids have seen most of the country, but they’ve never been to some places. We lived in Texas, but we have not been able to spend a lot of time in Arizona. So those are our sister facilities. Staying with the program allows me the potential to travel and to have those new experiences with my family, but I’m also really excited to grow in the program itself.

If you think about another large health system that’s considering a program like this, what kind of advice would you offer them?

Travis: I would definitely say developing and implementing an in-house program takes a lot of thought leadership. It’s really important to approach this endeavor with a sense of excitement and curiosity, because you’re going to find old processes might not translate as easily as you would think. It’s vital to bring together a team with different skills, diversity and views.

If you knew of nurses who were considering a similar program at their place of employment, what kinds of advice would you offer?

Heather: I would say go for it. It’s the best of both worlds. It offers me the opportunity to grow and learn and be more well-rounded. It offers all of the rewards of a full-time employee, but the benefits of being a traveler, too. You don’t know what you don't know, and you never want to be the smartest person in the room. Every single person that you meet, you have the opportunity to learn something from. So I’m very excited for one big, lifelong learning opportunity from this.

Travis: Nursing is our largest workforce, so it just makes sense to invest in your nurses. It’s going to have a cascading effect and help reduce your turnover while boosting morale. As you know when turnover is low and morale is high, you’re going to have better patient quality outcomes.

If you had someone who was just starting in a position similar to yours and you wanted to give them some leadership advice, what would it be?

Travis: I guess if you want to throw my leadership into a theory of style, it’s being authentic. I also believe, as individuals and leaders, we cross into different theories. Everyone wants to be a transformational leader; it’s the buzzword leadership style. Of course, we are playing in the transformational realm, but we also have to do some transactional things. That's just part of leadership. I think I always hold true to myself and I approach it like, “I want to be the leader that I would want.”

Now, as a new leader, I don’t think you can ever ask enough questions, and always ask for feedback from anyone and everyone. As I'm hiring people into this internal travel program I tell them, “Hey, listen. This is a new program. We’re probably going to have some bumps in the road. We’re probably going to fall down and scratch our knees. But that’s where I’m really going to ask you how we can do this better. I want to know what’s working and what’s not working, so we can tweak this program to fit the needs of our team members, our facilities and, most importantly, our patients.”

Do you have a successful staffing solution that works in your unit or facility? We want to hear from you. Submit your solution.