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Column | Leadership

Joe Fifer: Solving the nurse staffing crisis — We’re all in this together

Column | Leadership

Joe Fifer: Solving the nurse staffing crisis — We’re all in this together

As COVID-19 hospitalizations have ebbed, demand for travel nurses has decreased, and their ultra-premium wages also have gone down. The peak period of $175 hourly rates for travel nurses may be over. Does that mean fi nance leaders can stand down now? Nope. Not at all.

I’ll admit it: When I worked in a health system, I got complacent about the nursing shortage issue over the years, even though it was a perennial area of concern for our leadership team. We were always able to recruit enough nurses, no matter how dire the situation was said to be. But this time is different. The COVID-19 pandemic has taken long-standing nurse staffing challenges to a whole new level.

During COVID surges, hospitals have been forced to rely on external staffing agencies to supply travel nurses at rates that not only blew up hospital budgets but also led to dissatisfaction among permanent direct care nurses, who were doing the same work for considerably lower pay.

In response, some health systems launched internal staffing agencies, which allow nurses to float among different sites within the system, as needed, and earn higher pay, while still reducing costs at the system level by avoiding the middleman markup. You can think of it as a short-term strategy for addressing a complex societal problem at an organizational level. And there is a definite role for such strategies.

As a long-term strategy, the healthcare industry needs to strengthen the “narrow part” of the nursing pipeline — that is, nursing schools. In 2021, nursing schools had to turn away about 92,000 qualified applications for lack of clinical placement sites, faculty preceptors and classroom space. When health systems partner with nursing schools to supply some of these resources, which is happening on a small scale now, everyone benefits. Health systems may want to consider establishing alliances that would pave the way for more substantial investments in nursing education, filling the pipeline for all.

Of course, the pipeline is just one aspect of solving the nurse staffi ng crisis. We also need to address the root causes. HFMA is one of five industry groups collaborating on the Nurse Staffing Think Tank, which has worked to identify priority areas for taking action based on the root causes. The group recently published a solutions tool kit with recommendations to address these areas — healthy work environment; diversity, equity and inclusion; work schedule flexibility; stress injury continuum; innovative care delivery models; and total compensation.a A task force is continuing and expanding on this work.

As an industry, we always seem to claw back from the brink of disaster. But we must learn from these experiences, or, as the saying goes, we are doomed to repeat them. The nursing crisis was exacerbated by COVID, but it didn’t start with the pandemic, and it won’t end with it. Finance leaders have an important long-term role to play in solving this problem. There is no room for complacency. Collaboration between nursing and fi nance has never been more important than it is now. 


a. Partners for Nurse Staffing, “Nurse staffing think tank: Priority topics and recommendations,” 2022.

About the Author

Joseph J. Fifer, FHFMA, CPA,

is president and CEO, HFMA, Westchester, Ill.

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