Remote RNs Can Help Ease the Nursing Shortage

By Sherry Smith, RN, MSN, MBA

The nursing shortage is striking all practice arenas and geographic areas nationwide. Almost daily, we are exposed to news about the shortage, its effects, and implications for the future. While many efforts are being made to draw more candidates into the field, the fact remains that many health care organizations will be competing for a limited supply of resources in the coming years. This article addresses some of the factors contributing to the nursing shortage, the benefits and value of telecommuting, and how those in the call center market may be able to offer virtual opportunities as a competitive advantage.

No Shortage of Causes: There appears to be a number of factors predominantly responsible for the current and projected nursing shortage. These include an aging nursing workforce, an aging patient population, and advances in technology, which will cause a predicted increase in demand for nurses at 40 percent over the next two decades.

Nothing can be done to slow the aging process of nurses or patients. Likewise, the organizations that employ nurses cannot control shifts in health care delivery brought on by advanced technology. Instead, technological advances can be utilized to make working in alternative care sites an attractive option. According to a study published by Dr. Linda Aiken and her colleagues in the May/June 2001 issue of Health Affairs, more than 40 percent of nurses working in hospitals said they were dissatisfied with their jobs, experiencing burnout, and planning to leave the profession.

Telecommuting: Organizations that employ nurses where little to no direct hands-on patient care is performed (such as in ambulatory care settings and phone triage call centers) should explore telecommuting as a viable tool for recruitment and retention. Telecommuting continues to grow in popularity. In 2004, nearly 45 million Americans were telecommuters, working from home one day to full time annually. Of these, 24 million worked at least one day/month at home, representing 18.3 percent of employed adult Americans, or nearly one-fifth of the workforce.

Research published to date on this phenomenon is overwhelmingly positive:

  • Over two-thirds of telecommuters express increased job satisfaction.
  • Almost 80 percent feel a greater commitment to their organization and most report they plan to stay with their employer.
  • Almost three-quarters of telecommuters report a major increase in productivity and work quality.

For the telecommuter, the work/life balance is the predominant factor leading to a boost in job satisfaction. Some estimate that eliminating a 40-minute twice-daily commute adds eight weeks of time off. Other benefits include lower costs for food, clothes, and transportation. Workers who telecommute report improved quality of life, better morale, less stress, increased personal control, a more harmonious work/family balance, and fewer commute-related stresses.

AT&T in the Telework America Survey of 2001 noted a 63 percent reduction in absenteeism and sick time. Issues related to tardiness as a result of unavoidable commuter problems are eliminated. Physical constraints of space and overhead costs are reduced for the employer. Nortel Corporation launched a telecommuting program in 1994 and with over 15,000 employees participating, they have saved over $20 million in real estate costs.

Concerns about productivity suffering when there is loss of control by direct supervisors or managers has not been validated. The value of telecommuting is well documented on a variety of fronts by many companies. There is also potential for better use of under-employed groups such as retired or disabled persons.

Some of the challenges that require consideration when exploring this model include equitable compensation, equipment, and connectivity. The potential for isolation of the employee needs to be considered and methods should be used to keep him/her engaged as part of the team.

The Remote Model as a Solution for the Nursing Shortage

The question remains on how to adapt telecommuting to the needs of health care organizations struggling with shortage of nurses. Many also face limited resources needed to attract and retain nursing professionals.

In non-traditional settings, the opportunity to telecommute is a viable option. Currently, not much exists in the literature relating to the success or failure of telecommuting registered nurses. Industry trends in the disease and management space clearly indicate a move in that direction. The remainder of this article will outline items to consider when exploring the opportunity to employ more of the RN workforce from home in a remote model.

Remote workforce issues can be broken into three categories: technology, performance/practice metrics, and leadership capabilities. Technology issues would involve ensuring nurses working from home have the same connectivity, stability, speed, and quality of phone/system connections as on-site staff. Access to content, reporting, client specifications, and feedback mechanisms is essential.

Outlining performance and practice metrics requires in-depth planning. Issues such as choosing candidates, training, education, communication, and scheduling take on a whole different meaning. Adherence to quality, confidentiality, and meeting national standards have to be factored into the implementation items. Compensation, performance monitoring, and at home pre-requisites such as ergonomic requirements need to be outlined so that all nursing team members have the same expectations.

Leaders responsible for managing diverse teams across different geographic locations have to begin considering how to keep the team and corporate spirit alive. There is great potential for isolationism and lack of communication when person to person contact is no longer available. Remote workforce management is a leadership style unique in its own right, with a fair amount of published literature now becoming available to assist managers. Leaders must rally full buy-in and commitment to the program while being able to champion the program to various stakeholders within the organization. Inherent in the process is financial costs, savings, and reliable reporting mechanisms to prove ROI. Collecting data at baseline is clearly essential, with projected goals and outcomes outlined as well.

For organizations faced with the challenge of attracting talented and competent nursing professionals to provide telephonic nurse services, remote options should be explored. The technology is available to deliver key functionality of telehealth services while ensuring quality, no degradation of service, and saving employers significant amounts of money. The additional bonus will be certainly recognized by recruiting and retaining RNs from a shrinking resource pool.

Sherry Smith, RN, MSN, MBA is a Consultant for 3CN (Call Center Consulting Network), a network of medical call center experts available to assist with strategic, operational, or technical projects. You may contact Sherry at 603-707-0151 or

[From the April/May 2005 issue of AnswerStat magazine]

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