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At The Methodist Hospital in Houston, the Magnet journey let the hospital to give nurses a greater voice in the hospital's governing councils. These councils work through problems that are identified in different units.

On July 1, Community Health Network in Indiana took the plunge: The five hospitals in the network stopped using agency nurses.

For the facility's chief nursing officer, Janet Bingle, MS, RN, the biggest challenge was fighting the fear that the facility wouldn't have enough nurses once it made the shift to being agency-free. Yet it successfully made the transition-an endeavor that required nothing less than two years of intense planning.

Community Health Network is not alone. Hospitals throughout the country are cutting back on the use of agency nurses. Although hospital executives may initially be motivated for financial reasons, they agree that the facilities are reaping much greater benefits as long overdue changes are made to prepare for the transition.

In order to gear up for agency-free deadlines, hospitals have poured money and resources into not only hiring more nurses, but also coming up with strategies to keep existing staff nurses happy.

Several hospitals tackled the challenge of improving nurse employee satisfaction by working to earn Magnet status. At The Methodist Hospital in Houston, the Magnet journey led the hospital to give nurses a greater voice in the hospital's governing councils. These councils work through problems that are identified in different units.

For example, nurses in one council worked on methods to reduce the rate of bedsores among patients. The team came up with the idea of purchasing mattresses that could better relieve pressure.

Valerie Jackson, RN, a nurse in the cardiac intensive care unit at Methodist, is a member of the hospital's research and education council.

"I'm interested in research and new products, and being on the council makes me feel like I am more involved and more accountable," she said. "I also feel like I'm making a difference."

Although it was critical to retain staff nurses, Methodist executives also knew they needed to beef up recruitment of new nurses if there was any hope of eliminating agency use. To that end, the hospital created a nursing internal flex team. The nurses they hired for the team would earn a higher wage and have a more flexible schedule, but they would not have employee benefits. These nurses also would differ from agency nurses in that they'd be expected to participate in hospital orientations and annual reviews.

The hospital also developed a more sophisticated float process as a second buffer for high patient-count days or to cover sick or vacation time for staff nurses.

Unexpected benefits

Before Methodist developed these programs, the facility was spending about $1 million per month on agency nurses. It has been agency-free since the beginning of the year, and the reward has been far from just financial, Tricia Lewis, MS, director of the coronary care unit, said.

"The reward is the satisfaction that we've been able to provide the patients with a high level of care," she said. "Patient satisfaction has continued to improve, and the physicians are also happy because they don't have to deal with nurses they have never seen before."

Staff nurses also enjoy having more time to focus on patients, Jackson said.

"It's a big change to no longer use agency nurses," she said. "It's improved the consistency of care because [staff nurses] better know each other's strengths and weaknesses. It also takes time to show agency nurses where things are and how to do different tasks, and it gave me less time with the patients."

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