The pandemic, followed by the Great Resignation, amplified an already-challenging nursing shortage. “You saw the word ‘unprecedented’ all the time — they were unprecedented times,” said Lee Ann Wallace, MBA, RN, NEA-BC, chief nursing officer at Nationwide Children’s Hospital in Columbus, Ohio. “So, we told our team to come up with some unprecedented solutions.”
That thinking paved the way for an unusual approach: nursing sabbaticals.
Although the notion of sabbatical leaves in nursing is not new, the practice is not commonplace at children’s hospitals. True academic-style sabbatical leave isn’t practical in a nursing unit, especially amid ongoing nurse staffing shortages, so Wallace and her team devised creative strategies to give nurses relief while still enabling nurse managers to properly staff their units.
Nationwide Children’s first introduced “sabbatical-like” interventions for its nurses in 2022. Among them:
- Temporary low acuity. Nurses in high-acuity units, such as the NICU, could step down to a lower-acuity unit or ambulatory clinic for a defined period, typically four to six weeks. Staff members appreciate this approach because it allows them to remain connected to their unit while providing a temporary break from a higher-stress area.
- Permanent low acuity. Another approach flexes nurses to entirely different units on a regular basis. For example, a nurse working with high-acuity behavioral health patients may work every fifth shift in a lower-acuity unit. “It’s helps them reset their stress levels and then go back to what they love: therapeutically interacting with these kids.”
- Home health. For PICU nurses, Wallace arranged for temporary stints with Nationwide Children’s home health nursing team. In some cases, nurses cared for the same children they treated in the PICU in a more relaxed, personal setting. “They see the impact of their care. The kids are getting better and thriving at home versus only seeing them when they're very sick,” Wallace said.
Nationwide Children’s leadership is still measuring the nursing sabbaticals’ impact, but early indications are positive. The current vacancy rate is below 2% and turnover is at its lowest rate in nearly six years. Nurse-sensitive patient care quality indicators are at pre-pandemic levels. And feedback from nursing staff and patient families has been very positive, according to Wallace.
Four other retention initiatives
The sabbatical program is just one of five key retention efforts at Nationwide Children’s that other children’s hospitals can replicate:
- Expanded residency. After seeing a spike in turnover rates among nurses who’d been employed about 15 months, the hospital lengthened its nursing residency program from one year to two. They added training and education modules in the second year to better prepare nurses for long-term success, including training for self-care and caring for medically complex patients. Further, the hospital offered nurses a chance to see future opportunities and understand potential career paths at the hospital.
- Travel teams. Nurses considering leaving the organization or simply burned out in their current units have the option to join a group that rotates shifts through multiple hospital units. This gives nurses new experiences and opportunities to develop skills while potentially discovering a better fit within Nationwide Children’s.
- Flexible scheduling. Wallace and her team adopted new scheduling policies based on nurse feedback. They created eight-hour shifts (compared to the typical 12 hours) for higher-acuity units and allowed more leeway in start times to work around family life. The hospital also constructed school-year schedules in units where census seasonality allows, enabling nurses to spend summer months at home with their children.
- Virtual nursing. A pilot program will leverage experienced nurses working in command centers advising newer nurses at the bedside. Younger nurses benefit from the shared knowledge while the virtual nurses can work shorter, less-taxing shifts.
The key to approaching the new nurse staffing paradigm is to leave no stone unturned. “We're looking at all options to retain talent and willing to consider any outside-the-box solutions,” Wallace said.
