Hospitals all over the country have been struggling to hire and retain experienced nurses coming out of the COVID-19 pandemic, and Jefferson Health is no different.
In January 2023, the system had more than 1,000 open nursing positions and administrators knew they needed to take action to keep nursing schedules full.
So they created an elite team of nurses that could be deployed to any of the system’s 13 hospitals in the Philadelphia region. They made the job appealing by offering higher pay and more stable schedules, and branding it as a highly skilled, exclusive group. Jefferson’s so-called SEAL team, named after the special operations Navy unit, has helped maintain staffing levels as the system hired new nurses.
Most hospitals fill last-minute vacancies with floater pools, teams of nurses who are sent wherever they’re needed within the facility. But these positions can be unpredictable and aren’t always appealing. And Jefferson wanted to deploy nurses across multiple hospitals, not only within one location.
Jefferson’s SEAL nurses rotate between hospitals within a 40-mile radius, and are assigned a six-week schedule, instead of getting a new assignment at the start of each day. They earn more than unit nurses, and have an average of nine years experience while seasoned nurses nationwide are leaving bedside jobs.
Jefferson says that this system-wide resource has been a solution to scheduling problems, while helping retain and rehire experienced nurses. In two years, the team grew to 150 nurses — and the overall vacancies at Jefferson went down from 1,000 to fewer than 300.
“Man, that sounds kind of cool,” Eric Purnell, a longtime intensive care nurse, recalled thinking when he heard about the SEAL team openings.
He was one of Jefferson’s first SEAL hires in 2023. The job appealed to him because it had just enough variation to keep him on his toes without feeling unmoored.
“I like to bounce around,” he said. “It keeps me fresh as a nurse.”
Small geography, large notice
One in three nursing positions in Pennsylvania hospitals were vacant in 2022, according to a survey by the Hospital and Healthsystems Association of Pennsylvania, as many nurses left patient-care jobs since the the COVID-19 pandemic began in 2020. The trend can compromise patient safety and has added stress for nurses who remain on the job with greater patient loads.
Hospitals have increasingly used agency nurses on short-term contracts to fill worker shortages, which executives cited as a challenge for hospital budgets.
The main resources that Jefferson had to deal with these problems were float pool nurses who were assigned on a daily basis.
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“Somebody called out five minutes before a shift, let me be able to move those people around,” said Daniel Hudson, Jefferson’s associate chief nurse executive.
That approach wasn’t enough. So in 2022 Jefferson launched its SEAL team with just over two dozen nurses.
“We deploy them down to units that might be experiencing leave of absence, pregnancies, things of that nature,” said Lauren Ciocco, the team’s nurse manager.
The SEAL nurses are scheduled in six-week increments, instead of receiving a new assignment every day. Knowing the schedule ahead of time is a big incentive for nurses, Ciocco, the nurse manager, said.
“When I get a deployment and I’m in three separate places during the course of a week, to me that’s fantastic,” said Purnell. “It’s almost like I’m starting over every day.”
What sets Jefferson’s SEALs apart from other float pools is geography, Hudson said. Jefferson has 13 hospital campuses within less than 40 miles. Other large systems just can’t expect employees to cover so many hospitals because they would span hundreds of miles.
“We’ve taken advantage of that geographical spread,” Hudson said.
The system has not yet figured out how the SEAL team approach will work with Jefferson’s newly expanded footprint. Jefferson acquired Lehigh Valley Health Network, bringing its hospital count to 32 and expanding its operations across 140 miles between northeastern Pennsylvania and South Jersey.
Culture ambassadors
Over the past decade, Jefferson has grown from three to 32 hospitals.
One challenge of such rapid growth is creating a shared culture, Jefferson CEO Joseph Cacchione told The Inquirer early this year.
“We’re doing a lot of work today on aligning the culture around the mission, vision, and values of the organization,” Cacchione said.
Purnell sees himself as part of this effort. He tries to learn from the best practices of each unit that he works on, and pass them along to other units. But what it comes down to for Purnell is trying to be the best nurse he can be, no matter where he works.
“Nursing is nursing,” he said. “Instead of being on a floor and I have 20 nurses I work with, I work with 500 nurses.”
