Is 25-30% of your Emergency Department Volume gone forever?

Author: Betsie Sassen, R.N., M.S.N.

During COVID-19, volume in Emergency Departments across America have decreased by as much as 25-30% in some cases.  The volume that has been lost is mainly lower acuity patients that found another alternative such as Urgent Care, Acute Care Clinics, or even Tele-Health.  As these patients have been slowly transitioning away over the years, COVID-19 brought an abrupt halt to this type of volume coming to the Emergency Departments. These new avenues are not going away. The remaining patients are maintaining the higher acuity, and at times, even higher.  In fact, our clients are reporting that while there has been a drop in volume, there has been a rise in level charges.

The challenge many are facing today is how do we look at our current standards knowing that the department “DNA” has changed. Yes, we should be adjusting our staffing down as closely as we can to the existing standard, however, do we need to re-evaluate what that standard makeup is? Is there a need for us to re-model our grids and the projected volume knowing that the average patient is carrying a higher level of care? Our advice is to reset and determine the new level of care just as if a Medical Surgical Unit switched to an Intermediate Care Unit. In that case, you would change your targets and adjust your staffing. This does not mean there are not improvements that are to be made with the volume drop, rather, the totality of the improvement might be inflated until the target has been readjusted. This is also important because many Emergency Departments have started using outside agency and higher incentive pay to compensate during the COVID-19. This needs to be cleaned up, cleaned out, and an affordable yet high quality Emergency Department must be restored.

We can help.



Traveler Agency Nurses: Why Now?

Author: Betsie Sassen, R.N., M.S.N.

At C2 Healthcare we’re noticing a strange phenomenon happening in hospitals across America.  COVID-19 cases are dropping precipitously while other volumes are softening.  Yet, hospitals are adding Travelers and Agency Nurses now at unprecedented rates.  Why?  Are more staff nurses leaving to join Travel Staffing Agencies?  Some hospitals have decided to bring in agency to rest their staff.  Again, all this happening while volume is softening, and Agency Staffing Companies have increased their hourly rates 300% and are at an all-time high…upwards of $180/hour!

Many times, departments are using agency and overtime when they are running over on the Hours Per Patient Day (WHPUOS) target.  In most cases, the simple removal of agency hours would get a department to a zero variance on hours and obviously save 3 times what hours paid at straight time would be.  If a department is over on its WHPUOS, agency contracts should not be renewed and in some cases cancelled with penalty.  If a department is running over its target, look to see how many agency hours and overtime hours are being used, and eliminate those first to bring down the hours variance and improve cost.  The cost has become so unaffordable making them “budget busters”.

Unfortunately, the pandemic has left many staff nurses feeling tired, under-appreciated, and under-valued.  The lift from the “Heroes Work Here” signs and pandemic pay has worn off.  Staff nurses are aware of what hospitals are currently paying agency nurses and it is creating resentment and bitterness.

If the objective of adding agency is to replace vacancies left by nurses who left to be “travelers”, what are the initiatives around trying to bring them back or stop them from leaving in the first place?

If the objective is to rest staff by adding agency, make sure the initiative is working and that your staff is indeed taking time off.  Another and perhaps better question to ask yourself is if volumes are declining, is there a way to do so without adding agency?

The appeal of travel nursing will likely wear thin eventually for those who jumped ship.  But, in the meantime, what is your organization doing to stop them from leaving?  At C2 Healthcare we’ve seen effective “re-recruitment” campaigns of reaching out to former nurses and inviting them back.  The goal is to give them an opportunity before their position is filled.


Similar to digging out of the recent snowstorms, what is your plan to get out from under COVID-19?

Author: Betsie Sassen, R.N., M.S.N.

As much of the country has been blanketed with snow over the last month, we are in the process of digging out using various techniques that have been used for generations. These techniques and resources have been used for many years and have worked because the challenges we have faced with weather and snow remains consistent.

However, during COVID-19 we are facing many challenges that have never been seen. Whether it is a loss of nurses to agencies, increased bonus or hazard pay, or temporary market adjustment exceeded over 30% to fight the COVID-19 battle, we now must begin the process of digging out of COVID-19 and get back to a new sense of normal.

  • If the volume continues to return to normal without COVID-19, what does your bottom line look like?
  • What is your plan to “sunset” agency contracts?
  • What are you doing to quantify and eliminate the excess pay in resources used over the last 12 months?
  • What is your plan to regain nurses that have left for Nursing Agencies? What is your plan to replace them…travel and missing family at home may start to grind on them.
  • Are you looking to eliminate the bonus pay for COVID-19 units?
  • What is your communication plan to help the staff when this pay is taken away?
  • When do others return to work?
  • Do you have dates set when all staff needs to be back in the hospital? This may be an exceedingly difficult time for some as many have become very set in their habits.
  • Is there a change you made that you may want to continue? Decreasing leases, remote visits, cross training, etc.

These are all difficult challenges, like the after effect of a storm, but without a plan . . .

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