By Carol Boston-Fleischhauer, Chief Nursing Officer, and Lauren Rewers, Senior Analyst

Many hospitals across the country are just days or weeks away from their projected peak surge. One of the top questions we're getting from nurse leaders is: how can we redeploy staff to increase acute care capacity?

Your Covid-19 checklist to expand capacity

To learn more about how leaders are proactively redeploying staff, we spoke with leaders at Allegheny Health Network, an eight-hospital system based in Pittsburgh, Pennsylvania, and asked them four key questions about their nursing staffing strategy.

Question 1: Which nurses are you redeploying, and where?

Allegheny Health Network closed 80% of its ambulatory business and most elective surgeries to reduce volume weeks before the state’s projected surge. This freed up a number of practicing RNs who typically work within the OR or ambulatory sites.

The system immediately redeployed these nurses to its hospitals. Nurses were provided access to the inpatient EMR, and assessed for the best unit placement. Considerations for placement included:

• Inpatient experience, particularly in the ICU
• Shift preference and shift assignment based on seniority; Allegheny incentivizes night and weekend shifts by adding a shift differential of $3-5 per hour.
• Nurses at high risk of contracting Covid-19 (those who are immunocompromised or pregnant) are offered a work from home positions, including managing Allegheny Health Network’s nurse-led triage line or proactively checking in on high-risk patients. Nurses must have a doctor’s note to be considered high risk, which is expedited if needed through the organization's employee health or primary care services.

Question 2: Will you recruit legacy staff or nursing students?

Many legacy nurses are in the high risk category, so the system is tapping them conservatively. Those who are interested can enroll in AHN's existing Return-to-Work program.

Though AHN has canceled its nursing clinical rotations, many of the students already employed within the system are continuing their work as nursing assistants. They are given as many hours as they want to work, after full-time AHN employees schedule their work hours. Nursing students may be redeployed from their home floors to other areas as needed (for example, Covid testing sites or EDs).

Question 3: How are you adjusting the staffing model?

Redeployed nurses are working as "nurse extenders." There is one nurse extender for every two nurses in the ICU, and one for every three nurses in all other units.

Currently, their responsibilities are primarily to support their assigned nurses and meet patient needs. This includes:

• Communicating with patient family's on their condition, as there is a no-visitor policy in place;
• Relieving nurses for breaks and meals;
• Assisting with the donning and doffing of PPE; and
• Reminding staff of hand hygiene policy.

Over time, as nurse extenders spend more time shadowing their assigned shifts, they may take on more clinical responsibilities. For example, as surge volumes increase, nurse extenders will be given assignments. They will also serve as replacements if their assigned nurses fall ill.

Question 4: How do you upskill redeployed nurses?

Nurses reassigned to acute care must pass a cardiac dysrhythmia reading test and take a virtual 4-hour inpatient refresher course. This course is a slimmed down version of the online course AHN uses to re-introduce legacy RNs to practice.

This virtual training is supplemented by in-person education led by ICU nurse educators. Nurses must also shadow a member of the unit for at least one shift.

Find the right strategy for your organization

Expanding the nurse staffing pool should be a top priority for all organizations gearing up for the Covid surge to hit their market. What was right for AHN may not be the right strategy for all organizations. But I encourage all nurse leaders to revisit our four key questions on RN redeployment to find the strategy that works for them.

We will continue to share insights on Covid clinical staffing strategy in the coming days and weeks. If you would like to share a creative staffing strategy with our team, please email us directly at RewersL@advisory.com.