Building a More Agile Nursing Workforce

Building a More Agile Nursing Workforce

By Rose O. Sherman, EdD, RN, FAAN

agilityI recently attended a meeting with nurse leaders focused on succession planning.  One of the leaders expressed concern about the readiness of her staff to adapt to what the future of healthcare could be.  She illustrated her concern with a story about a position that her facility had recently advertised for a community care coordinator.  Several of her best and brightest nurses expressed interest in the position.  When they learned that they could not work 12 hour tours, they immediately lost interest.  She attempted to explain why it was very important for continuity that this role be five days per week.  One nurse told her that losing a 12 hour tour was “a deal breaker” for her.  This led me to wonder about whether we have built a nursing workforce that is agile enough to survive and thrive with the inevitable changes that will come with health reform.

What is workforce agility?

Workforce agility has been described as the ability of a workforce to respond to uncertainty in the environment and create new windows of opportunity for themselves and their organizations through their flexibility and willingness to take on new and different responsibilities.  The capability of organizations to have this agility is critical so they can proactively respond rapidly and effectively to unanticipated opportunities.

The future of healthcare

Dr. Topol is a physician and director of translational sciences at Scripps in California.  Like many healthcare futurists, he sees a significantly decreased role for hospitals in the healthcare delivery system as technology becomes less costly and healthcare reform is fully implemented.  Topol predicts that in the future there will be far fewer hospitals and only patients requiring an intensive level of care will be hospitalized.   Future healthcare will be community based and patient focused.  Technology and close communication with patients in the home will be a key component of care.

A vision like this may seem shocking to many of us who have spent our lives working in healthcare.  Yet even today, many hospitals are already seeing their volume of patients drop with the implementation of the 30 day Medicare readmission penalties.  The majority of nurses today (62.2% according to the National Nursing Sample 2008) work in acute care hospital settings.  But as Dr. Pamela Cipriano pointed out in a recent article in the American Nurse Today titled The Disappearing Inpatient – the future of healthcare will likely not be hospital-based.  She wrote “hospitals are feeling the shift from volume to value as admissions shrink across the country, putting nursing jobs at risk and creating a dilemma: While we want hospitals to thrive, we also know the importance of keeping people out of the hospital, preventing illness, and promoting care management in low-cost settings.” There will of course be many roles in community care coordination, primary care delivery, hospice, home health and long-term care that will be available for Registered Nurses with the right education, experience and willingness to be more agile in their work.

How can we promote workforce agility?

A big part of developing this agility is to help staff clearly understand what is changing in the environment and how it could impact their jobs.  An opportunity such as the care coordinator position needs to be promoted and marketed as the “future of healthcare”.  The skills and competencies needed in the position are ones that all nurses will need to develop to be competitive.  Cross training and encouraging new skill development are a good start.  Agility promoting behaviors should be rewarded.  We need to present nursing as a profession and not a lifestyle.

As nurse leaders, we should consider the implications of these significant future changes now.   Ask yourself about what skill sets  nurses might need to become more competitive to work in newly emerging community-based agencies.  Without question, healthcare will undergo many disruptive changes in the next decade and they could come quickly.  We should be proactive and prepared for exciting new challenges, and they may or may not include a 12 hour tour.

Read to Lead

Joerres, J. ( 2014 CEO Manpower Group).  Building the Agile Workforce.  HBR Ideacast

Topol, E. (2012).  The Creative Destruction of Medicine: How the Digital Revolution will Create Better Healthcare.  New York:  Basic Book

Topol, E. (July 29th, 2013).  Interview about the Future of Hospitals.  Hospitals and Health Networks.

© 2014


  1. Mary K Parker
    February 3, 2014 at 12:17 pm

    I, too, am concerned about your anecdote: When they learned that they could not work 12 hour tours, they immediately lost interest. New evidence has surfaced that shows our 12-hour shifts are not all that benign and there are many nurses working several jobs in order to sustain their families and/or lifestyles. This is a huge leadership concern: People seem to forget that being hospitalized is very disruptive to families. It interferes with work and life schedules, it causes additional stresses for families who are frequently geographically separated and worried about older family members, and older patients do not tend to do well with hospitalizations in general. Nurses who cannot see the disruptions happening in healthcare today are unlikely to successfully navigate the future healthcare environment. I've discussed the changes in patient demographics and relayed all these articles about the changing inpatient demands to my senior nursing leadership and I feel like I'm Chicken LIttle.

    Reply »
    • Mary K Parker
      February 4, 2014 at 9:38 am

      I have been thinking more about this and my question for these nurses is "What is your purpose in nursing?" It's not to provide employment (although that is the outcome). The purpose is to deliver safe and effective quality nursing care. I am reminded of the military-industrial complex---where tanks are still being built because congressmen need the jobs for their districts, yet military leaders say they don't need them and they're no longer needed. Is this what is going to happen to nurses?

      Reply »
      • rose (Author)
        February 4, 2014 at 4:46 pm

        You make a good point here Mary. While accommodating staff needs is very important, the needs of patients must also be considered and consistency is an important component of care. Keep asking these important questions even if others don't seem to see their significance. The changes are coming and you will be proven right in the long run.

        Reply »
        • Mary K Parker
          February 24, 2014 at 9:24 am

          You might appreciate this post from Paul Levy. "Why should our industry expect success when we consistently put our own concerns and fears before the needs of our patients? At a minimum, we must align our skills with their problems even if our motivation is pursuing our own interests and financial well being. This is a truth that real service industries take as a given. Many in the traditional professions like medicine, education, law, and even the clergy are beginning to see the need to approach their relationships in a way that is more cognizant of the concerns of their customers who are now armed with enough information to have the courage to push back and ask “why.""

          Reply »

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