Take the plunge and start a skilled services unit
Private duty director offers these tips
Companies across the nation are starting to rely more on temporary services and contract employees to replace full-time skilled employees, and hospitals are no exception.
So what does the enterprising private duty agency do to meet this growing need? The obvious answer is to start a skilled services division.
It can be done successfully and within a reasonable time frame, one Maryland agency has discovered.
Adventist Preferred Nursing Inc. in Silver Spring, MD, started a skilled services division last year to meet the nurse staffing needs of the area Adventist Health Care System hospitals, says Alfred Simons, executive director of the agency, which is an entity within the Adventist Health Care System and serves southern Maryland, Northern Virginia, and the District of Columbia.
The Adventist hospitals had been using outside resources to meet the hospital’s staffing needs. So it made good business sense for the private duty company to start a skilled services division, offering medical-surgical nursing and critical care, that could meet those staffing needs, Simons says.
So far it’s worked well.
"We’re generating about eight to ten 12-hour shifts a day out of this division, which is pretty good considering it only became operational on Aug. 4," Simons says.
The agency started planning the program in April 1997 and within four months had obtained all needed licenses, equipment, staff, and a business plan.
Adventist Preferred Nursing has hired about 60 registered nurses who work on a per diem basis. "Actually we need more," Simons says. "So we’re in the process of heavily recruiting RNs."
The agency provides nursing service for an open heart unit, emergency departments, intensive care units, cardiac care units, and other areas.
Any agency can offer these services
It might be easier for hospital-affiliated private duty home care agencies to start a skilled services division, Simons notes. But any agency can do it and possibly reap the benefits. Here are Simons’ suggestions on how to start a skilled services unit:
1. Assess the community’s need.
Chances are that the hospital in your area needs some help with staffing. "Hospitals are very census driven. One day the census is very high, and one day it’s low, so it’s almost impossible for them to meet all their needs through their own staffs," Simons says.
So when a hospital’s census is high in one or two units, then the hospital will call in an agency’s nurses. Agencies that are affiliated with a hospital system simply have to determine how heavily the hospital system relies on skilled staffing services.
Adventist Preferred Nursing collected statistics from two Adventist hospitals to see how many hours or shifts were filled with agency nurses. "We had to make sure there was enough need within the two hospitals to support this service," he adds.
Freestanding agencies could solicit staffing information from the hospitals in their areas and from any existing skilled services agencies. However, Simons advises, the hospitals will provide the best and most accurate information, so agencies should start there. "Then find out if the hospitals would be interested in doing business with you if you should form such an agency because you have to be as proactive as you can," Simons says.
2. Write a business plan.
Adventist Preferred Nursing had financial experts help with the business plan, and their input was invaluable, Simons says.
"Certainly an agency will need a financial person, an accountant, or someone who could give them a good forecast on figures and that kind of thing," Simons says.
The business plan used hospital statistics to determine its projected income, revenues, and expenses. The plan also included an estimate of how much the hospitals would use the private duty agency’s skilled services division. This estimate was determined after the agency collected the following information:
data on how much money the hospital had been paying to outside agencies;
the hospital’s census;
a list of which shifts were in the greatest demand and which units used outside agencies the most.
"Those are the figures we go on to tell us where our recruiting needs should be focused," Simons explains.
The hospitals’ data also helped the agency determine how much it could charge for the new service. The price had to be competitive with other staffing services, but also high enough to make the venture worthwhile.
The agency also decided it would need to hire two full-time clinical employees and two part-time clerical and administrative employees, and some office space and supplies would be required. So the plan included these projected expenses.
Finally, the business plan had to be approved by the agency’s board before it could proceed with forming the new division, Simons says. "We didn’t go into this blindly we had all the information at our fingertips."
3. Advertise for nurses.
"We held open houses that were advertised in the Washington Post, letting all nurses in the area know there would be an open house on Sunday from 2 to 4 p.m.," Simons says. The open house offered refreshments while the recruiters circulated among the prospective employees. The nurses who attended were offered employment forms to fill out, and interviews were lined up for the following week.
Mailouts to nurses
Adventist Preferred Nursing also mailed solicitations to nurses whose names were obtained from the state nursing board. "The open house worked much better, but it’s very expensive," Simons notes, adding that weekly classified advertisements also worked well. The ads targeted nurses who have experience in the areas the agency most needed, such as intensive care units.
Nurses are attracted to the per diem work because of its flexibility, Simons says. Some of the agency’s nurses have full-time jobs and want to make some extra money by moonlighting.
Others don’t want a full-time job and enjoy having a schedule that changes as much as they desire. "We do have the work available; it’s just a matter of finding enough RNs to fill the need," he says.
4. Get ready, set, go.
The agency set its rates for the service lower than its competitors and offered nurses a per diem rate that was higher than its competition. "We didn’t have to incur as much overhead as would another agency down the street that’s starting up from scratch," Simons says. "A lot of the support staff was in place already."
Adventist Preferred Nursing has about 300 custodial employees, in addition to the 60 nurses. And the agency already had available office space and computer equipment to use for the new division.
Before setting prices, the agency investigated what its competitors were charging. "We called around and checked with agencies to find out what they’re charging," Simons says. "You can shop an agency, and they don’t have to know you’re the one calling for rates."
They did the same thing in trying to determine the nurses’ per diem wages. Also, the nurses who interviewed told them how much they were being paid.
Massive growth in four months
The agency then started operating the skilled services division, and within four months the demand for its nurses had surpassed the supply. "We need to continue to hire massively in order to completely meet the needs of our two hospitals," Simons says.
5. Develop long-term goals and plans.
The agency’s plans are to have the skilled division fully staffed by the second quarter of 1998. The first goal is for the new division to completely meet the skilled needs of the two hospitals, and then the next step is to grow geographically, he explains. "We’ll take it outside the system and cover as much of a geographical area as we can, serving much of the metropolitan Washington, DC, area."
Adventist Preferred Nursing already has been sending out "icebreakers" to let the outside facilities know about the skilled service. So far, there has been a very positive response and some sales.
A long-term goal is to expand its services to include offering skilled labor to Adventist nursing homes, assisted living centers, and other facilities.
"Also we’d like to service our nursing facilities and retirement living facilities, even if that means bringing on LPNs because those facilities use more LPNs than RNs," he adds.
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