Alegent Creighton Health Mercy Hospital in Council Bluffs, IA had a staffing problem.
It had a lean staffing model—so lean, in fact, that the hospital was relying more and more heavily on an outside nurse staffing pool called Noll Pool that's meant to fill emergency, same-day absences at the hospitals in the Omaha-based Alegent Creighton Health system.
When Denise McNitt, MS, RN, NEA-BC, started as chief nurse at Mercy in January 2012, the hospital's nurse staffing problem was about to hit its tipping point.
"We really hit an unsustainable number of contract hours," says McNitt, who is now vice president of patient care services. Although Mercy Hospital isn't the largest hospital in the Alegent Creighton Health system, it was using a much bigger percentage of Noll resources than other hospitals.
And because Mercy Hospital was dipping into the emergency pool so much, it was getting harder to staff the rest of the system, too. "My problem at Mercy was starting to affect all the other hospitals," McNitt says.
Mercy Hospital was also experiencing a significant amount of turnover among its core nursing staff. McNitt says the hospital was itself continually taking people off of some shifts to cover others, and directors were competing with each other for core staff, in addition to being overreliant on the Noll Pool.