Coming out of retirement
Former clinicians tapped to fill staffing gaps, mentor younger employees
Bayhealth has been feeling the vice grip of the “Great Resignation” for years. The Dover, Delaware-based health system has offered bonuses and partnered with local nursing schools to alleviate its clinician shortage, but the strategies have only done so much. “A lot of people had to start thinking out of the box,” said Director of Education Angel Dewey.
This spring, leaders at the system began recruiting local retired nurses via social media and professional networks. As a result, representatives said the two-hospital system has started to turn the corner on staffing issues.
Around the country, providers like Bayhealth are filling out their staff
rosters by targeting clinicians who have left the workforce. Through partnerships with outside organizations and adjustments to their onboarding processes, health systems are addressing gaps in care while giving younger employees the chance to learn from industry veterans.
“The idea is not to force people back into the workforce, it’s to give an option to people who perhaps haven’t planned their retirement well enough, who are bored and who feel that they could benefit from giving back to medicine,” said Dr. Derek Raghavan, president of Advocate Health’s Levine Cancer Institute in Charlotte, North Carolina. “And it gives patients and younger doctors the benefit of vast expertise from really good doctors who love medicine and can continue.”
FILLING THE GAPS
To address staffing needs, some health systems are turning to national agencies that source “locum tenens” clinicians, who are often close to retirement age or recently retired. Other provider organizations are trying to pull from their local retiree pool, in addition to continuing with traditional hiring and recruitment efforts targeting younger professionals.
But neither strategy is cheap. Shortterm locum tenens labor—generally used to temporarily replace physicians and advanced practitioners who are on brief leaves of absence—has seen a 10% to 20% increase in interest over the years compared with pre-pandemic rates, said Bill Heller, executive vice president of sales for CHG Healthcare, a staffing and recruiting company based in Salt Lake City. On average, physicians in locum tenens positions make $32.45 per hour more than permanent physicians, according to a study conducted by the organization.
Some hospitals have hired clinicians from within their own extended networks or partnered with associations on outreach efforts. The tactic means health systems can dodge staffing agency surcharges. But Kim Martini, division president for nurse staffing solutions at AMN Healthcare, said retired clinicians are still generally asking for higher salaries than the ones they left behind.
This year, more than 200 retired nurses agreed to step in, including at Bayhealth, when the Delaware Healthcare Association sent out a letter calling for help. The association also collaborated with health systems and government entities to secure funding to pay workers.
“There was a concerted effort, both with our association and also at the individual hospital level, to use some of the available state and federal funding that had been offered to hospitals to meet some of these expenses. We were able to work with [Delaware Gov. John] Carney’s administration to get $25 million in employment assistance around a year ago,” said Wayne Smith, the association’s president and CEO.
Some in the staffing industry believe there are more effective ways to use financial and administrative resources than trying to hire former clinicians.
“It’s a strategy that many health systems have tried and it has failed for the most part, because retired nurses are not coming back,” said Dr. Iman Abuzeid, CEO and co-founder of Incredible Health, a nurse hiring platform based in San Francisco. “Hospitals need to focus on the generations that are in the workforce and are actively working.”
Licensing is another potential hurdle. Depending on how long a retired clinician has been out of the industry, their state of residence, and how much their skills have lapsed, they may have to prove they have the competency to provide safe and professional care.
Many health systems worked with state administrations during the COVID-19 pandemic to waive and relax licensure requirements via public health emergency orders.
In Arizona, the state medical board allowed physicians who had been retired less than four years to return with temporary licenses, valid through the end of 2022. Retired healthcare professionals in Indiana who have practiced within the past five years can apply to provide services during the national public health emergency, expected
to end in 2023.
Health systems may otherwise direct clinicians who need new or renewed credentials to organizations such as the Center for Personalized Education for Professionals, which offers recertification trainings around the country.
The center’s classes typically involve written testing, simulated patient encounters, documentation exercises, technical skills simulation, cognitive screening and structured interviews tailored to the clinician’s circumstances and specialty. The center develops customized education plans for clinicians so they can demonstrate competence while practicing under high levels of supervision, with oversight gradually decreasing.
Participants usually pay for the center’s services, which can cost between $3,000 and $10,000 per month, themselves.
“Clinicians who have been out more than a couple of years probably will have a lot of learning to do in the areas of technology, [including] electronic medical records and patient portals, and communicating with patients,” said Dr. Elizabeth Grace, the center’s medical director.
Most individuals can get up to speed in around three to six months, though some who have been out of practice longer may need more time, she said.
GETTING REACCLIMATED
Even after just a few years, clinicians may be reentering a dramatically different work environment.
The rapid acceleration of technology can present a barrier, especially for those in older generations. Early on, Dewey said the Bayhealth team realized it needed to improve its computer documentation system training course to accommodate returning clinicians, giving them extra practice sessions and time learning their way around a simulation of the system’s electronic health record.
The health system often pairs former retirees with a nurse who can take care of charting and documentation while they tackle other tasks and hands-on care measures.
Dewey said there hasn’t been much of a so-called culture clash between retirees and other nurses. Instead, Bayhealth gives the returned clinicians the opportunity to share their experience from decades on the job and give feedback on areas of operation that need to be tweaked to improve workflows. The health system also allows retired nurses to propose reintroducing processes that have fallen out of practice.
“Each generation brings something to the forefront,” Dewey said. “My favorite thing about the baby boomers is they are workhorses. They are ride or die. The millennials and the Gen Z [workers] are super good with computers and all that technical stuff. So they play off of each other a little bit.”
Dewey said it’s important to consider whether older nurses can keep up physically due to all the walking involved at larger hospitals, and whether the expectations of the new role are realistic.
“The other thing that we had to get creative about was work hours,” she said. “Typically nurses work 12-hour shifts, and that’s not very appealing to nurses coming out of retirement.”
The system implemented four- to-sixhour shifts for formerly retired nurses, scheduling them during peak busy periods.
Most returning clinicians at Bayhealth choose to enter areas of medical surgery or non-critical care, although some have felt comfortable enough to work in the intensive care unit.
“You have to sit down and have a conversation [with them] about what they feel like their strengths are,” Dewey said. “Maybe you use them to do the admission assessment or to help with [your] new graduate nurses that [you are] trying to hire. [Maybe you] use them in skill labs, or with simple things like catheter insertions and nasal or gastric tubes.”
As with other clinicians, retention of returning healthcare professionals requires a strong relationship and robust communication, said Alana King, senior recruiter with Bayhealth’s talent acquisition team.
“If you can implement their expertise into a position where they are best utilized, it’s a win-win,” she said. “They’re gonna be happy and more likely to ... stay, and maybe increase their hours, if they want to work for us.”
To avoid potentially lengthy retraining efforts, the Levine Cancer Institute’s Raghavan said he typically offers positions to physicians who are getting ready to retire, or those who have only been retired and inactive for a short time.
“If someone came to me and said, ‘I’ve been out for a period of more than six months,’ I would require them to go and do some sort of retraining course to make sure they were up to speed, because there’s a risk they could forget stuff very quickly,” he said.
Because he has worked with most of the retired clinicians the Levine Cancer Institute recruits, Raghavan said he is aware of their professional reputations. He ensures that they all have good patient satisfaction scores and are clinically adept.
The institute has accommodated physicians who come back after becoming burnt out from managing patients and running their own oncology practices, as well as clinicians who are tired of always being on call.
Returning professionals at Levine frequently help patients diagnose and manage conditions that arise as a result of cancer or cancer treatment, with referrals to full-time specialists as needed. Often the institute will put a physician on a rotation to work one week a month or every six weeks, Raghavan said.
“We need people who are really good with patients and have good clinical skills and still have the knowledge but are not
“We need people who are really good with patients and have good clinical skills and still have the knowledge but are not working as fast as they normally would have to.”
Dr. Derek Raghavan, president of Advocate Health’s Levine Cancer Institute
working as fast as they normally would have to,” he said. “We’ve created an environment where these folks can continue to practice.”
Working after or through retirement isn’t for everyone, but it may be a good option for clinicians who can find a position with a strong support system, said Dr. Samuel Zimmern, a cardiologist at the institute.
After working 60- to 70-hour weeks for the first 30 years of his cardiology practice, on call nights and weekends, Zimmern said he spends one day a week as an outpatient doctor. He sees patients who need his specific help and shares his years of medical experience with the institute’s doctors and administrators.
“I want to continue as long as I feel like I can do a good job for my patients,” he said. “I’m just going to keep assuming they’ll have me until I get to the point where I’m worried that I’m going to lose the skill and intellect needed to take care of these patients correctly.”
ONE LAST JOB?
Some health systems are still brainstorming the best ways to bring retired clinicians back onboard.
At Livonia, Michigan-based Trinity Health, leaders may create a new role for retired nurses that allows them to be a part of the care team without having to put on protective equipment and hike up and down hallways, said Gay Landstrom, the health system’s senior vice president and chief nursing officer.
The role would be virtual, with the nurse sitting in front of multiple computer screens and communicating with patients at the bedside, Landstrom said.
Retired nurses could contribute their relationship skills and healthcare knowledge, mentoring newer clinicians without being run down by the physical demands of the job, she said.
“It’s one of the things we’re really trying to solve for right now,” Landstrom said. “We don’t have enough nurses, and we’ve had a lot of really great knowledge that just retired and walked away from this. Can we get some of them to come back?”
Dr. James Hall, who works at the Levine Cancer Institute’s supportive oncology clinic, said he wasn’t initially sure his return would benefit patients. He views physical stamina as necessary to provide complex care.
But he’d been getting bored with retirement when Raghavan called to offer him a part-time job working with patients to discuss the potential complications of their cancer treatments.
“As I got more involved with it, seeing the time we were able to spend with the patients to address very specific issues, I became pretty quickly convinced that this really was value added for the patients,” Hall said.
“I wanted something to still intellectually stimulate me and to be able to provide a service to our health community,” he said.
Hall said one of the most challenging aspects of coming back to practice has been the transition to a new computer system, though he was able to navigate the technology after some coaching.
“I’d quite honestly thought about saying, ‘OK, that’s the Rubicon that I won’t cross, I won’t go through the process of learning a new system,’” he said. “But remarkably, I survived doing so with a lot of help from my
n colleagues and the nursing support staff.”
“I want to continue as long as I feel like I can do a good job for my patients. I’m just going to keep assuming they’ll have me until I get to the point where I’m worried that I’m going to lose the skill and intellect needed to take care of these patients correctly.”
Dr. Samuel Zimmern, cardiologist at the Levine Cancer Institute