March 18, 2021

Negentropy: Using Physics to Conquer Chaos in Nurse and Healthcare Staffing

Wolters Kluwer, a global provider of professional information, software solutions, and services for clinicians, pointed out that “it is becoming more and more difficult to attract and hire nurses. Nurses account for the largest profession in the healthcare sector, yet the increasing demand for nurses is making the current shortage even more challenging for recruiters.” The quandary its analysts pondered: “How can you recruit nurses in an environment where there are so many uncontrollable factors?” The scary thing is that Wolters Kluwer posed this question in December 2019—just months before the pandemic hit and sent everything off the rails. How can staffing agencies help quell this chaos for their clients and candidates? Like the idea of chaos itself, the solution may also come from a concept in physics. Sure, it’s a bit weird, but let’s explore the wonders of negentropy—a sort of anti-chaos.

Nation’s Nursing Pools Face Severe Droughts

The situation prior to the outbreak of COVID-19 was approaching problematic levels for nurse burnout. Now it seems dire. As we wrote previously, more than half of nurses in the workforce are considering leaving:

The average national turnover rate for nurses is typically 17% annually, with some regions reaching as high as 40%. The pandemic has had a profoundly detrimental impact on those figures. We now confront the worst nursing staffing shortage in decades, with 60% of nurses and 20% of physicians preparing to exit their professions directly because of COVID-19. Analysts project these departures to cost individual hospitals an average of $5 million in turnover per year—about $137 billion overall.

Even without the added stress of the pandemic, a host of factors contribute to a growing divide between supply and demand in available nurses.

  • The need for nurses will increase as the aging population grows, doubling in size by 2060.
  • Nurses themselves are also members of this aging workforce. That means many of them are approaching retirement. The U.S. Bureau of Labor Statistics (BLS) estimates that 62% of registered nurses age 54 and over are expected to retire within the next three years.
  • In 2018, nursing schools were forced to reject 75,000 qualified applications because of inadequate staffing, teaching facilities, clinical sites, and funding. Without access to the proper education and credentialing, fewer nurses will be trained and ready to join the labor force.
  • According to the American Journal of Nursing, more nurses have chosen to take roles as managers instead of practitioners. Others have decided to continue their education in other areas. Whichever way you slice it, more nurses seem to be heading toward non-clinical positions during a time when hands-on expertise is sorely needed—further indicating a serious dilemma between supply and demand, 

When all of these elements combine, you get a whole lot of chaos—or entropy, a concept of discord and disarray in physics. As Alison Carr-Chellman illustrated in her article for “Entropy is a measure of how much energy is lost in a system. If a system loses too much energy, it will disintegrate into chaos. It takes only a little bit of energy to pick up one sock. But if you don't take care of your yard, let pipes stay clogged and never fix electrical problems, it all adds up to a chaotic home that would take a lot of energy to fix. And that chaos will leach away your time and ability to accomplish other things.”

In physics and social systems, energy can be defined as the capacity and ability to perform work. To expand on Carr-Chellman’s example, let’s place it in context of staffing.

Receiving a resume for a nurse is an example of entropy. It requires review, followed by an email or phone call to gauge interest, pre-screen for qualifications, and discuss the potential submittal. The process takes only a few minutes—a small amount of energy. But if that resume is left unattended, others will inevitably pile up. As the load increases and spreads, the amount of energy required to sustain order blossoms exponentially. The “system” will begin losing too much energy, disintegrating into chaos.

Yet when faced with entropy, the answer may also be sought in physics by leveraging a concept called negentropy

A Negentropic Approach

Carr-Chellman and her colleagues began applying physics constructs to social systems to see if they could help these processes run better. “Over the past four years,” she said, “my colleagues and I developed a theory of negentropy and, using interviews and case studies, have studied how energy is lost or gained in many types of systems – including in higher education, leadership for online education, workplace organizations and online learning settings.”

By applying this same “negentropic” methodology to recruiting, we may achieve better results in our hiring systems when combined with other proven strategies.

Find the Sources of Entropy

“A badly sealed window leaks heat energy. A poorly organized kitchen makes things hard to find. A badly designed new employee onboarding system can lead to serious legal problems later,” wrote Carr-Chellman. Before attempting to solve for the catalysts of chaos, we must first identify the sources. In healthcare staffing, particularly for nursing positions, the origins of entropy can span several areas, such as:

  • Inflexible scheduling
  • Limited sourcing outreach
  • Disjointed or dispassionate engagement
  • Low advocacy for workers
  • An apathetic stance toward the candidate experience
  • Lack of a compelling employment brand
  • Unappealing advertising of the open role
  • No apparent mitigation of inherent risks or safety concerns
  • Non-commensurate compensation

Triage and Prioritize the Energy Loss

“Identify the largest or most annoying losses and those that draw your attention most often,” Carr-Chellman suggested. “For example, perhaps that leaky kitchen faucet drives you crazy. Fixing it might make room in your mind to consider other improvements to your kitchen that would make it more functional.”

To avoid significant losses of energy, which increase entropy in the system, staffing agencies must define the primary sources of inefficiencies or procedural deficits to overcome the chaos. 

  • Relying on inefficient recruiting sources such as exclusively using job boards instead of investing in targeted job sites, social networks, specialty groups and associations, custom career pages, and referral programs. Expanding the talent sources, while targeting them to the appropriate healthcare or nursing professionals, will optimize the time and effort of recruiters.
  • Create recruiting marketing and hiring processes that address the challenges of candidates, such as travel nurses: rigid but erratic schedules, uncertainty of work locations in float pools, inefficient handling of travel expenses or per diems, and more.

Develop a Plan

With the origins of entropy and energy loss known, staffing agencies can launch new strategies to enhance hiring, placement, and retention outcomes—for candidates and clients. Following is a brief example. Your mileage may vary, as they say.

  • Advertise jobs in targeted channels. Outside of traditional job boards or professional networks like LinkedIn, savvy healthcare staffing companies can attract and engage nurses through email marketing campaigns, sponsoring conferences and continuing education programs, advertising in medical journals, joining relevant associations or groups, tapping into alumni programs, and more.
  • Compelling branding. Create custom career pages on your site that promote the brands of your agency and the clients you serve. Give nurses a reason to invest their energies in the mission by making them feel part of something meaningful. Highlight opportunities, diversity and inclusion, corporate culture, benefits, and more.
  • Fostering advancement and development opportunities. As Wolters Kluwer pointed out, “Offering new-graduate residency programs and transition-to-practice programs enable you to attract and hire new graduates into various specialties. This also helps in filling positions in specialties which are difficult to fill such as neonatal ICU.” Cultivating the skills of talent and nurturing their development goes a long way in bolstering retention rates and the potential for redeployment at the completion of assignments.
  • Flexible scheduling. Work with nurses to determine their ideal schedules, including shifts, shift hours, holidays, and the dates and times they want to be on call. As staffing providers build out their float pools, they should use this information to create strategic staffing plans that ensure coverage for all client needs while satisfying the expectations and preferences of the nurses in the pool.
  • Compensation. Determine the type of pay best suited to the nurse and his or her assignment. You can offer traditional payrolling structures like full-time or part-time, which guarantee rates and hours each week, or per diem.
  • Safety and choice. Many hospitals encourage nurses to decline assignments if they have no comfort level with a specific unit, such as ICU or labor and delivery. In terms of maintaining patient safety and superior levels of care, this is an endorsed practice. Staffing agencies should be proactive by gathering this information upfront from their nurses and incorporate that data into staffing plans. This way, the best-matched nurse is always dispatched to a commensurate assignment without disruptions or surprises. It’s equally critical that staffing agencies provide well-rounded and comprehensive safety plans to demonstrate their commitment to the safety of the nurses on assignment: exposure to infection, injury and illness prevention, etc.
  • Communication and transparency. When floating between hospitals, nurses may encounter new protocols or procedures. Confronting an unpredictable situation will complicate performance and satisfaction. Savvy staffing providers should take the initiative to learn as much as they can about the hospital’s demands, expectations, processes, procedures, operating environment, culture, and other relevant details. By incorporating these elements into an adaptive onboarding experience, nurses will be better prepared to hit the ground running.
  • Go above and beyond with wellness. Even healthcare professionals need assistance with their own health and wellness. Given the growing incidence of burnout and the stressors of the pandemic, staffing agencies should consider extending their benefits to include  counseling for nurses on difficult assignments, including the emotional strain of losing patients. Promote self-care for all nurses and integrate programs and benefits into your organization, which are easily available. Meditation programs, wearables, and other creative options can make a big difference.

Measure, Monitor, Improve

In science as in business, results are only impactful when they are monitored, analyzed, and adjusted. “Stay focused on energy gains and losses,” Carr-Chellman advised. “As you try to implement negentropic ideas, keep track of what works, how much effort it took and ideas you come up with for future negentropic actions.”

“As you work to reverse energy losses, you may find that at times you are actually maintaining a social system that isn’t beneficial no matter how smoothly it works,” she added. “Spending time improving an orientation to introduce new workers to a company culture may not be very useful if the culture itself needs to change.”

Achieving a high-performing nursing recruitment system and a successful negentropic process require agencies to refine small processes while keeping sight on the larger picture. Too often, the status quo itself can promote energy loss. A vigilant eye for detecting defects early and resolving them before they erupt into chaos remains key, whether you’re talking about nursing, physics, or staffing. 

Image by Gordon Johnson from Pixabay

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