CHCF

 

NOVEMBER 2021

INNOVATION LANDSCAPE SERIES

Solving Shortages: How Technology Can Help Meet
California's Immediate Health Workforce Needs

programs and providers that serve Californians

with low incomes, faces unique challenges in
recruiting and maintaining its clinical staff due to work-
force shortages and inequitable distribution of health
care providers across California. To address these short-
ages, many health care systems serving patients living on
low incomes turn to the temporary workforce to fill their
needs. Staffing agencies play an important role in sup-
porting these health care organizations with recruitment,
given that many have few resources to maintain a tem-
porary provider pool or a sizeable human resources (HR)
department. In recent years, technology-enabled staffing

Te health care safety-net system, a patchwork of

services have emerged and addressed some limitations
of traditional staffing agencies, including limited trans-
parency and high cost.

This paper reviews the barriers to hiring providers in this
specific sector of the health care system, the role of the
temporary workforce, and the emergence of technology-
enabled staffing companies as a potential alternative to
traditional staffing agencies. This landscape analysis is
intended to inform investors and entrepreneurs invested
in or working on these issues to help them understand
the unmet needs and opportunities ripe for tech-enabled
innovation. It is also intended to help provider organiza-
tions encountering these challenges to understand the
emerging class of technology solutions that may meet
their needs.

To understand the recruiting and HR needs of safety-
net organizations, the authors conducted a literature
review, interviewed five leaders of technology-enabled
staffing companies, and talked with HR executives from
13 safety-net organizations. Among the HR executives,
seven were hospital leaders (either county hospitals or
private nonprofits) and six were executives at multisite
clinics. Six of the organizations are located in the Central

Valley, five in Southern California, and two in Northern
California. While this sample size is small, the organiza-
tions represent a range of size and location (geographic,
and rural vs. urban), as well as varying degrees of tem-
porary workforce needs, and thus provide information
likely applicable to the workforce recruitment practices
and experiences of similar organizations throughout
California.

The data for this paper were collected before the
COVID-19 pandemic. The impact of the pandemic
appears to have increased the need for temporary work-
ers. Although there are limited data, initial reports and
interviews conducted for this paper indicate that the use
of temporary workers has increased. One recent study
of traveling nurses found that at the height of the pan-
demic, job postings for temporary nurse positions had
tripled and increased faster in places facing extreme
pandemic conditions.' While it is still early to predict last-
ing changes, the COVID-19 pandemic highlighted the
continued importance of the temporary workforce in the
delivery of health care.

About the Authors

Joanne Spetz, PhD, is director of the Philip R. Lee Insti-
tute for Health Policy Studies and is a health economist
whose fields of specialty are the health care workforce,
organization and quality of health care services, and
the evaluation of health care policy and programs. She
has conducted studies of the registered nurse, nurse
practitioner, and long-term care workforces for nearly
30 years.

Amy Quan is a research analyst at Healthforce Center
at UCSF and works on a variety of projects related to
the health workforce, researching professions such as
registered nurses, physicians, nurse practitioners, and
community health workers. She is a master of public
health candidate at UC Berkeley.
Background: Workforce
Shortages in the Safety Net

Workforce trends nationwide point to a growing shortage
and inequitable distribution of providers. In California,
the shortage of primary care providers (physicians, nurse
practitioners, and physician assistants) is expected to
become worse over time, with some regions expected to
face greater shortfalls than others.? While the supply of
registered nurses (RNs) is actually projected to be slightly
higher than demand through 2035, some RN job catego-
ries are projected to experience shortages, especially for
experienced nurses who work in clinical specialties such
as critical care, emergency, and perioperative nursing.?

These shortages and the inequitable distribution of the
clinical workforce are most acute in rural areas and in
the safety net. A number of factors make it particularly
challenging to recruit providers; these factors fall into
four main categories as detailed in Table 1: professional,
sociocultural, structural, and workplace.

Over the long run, there are many strategies that gov-
ernment organizations, training institutions, and even
safety-net organizations can take to address workforce
shortages. (For more information on recommended work-
force strategies, see the 2019 California Future Health
Workforce Commission report). However, the need to
address the challenge is immediate, and utilizing the
temporary workforce is a common short-term solution.

Leveraging the Temporary
Workforce

Leveraging contract or temporary providers can serve
as a stopgap measure that enables health care facilities
to maintain consistent levels of staffing when care teams
are lean, such as when there are unfilled vacancies, staff
absences, turnover, or during high-census periods when
patients outnumber staff available to provide services.
Doing so can reduce the risk of staff burnout and ensure
consistent quality of care.4 The temporary workforce also
allows health care facilities to maintain their patient vol-
umes, which can reduce revenue losses when faced with
a shortage of providers.

There are models for leveraging temporary RNs and tem-
porary physicians and advanced practice providers. The
three main models for temporary RNs are (1) an internal
per diem pool maintained by the health care organiza-
tion, consisting of employees who do not work a regular
schedule and who are called to work directly by the
employer; (2) agency-employed temporary nurses, who
are assigned to single shifts or short-term assignments for
multiple shifts; and (3) traveling nurses, who are agency-
employed and assigned for longer periods of time
(typically a minimum of 6 weeks, and often 13 weeks).
Physicians, nurse practitioners, and physician assistants in
the temporary workforce are usually employed through
agencies as "locum tenens:" temporarily for a few shifts
or for an extended period.

Table 1. Characteristics of Rural Practices and the Safety Net That Contribute to Provider Shortages

PROFESSIONAL SOCIOCULTURAL

STRUCTURAL

WORKPLACE

 

» Greater breadth and depth
of medical knowledge
required due to scarcity
of in-house subspecialists

» Fewer career opportunities
for spouses/partners

> Challenges with work-life
balance

» Professional isolation > Community expectations

that extend beyond
clinical role

» Lack of role models and
mentors

» Cultural barriers and
language differences

» Fewer clinical education and
professional development

opportunities » Fewer social and cultural

opportunities in the
community

» Limited financial resources

> Lack of clinical infrastructure
{e.g., lack of administrative
and clinical support,
resources, and equipment)

for recruitment due to
dependence on patients
who are more often

uninsured > Heavier workloads

High demand for care due
to demographics of safety-
net and rural populations
and retirements in the
current aging workforce

> Greater bureaucratic demand
{e.g., higher Medicare and
Medicaid populations and
associated required paper-
work)

Transportation and

» Lower pay than urban,
accessibility challenges Pay

private hospitals

 

Sources: Ines Weinhold and Sebastian Gurtner, "Understanding Shortages of Sufficient Health Care in Rural Areas," Health Policy 118, no. 2 (Nov. 2014): 201-214;
and Xiaoming Zhang et al., "Physician Workforce in the United States of America: Forecasting Nationwide Shortages," Human Resources for Health 18, no. 1

(Feb. 6, 2020).

 

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The use of a temporary workforce is increasing overall,
and in the health care sector in particular, it is used to
meet the needs of people who are underinsured and/
or living with low incomes. A complementary publica-
tion to this brief (Solving Shortages: A Snapshot of the
Temporary Workforce in California's Safety-Net Hospitals
and Clinics [PDF]) presents statistical information on the
use of temporary workers in hospitals and clinics in Cali-
fornia. The analysis indicates that safety-net hospitals
are more likely to utilize temporary RNs, and of those
safety-net hospitals that use temporary RNs, most are in
rural areas or are critical access hospitals.> Safety-net
clinics are more likely to utilize contract or temporary
advanced clinical providers, like physicians, than other
types of contract providers, including RNs. Further, the
top quartile of safety-net clinics that use contract
provider full-time equivalents utilize the vast majority
(96.3%). These findings are generally supported by pub-
lished literature. One study found that on average, one-
third of Federally Qualified Health Centers (FOHCs) in
the US utilized temporary providers between 2013 and
2017; 59% of these health centers were large FOHCs
and 39% were located in rural areas.° It was estimated
that 45,155 RNs worked in temporary positions in 2019
and that this number would grow 10% to reach 49,637
by 2025 across the US.' In 2018, 2.7% of RNs living in
California reported that they worked with a temporary
or traveling agency for their primary job.®

The Role of Staffing Agencies
in Recruiting Temporary
Workers

Data and interviews suggest that many safety-net and
rural facilities rely on staffing agencies and recruiters
to assist with the hiring of temporary providers due to
those facilities' limited scale, resources, and administra-
tive personnel. Staffing agencies are search-and-recruit
firms that help to match candidates and open positions.
Health care organizations less able to maintain an inter
nal pool of nurses, physicians, and other providers may
call on a staffing agency to coordinate the recruitment of
temporary providers.

Staffing agencies enable health care employers to access
a large network of passive and active candidates. The

health care organization receives a list of prescreened
candidates from a professional recruiter responsible for
the early stages of the recruiting process, which may
include identifying candidates, verifying credentials, con-
ducting initial interviews, and checking references. This
enables the health care organization to maintain a leaner
and more focused human resources team.

From the employer's perspective, the main disadvan-
tages of staffing agencies are costs, trust in the agency's
credentialing process, the challenge of managing multi-
ple staffing agencies to ensure that recruited staff possess
the appropriate experience and skills, and the lack of
transparency in pricing and candidates referred.'

Because agencies are not intimately familiar with a health
system's needs, agency nurses can be assigned to units
that do not match their experience or skill level - either
to units that demand more complex skills than their com-
petence, where nurses may not know how to operate
equipment and/or lack the confidence to deliver effec-
tive patient care or to less-complex units, where their
skills are underutilized.'° This mismatch can contribute
to a negative working environment for both temporary
nurses and their permanent counterparts. Moreover,
staffing misplacements can negatively impact the quality
of patient care and perpetuate workplace inefficiencies.

Additionally, safety-net organizations sometimes find
that staffing agencies do not understand their unique
challenges and the importance of a cultural fit within the
organization. Faced with these challenges, some of these
organizations report feeling that statting agencies do not
always provide a strong match. Therefore, even with lim-
ited HR staff, they continue to recruit directly.

Emergence and Potential of
Technology-Enabled Staffing

Technology platforms for recruiting and placing provid-
ers have emerged to address some of the disadvantages
of working with a traditional staffing agency. A variety
of companies leverage information technology, such as
complex relational databases, machine learning algo-
rithms, and automated query systems, to improve the

 

Solving Shortages: How Technology Can Help Meet California's Immediate Health Workforce Needs

www.chcf.org 3
staffing process. These emerging companies offer a
range of services, including these:

» Algorithm-based "smart" matching between
candidates and clients. Several companies aim to
streamline and improve the match between candi-
dates and health care facilities by using algorithms.
Typically, candidates create a profile, input their per-
sonal information (experience, education, hard and
soft skills, personal and professional interests), and
preferences (location, specialty, availability), and the
algorithm analyzes their profile to match them with
open positions posted by health care facilities. The
matching algorithms are improved as users spend
more time using the platform by incorporating infor-
mation about the searches made by candidates and
the positions that candidates click on. These platforms
have different approaches in how they deliver candi-
dates to employers.

>» Automated workflow support for clients. Companies
have developed tools to increase the efficiency of
recruiting by automating portions of the process.
These tools may include license verification, auto-
mated interview scheduling, in-app chat functions,
and systems that track candidates from the initial
screening all the way through to hiring.

» Services that attract job seekers and increase the
pool of candidates. Some companies offer candidates
services to attract them to their platform. Services can
include free continuing education courses, online com-
munity groups, newsletters and blogs, and podcasts.

» Internet and social network marketing. Recruitment
advertising on internet search platforms such as
Google and within social media sites such as Facebook
is an essential piece of the search and placement pro-
cess. Some companies specialize in these marketing
techniques while others simply integrate them into
their overall platform.

Companies that leverage these technological approaches
for recruitment claim to offer health care organizations a
number of benefits:

» Lower costs. These technology platforms aim to
reduce or eliminate the need to employ recruiters and
marketing specialists, which can lower operational

and overhead expenses compared to traditional staff-
ing agencies. Their intent is to drive efficiencies for
their customers so that every dollar spent on recruit-
ing can go further and be more effective. Using these
platforms may help organizations either reduce costs
or hire more providers for the same spend.

» Faster placements. They aim to offer a one-stop
model where employers can complete multiple tasks
on one platform. Thus, these platforms have the
potential to speed up the placement process.

» Streamlined verification. Some companies automati-
cally verify licenses and credentials, which can be an
important benefit for employers, allowing them to
focus on interviewing candidates. The early verifi-
cation of licenses may reduce the amount of time
between interviewing, hiring, and onboarding.

» Increased transparency. In some systems, employ-
ers can see how many and which candidates fulfill the
positions' requirements rather than seeing only the
candidates selected by the recruiter.

The authors identified three categories of companies that
offer technology-enabled staffing platforms in the pro-
vider recruitment space and interviewed five companies
to learn more about their offerings. While not intended
to be a comprehensive list, these companies represent a
range of solutions in the market and the potential value
for health care organizations facing challenging recruit-
ment environments and limited internal HR resources.
Each company has a unique approach to leveraging
technology in the temporary and/or permanent place-
ment process. Some focus on a single professional group
and others focus on multiple professions. Some focus on
temporary placement and others on permanent staffing.
The categories and companies interviewed include:

» Managed service providers (MSPs). In general, a
staffing managed service provider (also called a man-
aged services program) is a company that manages
specific human resources services such as staffing and
recruitment for its customers. MSPs have been estab-
lished for a long time and typically take responsibility
for specific HR functions such as recruitment and hir-
ing, which can benefit organizations by outsourcing
this expertise that may be hard to maintain in-house,

 

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or provide more efficiency by taking advantage of
economies of scale. MSPs are increasingly evolving
to integrate more technology into their product and
service offerings. A number of companies specialize
in health care facility recruiting, and some are subsid-
iaries of larger temporary placement agencies. Some
MSPs also offer a vendor management system (VMS),
which provides web-based software systems to man-
age staffing and recruitment, including storing and
tracking information, and to support the recruitment
and matching process. Most MSPs tap into multiple
temporary staffing agencies and aggregate candi-
dates into a single platform. MSPs usually operate in
one of three ways: (1) some are also staffing agencies
and recruit candidates from their own roster before
offering candidates from other agencies; (2) some are
staffing agencies but are vendor-neutral, meaning they
source candidates from any agency, and (3) some are
not staffing agencies and work with various agencies
to fill positions. Many of these companies also offer
workflow tools for their clients in addition to VMS soft-
ware. There is a growing number of MSPs; prominent
companies include Aya Healthcare, Medefis, Medical
Solutions, MedicusOne. More than half of travel nurse
revenue was billed through a MSP program in 2017."'
The authors interviewed leadership at Medefis, which
offers a vendor-neutral MSP and is a subsidiary of
AMN Healthcare, one of the nation's largest health
care staffing companies.

» Placement agencies that leverage internet and
social network marketing. Some traditional staffing
agencies have developed sophisticated marketing
strategies as a pillar of their approach. The authors
interviewed leadership at Inline Group, whose services
include the development of dedicated recruiting web
pages for each of their clients and advanced internet
advertising techniques to identify and target candi-
dates for job openings.

» Algorithm-focused staffing agencies. While the two
previous categories of companies grew from tradi-
tional organizations, a new category of technology
staffing company has been established within the past
several years that leverages advanced computing
algorithms to streamline temporary and permanent
clinical placements in health care organizations. Often

these companies are open marketplaces where candi-
dates can directly engage with job postings. They aim
to reduce the need for human recruiters by using better
data and matching algorithms. Many of these com-
panies also offer workforce tools, candidate-focused
services to draw candidates to their platforms, and
internet and social network--focused marketing. The
authors interviewed three companies in this category.
Incredible Health focuses on permanent placements,
matching nurses to positions for which they are quali-
fied and allowing nurses to decide which jobs they
want to interview for. Nomad Health has developed
algorithms for matching nurses with temporary job
opportunities, with each algorithm focused on a par-
ticular aspect of the matching process. Trusted Health
has its own staffing needs system focused on tempo-
rary and traveling nurses, which health care facilities
can use independently to recruit providers or can
integrate into the human resources system they are
already using.

Limitations of Technology-
Enabled Staffing

While these emerging companies and technology ser-
vices are promising, most are new and still encounter
challenges to widespread use in this particular health
care sector. Interviews conducted for this report surfaced
a number of important limitations for the use of technol-
ogy-enabled staffing for hiring temporary providers by
safety-net organizations.

Perhaps the biggest issue is that few providers in this
health care sector are aware of these platforms or use
them to date, and none of the technology-enabled staff-
ing companies identified for this report are currently
focusing on safety-net organizations as a key customer
segment. These companies are very early in proving
their value to customers in general, and potential users
express concerns about timeliness, quality of matches,
comprehensiveness of services, and cost. Even as these
platforms demonstrate value over time, many employ-
ers will continue to work with multiple staffing solutions
to fulfill their staffing needs. The market for recruiting
services in California is fragmented; even traditional
agencies do not hold more than 10% of the market.

 

Health Workforce Recruitment Platforms

www.chcf.org 5
HR executives interviewed for this report said that
working with a recruiting partner that can establish a rela-
tionship to understand the organization's needs is critical
to help make the appropriate match. Safety-net organi-
zations serve a diverse population of patients. Therefore,
the quality of candidates is paramount, particularly
because the patient population served often has com-
plex health and social needs. Safety-net organizations
that have used staffing agencies to fill temporary posi-
tions expressed the value of an established relationship
with their assigned recruiter(s).

Furthermore, while a technology-enabled solution has
the potential to cut the cost of recruitment by using more
data and automation, these platforms still need to meet
a wide variety of recruitment needs among their custom-
ers. For example, organizations that have worked with
MSPs value the comprehensive list of services they offer.
For these organizations, MSPs are essentially an external
HR team that can assist with managing most if not all tasks
associated with hiring temporary providers. This compre-
hensive approach usually involves working with one MSP
company instead of several staffing agencies and may
be particularly valuable to safety-net organizations with
small HR teams but sizeable temporary workforce needs.

Last, while these technology-enabled platforms auto-
mate some parts of the recruitment process, employers
must still conduct their own interviews to assess whether
a candidate is truly a good fit for the organization and
position. Employers are also still responsible for onboard-
ing temporary staff and need to develop and deploy an
orientation process for them.

Looking to the Future

The landscape of technology-based staffing solutions
continues to grow and evolve. Companies are constantly
working to craft solutions that meet the needs of their
potential customers. As new companies enter the mar-
ketplace, bringing new approaches and technologies,
older companies adjust their services and offerings to
address the competition. For example, Nomad Health
began by placing both locum tenens physicians and
temporary nurses but has since narrowed its focus to
registered nurses. Two of the newer entrants (Nomad

Health and Trusted Health) started with a focus on plac-
ing temporary providers but may find opportunities
for growth in permanent placements while, conversely,
Incredible Health, which started with a focus on perma-
nent placements, may find opportunities for growth in
the temporary placement market.

Safety-net clinics and hospitals, both urban and rural,
struggle with staffing shortages. They may have more
opportunities to work with emerging technology partners,
given that they may be more susceptible to workforce
gaps because of the professional, sociocultural, struc-
tural, and workplace factors that influence providers'
decisions on where to practice. While some safety-net
organizations may utilize a rotation of temporary provid-
ers as a part of a long-term staffing strategy, most turn to
them to fill gaps when there are unfilled vacancies, staff
absences, or significant unanticipated turnover, as well
as during high-census periods such as flu season. These
organizations currently turn to traditional staffing agen-
cies or MSP companies that provide a full set of services
to meet their recruiting needs.

The challenges of recruitment in the health care safety
net create a unique opportunity to consider how emerg-
ing technology-enabled recruiting solutions can bring
more efficiency, transparency, and lower costs to the
market. Emerging technology vendors with data-driven
approaches have an opportunity to accurately match
the unique needs of a safety-net organization with the
unique qualifications of a provider applicant. Over time,
these vendors may also provide valuable support in hir-
ing temporary and permanent providers, or even serve
as viable alternatives to traditional agencies.

However, these companies have significant work to do to
meet the unique needs and concerns of safety-net health
care organizations and to tailor their services accordingly.
This could include highlighting bilingual candidates or
candidates with experience working with vulnerable and
rural populations, and tailoring price points to meet the
budget needs of safety-net organizations. Eventually,
while technology-enabled platforms may not solve all
safety-net provider staffing problems, they could poten-
tially serve as valuable partners.

 

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Nurse, Physician, and Other
Provider Recruitment
Technology Vendors

The organizations presented in Table 2 were identified
as providing a technology platform for provider recruit-
ment. This is not intended to be a comprehensive list of
organizations nor an endorsement of these companies.

Rather, the goal was to give a sense of how this market
is shaping up and the types of organizations addressing
this unmet need. For more information, please contact
each organization directly.

Table 2. Examples of Technology-Enabled Platforms Focused on Nurse, Physician, and Other Provider Recruitment

 

 

 

 

 

 

OTHER
TARGETED YEAR SERVICES LICENSE
COMPANY TYPE PROFESSIONS KEY CUSTOMERS FOUNDED OFFERED VERIFICATION
INCREDIBLE Algorithm- Permanent nurses Hospitals 2017 Workflow tools Yes
HEALTH focused staffing for clients,
agency candidate-
focused
services
Placement agency Permanent Outpatient 2007 Workflow tools Yes
6 | N L | N IE that leverages physicians, nurse clinics, hospitals, for clients,
internet and practitioners, managed care candidate-
social network physician assistants, organizations, focused
marketing specialists, nurses skilled nursing services
facilities
\ oo Managed service Contracted Ranges from 2003 Workflow tools No
NV Medefis provider (and providers and critical access for clients {available
vendor manage- nonproviders hospitals to multi- through
ment system) hospital systems optional
outsourcing)
eo Algorithm- Travel nurses Hospitals 2015 Workflow tools Yes
focused staffing for clients,
N omad agency candidate-
focused
services
oe Algorithm- Travel nurses Academic medical 2017 Workflow tools Yes
e t rusted focused staffing centers, acute for clients,
agency care facilities, candidate-
post-acute care focused
facilities services
Health Workforce Recruitment Platforms www.chcf.org 7
About the Foundation

The California Health Care Foundation is dedicated to
advancing meaningful, measurable improvements in the
way the health care delivery system provides care to the
people of California, particularly those with low incomes
and those whose needs are not well served by the status
quo. We work to ensure that people have access to the
care they need, when they need it, at a price they can
afford.

CHCF informs policymakers and industry leaders, invests
in ideas and innovations, and connects with changemak-
ers to create a more responsive, patient-centered health
care system.

For more information, visit www.chcf.org.

About the Innovation Landscape Series

As part of its efforts to help promising products and
services succeed and scale among California's safety-
net providers, the CHCF Innovation Fund conducts
high-level landscape analyses of issue areas especially
ripe for tech-enabled innovation. The Innovation Fund
publicizes the findings of these landscape analyses to
inform other funders and customers seeking scalable
solutions to challenges faced by safety-net providers.

Readers should note that these reports are not intend-
ed to be exhaustive, nor are they endorsements of the
companies included in them. Finally, because solutions
landscapes can evolve quickly, these reports may not
fully reflect the current market.

NAA Aetateu Melee Alaa LiCelaie lire]

 

Endnotes

1.

10.

11.

Joshua D. Gottlieb and Avi Zenilman, When Nurses Travel:
Labor Supply Elasticity During COVID-19 Surges (PDA),
University of Chicago, November 19, 2020.

. Joanne Spetz, Janet Coffman, and Igor Geyn, California's

Primary Care Workforce: Forecasted Supply, Demand, and
Pipeline of Trainees, 2016-2030, Healthforce Center at UCSF,
August 15, 2017.

. Joanne Spetz, Forecasts of the Registered Nurse Workforce in

California (PDF), California Board of Registered Nursing, May 2020;
and Joanne Spetz, Regional Forecasts of the Registered Nurse
Workforce in California (PDF), Healthforce Center at UCSF,
December 2018.

. 2020 Survey of Temporary Physician Staffing Trends (PDF), Staff

Care, 2020.

. "Critical Access Hospitals," Rural Health Information Hub,

last reviewed September 3, 2021. Critical access hospital is a
designation given to eligible rural hospitals by the Centers for
Medicare & Medicaid Services. Congress created the critical
access hospital (CAH) designation through the Balanced Budget
Act of 1997 (Public Law 105-33) in response to over 400 rural
hospital closures during the 1980s and early 1990s. Congress
has amended the CAH designation and related program
requirements several times through additional legislation.

. Xinxin Han, Candice Chen, and Patricia Pittman, "Use of

Temporary Primary Care Providers in Federally Qualified Health
Centers," Journal of Rural Health 37, no. 1 Jan. 2021): 61-68.

. "Temporary Employment in the U.S. to Grow Faster Than All Jobs

Through 2025, According to New Job Forecast from TrueBlue
and Emsi," Business Wire, November 1, 2019.

. Joanne Spetz and Lela Chu, California Board of Registered

Nursing 2018 Survey of Registered Nurses (PDF), California Board
of Registered Nursing, May 2020.

. lakovos Theodoulou, Akshaya Mohan Reddy, and Jeremy Wong,

"Is Innovative Workforce Planning Software the Solution to NHS
Staffing and Cost Crisis? An Exploration of the Locum Industry,"
BMC Health Services Research 18, no. 1 (Mar. 20, 2018); and 2020
Survey, Staff Care.

Catherine Birmingham et al., "The Experiences of the

Agency Registered Nurse: An Integrative Literature Review,"
Journal of Nursing Management 27, no. 8 (Nov. 2019): 1580-87;
and Kate Simpson et al., "What Do We Know About Our Agency
Nurse Population? A Scoping Review," Nursing Forum 54, no. 4
(Oct./Dec. 2019): 492-98.

Amy Chang, "Moderating Growth in Healthcare Staffing;
MSP and VMS Penetration Continues," Staffing Industry Analysts,
October 9, 2018.

 

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