Indiana University Health is enacting a series of reforms aimed at hiring, and keeping, more in-house nursing staff. One of the moves, a change to on-call requirements for nursing staff, will be test run at the Bloomington hospital.
In a health care system plagued by a nurse shortage and high prices, IU Health leadership sees the shift as a way to decrease costs. Here’s what to know about the changes:
Nurse on-call requirements
In one of the biggest changes the hospital system’s making, nursing staff at the IU Health Bloomington Hospital will be required to be on-call for 12 hours every six weeks starting Dec. 28.
In today’s understaffed hospital system at large, that could mean nurses would be called in for much, if not all, of that required time.
Nurses will be able to swap shifts and won’t be required to take hours they aren’t already working — meaning day shift nurses won’t need to take night shifts.
Angela Tritle, associate chief nursing officer at IU Health Bloomington, said the change came after forming an advisory nursing team over the summer. Part of that team’s recommendations pulled from the surgery and labor-delivery departments, which already had on-call requirements.
After the test run at the Bloomington hospital, IU Health South Region President Denzil Ross said leadership will look at its effectiveness and will then evaluate where the model could expand to.
One of the reasons for the change is a decreasing reliance on contract and agency nurses. Contracted nurses typically take full-time positions at health care facilities, often with higher pay rates than nurses on staff. They’re used to cover leave, help out during surges and cover hospitals while they’re short-staffed, but they’re more expensive and move around frequently.
“If we can find other ways to utilize those dollars, we are hopeful that it would help,” Ross said.
The hospital will already have fewer contract nurses going into the end of the year. Because new nurses tend to come off orientation in fall, Tritle said, contract renewals typically decrease.
“And also, some agency nurses really like to exit around the holiday time and also take contracts somewhere where it might be a little warmer,” Tritle said.
New bonus changes and retention pushes
As IU Health pushes for more in-house, non-contracted, nurses, it’s trying to incentivize recruitment with more bonuses.
System-wide, it implemented a $30,000 bonus for nurses starting their careers at IU Health, and a $5,000 referral bonus in late summer. Cynthia Herrington, IU Health Bloomington’s chief nursing officer, said those will be offered until March 31 next year.
Market shifts, Herrington said, mean different focuses between recruitment and retention for nursing staff. But with Indiana’s nursing shortage, recruitment is more important than ever for all health care providers.
Indiana only has 72% of the licensed practical nurses needed for the state’s population, according to IU's Bowen Center for Health Workforce Research. By 2037, the center estimated that could drop to 43%. The COVID-19 pandemic only made things harder, as the surge caused burnout and trauma for many nurses.
“COVID sure did take a hit on nursing, didn’t it,” Tritle said.
Since 2020, Ross said, average nurse wages at IU Health have increased by about 33%.
Around two years ago, IU Health implemented reforms with its human resources and talent acquisition departments, Tritle said, aimed at decreasing the time it takes to hire nurses. She said they were able to reduce application screening to 48 hours, and that the system was able to make job offers “pretty much within the week, if not within three days.”
That effort paid off, Tritle said. She said IU Health has hired 144 nurses in Bloomington this year, not counting recent weeks.
“That is probably about 50 nurses more than we brought on board last year,” Ross said.
As for nurse retention, Ross said, IU Health Bloomington Hospital is no better or worse than the state or system average. They’re aiming for better numbers.
“It is a focus for us, I think we do a good job today, but it's definitely something that we want to improve on and be better at moving forward,” Ross said.
An aim to decrease health care costs
Overall, the moves are focused on increasing the number of in-house nurses the system has on staff, cutting reliance on more expensive contract and agency nurses. Ross said that will help lower costs for people needing care.
One July study found Indiana ranked eighth in the country for health care costs this year, an improvement from 10th in 2024. The same study put the state at 20th for health care access and 36th for outcomes this year.
Last year, Ross said, IU Health spent more than $90 million in uncompensated health care, providing care to many who weren't able to afford it. The system’s goal is to further increase access by slicing costs.
“If we are able to reduce the cost of healthcare overall, we are then able to put those dollars back into the community,” Ross said.
