How bad did the COVID-19 surges get? Well, at the Ascension Texas health care system, Holly Taylor, MPH, CIC, the infection prevention director at that institution had to call a couple of infection preventionists (IPs) out of retirement and asked another to delay her retirement. Taylor is the coauthor of a study unveiled today at the annual conference of the of the Association for Professionals in Infection Control and Epidemiology (APIC). The study states that the “IPs required no onboarding or training due to prior knowledge of surveillance methodology, electronic health records, and surveillance software systems. A PRN [as-needed] status was preferred over full or parttime status by both the IPs and the organization. Full-time IPs reported increased availability for unit-based activities.” Taylor tells Infection Control Today®(ICT®) that the presence of the PRN IPs did more than just free up time for fulltime IPs to make more rounds rather than be chained to their computers. They also acted as mentors, and not just for the novice IPs. “I have one who was an endoscopy manager for an extended period of time,” Taylor tells ICT®. “She brings just a really invaluable set of skills and level of expertise related to high level disinfection of endoscopes.” The use of IPs who are retired or near retirement on an PRN basis might be one way to shore up the ranks of IPs as the profession looks to recruit younger practitioners—and keep them there. “We know novice infection preventionists often come in without a lot of support,” says Taylor. “The attrition rate is pretty high.”
Infection Control Today®:So how did your study come about?
Holly Taylor, MPH, CIC: It was kind of necessity. Heading into February of 2020, I had almost a 40% vacancy rate within my department. The workload was mounting, we were becoming overwhelmed. And I just we knew we had to do something to keep the department afloat. We tried to figure out what we could do creatively to help supplement the department and staff.
ICT®: How did you lure people out of retirement? Did you appeal to their sense of duty? Did you appeal to their sense of duty, and also offer them a nice signing bonus?
Taylor: I was very lucky in the sense that we had kind of the framework for keeping retiring infection preventionists on in these PRN [as-needed] positions. I had two [infection preventionists] in that function already, doing very limited projects for the department. And then I
had another one retiring, and so she wasn’t quite ready to go. I was able to ask her to stay on in this PRN status, and she was thrilled to have the opportunity. So really, it was working within the resources that were already in that capacity. Asking one more to stay on and then expanding the job duties. They were thrilled to be able to do it. And very happy to help the team with the boots on the ground.
ICT®: When your department is at full staff, how many infection preventionists to you have?
Taylor: I have eight fulltime infection preventionists when we’re fully staffed, and it’s about 1500 licensed beds.
ICT®: Are you fully staffed now?
Taylor:I am fully staffed right now. Fortunately, we are still able to keep those retired infection preventionists on helping kind of function in a centralized surveillance capacity. They help me offload some administrative tasks to support the training and onboarding of two novices into becoming proficient IPs that I’ve been able to hire into the department.
ICT®: Have people [the heads of other infection prevention departments across the country] taken notice and asked you what you did and how you did it?
Taylor: I don’t know that I have had that happen yet. I think it’s a really viable model for folks when you’re looking at how to staff gaps when you have folks that are retiring. How to create a little bit more bandwidth within the department when you have potentially prolonged vacancies because we do know that IP staffing vacancies last longer than other health care vacancies. It’s a really great model and it’s been very symbiotic for the organization and the retirees that aren’t quite ready to be done with infection prevention. But definitely we want to take it a little slower.
ICT®: Do you see what you did down there [in Texas] as possibly a stopgap for the infection preventionist profession as a whole until the ranks are filled up again?
Taylor: Absolutely. I think when you are a novice coming into infection prevention, there is so much content, so much work. It’s incredibly fast-paced. And we know novice infection preventionists often come in without a lot of support. The attrition rate is pretty high. So even just being able to offload some of those administrative tasks, administrative burden, to help facilitate a [better] learning environment, I’ve had feedback from my novice infection preventionists talking about how much that has given them space to learn the profession, develop competency in key areas. [As opposed to just] sitting at the computer doing the tasks that the infection prevention departments are responsible for.
ICT®: That’s mentioned in the study. The fact that the retired infection preventionists coming on board allowed you and other fulltime infection preventionists to make more rounds, talk to more departments, talk to more people.
Taylor: Yes, and that’s been a selling factor with administration as well and one of the reasons that they have not balked at all, with me keeping these staff in this PRN role. They see the benefit of infection preventionists being out, being around. I think one of the things that was great with our team during COVID is that we had people keeping an eye on what was going on with the infections and continuing reviews of HAI’s [health care-acquired infections] that occurred during COVID. As soon as the pace slowed a little bit, and the organization had the bandwidth to restart performance improvement activities related to infections, we had the data. We had those key drivers identified and ready to go. We were able to really pick back up and start making some improvements.
ICT®: How much longer do you think you’ll be permitted to keep these—I guess you could call them consultants—on board?
Taylor: I don’t know. The organization has been super supportive. I know that they are helping support and work through expanding the staffing complement of my department. I see this as being something that they allow me to keep for a while. I have not heard that they have put an end date on it for me at all.
ICT®: As I mentioned in the introduction—and you know this better than I do—infection preventionist as a field faces some demographic challenges. Just the fact that so many IPs will be retiring in the next few years. You have, in the short term solved the problem by using retired infection preventionists. But I guess we need to do something else to figure out what to do long-term? Are you thinking along those lines? And what are you doing?
Taylor: Well, I think the beauty of this is when folks are ready to really stop working, I have had the opportunity to bring on and train new folks that have gained expertise in the field. We’re moving through the phases of the competency model. And when those folks are ready to make the step to be more retired than working on an as-needed basis, I’ve been able to backfill and train and I’ll have a highly competent staff. So, you have the ability to almost continue the model. So then, with the next wave of retirements, so to speak, if any of those folks are willing to stay on in an PRN capacity, then it just gives you a little bit more space to bring folks on, help them get proficient and then as the retiree is ready to be more retired, my department has already maximized the benefit of that incredibly valuable resource. I love having a multidisciplinary team. My two latest hires were members of microbiology departments. One was external and one was internal working within our microbiology department. And you just bring that level of knowledge base and expertise within the department and all of us have benefited from their knowledge. I think casting a wider net than just nurses is a huge asset to the field and makes us more robust as a team. It gives great levels of experience and perspective that I think really just enriches the field.
ICT®: Are the retired infection preventionists who come back and help looked upon as mentors to the younger people?
Taylor: In some respects, yes. I have one who was an endoscopy manager for an extended period of time. She brings just a really invaluable set of skills and level of expertise related to high level disinfection of endoscopes. And so yes, she has, come in to round with folks or get perspectives and give feedback, consult with them. To help prioritize any follow-up actions and so forth. So, yes, there definitely is some passing on of that information to the next group. I have one retired infection preventionist who worked at our pediatric hospital. She is just a wealth of knowledge related to a specialized field: neonatal/pediatrics. And so being able to kind of hand that off even to an experienced IP, but who hasn’t had extensive pediatric experience; being able to maintain that institutional knowledge, being able to maintain that history and build that continuity has been just incredibly valuable as well.
ICT®: So how do you think this might fit into an overall plan to replenish the ranks of infection preventionists?
Taylor: I think with this type of plan, I would recommend a couple of things. Talk to your administrators early. I think there is a lot of … it’s a lot easier to kind of keep somebody within the HR system than to bring somebody back. The PRN status is something that our clinical partners use regularly. Our nursing departments, our respiratory therapy departments; a lot of those clinical departments use that staffing status pretty regularly. It’s something that your HR team is familiar with. It’s something that your administrators are familiar with. It’s a less expensive option than adding a parttime or a fulltime [IP], or fulltime equivalent, just because of various benefit costs, and so forth. I think there is a very good financial case for how you can … when you’re planning for the vacancy of the role, and kind of how long that lasts. And this is a much less expensive option to kind of build continuity with the program. It also creates a recruitment benefit because you haven’t had…. You’re not bringing someone into a department that maybe hasn’t had surveillance done in six months. Because that’s incredibly overwhelming for someone coming into an organization. I think it does have some recruiting benefits. I think it’s something that organizations are very familiar with and is a much more cost-effective option than adding other types of staff. I might have a floor nursing department that has difficulty filling shifts, and so they might bring somebody on to fill just those shifts or cover those shifts. They work on an as-needed basis.
ICT®: As far as you know, has this been done for infection preventionists?
Taylor: Not in a systematic and intentional way. Not strategically.
ICT®: And of the many benefits that you spoke of, one of the benefits will be that an infection prevention department—or the head of infection prevention department such as yourself—will not be desperately searching for bodies to fill gaps during a crisis such as COVID-19. You’re not just throwing a novice into a situation that a novice just can’t handle. I’m not saying that you would do that or that anybody else would do that. But we all know what happened in the pandemic. Things were done because you just had to do them. This will allow you to better train novices and better guide them and ease them into infection prevention department, right?
Taylor: Absolutely. As well as hiring for goodness of fit of the organization. When you’re looking at these roles, there are skill sets that sometimes work better for an infection preventionist. Maybe you just need somebody who really demonstrates an ability to be a self-starter or has a passion for lifelong learning. You want to interview and hire for those characteristics that are great for the profession, great for the organization. Sometimes if you’re just trying to fill a role so that you don’t have a vacancy, you may not have the luxury of really targeting those characteristics that are going to support longevity in the role. And I think this gives folks an opportunity to kind of help really target those characteristics that are going to be the most successful.
ICT®: Is there anything that I neglected to ask you that you think is pertinent and that you’d like your fellow infection preventionists—or other health care professionals—to know about? What you did and how you did it?
Taylor: Just to echo how much great feedback I’ve gotten from the retirees, as well as the new folks coming on board. The folks who are retiring have really come to embrace this role that they are serving in right now. And have really worked to hone their skillset and kind of those remote functions. They have been incredibly passionate and wonderful. And I cannot thank them enough. I feel the benefit of their work every day. It’s just been a great experience.
This interview has been edited for clarity and length.