The ‘impossible’ nurse model that saved this hospital $40k annually

Hartford, Ky.-based Ohio County Hospital has saved more than $40,000 a year by converting all of their nurses to salaried positions.

The change came about during COVID, when 50% of night shift nurses in the medical-surgical unit were staying for only six to eight months, and what staff remained were burning out because of the high turnover. 

“I remember sitting in my office one day, shutting off my phone and computer, and writing on a piece of paper, ‘When I was a nightshift nurse, what did I hate? And what could I change about those things?’” Athena Minor, MSN, RN, chief nursing and clinical officer at Ohio County Healthcare, told Becker’s. “At the time, I had young children. The way the schedule was set up, my days off weren’t really mine. I was recovering from the previous shift, maybe had one ‘normal’ day, and then I was preparing to go back to work. I couldn’t plan much or spend quality time with my kids. That was one big problem: work-life balance.”

Another issue was pay. The critical access hospital would call off shifts when volumes were low, meaning some nurses lost one-third of their week’s salary.

Ms. Minor started to design a new schedule that would resolve both of these issues. She came up with a seven-days-on, seven-days-off model that allowed nurses time to spend with family and recharge. She also created a system whereby weekday nurses didn’t work weekends, and weekend nurses were paid well enough to cover every other weekend.

But these new workflows required a new pay structure: salaried.

“That way, overtime rules wouldn’t apply, and we could structure shifts differently,” she said.

State labor laws confirmed it was possible so leadership ran the numbers.

“Factoring in benefits, we discovered we could actually double the staff needed to cover shifts and still save $20,000 a year,” she said. “Our CEO and CFO were skeptical, but the math held up.”

The hospital rolled out a six-month pilot to test the new model. Nurses on the night shift had their benefits frozen, so no one lost vacation time.

“At first, nurses were wary,” Ms. Minor said. “But three months in, during night rounds, a couple of them grabbed my arm and said, ‘Please don’t take this away from us. This is absolutely wonderful.’”

The model was so successful that day-shift nurses requested to be on it as well. Then it expanded to the emergency department, then surgery until all acute care nurses were on salary.

“The schedule flexibility was also a big draw,” Ms. Minor said. “Nurses could swap shifts, take extended time off if they found coverage, and cross-train in other departments during low census. Instead of sending staff home, they did audits, policy updates or training. Productivity improved and burnout decreased.”

In the first year of having salaried nurses, the hospital saved more than $40,000 due to reduced overtime. This model also cut the need for agency nurses during COVID, and cut the night shift turnover from 50% to 2%.

Today, weekday nurses earn around $60,000 to $68,000 annually, weekend nurses around $35,000, and nurses who pick up both can make close to $100,000 a year. 

“What I’ve learned is this: you need support to try something new,” Ms. Minor said. “When I first suggested doubling staff and saving money, people thought it was impossible. But they were willing to let me try. And it worked — better than we imagined. This model may not translate exactly to larger organizations, but the principle is universal: don’t be afraid to innovate. Ask, “Why not?” instead of “Why can’t we?” Pilot ideas, measure results and be willing to pivot. Sometimes, the solution that looks impossible on paper is the one that truly changes everything.”

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