Restructuring the
Healthcare Business Model

Part One of Four

A structural change has been taking place in American Nursing for some time now. Historically, high-profile physicians attracted loyal patients to a particular hospital and drove a consistent source of profit for them. However, when hospitals combined to form larger healthcare systems, healthcare brands began to have market share power, physicians lost some of their influence, and nursing care became an additional primary driver for a hospital’s brand and profit. Nursing positions began to get more competitive, and the educational requirements rose. With patient satisfaction scores becoming a primary driver of insurance reimbursement revenue, strong teams of nurses have become a new source of revenue power over a healthcare brand.

This trend was the new way of life for hospitals when the global pandemic, COVID-19, hit and disrupted the new system once again. The pandemic has put an enormous strain on the healthcare system, and nurses have borne the brunt of it while hospital systems are left wondering how best to respond.

Now that we are over two years into this new reality, we see the nursing system restructured. Here are five ways those changes are happening:

1. Exhaustion 

Covid-19 took the world by storm and threw healthcare organizations into a steep learning curve. Long and hard-fought battles ensued while struggling to outsmart and outrun a virus that was morphing before their eyes. Waves of grief over lost patients pounded each new shift, all the while tension and anxiety ran high from fear of contracting the contagious virus or spreading it to loved ones. Hospitals were in constant crisis for a whole year until hope arrived in the form of a vaccine.

Despite the relief a vaccine usually brings, many in America refused to take it, and the pounding waves of new variants overwhelmed hospitals repeatedly. Healthcare workers are exhausted and suffering from PTSD. Many are leaving the field to find new work, and honestly, who can blame them?

2. Travel Nursing 

Travel Nursing has always been a draw to young nurses beginning their careers. The opportunity to travel the country and the perks of great pay attract adventurous nurses willing to live a nomadic life for a few years. Before COVID, hospitals utilized travel nurses to fill temporary, vacant positions but preferred a steady employee to an expensive short-term one. The pandemic changed all that.    As the waves of surges moved throughout the country, travel nurses were needed to fill staffing shortages due to quarantined nurses and increased patient volumes. Travel positions with high pay heavily recruited nurses to meet the flow of demand cascading from one state to another. Often a traveling nurse did not need to leave their county to fill in at the rural hospital an hour away.

Now that the traveling model has been relied upon so heavily and nurses have experienced the benefits, many will not return to a lower-paid hospital job. Travel nursing is here to stay, and hospitals must re-frame their structure with or without them.

3. The Great Retirement 

The trauma and relentless stress of the pandemic on hospitals led to what many have called, The Great Retirement. Nurses just a few years away from retirement decided to cut ties early and leave the high-risk profession. Age increased vulnerability to the virus, and with nurses on the frontlines, it made more sense to retire than to place oneself in harm’s way. Early retirement left an already understaffed nursing system depleted.

4. School Qualifications 

With nurses carrying more weight of the hospital system’s brand, many hospitals began requiring nurses to have both a four-year degree and a graduate degree rather than the traditional two-year plan. Many nurses needed to extend their education to qualify for higher compensation or open positions. In light of the slower education time frame, the supply of new graduates has not caught up to the demand for open positions, and as a result, it takes hospitals longer to fill their nursing job vacancies. Not only that, but the cost of a four-year degree is significantly higher and can act as a deterrent to those who may be considering nursing as a career.

5. Increase in Baby Boomers needing nursing care 

The healthcare needs of the largest generation in recent history have rapidly increased as Baby Boomers age. Nurses are needed more in physician offices, outpatient surgery centers, rehabilitation centers, and long-term care facilities. There are many more career opportunities for nurses beyond the walls of the hospital that are far less demanding and stressful. In a post-covid world, many nurses will choose these options both because there is a demand and because they need a break from stress.

With all these changes, it seems inevitable that nursing is restructuring, and hospitals need to rethink their business models to match the trajectory. At Endeavor, we have the tools and expertise to help you through the changes.


Michael Shook MBA

Executive Vice President

Michael Shook has been consulting for almost 20 years, helping Senior Leaders achieve their organizational, operational and career aspiration goals through executive coaching, strategic leadership development, organizational and cultural transformation, high performance team building and strategic organizational performance.

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