When Deerfield, Ill.-based SCA Health set out to solve its nursing problem, the answer wasn’t recruiting harder, it was recruiting differently.
By expanding who it was willing to hire and investing in training nurses without perioperative experience, SCA Health has helped several of its roughly 350 ASCs completely eliminate their use of agency nurses.
The financial payoff has been substantial. With each nurse turnover costing a facility approximately $60,900, according to the “2026 NSI National Health Care Retention & RN Staffing Report.” Additionally, agency nurses frequently cost 50% or more over the hourly rate of permanent staff, with some, particularly in travel positions, costing up to three times more, according to 2024 data published in the Journal of Healthcare Leadership.
The roughly 7% nurse retention has saved the company “multiple millions of dollars,” Dare Meeks, MSN, RN, SCA Health’s chief nursing officer, told Becker’s. She attributed these figures directly to reduced turnover and lower agency dependence.
Additionally, according to Ms. Meeks, agency nurses can carry operational risk beyond the financial burden.
“Not because agency nurses aren’t good nurses — they are — but they don’t work in that facility. They don’t know all the processes, the physician preferences,” Ms. Meeks said. “There’s always that risk when you introduce someone who’s not worked in that environment. When you’re able to reduce agency use, you see a positive on two fronts — financial and safety — and those programs help us do that.”
SCA Health had been anticipating significant nursing headwinds for years, but COVID-19 accelerated the timeline considerably.
“Folks who were thinking about retiring in five to seven years decided they were done. That created this immediate bottleneck,” she said. “Even in nursing faculty, we’ve seen difficulty retaining people as they retire and getting new blood in, because nurses today can make significantly more in acute systems with very deep pockets compared to going into a faculty position or working in an ASC.”
In response, SCA Health has made meaningful investments in its nursing workforce across two key areas: expanded training pathways and a clinical ladder program
Training programs for frontline nurses
SCA Health has expanded training programs for frontline nurses, along with sterile processing and surgical tech programs. The driving force: a shrinking pool of candidates with traditional perioperative experience.
“Historically in the ASC industry, when we went to market to look for talent, we were always looking for people who already had perioperative experience,” she said. “That talent pool is now much more constricted, so we’ve had to be creative and innovative about engaging and recruiting nurses who haven’t necessarily worked in pre-op, the OR or a procedure room — broadening that talent pool and investing in those nurses in a way that helps them become competent and confident in our setting.”
One solution is the “Peri-Op 101” program, developed by the Association of periOperative Registered Nurses. SCA Health purchases seats, runs the education and moves nurses through the curriculum in 15-person cohorts. The 13-week program combines virtual classroom instruction with hands-on preparation; upon passing the exam, nurses are certified to work as circulating nurses in the OR.
“You could be a new graduate nurse, a nurse who worked in a doctor’s office, a school nurse, or a nurse in a nursing home with no perioperative experience,” she said. “If you’re a good culture fit and have a current nursing license, we will hire you.”
A companion program, “Pre-Op and PACU Nursing Development,” follows a similar model, an eight-week curriculum focused on those two areas, with an exam at the end. Both programs include a parallel leadership track for directors of nursing who may have experience in one area but not the other.
“What that has done is really expand our hiring pool,” she said. “Where previously I would not even look at applicants without perioperative experience, now we’re able to consider 10 additional applicants and support their development and long-term success.”
Clinical ladder
In 2024, SCA Health launched a formal registered nurse clinical ladder — a five-level, points-based system now active across its roughly 350 ASCs. Nurses earn points for years of experience, education level and additional degrees or certifications such as a bachelor’s or master’s of nursing science or certified perioperative nurse. They can also earn points by taking on expanded roles, including resource nurse, specialty nurse, education nurse, infection control preventionist or quality nurse.
“We spent a lot of time doing research ahead of that pilot to format a way that our front-line nurses who are not seeking leadership roles could advance professionally — as a retention tool, and also a way to affirm how amazing our nurses are,” Ms. Meeks said.
The response has been strong. About 10% of SCA Health’s enterprise RN team, roughly 320 nurses, applied in the first cycle in 2024, growing to approximately 12%, or 370 nurses, in 2025. The current application period, which opened May 1, will indicate whether that momentum continues.
SCA Health has seen strong retention results from its programs, with most attrition attributable to circumstances like relocation or personal reasons rather than dissatisfaction.
“We’ve seen multiple millions of dollars in savings from reducing turnover, and that helps our facilities continue to be successful and able to invest in the staff they have,” Ms. Meeks said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.