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EP41: Jim Burns, Vice President of Talent Acquisition at Thrive Skilled Pediatric Care

Podcast Transcript

James Mackey  0:00  
Hello, and welcome to Talent Acquisition Trends & Strategy. I'm your host, James Mackey and today we are joined by Jim Burns. Jim, welcome to the show!

Jim Burns  0:20  
Thank you, James, nice to be here.

James Mackey  0:21  
It's great to have you. Could you share a little bit about your background with everybody so they know what kind of perspective you're coming from and the topics we're going to discuss?

Jim Burns  0:29  
Sure, I'd be happy to. So I've been in healthcare, recruiting, and operations for a long time. I started my career in travel nursing, in recruiting, and operations. So a different subset of the nursing population that travels to typically three-month assignments in different areas of the country. 

So I might be a nurse that I live in Boston, and I want to become a travel nurse and I'm a sign-on with a travel nurse company, I interview at a hospital in Seattle over the phone, and they accept me based on my resume, my credentials, my recommendations, my work experience, and I go and travel to Seattle, and I live there for three months and work in that hospital. And I may extend or I may want to go somewhere else. So that's a whole other industry. That, you know, exploded over the years, particularly during the pandemic, right when hospitals had to really staff up with nurses. And I'll save that for further in the conversation where that put a real drain on our supply in pediatric homecare of nurses who said, Oh my gosh, for this one time in my life, I might be able to, you know, really go monetize. And I'm gonna go right so that he said a real strain on the available nurse pool for not only Thrive Skilled Pediatric Care but all of our competitors in all the other clinical settings. 

So as in travel nursing, for a while, I worked for a really great company that merged and went public and was really a tonne of fun. I learned a lot. And then I transitioned into a company that worked in health IT. So when hospitals and doctors' offices and everybody was going from paper to electronic health records, the company that I work for, we kind of went in on the heels of some of these EMR vendors like McKesson and Siemens, Cerner, Epic Meditec. And we hired consultants to help with those installs when maybe legacy support or maybe training after those systems launched. And that was a tonne of fun, because, you know, the consultants worked on these projects, and we got to kind of live that experience with them. And it was a super healthy business in terms of demand. And that company got acquired and, you know, again, another really fun time in my career. 

So I joined Thrive Skilled Pediatric Care six years ago, almost at the inception of the company, and, you know, your network, right, that you built over the years, you know, the people I had worked with at the travel nurse company, and at the Health IT company, you know, were my connections to coming into Thrive Skilled Pediatric Care, right. So two people I had worked with joined Thrive. And they, you know, called me and said, hey, you know, a brand new company, pure-play startup private equity backed, looking for someone to help with recruiting. So, we thought of you, Jim, so I said, Oh, that's awesome. Right. So I met with the CEO founder, who offered me the role here, and here I am six years later, right? 

When I joined Thrive Skilled Pediatric Care, we had nothing. We had some laptops, we had some chairs and desks. And, you know, we built it literally from you know, acquiring technology platforms too, you know, doing our first acquisition and early stage. That's how we built a company. We acquired some pediatric home care agencies, in Texas, North Carolina, Colorado, Arizona, and Virginia. And now we're at 10 states and 31 offices and growing.

James Mackey  4:15  
Okay, cool. So how many employees when you started and where are you today? Just so we have that context too.

Jim Burns  4:21  
When I started, I was the fourth person in the door, and today we are 2500.

James Mackey  4:29  
Okay, cool. And that's over six years.

Jim Burns  4:33  
Yeah, six years. And most of those are our nurses and therapists, physical therapists, occupational therapists, speech-language pathologists, and caregivers that are in the field, right and work with the medically fragile children that we take care of on a daily basis.

James Mackey  4:50  
So you mentioned, a lot of the recruiting you're doing is project-based like quarterly three-month engagements is that right?

Jim Burns  4:56  
No, all the recruiting we do today is all nurses, mostly nurses, physical therapists, occupational therapists, and speech-language pathologists to work with the kids that we support, the patients that we support, which are medically fragile children, right? And, and in, these kids kind of run up and down the acuity scale, right? Like, we generally get them when they're coming out of the hospital. So most of them are premature births, right? And they've got some medical complexity as a result of being preemies. And they're coming home from the hospital, somewhere on the acuity scale, right? 

So it might be that they're, you know, their throat muscles aren't developed yet, and they can't swallow. So they have to eat through a feeding tube. And as a result of that, they qualify for nursing care in the home, right? Some kids might have been in the NICU for months, and they are coming home with a trach. And they're coming home on a ventilator, and they get 24/7, round-the-clock care, right? So they're not, quote-unquote, sick enough to be in the hospital anymore, but not well enough not to need nursing care. So our kids kind of go up and down that Acuity Scale. And at any point in time, you know, they might be back in the hospital where they've had an event they get sick, or they're going in for a surgery that they have to have that'll hopefully eventually make them better. Right. So all the recruiting we do are for caregivers that take care of med-frag kids.

James Mackey  6:28  
Are these primarily W2 employees or contractors?

Jim Burns  6:28  
All W2.  So all W hourly employees, depending on how many hours a week they work, they get benefits. So, you know, for 30 hours a week, they get benefits to light for 36 hours a week, they get a little more benefits. And then for you know, 40 hours a week and more they get a really robust rich benefits plan inclusive of PTO, medical, dental life 401k, you know, normal benefits stack.

James Mackey  7:00  
That's. So, getting into recruiting, one of the things that we wanted to discuss was challenges and finding and hiring top talent at the lower end of the pay scale. Is it that your team is kind of mid-tier when it comes to comp plans, or it's just more so your position as the full package? Because you had the benefits too or what would you consider low into the pay scale? Like, would you consider industry? Would you consider it? You know, where your company specifically fits in the market in some context there? And then I'm curious to see how you approach hiring in that space.

Jim Burns  7:45  
Yeah, no. So that's a great question. So, one of the challenges in our business. So the kids that we take care of, right, like, they don't have insurance, so their parents have insurance, right? So there may be an element of what's called private duty nursing on the apparent commercial plan right? Now, generally, that's going to be a capped benefit. So, parents or parents' commercial plans may have 80 hours a year of private duty nursing in-home nursing services right. Now, again, the kids are writing their parents' plans. We could chew that up in, you know, two weeks or a week. So then the kids kick over to generally the state Medicaid plans, right? So Medicaid is federally funded from the federal government to the state government, states get their Medicaid dollars, and then they decide how they're going to allocate them. So they set the reimbursement rates. 

So for us, the challenge in wages is for the states we operate in, what are the Medicaid reimbursement rates? Right. So for some states, it's fairly healthy, right, where we can compete in wage with other clinical settings for the nurses were trying to attract, in some states the Medicaid reimbursement rate is low, and therefore, we can't afford to pay our nurses wages that they can make in the hospital Doc's offices, urgent care centers, wherever it is. So we've got to compete at a different level. And for us, competing is on the recruiting side. So, the states are super sensitive right now to what's going on with, you know, medically fragile children, even adult home care to the right kind of, you know, that's generally going to be Medicare reimbursed, but, it's more cost-effective when people get care at home. They get better, right? Because they're in their environment. So kids are no different, right? But there can be some of these kids that need full-time around the clock nursing service. And depending on what that state reimbursement looks like, again, it makes it difficult for us to compete in wages. 

The nurses love the clinical setting, they love working one on one with a medically fragile child, it's why they went to nursing school, right one on one patient care, I can really make a difference in this patient's this kid's life, I can become part of that family, and I can watch that child progress and eventually get better. And then they don't need us anymore. Like, that's awesome when the kids graduate services, right? You know, we celebrate because you know that child is on their way to, you know, a normal upbringing and, hopefully, a fruitful life. But while they're getting care from us, the reimbursement structure in some of the states makes it really hard for us to compete in wages. So we got to compete in other ways.

James Mackey  10:50  
So you mentioned experience, too. So there's obviously the mission aspect, which we touched on, which is very mission-driven, people want to make an impact, one on one care, and that doesn't make a lot of sense. And I think that in and of itself is a significant driver. I don't know how many competitors you have in each state. But is it a competitive market where there are several companies offering this solution? I guess then, all of them have the same challenge. 

Jim Burns  11:19  
Yeah, that's right.

James Mackey  11:24  
So then you mentioned experience, right? So you mentioned experience being a standout as a way to attract talent? What do you mean by that? Is that a benefits package? Is that like PTO? 

Jim Burns  11:37  
When I say experience, James, the context is the experience the nurse has. Meaning, How's her experience with us? How's her customer experience? Because we consider the nurses, the candidates that apply to our jobs as customers because without them, we don't have a business if we don't have the nurses to treat the kids. Right, a bit like, we don't have a bit we don't have any revenue stream, right? Because the nurses go out, they build Medicaid, and that's how we make our money. But without those nurses, we don't have a business. Right? So, unfortunately, there's no shortage of medically fragile kids, right? So we just don't have enough nurses to serve all the kids that need service. 

So it's a very competitive market, and not only recruiting nurses, you know, every hospital will tell you they struggle to recruit nurses, right? We're no different. And we're in pediatric home care. So the experience that the nurse has with us, right, that very first phone call from one of our recruiters talking to the nurse about taking care of medically fragile children, our purpose, our core values, right, but you're right, the playing field is completely level, we know, you know, within a geographic radius of one of our offices, we've got competitors, we're all getting reimbursed the same. Now it's how you slice the pie. So plus or minus, we're about all the same terms of wage plus or minus, we're probably very similar in benefits. And then the question becomes, how do we, how do we service our nurses better than our competitors?

James Mackey  13:15  
Right. So definitely candidate experience is huge. Right? And then on an ongoing basis, are there any processes or experiences offered beyond that? I'm just curious to see what you are selling in terms of experience in the talent acquisition process.

Jim Burns  13:36  
So in terms of the experience for us, it's when a nurse reaches out to us, right, our goal is to reach back out to them when they apply to one of our jobs, is to reach out to that nurse, if it's not within minutes, it's within hours, and say to that nurse, hey, you know, thanks so much for your interest in our company. You know, tell me about your experience as a nurse, tell me what's important to you. Right? Is it? Is it making the most money possible? Because if that's the case, then we're probably not the employer for you, right, we'll probably not be the setting for you. But if it's a healthy blend of, you know, fair wage and a competitive benefits stack, and if you're looking for a work setting that gives you real purpose, and, you know, is more meaningful than pediatric home care with a med fridge, kids is the spot, right? So it's a combination of speed, service, and then ongoing relationship building, right?

So again, these are our customers, right? And if we're not servicing them, someone else's calling them. I mean, I, you know, every nurse probably comes home at the end of his or her workday. His or her shift looks in their email and probably sees 20 to 25 employment solicitations, right? So they're not in a shortage of the opportunity. Where do they connect? You know, do they feel like they're getting the right level of attention from their employer? And that's really what we're all about. It's a differentiator for us. How do the nurses connect with us? How do we build relationships? And how can we retain them?

James Mackey  15:18  
Gotcha. Is this the type of industry where it's like, if a competitor offers them a slightly higher wage, like $1, 2 more an hour that they're going to jump?

Jim Burns  15:29  

James Mackey  15:31  
I've been in that type of situation before in the past. I know how that's like, that's highly competitive,

Jim Burns  15:37  
It really is, and not all of them, James like, you know, you can make an app, you can make a buck or two an hour go away with service. And, you do a really good job. And, another company might call you and say, you know, something, Thrive Skilled Pediatric Care, I've got a great relationship with, you know, the office folks, and they really treat me well. And they check in on me. And, I really love the company. And, all those things, right? They go, Yeah, I'm good, right? Someone calls him it's five bucks more an hour, you know, well, that's real money, right? So, you know, they may hope for that. 

But what we do, when that happens, we make it a point to stay in touch with that nurse, like, those people get flipped back to my team in recruiting. And we reach out a month later, we go, Hey, is the grass greener over there? Or you may think you might want to come back, right? So we make it a real point to stay connected with not only our employees but those who have worked with us in the past and have left us and we try to bring them back.

James Mackey  16:34  
Yeah, that's smart. So, if we can get a little more tactical there. What does that process look like? Because I think, honestly, beyond your industry, I feel like that's just a good best practice. Whenever top performers move on, almost from a marketing perspective, it's like you've put them into the nurture phase almost where you reach out and see how they're doing and see if you can kind of like boomerang back into the organization. And, you know, particularly in some industries, too, it's like, they come back a couple of years later, maybe they have new skills. 

What's the process around that? How do you bake that into the process to make sure nobody, nobody slips through the cracks? And then that's a consistent motion for talent to go through?

Jim Burns  17:13  
Yeah, it's a great question. And, this, to me, is where it all kind of comes down to systems, process, and workflow, right? So without decent without good systems, that are what I want to say, kind of easy to navigate, but have a rich feature set, but aren't over burdensome, meaning, you know, like a system we use, I love it, it's, you know, I say it's got everything you want, and nothing you don't, right. So we can operate really efficiently and quickly in our system and document our interactions with not only our candidates but our employees, right? And with good systems, if people use them, you can scale, right? 

So now using the systems to kind of communicate with each other, we don't have to call each other on the phone, or we have to, you know, get on a team's call and, you know, ask if we can look in the system, right? And that allows you to scale. So a good system coupled with good processes and workflows allows you that ability, not only to stay connected with your current employee population but when they leave you, for whatever reason, right? Then that allows you the ability to reach back out to them. 

James Mackey  18:27  
So what system are you using to reach back out to it? So when somebody leaves how is that recorded? That's like a hrs? 

Jim Burns  18:34  
Yeah, you got it, like an ATS system. And, I'm a phone person.  I said this to someone a little while ago, I've never seen somebody accept a job over text. Right? Without interaction from a human, right? I've never seen someone have a successful interview over text, right? So people do business with people, and you talk to people on the phone and you build relationships and those don't have to be long conversations, they can be very transactional, it really depends on what that customer wants. Right? And you read the customer, right? Do they want to talk for a while and you know, then you talk? If they have a matter of fact and they say you know something? You don't have to check in with me every week. I'll call you when I need you. Right? Okay, cool. But you know, listen, I'm gonna call you every two weeks just to say hello right, and leave you a message but when they can hear you smile makes a big difference right?

So your chances of getting a call back or an outreach back from someone over voicemail as opposed to text messaging, I think is higher now. I think there's you know, listen, use all methods of communication right, use phone, use the text you use email use, you know smoke signals, whatever it works for you right you use them all. But you gauge not only the candidate but once they become an employee, how do they Want to interact with you? Right? And then again, when they leave you, that's about having a methodology that you follow for those touch points. 

So it's a month out after they've left, Hey, how's it going? You know, are you happy where you are? And if you're not getting full-time hours with that company, would you be open to picking up some shifts with us? Right? And, we keep them in the nest, right? And eventually, maybe reel them back in and one shift becomes two and two becomes four before, you know, we get them back full-time again, right? It's those touches with those. And really, again, they're customers that we may have lost, that we have the opportunity to pull back in. And we do a lot of that.

James Mackey  20:40  
That's really smart. I feel like, again, that's transferable to a lot of industries. I mean, I definitely see it being a big part of your business. Even like it for technology companies, for instance, right? Like, there should be some kind of cadence like, maybe it's more than a month, but a six-month check in a one-year check in? 18 months, like, why not just twice a year, touch base with your top people, and ask, Hey, how are you doing? Do you like it? Hey, we have this opening? Would you be interested? Also, by the way, is there anybody you know that might be interested in kind of using it as a referral? 

Jim Burns  21:15  
Bingo. That's it. You got it. So not only are you trying to leverage your existing workforce for referrals, right? So people that are working for us in the field today, nurses, therapists, right, that they know, nurses and therapists, right? So we are constantly reinforcing referrals, right? And what you notice is, you know, people talk about referral bonuses, and my gosh, we should offer a referral bonus, we got to up our referral bonuses. People don't refer people to accompany because they're going to make $1,000 or $2,000, or $5,000, right? 

They refer people to a company because they have a good experience with the company, right? And if they're not having a good experience, it could be a $20,000 referral bonus, and they're not going to refer someone because they're not going to say to their friend, hey, go work there and have a lousy experience. If you offer, you know, if you want for a fair attractive, and it really doesn't even have to, it doesn't have to be that much money. Referred bonus, people just refer to their friends, because they're having a great experience with your company and saying, come work here. It's a great place to work.

James Mackey  22:19  
I think when it comes to sometimes those types of bonuses, people just consider it thoughtful. We have certain programs where people can earn a $25 gift card. This is not like $25 a life-changing money or anything. It's just that they appreciate Jeff's token. That's right. And again, like they're not going to do the thing unless they believe in what you're building or less, right? Like it's a good type of solution. So I agree with you, I don't think you always have to throw money at people to get them to contribute, in a way I think the one area that I feel like I have to throw a lot of money at is introductions or referrals is like new clients stuff, right? 

So we have a really high-powered referral network of top influencers and stage b2b. Yep. And we have a very lucrative program because these people are incredibly business high-level executives. And they're not, they're just not going to do it unless we make enough money for them to kind of go like, Oh, wait. Okay. Yeah, I'll send you a few email introductions, right? But generally speaking, I feel like that's more of an exception to the rule. And by the way, those people even for all that money, even if it's like six figures, they're still not going to do it. If they don't believe in you. That's exactly right. They're not gonna mess it up there. They have no, I don't need, you know, that's right. It's even at any level, like, you know, whether or not there's a lot of money involved, like, your reputation in the marketplace is still paramount.

Jim Burns  23:47  
That's it, they won't refer someone to you if they're not having a good experience. And if they don't believe in what you're doing, or, you know, again, they're not gonna, they will not damage the relationship on the back end. For monetary value, there's just so much at stake. 

James Mackey  24:03  
Yeah, I hear you. I have a question. It wasn't actually the outline of our conversation. But you mentioned growth through acquisition. From a workflow process systems perspective. I would love to learn more about how you kind of pull the talent acquisition function into one centralized function when you're going through acquisitions and hypergrowth. 

Can you just tell us a little bit about your experience in hyper-growth through acquisitions, keeping things organized, building out workflow systems, tech, and Chure, I would love it if we can start with a strategy, maybe a story or two, and then really get actionable. We'd like tactics step by step. This is how you do it because that's the stuff that people listen to. I think growth through acquisition and unifying tonic position, Nick, by the way, that's a good title or something like that for this chapter, but that's a topic we haven't discussed yet. And if we can get tactical and tell people exactly how to do it, there's a tonne of value in that we haven't done yet on the show.

Jim Burns  25:10  
Sure. Disclaimer, I don't have all the answers, right, I can just tell you kind of what's worked for us. And I tell people, I've been in the human capital space for a long time, you know, my entire career, right? And, and when I say human capital, meaning, you know, you said it, James, like, you know, the humans do the work, right? And the humans are the customers. And without them, we don't have a business, right? So the human capital is, you know, the people that create the value for the company. And it's important that they have a really good experience, right? So as it relates to acquisitions, those are hard like, well, the acquisition itself, the deal is easy, right? Putting the deal together isn't the hard part. 

The hard part then is the cultural piece, because these acquisitions that we've made, you know, they're a pediatric home care company, who's enjoyed success, for years, and maybe decades, right, and built up their company, and they're super proud of what they've built as they should be. And now, you know, they got acquired and the owners are happy because they got a check. And the rest of the team, the operators were thinking, including, you know, the operators and the nurses, remember, who generate the revenue, we're thinking, Okay, what's this mean to me? Right? 

So now you got to kind of come in and say, well, listen, our goal is to do no harm, right? Like, don't mess it up. So you want to come in slow. And you want to say, hey, you know, you used to be XYZ, and you know, now we're going to change your name to thrive school pediatric care, you know, ABC location, whatever it is. And, you know, we're nice people, right? And they go, oh, yeah, sure. I know, we heard that before. Right? And we say, No, we're really nice people and, and with the, with the, again, the intent and the, you know, you gotta hold true to it, do no harm, right, make sure you don't mess it up. 

So that's cultural, embracing people of what's important to you, and an employer, because guess what, you got a new one. And, what makes you stay, and what motivates you? And then wrapping kind of, you know, not only acclamation into that with the existing workforce but then how do we turn on the recruiting engine, our recruiting engine in that region now, as Thrive school pediatric care, which, if we're brand new, you know, the nurses and other caregivers in that area? Like, who the heck are you? Right?

So we don't have brand awareness there. So now it's building brand awareness. And then it's slowly kind of getting, you know, getting the word out there and getting postings out there and getting presence on social media. And then, you know, slowly it starts to kind of Germany, and now you got to, uh, you know, you got to drip, and then you get a trickle. And then you get a flow. Right. But it's only predicated upon the people that do reach out to you. Are you responding to them? Do they feel like, you know, are they? Are they you know, are you excited to hear from them? And are they excited to hear from you? Is it timely? Is it welcoming? And is it efficient? Right, and you do all that, you start to get, you know, you get things moving?

James Mackey  28:35  
And some of these companies, I'm assuming probably have their own internal talent departments. Right? How have y'all managed that, historically? You give them a severance payment, and they they have to move on? Or do they get absorbed into your internal talent team? And if so, what's the kind of process to get them up and running? I mean, are they essentially just doing what they're doing? They just report it to you now, or how does that work?

Jim Burns  28:58  
Yeah. So I mean, it's kind of been a bit of a mixed bag. You know, we've acquired some talented folks from some of the acquisitions we've made. But for some of the locations that, you know, we've acquired, they were kind of on cruise control, you know, what I mean? Like, they'd been around a while, you know, they were kind of good, where they were with their growth. And, you know, there really wasn't a huge focus on acquiring more talent. They were, they were kind of just going along at that point, you know, what I mean? So, not complacent, but they were good, right?

So now, we come in, and that's what some of the balance is, like, you know, we're ready to, you know, Okay, we're coming in with the gold juice, you know, we want to grow. So, it's, in some cases, a little bit of a cultural shift, but, growth isn't an option growth is something we want to do. At the end of the day is really because we want to take care of more medically fragile kids, we want to help more families, right? So, for us, growth is non-negotiable. And for some people, they either got to kind of, you know, you're either in or out, right? So, and most have been in it's been really, really good. But now it's a different workflow, workflow, methodology system, and approach to the customer.

James Mackey  30:21  
One of my favorite sayings, which I actually got heard from Tony Robbins initially was life support which supports life, this concept of putting value being value creators and finding ways to be of service to your community, and the people around you. And when you do that, at scale, you're yourself rewarded with growth. Yeah. And I think that that's a really healthy business philosophy and something that I believe in, the more people that you serve, and that you give value to, the more that you're going to see that growth as an organization or an individual.  So I always loved that, that always stuck in my mind. 

So hey, quick question. I know, you said that there are the same wage pressures across the board in your industry, but are there any issues with acquisition where there's like wage differences amongst employees from a different company? And then you have to do something to make that equitable? I mean, obviously, wage details are private too. Has there been any trouble there? Or not so much?

Jim Burns  31:26  
Not so much. But I mean, it's a good question, right? I mean, it's really more location specific than it is anything, right? You know, what we pay our nurses in one location may, you know, vary dramatically from what we pay our nurses in another location, simply because those reimbursements remember, they're state mandated. 

So the wage swings could be huge. But it's all based on the Medicaid reimbursement in and not that our nurses don't ask, right, you know, what are the nurses in Texas making? If it's a Kansas nurse, right? They never asked that question. They might say, Hey, am I paid equitably to the other nurses that are working in my location? And we can look them all in the eye? And say, you sure are, right? So as long as you're doing that, then you're good, right? But really, with a wage, wage pressure, and location really comes from the other clinical settings. And you know, what's going on with those, and in particular, today to James like, you know, look at SQL, right, inflation is hitting everybody. Everybody's trying to, you know, monetize in a nurse can go work somewhere else for five or six or 10 bucks more an hour. And that's really beneficial to his or her family, then that's what they're gonna do. Right, given the market.

James Mackey  32:46  
Yes, particularly if they have kids.

That's it! Amen. 

I feel like in your industry, there's probably a lot of money being put into lobbying. Like, you need to get the medical up as much as possible. that's a classic communication with Congress. Right?

Jim Burns  33:06  
You got it. You got it. But as you know, the wheels of a government turn us slowly right and it's a grind.

James Mackey  33:13  
Is inflation hurting you all? I mean, that must be tricky because is the cost but then you have locked-in reimbursements.

Jim Burns  33:25  
You got it. 

James Mackey  33:33  
That's though! Yeah. You can't raise rates, your wages by 9%. 

Jim Burns  33:43  
You got it. Yeah, that's the challenge. 

James Mackey  33:46  
Yep. There it is. That's tough. That's an interesting insight.  I'm assuming lobbying is huge. That's what I was thinking.

Jim Burns  33:57  
It is. Yeah. But you got to be able to afford them too. Right. So again, for us, you know, we say, because the reimbursement of capital is precious. So we have to, as a company, we have to decide not only how much do we, you know, pay our clinicians, you know, in terms of wage, what the benefits stack looks like? What's that cost? What's that leave us for? Recruitment, marketing, branding, advertising, right? So I tell people, we do a lot with a little, which is why the service element of what we do is so important, like the workforce that we're trying to attract, and retain, is the most sought-after workforce in the country. Right? 

So if they're little golden nuggets, and you got to treat them as such, because they're really valuable customers. And it's not only all about wages, it's really a lot about service and how they feel about their interactions with the company. So I know I talk about that a lot. But that's it's super important in this space. And you know, that's it's been it's kind of been my history in terms of, you know, health hear in the nursing employment market? And you know that pressure.

James Mackey  35:06  
Right? I mean, and on the flip side of service or not the flip side, but like a parallel to it. It's like, the whole thing you talked about EXPEED.  You're competing with other companies, particularly in some environments, which may be providing a few more bucks an hour. Can you respond to that job, application faster? Can you go on the phone to build faster? You get that offer out faster. The one thing is like, you know, if you as long as they get started with you, they might not return the calls. Or some of the other ones. Right. So it's like, that's the right speed. So operational efficiency and processes.

Jim Burns  35:41  
You got it. Yep. And once they start working for us, then it's about relationship building, solidifying that. Because inevitably, right it's going to happen is probably every day, our nurses are getting phone calls, emails, and text messages from our competitors saying, Come to us, and they say, you know, something? I like Thrive Skilled Pediatric Care, they treat me well, right? And could I go there and make a buck, the benefits can be plus or minus, maybe. But I feel a connection, I've got a really good relationship with the people at the office that take care of me, and serve me, and I love my patient. I love the family. I'm not going anywhere. Right. So it's the service element of this, is huge.

James Mackey  36:25  
So one more question that's a little bit more focused on COVID. Just because we're in the healthcare space, what was that?  Like trying to recruit in that environment where, you know, supply super short and super high, age pressures? I mean, it's like you're going from one battle, going from bad to a high inflation environment.  I mean, what was that initially and how did you get through it?

Jim Burns  36:57  
Yeah, no, great question. So when it first hit, we weren't sure we were going to have a business.  So you know, we got tipped upside down. So, initially, the parents of the kids that we take care of were really scared, because, COVID for a medically fragile child could kill them. A lot of the parents said, when it first hit, no nurses in the house, right? Like, not even the nurse we've had working here for five years. We don't want them in an exposure. And then we quickly jumped on it in terms of protocols and procedures, and,  safety and testing. And we jumped all over that, to make sure that the parents knew it was as important to us as it was important to them. 

So they slowly let us back in. The nurses that they had on service for their particular child, would say, Give me back my nurses or the nurses that have worked here, but no new ones. And then they started to say, Okay, well, we'll give us you know, the nurses we had, and we'll take some new ones too, right? Because remember, if we're not providing services to that child, mom and dad are doing it, right? So they were overwhelmed, right? But they were like, Oh, my God, you know, if our child gets sick from COVID, they could die. Like we'll do it ourselves. Right? And then again, we reassurance that we listen, where we've taken all the safety protocols. 

We're following all the CDC guidelines, and we're communicating that and they quickly got comfortable that, we were doing everything we needed to do to keep them in their family safe. So the spigot slowly opened back up again. But the supply was squeezed, right? Because now the nurses are going to the hospitals on the COVID floors making crazy money. They're going to the testing clinics making crazy money than the vaccine clinics. So we were competing, for that talent that left us, not a tsunami, but you know, they monetized right. So, there was the outreach of Hey, you know, we worked together in the past, could you pick up a weekend shift? Or could you pick up a couple of nights a week and we worked really hard to claw back the nurses that had left us during the pandemic and now it's definitely flattened out but you're right like now you get hit with inflation and wage pressure and it's a constant challenge to recruit and retain.

James Mackey  39:40  
When it comes to pricing, right, not 100% of it has to be covered by Medicaid. I'm assuming the parents cover a certain percentage of the costs too. You can set your pricing a little bit higher, or is that not how it's done?

Jim Burns  40:04  
I mean, for some, if they private pay? Yeah. But, you know, that's a lot of money. Right? So you've got to have someone who can afford that if they're going to private pay that ensures we can staff them 24/7 around the clock, but that's not the case. I mean, a lot of our kids live in remote areas and come from totally varying socioeconomic backgrounds. And again, that makes it a challenge as well. Right. 

So, for our nurses, you know, I call it the four legs of the stool, right? One, they gotta have the clinical skills that support that child, right, whatever they have going on, the nurse has to be able to take care of that kid, depending on their acuity level, right? Two, they got to live in proximity to be able to drive to and from their home to the child's home, right? And depending on where that child lives, they qualify clinically. It could be 45,50 miles away, they gotta be willing to make that ride, right? Some say nope, too far for me.

James Mackey  41:11  
Some might say yes, and then do the job a few times.

Jim Burns  41:15  
Like I'm out exactly. That's tough. And number three it's not a typical hospital shift, eight-hour day, eight-hour evening, eight hours and a 12-hour day, 12-hour night, it could be the parents saying, Listen, we got to work. So we need nursing services from 6 am to 4 pm. Or we got to sleep, we need 7 pm to 7 am or 11 pm, to 7 am, whatever that is right in everything in between. So the nurse has to be willing to work the shifts that the parents want. Now, there's some give and take there. And what we've noticed over the years post-pandemic is the parents have gotten much more flexible with the hours that they'll take. And then the fourth leg of the stool is you walk into that house, and you got to you know, you happen to have a black T-shirt on. And you might be the best nurse that ever walks across the threshold. But the parents are oh my gosh, James walked in. And he seems like a really nice guy. But he had a black T-shirt on you guys know, we don't like black T-shirts. Right? So find us another one. Like, we got James. Right. So conversely, James, you might walk into that house, and you might look and see drug paraphernalia or weapons and you might say, Nope, not for me. So it's all those things that go into the match but at the end of the day, this is all about the medically fragile kids in the nurses are incredibly committed to these kids. And will do, they'll do a lot to provide services to these kids drive 45,50 miles, you know, turn a blind eye to maybe some things that are going on, to be able to take care of that kid. Right. And that puts them in a you know, it's just a different,

James Mackey  43:10  
I can tell, I mean, I get it. I kind of feel your passion from you, too. It's definitely a mission.

Jim Burns  43:17  
It's awesome. I love what I do. I love what we do. I have a real purpose every day and the work that I do, it's hard. Yeah, the recruiting retention of clinicians on our wage scale. It's hard.

James Mackey  43:33  
No, it's incredible, incredible work. And there are people like you and your team out there. Thank you, this has been really, really super engaging. And there are a lot of great insights here for, people to listen to, and learn from. And we covered a lot of topics that we haven't thus far on the show. So we'll make sure to put in an episode title that really shares some of the different things that we've discussed. So people can pick it out from the list because I think there's going to be a lot of insights here that they might have not considered before. 

So this has been great, Jim, and I just wanted to say thank you for joining us on the show today. And, I guess the last question would just be if people want to engage with you online, where can they find you? Is there anywhere they should be reaching out to?

Jim Burns  44:23  
I obviously have a LinkedIn profile and you know, I'm at Thrive Skilled Pediatric Care, and you can Google us and you'll find us online, so I'm happy to hear from anybody and connect with anybody.  I'm an open book and my networks are broad just because I'm, you know, I'm old and I've been at it a while and but networking for me is important, right? And, you know, you're you connect with people and in other areas and businesses and you learn things and the opportunities to connect and share whatever it is related to recruiting and tactics and other types of tips and tricks and whatever makes it work so and I'm happy to do that with anybody as well. 

Thank you guys for having me. I enjoyed being here and dialoguing with you, James, and insightful questions and you certainly get it. So I appreciate that.

James Mackey  45:20  
Well, thank you. Thank you and for everybody tuning in, thanks for joining us today, and we'll see you next time. Take care. 

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