Hospitals can change their models of care to meet the worsening nursing shortage

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There's been a nursing shortage in the U.S. for years, but the COVID-19 pandemic has made the situation even more dire. Nurses are retiring, leaving for new roles or abandoning the profession altogether, and there aren't enough trainees in the academic system to make up for the expected shortfall. Nursing, it would seem, is in somewhat of a crisis.

That was highlighted recently in a survey issued by Wolters Kluwer Health and UKG, in which 92% of respondents predicted they would be short of their budgeted nurse headcount over the next 18 months. And 58% of health leaders said they don't expect to bring in additional staff or new roles due to financial constraints.

"The nursing shortage isn't going to go away, and we need to address it head-on," said Anne Dabrow Woods, chief nurse at Wolters Kluwer Health Learning, Research and Practice.

Part of the issue, she said, is not necessarily that there aren't enough nurses out there, but rather the "churn" that's taking place – the term that describes nurses leaving their jobs for other roles or new professions altogether.

Baby boomers are retiring, and that's not a surprise. What raises eyebrows is that many nurses in the 25- to 35-year-old range are leaving the profession, as well, and academia doesn't have the numbers to fill the gap. That's due to a number of factors, including underpaid trainees, not enough clinical sites in which to put students and not enough resources generally.

Woods estimated the nursing workforce would need an additional 1.1 million RNs by 2030.

"A lot are getting out of healthcare completely because they feel that healthcare isn't providing a safe enough environment," she said. "There was not enough personal protective equipment at the beginning, and now there are not enough competent healthcare workers. And the patients we have are much sicker than ever before.

"If you ask a nurse what they want to do, they'll tell you they want to take care of people. But when you're there day after day and you don't have enough competent staff beside you, you don't want to do it anymore."

IMPLICATIONS

It stands to reason that if there aren't enough well-educated professionals at the bedside, patient outcomes will suffer. Hospital-acquired conditions increased during the pandemic, which Woods attributed to either poor technique or an inability to detect when issues were occurring with patients, all part of the ongoing shortage.

"A lot of quality indicators are really starting to be affected because of what happened with the pandemic, and with not having enough competent people at bedside, we really need to be looking at different staffing models," she said.

The RN model is the primary model used in the U.S., but it's common these days for an RN to be taking care of a couple patients in the ICU and a handful more on the surgical floor. The nurse-to-patient ratio is becoming ever more unfavorable to RNs as a result.

Woods said an alternative care model would be to bring in licensed practical nurses and other license-assisted personnel to care for patients. Currently, registered nurses provide direct care to patients, while licensed practical nurses assist doctors or RNs.

She also suggested hospitals could adopt more of a team model of care, a model that hasn't truly been employed for the past 20 years or so. Technology is another big factor that can have an impact, especially solutions that can automate tasks such as staffing and scheduling, as well as budget management.

Hospital administration can start by looking at how shifts are handled.

"Hospitals are going to have to get more flexible with their shifts," said Woods. "Nurses need to have options. Instead of working 12 hours, give them the option to work 10, eight, six or even four hours."

Having more flexibility would allow nurses to care for children or aging parents and tend to life's other obligations. Recruitment and retention bonuses would help to further sweeten the pot.

"Also, we have exit interviews, but we also have 'stay' interviews, where you talk to staff who have committed to stay and ask them why they're staying," said Woods. "If the organization really values their nurses and makes that known to the nurses, they tend to stay more readily in that organization."

Many healthcare organizations are renewing their partnerships with academic institutions to bring in more students and taking a look at how those students are oriented when making the transition to a full-time professional role. Others are going so far as to install "rejuvenation lounges" for their workforces, offering massage chairs, yoga, healthful snacks and music. 

Having a space in which to recharge has been huge, as Woods has seen firsthand at Wolters Kluwer, a global provider of software solutions and services for clinicians, nurses and others.

According to Woods, the staffing crisis isn't going away any time soon unless healthcare organizations continue to examine their staffing models, partner with academic institutions and be more mindful of techniques that can help retain workers.

"Personally, I think this is the absolute best time to be a nurse," said Woods. "We need to change the narrative. We need to redefine what nursing is and articulate what we need as a profession. We can't just think about what's going on in acute care. Primary care, rehab settings, clinics – it's about being able to deliver the best care everywhere. Nurses need to articulate what they need to change the paradigm."
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com