5 Steps Hospitals Can Follow To Revamp Nurse Staffing
Look around the healthcare industry and you’ll find near unanimous agreement that something dramatic needs to change, and soon. US employers anticipate total health benefit cost per employee to rise 5.4% next year. That spike comes after nearly of decade of increases hovering between 3% and 4%. And while margins have stabilized slightly, most hospitals continue to see their bottom lines tighten, largely from rising labor and supply chain costs, as well as a shifting payer landscape. From a provider perspective, the cheers from balconies and fanfare for their heroic work during the pandemic have faded but the risk of burnout remains high, and wage increases aren’t fully countering an exodus from the industry.
At the center of these forces is the bedrock of our healthcare delivery system: nurses. As provider groups, hospital systems, and payers all look to lower the total cost of care, nurses are central to nearly every plan. Unfortunately, the COVID-19 pandemic exacerbated staffing woes as nurses reported being overworked, fatigued, stressed, and burned out. Some estimates show that 100,000 nurses left the workforce during the pandemic and an astonishing 610,000 reported an “intent” to leave by 2027. The training pipeline may turn to a slow drip, too. Enrollment in entry-level baccalaureate nursing, Master of Nursing, and PhD nursing programs fell in 2023.
We need a paradigm shift in how the healthcare industry leverages and deploys nurses, particularly hospitals which employ 60% of the nurses in the US. From an operational perspective, most core processes at health systems were developed in a period of analog communication. While digitization and automation are gaining ground, few processes have been completely redesigned to take maximum advantage of the new technologies and to create new workflows. The long and painful implementation of electronic health records is a prime example as nurses invented multiple workarounds due to poor user interfaces.
5 Steps to Meaningful Change
These five guiding principles can help health systems make a step-change in process redesign, not incremental improvement:
1. Build a foundation for process management. Creating and understanding standard expectations and management structures around roles, headcount planning, and staffing often get overlooked when organizations are trying to put out fires — there’s a desire to come back and fix things later, but a new fire is always on the horizon. While seemingly simple, these are critical building blocks that can lead to quick wins, creating consistency and removing unnecessary variation across hospitals and units.
For example, ensuring that clinical leaders are aligned on the goal of nurses practicing at the top of their license. Additionally, leaders should coordinate with housekeeping, allied professionals, and other units to maximize the time nurses have for bedside care. And, at the highest level, nurse leaders should be well integrated into quality and safety committees to ensure continuity across units.
2. Assign specific processes to focused teams or individuals. Specialization enables higher volumes of task repetition, resulting in greater familiarity and proficiency. Typically, a specialized team can get more done at a higher level of quality.
For example, a centralized virtual nurse hub to manage the discharge process across multiple units or hospitals can result in significantly shorter time to discharge for patients and higher satisfaction for floor nurses, who are regularly interrupted during discharge processes. Roberta Schwartz, Executive Vice President and Chief Innovation Officer at Houston Methodist Hospital, describes how the system is using virtual nurses to manage the discharge process in this Oliver Wyman Health podcast.
3. Automate standard processes. Leveraging technology for standardized tasks enables team members to focus on higher value responsibilities and patient engagement. Predictive analytics can be used to develop accurate census forecasts, enabling charge nurses to make timely staffing plans and avoid the scramble to generate more capacity for patient care. On the clinical side, the integration of AI-based automated decision support tools alleviates manual completion of risk assessments, while smart IV pumps reduce clinical documentation burden by automatically sending infusion data to the EHR. Once standardized, processes across administrative and clinical functions could be eligible for automation including those in supply chain, credentialing, pharmacy, and revenue cycle.
4. Leverage hybrid teams. Hybrid teams — across roles and modalities — provide a new avenue to pool resources, avoiding mismatched capacity.
Telesitting, for instance, reduces the need for in-person sitters while reducing falls, and virtual stroke teams provide 24/7 consultations while reducing shift coverage requirements for physicians. To mitigate bedside understaffing during surges, health systems can draw from a broader pool of clinical talent by redeploying MAs, LPNs, and RNs working in employed medical group outpatient clinics. These expanded flex teams require periodic bedside training but offer an avenue for reducing reliance on premium pay or an agency for nursing resources.
5. Improve information flows to reduce waste. Streamline information handoffs to improve timeliness of decision making and reduce frustration.
For example, real-time tracking devices on key equipment eliminates wasted time spent searching for pumps and other mobile medical devices. They can also be used to track patients as they move around a hospital, helping to improve patient handoffs. Automated vital tracking, combined with analytics and streamlined alerts, eliminates labor-intensive processes, improves patient experience, and can improve patient outcomes.
Addressing the nursing shortage and rising costs will take coordination across an entire ecosystem. However, heath systems can control their own destiny to some extent by reassessing why, where, and how they deploy nurse staff. Doing so should result in benefits all around as nurses feel more supported by their hospital and more nurses are available to focus on patient care, while hospitals bend the cost curve through improved efficiency and automation.