Stakeholders share solutions to nurse staffing challenges

Nurse providing care to a COVID-19 patient

Hospital nurse staffing is a complex undertaking under all circumstances. Introduce a pandemic in which space and treatment needs exceed the capacity of available professionals, and you end up with a situation that can sometimes seem insoluble. Yet difficult situations tend to breed innovation, and American hospitals have risen to meet the challenge of the nursing shortage in a variety of ways.

“COVID-19 has really strained the system,” says Kendra McMillan, registered nurse and senior adviser on nursing practice and work environment at the American Nurses Association.

Kendra McMillan
Kendra McMillan

“This has brought to light long-standing staffing issues in health systems. We are now seeing another wave of increased demand for treatment, but this one consists of people in advanced stages of other illnesses due to delayed care. This led to nurses taking longer and longer shifts and working more overtime, sometimes without a break. They are working to meet growing demand, and it has consequences. »

McMillan says another serious problem is the departure of experienced nurses and their replacement by much younger colleagues. “Many older nurses who were nearing retirement when the pandemic began made their plans to leave early, meaning many new graduates and early career nurses are moving into more experienced nursing roles in the past. “, she says. “We call this the ‘Experience Complexity Gap’.

Anne Herleth, director of research and consulting at the Health Management Academy in Virginia, agrees that there is a shortage of experience in addition to existing staffing shortages. “You may be able to increase enrollment in nursing schools in the short term, but you can’t replicate long-standing skill sets overnight,” she says.

Anne Herlet
Anne Herlet

“It is possible to bring in educators virtually to offer expertise, which can be expensive and difficult, but has the potential to be useful. And you also need to think about how the experience levels of nurses fit into emerging models of care like in-home and outpatient services. You need to re-develop nurses who have been trained in acute care so that they can move into those areas.

The increase in workplace violence against nurses, from both patients and family members, compounds existing challenges. “Nursing professionals are enduring hostile conditions these days,” McMillan says. “The environment is detrimental to their psychological and physical health, and rates of depression and anxiety are higher, as are rates of suicide attempts and suicides.”

Looking for nurse staffing solutions

All of these factors taken together, it’s no surprise that leaders tasked with hiring, retaining and planning for hospital nurses have their hands more than busy. They need to think in multiple dimensions at all times to be effective, according to Herleth. “They need to consider the immediate, short-term needs of the facility as well as its longer-term benefits,” she says. “They also need to make innovation happen top-down and bottom-up. All of these things are essential.

Herleth says one way to improve efficiency and job satisfaction is to ensure nurses are able to use their full skills. “You want nurses to work at the ‘top of the license’,” she explains. “That means they practice to the fullest extent their license allows. Sitting at a computer inputting endless information or spending time clicking through many different screens takes time away from the bedside and compromises their ability to work effectively When nurses have worked hard to earn additional credentials, they should use them to feel fulfilled.

According to Herleth, the fact that hospitals are working more closely with nursing schools also offers possible answers. “Schools and health system leaders have the opportunity to better align themselves in training and preparing nurses to provide care in changing contexts,” she says.

“The working environment that nurses are entering is so much faster than before, and there is little there is much health systems can do to support employees in the first year after nursing school, which is when much of the rolling occurs. There is room for improvement and collaboration on all sides.

Find common ground

So how can the challenges be addressed in practice in the nursing unit, in a way that benefits both staff and patients? Janel Allen, senior vice president and director of human resources at Children’s Hospital and Medical Center in Omaha, Neb., says the facility fulfills its mission by increasing connections between nurses, their colleagues and their employer.

Janel Allen
Janel Allen

“We know that our nursing team members are critical to achieving the patient experiences and outcomes we want,” says Allen. “We focus on listening and meeting their needs, and we do that in a number of ways.”

Allen says the hospital has a discretionary bonus program in place to allow staff members to share in its success, and an engagement reward program financially rewards team members for remaining employed by the hospital. ‘hospital. A paid community volunteer initiative called Be Involved offers the opportunity to seek fulfillment by giving back. New paternity leave benefits help families bond with their newborns and adopted children. The hospital is updating its staffing model to include licensed practical nurses. And a robust employee resource group program offers staff members a way to connect with each other, share common interests, encourage belonging and diversity, and support professional development and leadership. .

Children’s also had team members help design a nursing residency initiative for new graduates. And it hosts a program called S2RN in which nursing students are sponsored for employment, receive tuition support, and then continue to work in the hospital after graduation. “We’re building a ‘best place to nurse’ environment where team members can find joy and meaning at work,” says Allen. “We also have smaller initiatives like ‘zen dens’ where nurses can relax during a shift, and a moral support dog focused solely on easing tensions between employees.”

Howie, the Children's staff therapy dog, as part of efforts to support nursing staffing and welfare.
Howie, the Children’s staff therapy dog.

According to Allen, the nurses’ feedback shows that the hospital’s efforts are working. “Nurses tell us that they feel listened to, supported and valued,” she notes. “They say they feel empowered to participate in shaping the future of the hospital, and that loyalty shows in our retention measures.”

To advance

McMillan says technology and teamwork will be at the forefront of nurse staffing solutions in the future. “We are seeing hospitals implementing digital scheduling and recruiting platforms to screen and vet applicants and fill positions quickly,” she says. “There are also forecasting tools that nurse leaders can use to track patient flow and better match staff assignments. Health systems provide workplace wellness initiatives and ensure nurses’ mental health is supported. Respite rooms provide mental and physical breaks, and team members are encouraged to monitor each other. Even robotic technology is being used to do simple tasks like delivering supplies so nurses don’t have to.

Building on this momentum, the ANA recently launched a nurse staffing task force to design long-term sustainable solutions. It also convened a nurse staffing think tank to determine how the recommendations can be implemented.

“Nursing leadership steps in to ease the burden on staff members, and healthy work environments are a priority,” McMillan says. “There are some very creative things happening in nursing.”

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