Nursing in crisis

A Hospital IQ survey took a deeper look at the current realities of America’s growing nursing shortage, the harm it’s causing, and the future threats if these issues are not addressed. The survey of more than 200 registered nurses working at U.S. hospitals revealed how and why frontline nurses remain caught in a state of constant crisis as they attempt to deliver patient care while facing tremendously stressful environments, untenable patient-to-nurse ratios, and frustrating process inefficiencies. The survey results point to a dire situation: 90% of the RN respondents are considering leaving an already short-staffed nursing profession within one year if staffing issues and poor work environments go unaddressed.

The healthcare industry cannot withstand this potentially devastating loss of even more of the hospital nursing workforce. As nursing shortages get worse, hospitals are unable to staff to capacity, which leads to bed closures, diversions, decreased patient revenue, and less access to healthcare within the community. It’s time to take action to resolve the issues that are causing nurses to leave acute care nursing or exit the profession altogether.

There is cause for optimism. Many health systems are working to address the threats of nursing burnout and retention as a critical part of their strategy to protect their ability to deliver the quality and volume of patient care needed. Those health systems are seeing progress using staffing technology innovations that use predictive analytics to better align staff to demand. This increased focus on hospital operations improves the care delivery experience for both patients and staff by balancing the coordination of bed availability, patient throughput, and staffing needs across the entire enterprise. This complex balancing act increases staff productivity, eases the nursing workload, and boosts staff morale. It’s a powerful strategy that protects the vulnerable nursing workforce while also ensuring the health system has the capacity required to deliver the patient care needed by the community it serves.

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As we examine the survey results and the implications, we’ll take a closer look at these topics:

The Nursing Workforce is in Crisis

While COVID has been a significant driver of burnout and staff turnover, the challenges facing nursing are systemic and go deeper than COVID-driven surges in patient volume. Nurse staffing shortages, burnout, and turnover were creating challenges pre-pandemic, and now the pandemic has made those long-standing problems acute. With COVID amplifying already serious staffing and morale challenges, many more nurses could leave soon if the issues causing nurses to leave the bedside aren’t addressed. As more and more nurses leave, more beds need to be closed, fewer patients can be served, and revenues decrease.

Nurse burnout is going from bad to worse

The survey showed that 72 percent of nurses overall, including 83 percent of nurses with 11-15 years of experience, said they had experienced burnout prior to the start of the pandemic in early 2020.

Most nurses are working on an exit plan

The numbers are staggering – 90 percent of the nurses surveyed indicated that they are considering leaving the profession with 63 percent considering a move immediately or within the next few months. A closer look at the data reveals that longer-tenured nurses are more likely to be thinking about leaving. With long-term burnout issues reaching a breaking point, 71 percent of those with more than 15 years’ experience are thinking about leaving as soon as possible or within the next few months, taking their invaluable experience with them. This leads to a multi-level problem — not only are there fewer nurses, the remaining nurses are less experienced.

Many nurses who don’t plan to leave the profession are still contemplating leaving their current position. Only 24 percent of nurses said they are “likely” to stay with their current hospital. Here is where the rest are planning to go:

Staffing issues are impacting the quality of patient care

Patient to nurse ratios have soared. 45 percent of nurses surveyed said the average ratio across shifts is five or more patients to every nurse. The situation is most alarming in ICUs and Critical Care, where 96 percent said their patient to nurse ratios were 4-to-1 or higher, and in the Emergency Department, where 84 percent said the ratios were 4-to-1 or higher.

Rising patient-to-nurse ratios lead to care delivery delays and less-than-optimal patient outcomes. Overworked and overstressed, many nurses are trying their best but are making mistakes they don’t usually make. 38 percent of nurses said that they had seen patients return to their hospital for post-discharge secondary care. Medication errors or delays (38 percent), sharps injuries (33 percent), and healthcare-associated infections (31 percent) are other impacts nurses have seen due to critical staffing shortages.

Fewer nurses caring for more patients also impacts access to care. 36 percent of nurses said that they had seen patients with acute health conditions walk out of the ER because they had to wait excessive amounts of time for an inpatient bed. 37 percent said that surgeries had to be rescheduled because of bed shortages.

Understanding and Addressing the Key Issues

Overall, nurses are working harder than ever at a great cost to their own well-being. The survey results provide opportunities to examine the root causes of these challenges and uncover some strategies that can help mitigate the staffing crisis.

Understanding and stop the spinout: Protecting nurses’ personal and professional well-being while working short-staffed

The nursing workforce has become trapped in a vicious cycle. Understaffing leads to longer workdays and more overtime for nurses, who become more dissatisfied and burned out. Those unhappy nurses leave the bedside or leave their position to work for a staffing agency, which creates even more staffing gaps. In turn, the nurses who stayed become more overworked and frustrated.

The survey results show a potentially devastating spinout. When asked about their experiences because of understaffing, all Hospital IQ survey respondents indicated at least one negative impact on their own well-being, their ability to provide safe patient care, or both. They are facing serious mental health issues (39 percent), working extreme amounts of overtime (37 percent), experiencing a decreased ability to provide safe patient care (33 percent), and making mistakes they weren’t making before (33 percent).

Compounding the issue, a shortage of patient care technicians (PCT) has resulted in nurses being asked to do more with less. 43 percent said that a shortage of PCTs has impacted their workload.

We need to break the cycle.

While eliminating short-staffing and excessive overtime entirely is ideal, current circumstances make that unlikely for the foreseeable future. Instead, health systems are focusing on how to manage staffing shortages more strategically to create the best possible care delivery experience for both staff and patients. One way to do this is to use technology to analyze and act on staffing challenges systematically across the entire enterprise. Instead of making staffing based on individual unit needs, predictive analytics can provide insights into staffing needs across the organization so that all staffing resources can be deployed to the time and place where there is the most acute need. Rather than each unit fending for itself and protecting its own resources, nursing leaders and the staffing office work collaboratively to ensure optimal deployment of staffing resources, including a strategic plan to fully utilize all available support staff.

Use overtime and other premium pay strategically as part of a holistic compensation strategy

With an imbalance between the supply of nurses and the care needs of patients, many health systems are struggling daily to find staff to meet the needs – especially during patient surges. Decisions to push staff to work excessive overtime, use high premium pay incentives, and/or rely heavily on agency and traveler nurses are born out of desperation to fill a pressing, immediate need. While necessary in the short-term, these staffing fixes are not sustainable. Instead, they make the problem worse in the long-term as staff nurses become so dissatisfied that they seek other options.

The possible solutions for this issue are complex and multi-faceted. When asked what should be done to support nurse retention and increase satisfaction, respondents indicated factors related to their compensation package are essential – 40 percent want better, broader benefit packages and 32 percent said higher pay and/or bonuses. More attractive compensation packages could help prevent staff nurses from leaving to work at an agency. Recognition for a job well-done is also important (38 percent).

Beyond increased compensation and recognition, the long-term resolution also involves better staffing methodologies that enable more optimal staff utilization so that staff can get the time off they want – a priority for 33 percent of respondents. For example, using data-driven insights to determine staff allocation across the organization can eliminate daily staffing chaos. As a result, staff benefit from increased schedule predictability.

Improved staffing strategies also help organizations achieve a more balanced distribution of the workload, alleviating some of the burden of excessive overtime. Comprehensive staffing data can be used to find underutilized internal resources, such as staff who are not working up to their full commitment. That reduces the need to rely on the same nurses to continuously work excessive overtime or turning to high premium pay to fill staffing gaps.

Eliminate communication silos that complicate staffing and create frustration

With nurses in short supply and high demand, reducing inefficiencies that take them away from patient care can boost both morale and productivity. When asked about what must be done to decrease burnout and turnover, the vast majority of respondents indicated that improved processes, communication, and coordination are essential for creating a better work environment. Specifically, respondents desire streamlined processes that ensure visibility to patient needs (52 percent), better communication and coordination across departments (45 percent), improved communication with hospital leadership (40 percent) and more organized, consistent staffing processes (39 percent).

The right staffing automation enables the standardized, enterprise-wide staffing processes that many nurses feel would help create a better work environment. With visibility to both staffing needs and available staff across the entire organization, collaborative decisions can be made about how to utilize available resources to best meet the needs of the health system as a whole. And, integrated communication tools can automatically notify all staff of where, when, and for how long they are being deployed.

Automation can also improve the processes used to deploy float nurses. Without the right communication tools, float nurses start their day without knowing where they’ll be working or where they’ll be going next. They end up playing phone tag with the staffing office as they juggle their current assignments while preparing to move to their next assignment. With a system that uses predictive analytics and built-in communication tools, deployments can be planned in advance and that communication is automated. It’s a win/win – float pool resources are optimized, and deployment expectations are clear in advance.

Intelligent Automation Can Change the Trajectory of the Nursing Crisis

In today’s environment, nursing resources are a precious commodity that must be protected, nurtured, and fully leveraged. Health systems are rethinking how they can achieve operational excellence and prioritize strategies that optimize staffing resources while also removing the barriers and bottlenecks that inhibit nurses’ ability to efficiently deliver patient care. Hospital IQ has partnered with health systems to achieve the mission critical task of aligning beds, patients, and staff by delivering technology solutions that support their performance excellence goals.

Enterprise staffing model delivers a holistic solution

After managing staffing the same way for years – or even decades – many health systems are discovering new staffing solutions that enable better staffing workflows. Safe, effective staffing has a profound impact on patient care, staff well-being, and hospital operations. Simply put, better staffing leads to meaningful improvements across the entire organization.

A new staffing model that delivers clinical, financial, and operational benefits – including many of the things that nurses said would improve their work environment and morale – is enterprise staffing. Enterprise staffing is a holistic approach to staffing that leverages AI-driven predictive analytics, workflow automation, and streamlined communication to focus on collaboration, data-driven staffing decisions, and proactive issue resolution across the enterprise. Health systems manage their staff based on the needs of the enterprise, instead of looking only at the individual facility or unit. That leads to more balanced coverage across the entire system, which increases the number of patients who can be served and reduces the need for bed closures.

The use of new staffing strategies helped health systems manage pandemic patient surges, and many nursing leaders feel that new staffing methodologies remain a critical go-forward strategy. A longitudinal AONL survey found that nursing leaders feel that the adoption of new staffing models is the temporary advancement that will be most important to maintain beyond COVID-19, with 37 percent of respondents choosing this option in August, 2021 – a significant increase over the 28 percent who chose this in July, 2020.

Streamline the daily staff allocation process

By integrating with existing workforce management and other applicable systems, the Hospital IQ solution gathers data to provide increased visibility to unit-level needs, staff considerations (such as seniority, role, special considerations like light duty, no COVID, or orientee; and last float indicator), and available resources. This streamlines the daily resource planning process.

A system that automates daily staffing workflows and streamlines communications enables charge nurses to quickly specify their staffing needs for the day. The staffing office no longer needs to make numerous phone calls or round on the units multiple times a day just to determine what the needs are. As a result, the staffing office and nursing leaders spend less time allocating staff each day and are confident that the staffing deployment plan that is activated at the start of the shift is optimal based on the staff available. The streamlined processes free up valuable time – time that nursing leaders can use to focus on the needs of their patients and staff and the staffing office can use to resolve future staffing issues.

Improve 7-day schedule management process

To create future staffing plans that align with patient care needs, the staffing office and unit managers must have the ability to see and plan for future staffing challenges across the organization. The Hospital IQ platform provides predictions of future demand that give nursing leaders visibility to staffing variances days in advance, allowing them to proactively resolve staffing gaps and misalignments.

By providing the staffing office and unit managers with the insights they need to align nursing staff to patient demand days in advance, they can be more strategic about how they optimize available staff. Decisions about when to flex staff from low census to high census days, use staff who have not met their commitments, offer incentive pay or overtime, and rely on float staff or external resources are made deliberately and driven by data.

Staffing process improvements with far-reaching positive impacts

When asked what must be done to improve the poor work environment that leads to burnout and turnover, 39 percent of the survey respondents chose more organized, consistent staffing processes.

An enterprise approach to staffing enables essential process improvements that create a more productive workplace, making it easier for nurses to deliver care effectively:

Streamline communications and alerts across your teams

Collaborate to meet staffing needs across the entire enterprise

As many health systems have discovered, a collaborative, organization-wide approach to staffing benefits the entire health system. The transparency offered by an enterprise approach to staffing empowers nursing leaders to see and understand the state of the entire organization. With that knowledge, it’s easier for them to work together to resolve staffing issues across the system rather than focusing solely on protecting their unit.

The link between short-staffing and capacity management

Staffing and capacity management are interlinked – chronic, acute short-staffing results in closed beds, and capacity management has an effect on nurse satisfaction and productivity. Discover strategies to address capacity and patient flow issues by improving the care delivery journey for both patients and staff.

The Path Forward: Using Technology Innovations to Align Beds, Patients, and Staff

The healthcare workplace is dynamic and fast-paced. When unnecessary manual labor, inefficient workflows, and ineffective communication are layered over that inherent complexity and variability, both staff and patients suffer. Unpredictable schedules, short-staffing, working in unfamiliar locations, unexpected care delays, data that makes it difficult to understand current and overall performance, disconnected teams – these all add more chaos to an already complicated situation and eventually result in more turnover, more short-staffing, and more closed beds.

Nurses become nurses because they want to care for people. The unnecessary stressors detract from their primary goal of patient care and add burdens that can either be better managed or removed entirely. Left unresolved, or even worsening in times of short-staffing, these burdens can create a working environment that’s so unwelcoming and so far removed from patient care that nurses become burned out and leave the bedside.

A focus on improving your daily staffing to ensure your staff is allocated to the areas of greatest patient need across your health system can improve processes and communication to eliminate some of the unnecessary stressors. The result is a healthier, more productive workplace. Nurses can focus more time and energy on patient care.

This is how intelligent automation can change the trajectory of the nursing staffing crisis, slowing the mass exodus of high-value nursing talent and optimizing the skills of those who remain at the bedside.

Learn more about how Hospital IQ increases staff satisfaction and efficiency with future insights, automated workflows, recommended actions, and much more.