New efforts seek to balance nurse staffing with access to care
Are National Nurses Week 2024, and it’s time to celebrate the more than 5 million RNs across the country who are so essential to the delivery of care. But the celebration is overshadowed by many challenges impacting the nursing workforce. The most important among them: critical workforce challenges.
Some federal and state lawmakers are trying to impose patient-provider ratios to help improve care and reduce nurse burnout. But many nursing and hospital groups oppose laws requiring minimum nurse staffing levels, highlighting the risk of patients being diverted if there aren’t enough nurses available when they arrive at the hospital.
In addition to regulatory solutions, healthcare leaders are using information and technology – generative artificial intelligence, virtual nursing teams and algorithms that improve understanding of patient acuity – to help alleviate the burden on nursing staff.
Healthcare organizations are “very interested” in innovations that can modernize nursing and solve the challenge, said Tom Leary, senior vice president and head of government relations at HIMSS, parent company of Healthcare IT news.
“With patient and staff safety as fundamental values for engagement, the appropriate use of management system technologies can help nurses develop the right mix of staff to meet the needs of patients and nursing staff,” he said.
Feds and states are hiring nurses
The past four years have obviously been particularly tough for nurses. And even if the COVID-19 crisis has abated, the aftereffects remain: the workforce is being squeezed. In 2022, a report found that as many as 90% of nurses are considering leaving the profession.
Fortunately, quitting hasn’t happened on that scale, but it has significant turnover since the pandemic. And many challenges remain for nurses still working.
Catherine Kennedy, RN, vice president of National Nurses United, shared USA today this week that the current state of nursing is being affected by hospitals cutting costs at the expense of nurse safety, and nurses routinely fight the administration over staffing levels.
At the federal level, both the House and Senate introduced bills last year to amend the Public Health Service Act. The Senate Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act prescribes requirements for direct care RNs and others.
While California and Massachusetts have well-established hospital nurse-to-patient ratios, Oregon became the first to adopt one hospital staffing plan law in September.
Becky Hultberg, president of the Oregon Association Hospital and Health Systems, told News KMTR after the announcement that the final version was the result of long negotiations with all parties at the table.
“It was pretty clear that we needed to come to the table together and talk about how we could solve the labor shortage, and that’s what we did,” she reportedly said.
With a statewide nursing shortage, the Ohio Hospital Association opposes this policy stuckHouse Bill 285, which requires hospitals to establish registered nurse staffing plans.
Buckeye State Hospitals say this would hurt their ability to provide care, according to a Dayton daily newsreport this past week.
The American Hospital Association, meanwhile, calls state-mandated staffing levels ineffective in improving patient care and nurse experiences.
“Mandatory nurse staffing levels imply a ‘one size fits all’ approach to patient care,” the AHA said in its report. mandatory nursing workforce legislation toolbox. “Nurse leaders and nurses are best qualified to determine appropriate staffing levels for the needs of their patients.”
Mixed support for mandatory ratios
The Pennsylvania Patient Safety Act, which passed the House of Representatives in June, receives support from nurses. The bill is now in the hands of the Senate.
“Common-sense patient protection has been a nearly two-decade journey,” said Wayne Reich, CEO of the Pennsylvania Nurses Association
Last year, Michigan lawmakers proposed bills that would create mandatory minimum nurse-to-patient ratios, but Brian Peters, CEO of the Michigan Health and Hospital Association, called it “flat-out wrong” and said it would significantly impact patient access to care would endanger.
“Such a mandate would create an intolerable situation for hospitals when a patient shows up and the facility is already at the prescribed ratio: willingly ignore the law and risk fines, penalties and reputational damage, or follow the law,” leading to patient diversions and limiting access to care, he explained in September report.
In March, MHA released a new report aimed at prioritizing staffing levels because while Michigan hospitals employ more than 62,000 nurses, “the reality is we are desperately trying to hire thousands more in every corner of the state” , Peters said in one rack.
He said staffing decisions take into account the volume and acuity level of patients, the training level and experience of all members of the care team, technology and updated data.
“There is a good reason why the Michigan Organization of Nurse Leaders is firmly against this legislation, and a good reason why many nurse leaders I have spoken with in recent months have said they are personally offended by the premise behind it,” said he.
The role of technology in easing nurses’ workload
Informed technology can help “improve clinical care delivery and enhance the overall work experience for practicing nurses,” says Whende M. Carroll, clinical informatics consultant at HIMSS.
With the knowledge and skills to act as a liaison between clinical and technical stakeholders, informatics nurses assess and redesign workflows to reduce nurses’ administrative tasks and lighten their workload.
“Nurse informaticists in healthcare organizations can influence staffing practices for administrators and nurses by helping them leverage new technologies, such as using intelligent automation for improved scheduling tools and documentation capture for seamless access to medical records for burden reduction and deploying tracking and trending systems for real-time data reporting and visualizations to help leadership make more accurate and faster workforce decisions.”
GenAI could help address the nurse shortage by easing the burden of patient documentation, making the task faster and getting needed information quickly appearing in electronic health records, according to Jill Lashay, healthcare attorney, and Carly Barnes, associate at Buchanan Ingersoll & Rooney.
They said that while the nursing shortage is unlikely to ease this year, due to reduced enrollment in nursing schools and other factors, “health care systems may consider developing virtual nursing teams.”
Virtual nursing is designed “to both address the ongoing nurse shortage and improve the patient experience” and provide an additional layer of safety monitoring, Barnes told Healthcare IT News in February.
“Nurses can work from an on-site command center, or even from home, to handle patient admissions, discharges and transfers, review medical history and assess current symptoms.”
Salt Lake City-based Intermountain Healthcare, which has earned top marks for patient telehealth services, is testing a virtual nurse that helps floor nurses with patient care. On a recent LinkedIn afterBecky Fox, Chief Clinical Information Officer, reported on the modernization of nursing and said she heard firsthand “how excited nurses are to help innovate new technology, to share feedback on what works and what doesn’t and to collaborate creatively.”
She noted that a telehealth nurse at St. Joseph’s Hospital in Denver told her about a powerful bond with a patient during their admission.
Many nurses have a deep district of AI. But others are much more encouraged about what it could mean for clinical practice. Stesha Selsky, DNP, and Meg Furukawa, RN-BC, nurse informaticists for the UCLA Health System, said last year that algorithms make nurses’ workloads more equitable.
Where measuring nursing workload in acute care is needed in California, they helped build a nursing workload tool in the EHR to produce individual workload scores based on patient chart information.
Furukawa explained how informatics scientists involved bedside nurses and other nurses to create the scoring tool and guide how it works.
They say this has resulted in a more equal workload for nurses, as charge nurses can better assess and request additional support.
“The score is very transparent,” Selsky said.
Nurses have overwhelmingly reported in various surveys and studies before, during and after the pandemic that inefficient manual workflows and processes require too much time and attention, often making it challenging to spend time with patients and communicate care between departments and coordinate teams.
Their job satisfaction fell during the pandemic, and not surprisingly 100,000 nurses left the profession with another 610,388 intending to leave the workforce by 2027, according to research from the National Council of State Boards of Nursing published in 2023.
They have long said that improving nursing technology to spend more time with each patient – improving acute care, outcomes and experiences – increases job satisfaction.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.