There are many benefits to nurse staffing ratios, for nurses, patients, and health systems, says this CNO.

One proposed solution for ensuring proper staffing is staffing ratios.

Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.

"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."

Here are five benefits of nurse staffing ratios. 

Click here to read the accompanying article. 

Health systems like West Tennessee Healthcare are using AI platforms that can map out a patient’s predicted stay, allowing clinicians to plan discharges and even coordinate with payers on insurance coverage.

Predictive AI is starting to show its value in healthcare by helping hospitals plan patient care, from length of stay and discharge to insurance coverage.

At West Tennessee Healthcare, executives say they’ve saved more than $5 million over the past year by using an AI platform from Xsolis to review patient data, enabling them to predict when a patient will be discharged and communicate with payers on authorizations and any denials.

“Prior to this everything was a manual chart review, so the case managers were reviewing everything manually, looking through every chart, digging for a lot of information and documentation,” says Debbie Ashworth, executive director for care management for the 90-hospital network. “Now they don't have to do as much. The AI has really improved workflow processes [and] timeliness of those reviews.”

Health systems and hospitals across the country are embracing AI at a rapid pace, but the opportunities for clear and demonstrative ROI have so far been few and far between. Using the technology to sort through data from the medical record and other sources and give clinicians insight into improving patient care is one of those use cases.

The key to this particular use case is that AI isn’t affecting clinical decision-making. It’s performing administrative tasks that had previously been done by nurses, doctors and other care team members, reducing time spent in front of a computer.

At West Tennessee, the platform creates a Care Level Score for each patient, which gives clinicians an expected length of stay and discharge time based on patients with the same healthcare concerns. That score is used by utilization review, case management, and physician advisor teams to map out care management.

The platform’s link with payers takes that one step further. Ashworth says two payers are now connected to the platform, giving health system clinicians and staff the opportunity to coordinate patient care and insurance coverage more closely, reducing time-wasting delays and lengthy appeals.

 “That has really improved our relationship with the payer and also the timeliness of getting the responses back,” she says, noting this cuts down on the phone calls, e-mails and faxes that often pass between provider and payer while the patient waits for care services. “The conversations we have with them are better [because] you’re both getting information that you can share.”

Ashworth says the biggest challenge to the technology has been change management. Staff and clinicians need a little time, she says, to get used to using the technology—and learning what to do with the time saved.

She also says the toll is “not 100% but very accurate,” and case managers always review the care plans and have picked up on errors.

“Just having that [data] right in front of us, to know that this patient should discharge tomorrow or … this discharge is going to be two or three days from now, [enables care teams] to prioritize a lot better and get to the appropriate level of payer,” Ashworth says. “Now they're able just to focus on what they need to do to get the patients discharged or get their insurance approved.”

The significant changes in healthcare have also impacted nursing education.

On this episode of HL Shorts, we hear from Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing, about how nursing education has evolved to fit the needs and values of the new generations of nurses. Tune in to hear his insights. 

A recent HIMSS forum in Boston highlighted the challenges—some new, some expected-- faced by healthcare executives in managing AI adoption.

Health system and hospital executives looking to embrace AI will need to think long and hard about how they’ll measure ROI. That may include using the technology to actually replace care providers.

Lee Schwamm, MD, senior vice president, chief digital health officer, and associate dean of digital strategy and transformation for the Yale New Haven Health System and Yale School of Medicine, told a busy audience at last week’s HIMSS AI in Healthcare Forum in Boston that the technology will have a profound impact on healthcare delivery. The challenge, he said, will lie in understanding that impact before it happens.

“We’re going to need better financial models to really understand the ROI,” he said, noting that healthcare organizations have so far found only three or four successful use cases for the technology.

Schwamm says the healthcare industry has become “accustomed” and “complacent” in healthcare IT, and Ai is presenting healthcare leaders with issues they haven’t encountered before. The AI evolution, he pointed out, is similar to the development of the software-as-a-service (SaaS) model, but health systems and hospitals haven’t developed the governance to regulate these tools before they’re used.

Eve Cunningham, MD, MBA, chief of virtual care and digital health at Providence, agreed.

“I’ve had e-mails where [doctors] say, ‘I just really enjoy using ChatGPT while in clinic,” she said.

The challenge for hospital leaders like Schwamm and Cunningham is to get ahead of a technology that’s moving faster than anything they’ve seen before, and at a time when the industry is struggling with significant issues that AI could eventually address.

“We have to catch up to that SaaS model,” Schwamm said.

Healthcare leaders across the country are pulling their legal and compliance teams into the conversation, in some cases developing strategies based on hypothetical issues. And they’re trying to educate clinicians who might see just the good in AI and not understand the ramifications of fast adoption without governance.

AI “lowers the bar for non-technologists to use sophisticated technology,” Schwamm said.

Cunningham noted that AI tools are being tested out across the enterprise, often in small programs that show very specific, though limited ROI. Leadership has to find a way to keep track of all these programs and integrate them into a governance structure.

She said health system leadership needs to take a step back and assess the new tools and technology being pitched in healthcare. Many vendors, including those in AI, are aiming at the patient experience and engagement space, with products that promise to improve the clinician-patient relationship. But healthcare organizations are struggling with stress and burnout, to the point that a new tool that offers results “with just one more click” isn’t a good selling point, and products that aim to give clinicians time to take on more patients are just adding to the misery of overloaded workflows.

“There is no more room for one more click,” noted Zeev Neuwirth, an author, podcast host and former chief clinical executive for care transformation at Atrium Health who moderated the HIMSS panel.

Several panelists at the HIMSS forum said AI’s potential to synthesize data and take pressure off of clinicians has to be balanced with an understanding of how healthcare should manage the vast amounts of data coming into the enterprise. That may mean creating a change management strategy devoted solely to AI adoption, to give healthcare leaders an understanding of how AI will take that data and make it useful to clinicians.

AI’s potential to address workforce shortages in healthcare may also mean it can be used to replace people, especially for positions that hospitals are having problems filling. And Schwamm noted that as health systems and hospitals focus on operational factors to improve their financial standing, AI could work its way into labor negotiations.

Cunningham said the industry will eventually have to get its act together and pull all the loose AI threads into one organized strategy.

“What does it all look like five to seven years from now?” she asked. “How will all these things that we’re doing come together?”

Adequate nurse staffing ratios are associated with better patient outcomes, says this CNO.

The nursing shortage impacts other nurses by causing burnout and exhaustion, and inadequate staffing directly affects patient safety and experience.

CNOs must be aware of those risks and consider all possible staffing models and solutions so that they can make the best decision for their hospitals and health systems.

According to the American Nurses Association, proper nurse staffing improves patient outcomes and satisfaction among nurses and patients. One proposed solution for ensuring proper staffing is staffing ratios.

Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.

"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."

What are the benefits?

According to Tilton, higher nurse staffing ratios can reduce the likelihood of adverse events, falls, and patient deterioration. In this case, nurses have more time to monitor patients and spot warning signs, and they can intervene quickly when complications arise.

"Optimal staffing ratios enable nurses to conduct thorough assessments, administer medications safely, and implement proper infection control measures," Tilton said, "thereby minimizing the risk of errors and harm to patients."

Proper staffing ratios can also help mitigate burnout and job dissatisfaction, Tilton explained, by lowering workload intensity, stress, and fatigue.

"When nurses are not overwhelmed by excessive patient assignments, they can maintain a healthier work-life balance, experience less emotional exhaustion, and feel more engaged and fulfilled in their roles," Tilton said.

Additionally, staffing ratios can allow nurses to practice at the top of their license, according to Tilton. They provide more time for professional development opportunities as well, such as continuing education, specialty certification, and leadership roles.

"Nurses can collaborate more closely with interdisciplinary team members, participate in care planning, and contribute to quality care initiatives," Tilton said, "when they are not overwhelmed by excessive workload demands."

Financial impact

Just like with any new program or workforce strategy, CNOs need to be able to justify the cost to the rest of the C-Suite.

"While ensuring appropriate nurse staffing ratios may require upfront investment," Tilton said, "it can yield long-term financial benefits for healthcare organizations."

There are several financial benefits to staffing ratios that can lead to saving more time and money for both the nurse and the health system.

"Improved patient outcomes, reduced lengths of stay, lower rates of readmission, and higher patient satisfaction scores associated with optimal staffing ratios can lead to cost savings, enhanced reimbursement rates, and increased revenue generation," Tilton said, "for hospitals and healthcare systems."

Proper staffing ratios also lower nurse turnover rates, according to Tilton, which is an additional financial benefit as well as a solution to the staffing shortage.

"Organizations that prioritize nurse satisfaction and retention by maintaining safe staffing levels can avoid the high costs associated with recruitment, orientation, and turnover of nursing staff," Tilton said.

Overall, Tilton explained, staffing ratios for nurses promote patient safety, quality of care, and better organizational performance.

"By prioritizing adequate staffing levels and workload management," Tilton said, "healthcare organizations can achieve better clinical outcomes, enhance the patient experience, and create a supportive and sustainable work environment for nurses."

Legal implications  

While there is no current federal legislation mandating nurse staffing ratios, several states have legislated standards for staffing ratios or have made attempts to do so.

California has had legally mandated staffing ratios since 1999, which according to National Nurses United, are based on individual patient acuity and are designed to fix unsafe staffing in acute-care settings. The California staffing ratios require numerical RN-to-patient ratios as well as a patient classification system. The law also regulates the use of unlicensed assistive personnel and restricts "floating" nursing staff.

Implementing staffing ratios, however, requires levels of nuance depending on the health system.

"It’s important to note that the impact of legislation mandating staffing ratios can vary," Tilton said, "depending on factors such as geographical location, healthcare setting, patient population, and resource availability."

Health systems might run into several implementation challenges, Tilton explained, including budget constraints, potential staffing shortages, and a resistance to change from staff. These roadblocks can impact the effectiveness and outcomes in a mandated ratio scenario.

"Policymakers, healthcare leaders, and stakeholders must carefully consider the unique context and implications of staffing ratio legislation," Tilton said, "to maximize its benefits and address potential challenges effectively."

While wearable devices have gained attention for their use in remote patient monitoring programs, hospitals are finding more value in inpatient programs

Healthcare leaders are going wireless to monitor patients in the hospital, using new technology that can track a wide variety of vital signs and give providers new insights into improving clinical outcomes.

For many health systems, the initial thought is to use wearables to monitor patients who are discharged from the hospital and into a remote patient monitoring program. But Sarah Pletcher, MD, MDHCS, Houston Methodist’s vice president and executive medical director for strategic innovation, says the inpatient setting gives hospitals an opportunity to improve a key element of care management.

“We wanted to use it in the inpatient setting because we've seen the value of continuous algorithm-based monitoring by a dedicated and highly skilled remote clinical team in the virtula ICU space,” she says. “And the idea that we could hack the way vital signs are taken in the hospital setting, which hasn't really been innovated much in the last hundred of years, was a key opportunity area.”

Houston Methodist selected BioIntelliSense's BioButton roughly one year ago, after an exhaustive process during which Pletcher even slept and showered with multiple wearables to make sure they had the form, features, and would function as intended. Pletcher says she wanted an unobtrusive, durable, medical-grade device that would track several vital signs and be scalable.

Houston Methodist is using the wearable to supplement and replace manual collection of vital signs, pushing data hourly into the EMR and continuously to a central team, who respond to algorithm alerts and then alert bedside nurses when their review data suggests something concerning.

“As we began to advance the technology across the system, we also began to redesign how we did routine vitals,” Pletcher says. “We went from every four hours for routine vitals first to every six then to every eight. And we will look for opportunities to stretch it to every 12, especially at night and for stable patients so that the patient gets more rest. The bedside teams get a bunch more time back while at the same time there's a peace of mind that even when they're not in the room with the patient doing a spot check, the technology is there gathering data every minute and flowing it to a central monitoring team that's keeping an extra eye on things.”

While the wearable detects a wide variety of vital signs, Pletcher says she’s most impressed with the value of objective, high-frequency respiratory rate.

“It turns out that changes in respiratory rate are one of the earliest things you start to see in a patient,” she says. “By the time they get to the point where their blood pressure is tanking, you're late in the game, they've likely been deteriorating for a while.”

And that’s where wearables might prove their ROI in clinical outcomes. The ability to track vital signs in real time means clinicians can identify patients in distress much earlier, rather than waiting for a nurse or doctor to come to the bedside. In many cases clinicians can intervene even before a patient shows any outward signs of distress—and with AI tools on the horizon, the opportunity to collect and analyze data in the blink of an eye offers more potential for early detection.

Pletcher sees a more immediate ROI in workflow improvements, especially for nurses.

“The ROI is solid just based on the workforce savings,” she says. "Not having to send staff wheeling that vitals cart in there for every patient every four hours no matter what, can offset the cost of using the technology. And that doesn't factor in quality/safety catches, patient experience and nursing and physician satisfaction that there's more in place helping to look after their patients. Every day there are moments where we're catching patients earlier and hopefully avoiding them needing more intensive intervention.”

She’s also noticed the ability for wearables to pick up on heart rate arrythmias, giving hospital officials new insight into whether the wearables can reduce the demand for telemetry. And she’s looking forward to the ability to monitor pulse oximetry, blood pressure, and heart function and to differentiate between surface and core body temperature.

“Sometimes it's a case of we already are getting the data,” she says. “We've never had it before, not at this frequency and scope, so we're still learning how to use it.”

Aside from teaching clinicians how to be comfortable with the wearables and understand the data coming in—a common element of change management that comes with almost any new technology—Pletcher says one the biggest issues they’re having with wearables is remembering to collect them when a patient goes home. Sometimes, she says, the small devices are forgotten and thrown away or accidentally go home with the patient.

Using Wearables to Address One Specific Care Concern

While some hospitals see wearables as a means of improving inpatient monitoring, others are starting with one use case, such as monitoring cardiac care patients or trying to reduce sepsis cases.

At Sutter Health, hospital leaders are using a wearable that attaches to the neck and takes an ultrasound of the patient’s carotid artery and jugular vein. The Flopatch Doppler ultrasound patch, developed by Flosonics Medical, enables care teams to identify signs of sepsis, hypertension/shock, and renal failure earlier and take action.

“We’re losing a lot of people [to sepsis] every year,” Kristina Kury, MD, medical director of critical care at Sutter Health’s Eden Medical Center, says of the deadly infection, which is the primary cause of death in hospitals, killing almost 40% of the 1.7 million patients each year who get sepsis.

Kury says the patch focuses on carotid artery flow time, creating a waveform that’s similar to an echocardiograph. That measurement changes when IV fluids are administered—too much fluid causes heart failure and respiratory distress, while too little fluid takes out the kidneys and other organs.

“it's extraordinarily easy and practical, and that device can stay with the patient for a week while they're in the hospital because we know things are dynamic,” she says of the patch, which is now being integrated into care pathways in four hospitals. “It's another tool that you can use to incorporate into that clinical scenario, and it's a much more accurate vital sign than heart rate.”

Kury says Sutter Health has reduced its sepsis rate to 20% through other improvements, but seems to have hit a plateau. One option was a non-invasive cardiac output monitor, which consists of a console that has to be wheeled into each patient room and electrode patches that have to be applied to the patient and which isn’t ideal for patients with structural heart disease and vascular replacements.  Other options were cardiac catheters and central venous pressure monitors, both invasive and imperfect.

A wearable, Kury says, addresses a specific care gap but won’t make the patient any more uncomfortable.

“We have people at the outset who are going to be sensitive to giving any kind of intravenous volume because the heart muscle is not healthy [through] heart failure or their kidneys have failed, and they’re on dialysis,” she notes. “They have no way of intrinsically removing fluid from their body, so they quickly could get into trouble. That’s a vexing population to our clinicians, especially in the ER, where they're coming in with an undifferentiated person in shock.”

The Bluetooth-enabled platform, which isn’t yet integrated into the EHR, enables clinicians to monitor six patients through one dashboard in real time.

As a doctor, Kury says, “I would want to see the data myself, the curve, the waveform, the spikes, and I would want to see that myself and then have the interpretation.”

The Rise of Connected Care

Influenced by consumer-facing technology like activity bands, smartwatches and sensor-embedded clothing and jewelry, healthcare organizations have long studied the use of wearables in RPM programs outside the hospital setting. But with more sophisticated medical-grade devices on the market and a desire to create a “hospital room of the future” that places a premium on wireless technology, healthcare executives are now interested in bringing wearables inside the hospital.

Julia Strandberg, chief business leader of connected care and monitoring for Philips, says the next three to five years will see a fundamental shift in how health systems and hospitals view patient monitoring.

 “Scalable, integrated and optimized patient monitoring and management system for the hospital” will become more popular, she says, as decision-makers see the value in keeping a continuous eye on patients rather than relying on spot checks or scheduled vital signs monitoring.

The benefits are numerous. Many hospitals struggled with patient monitoring during the pandemic, when infected patients were isolated and staff and clinicians had to step into bulky PPE to see them. In addition, hospitals have long struggled with the number of wires, leads and other devices attached to the patient, hindering patient movement (a key metric for clinical improvement) and prone to tangles and trips. Add to that the stress and burnout rate for clinicians and staff and the propensity to use loud sounds to demonstrate a monitor’s effectiveness or an emergency health concern.

“Beeps and dings and alarms and alerts and are very burdensome, not only on the patient but also the care [team],” says Strandberg, who notes that wireless technology is now being developed to send data and alerts into the EHR or onto dashboards. Philips is also working on an avatar that can give clinicians a whole-patient view, using cues like a blue color to indicate the patient is cold.

The key to success for health systems and hospitals is what Strandberg calls the pitcher-catcher relationship. Healthcare leaders need to make sure the EHR is catching all the data being transmitted and connecting that information to the right providers.

“How do you synthesize all that data that we brought in and stratify it such that we can help enable more rapid clinical decision making and intervention if it's required?” she asks.

Nurse educators and nurse leaders must come together to be the unified voice and advocate for the nursing profession, says this nurse educator.

HealthLeaders spoke to Jason Dunne, chief academic officer at the Arizona College of Nursing, about the current landscape of nursing education and how CNOs can partner with academic institutions to create pipelines into the industry. Tune in to hear his insights.

New graduate nurses coming out of nursing school should have these qualities, says this nurse educator.

Amidst one of the largest workforce shortages in healthcare history, CNOs are looking for ways to recruit new graduate nurses now more than ever. Nursing schools must provide the proper curriculum for new graduate nurses so that they can enter the clinical environment equipped with the necessary skills for modern nursing.

According to Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing (AZCN), there are a number of qualities that nurses must learn to ensure career longevity.

Here are the four qualities of a career-ready nurse. 

Click here to read the accompanying article. 

Advocates are once again lobbying the White House and Congress to extend a waiver on using telemedicine to prescribe controlled medications, while the DEA prepares a new rule that could cause even more discord.

Telehealth advocates are gearing up for yet another battle with the federal government over the use of telemedicine to prescribe controlled medications, particularly in treatments for mental health and substance use disorders.

The Alliance for Connected Care is preparing stakeholder letters to the White House and Senate and House leadership urging them to put pressure on the U.S. Drug Enforcement Administration to extend for two years a pandemic-era waiver allowing providers to use telemedicine. Extending the waiver, currently set to end this year, would give the DEA time to create a long-sought registration process for those prescriptions.

“The ongoing challenges in accessing mental health and substance use treatment services, particularly in rural and underserved areas, underscores the importance of maintaining these flexibilities,” the letter states. “Telemedicine has proven to be an effective tool in bridging the gap between patients and providers, reducing barriers to care, and supporting those most in need.”

The fight over a pathway to use virtual care dates back to 2008, when the Ryan Haight Online Pharmacy Consumer Protection Act prohibited the use of telemedicine for drug prescription unless providers completed a special registration that the DEA was supposed to set up. That hasn’t happened yet, despite pressure on the DEA from lawmakers and others to create that process.

According to telehealth advocates, the DEA hasn’t been helpful. The agency had proposed long-term guidelines for telemedicine prescriptions in 2023, but that draft was widely condemned as being too complex and restrictive. A revised draft is now awaiting White House review, but reports indicate that draft, if approved, “would be a significant blow to the telemedicine industry … and hundreds of thousands of patients who have come to rely on virtual prescribing.”

In their letter to lawmakers and the White House, stakeholders say there isn’t enough time left before the end of the year for the DEA to release its new draft, allow time for public comment, review those comments and make any changes. Hence the request for a two-year extension on the waiver.

“Under the current waiver, controlled substances have been prescribed in a clinically appropriate manner to treat a variety of conditions—always by licensed medical professions with prescribing authority,” the letter states. “Given the widespread provider shortage across medical professions and specialties, this flexibility has been essential in ensuring that patients receive timely and necessary care. Continuing these practices is vital to sustaining access to treatment and addressing the ongoing healthcare challenges in underserved areas.”