When 100% of the nursing faculty at one upstate New York reported incivility as a major departmental issue, they reversed course.
Incivility among nurse educators—bullying, disrespect, harassment—is growing and affects new nurses’ view of nursing as a profession, according to a new study published in NursingCenter.
Workplace incivility among faculty and students in nursing education has been known to have “detrimental effects on health and well-being, disrupt teaching and learning, and negatively impact the adequate preparation of new graduate nurses,” the study notes.
With 85% of nurses report incivility in healthcare, creating a culture of civility beginning in nursing school and extending into the workplace, is crucial to healthy environments and safe patient care, according to the study, which outlines a particular nursing program’s efforts to address incivility.
At a large nursing program in upstate New York, 100% of the nursing faculty reported that incivility was a major issue in the department. They enjoyed teaching nursing students but did not care to work together as a faculty group. Their complaints included a lack of teamwork, favoritism; undermining, demeaning comments; stealing others' joy at work; blaming each other for incivility; bullying behavior; and failure to recognize accomplishments.
As a result, faculty did not work as a team in creating new innovative projects, developing and revising curricula, or simply helping each other when needed, according to the study, authored by Maureen Kroning, EdD, RN and Sara Annunziato, MSN, RN.
However, the faculty admitted their desire for a civil environment where they could experience joy in the workplace, so in May 2019, five nursing faculty launched an effort to address incivility and identify and implement effective strategies to create a civil environment so faculty could experience joy at work, according to the study.
The five faculty members and the nursing program director developed an Incivility Care Plan by incorporating the American Nurses Association (ANA) Nursing Process and the American Psychological Association's five essential components to healthy workplace practices: employee involvement; work-life balance; employee growth and development; employee recognition; and health and safety.
“Each step in the nursing process can help address the issue of incivility,” the study says. “Care planning using the nursing process allows one to assess incivility, diagnose the human condition as a result of the incivility, plan and develop strategies or interventions, evaluate if the interventions were successful, and revise the plan of care as needed.”
The study was implemented in early 2020 and by March COVID-19 cases surged in New York. The unexpected rapid transition to remote teaching created intense challenges, but it also led to an equally unexpected, “unprecedented” level of collaboration and communication among faculty, the study says.
For example, some faculty excelled in teaching remotely and helped other faculty learn and implement the needed technology to teach remotely. And during remote teaching, faculty met weekly to share experiences and how they were doing during the pandemic, which brought joy as they collaborated to achieve the semester's teaching and learning objectives.
From 2019 to 2021, as full-time faculty retired or resigned, potential candidates were carefully chosen for their ability and commitment to work effectively in a team environment, possession of a positive attitude toward work, and zero tolerance for incivility.
Implementation
For the next two years, accomplishments, such as weddings, births, graduations, promotions, and more were announced and celebrated at faculty meetings and shared with administration and adjunct faculty.
“Encouraging open communication and acknowledging, recognizing, and supporting faculty concerns were the first vital steps in addressing incivility in the department,” the study says. “To improve communication, faculty worked hard to include all adjunct faculty in team meetings and to disseminate all meeting minutes to full-time, part-time, and adjunct nursing faculty [as well as] support and lab staff.”
Evaluation
A five-question anonymous and confidential survey indicated that 73.7% of participants responded that they were experiencing joy at work.
Asked to select from a list of strategies that might contribute to bringing joy to work, participants responded:
A positive attitude: 92.1%
Collaboration with peers: 89.5%
Being a team player: 84.2%
Working toward a common goal: 78.9%
Celebrating each other's accomplishments: 68.4%
Accountability for creating an environment of civility: 57.9%
Creating a zero-tolerance attitude for incivility: 52.6%
Hiring new faculty who are positive and team players: 50%
Speaking out against incivility: 36.8%
“To effectively work as a team, the nurse faculty need to focus on effective collaboration instead of competition to improve nursing programs and student success,” the study notes. “True teamwork requires the mindset that the success of any team member is a success for all and that a failure to achieve a goal is a failure of the team as a whole.”
New study to determine whether stress-reduction techniques can remedy nursing students' struggle to graduate.
While stress is no stranger to nurses, it frequently begins long before they start their first job.
Indeed, research indicates that nursing students experience higher stress levels compared to other majors and that these levels are on the rise. The result is a “bottleneck” or struggle to graduate, which has further effect on a dire workforce shortage.
Cathy Tierney, EdD, assistant professor of nursing at the University of Nebraska Medical Center College of Nursing’s Northern Division and her colleagues are looking into this challenge with a two-year study, “Bottleneck Reduction: Use of Simulation and Stress Reduction Apps in BSN Courses to Increase Academic Success.”
The “bottleneck” is not new, Tierney said, and faculty often recognize it.
“If students struggle in the first and second semester, usually by the third and fourth semester, you can tell the difference,” she said.
For nursing students working through their final year of attaining a Bachelor of Science in Nursing (BSN), stress comes from three primary areas, according to a 2022 nursing study:
Academic stressors: Exams, anxiety of failure
Clinical stressors: Extreme fear of failure, negative reaction to death or patient pain
Personal/social stressors: Economic problems, family issues
Additionally, demands of studying, completing didactic and clinical assignments, and doing actual clinicals leave little free time for nursing students, the study says.
Clinical placements may require nursing students to spend considerable time away from campus and the feeling of being responsible for the well-being of patients can be overwhelming—both of which remove nursing students from the normal social developmental activities of their same-age peers, the study says.
Nursing students participating in the “bottleneck” study, which began January 1, are coached on meditation and stress-reduction techniques. They also are working with faculty to develop individualized study plans.
“We’re being proactive to address student stressors and develop a plan for success by making sure students are familiar with the academic resources available,” says Tierney, who has expertise in wellness and self-care.
Tierney completed her Doctor of Education at Bryan College of Health Sciences in 2021 with a dissertation topic on how traditional nursing programs incorporate self-care practices into the student nurse experience. She has extensive experience using complementary modalities to promote self-care and holistic wellness, and has practiced as a certified hypnotherapist and healing touch practitioner.
Additionally, the study includes incorporating simulation into classroom content, which is offered to all students regardless of whether they participate in the study.
Recently developed vrClinicals for Nursing training platform ramps up the 'day-to-day unpredictability of nursing.'
New immersive virtual reality (VR) technology is transporting Herzing University nursing students to a busy hospital floor where they must handle multiple patients and frequent interruptions—just like the real world.
vrClinicals for Nursing, an immersive, VR nursing education experience, recently was developed by Wolters Kluwer, Health and Laerdal Medical. Students using vrClinicals for Nursing with a Meta™ Quest 2 headset will be engaged in an authentic, virtual clinical environment where they must navigate real challenges nurses encounter on the job: prioritizing multiple patients with varied, complex cases; colleague interruptions; and patient requests.
With the current nursing shortage and limited clinical opportunities, newly licensed nurses are increasingly managing higher patient caseloads and must refine their independent clinical judgment earlier in their careers, according to Wolters Kluwer. Metaverse-related technologies, which are being used in many nursing schools, can provide the experiences to better prepare today’s nursing students for this environment.
The new technology mirrors the “the day-to-day unpredictability of nursing,” says Leila Casteel, DNP, APRN, NP-C, a practicing family nurse practitioner and associate vice president, Curriculum & Innovation at Herzing University, a Milwaukee, Wisconsin-based private university.
Casteel spoke with HealthLeaders about how the new technology is benefiting and preparing the university’s nursing students.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How much of the current learning is in-person clinical work and how much is virtual simulation?
Leila Casteel: About 45% to 50% of our clinical hours across all of our clinical courses are simulation and of that simulation, there's a component of campus-based high fidelity, which is a smaller component. So I would say overall, about 35% of our clinical hours are completed using a virtual clinical experience.
HL: As a practicing nurse yourself, and also as an educator, how effectively does virtual simulation prepare nurses for the real world of nursing?
Casteel: It may sound a little blasphemous to say, but in many ways it prepares students more so than some of the live placements, and that's for a number of reasons. We've recognized that something has degraded a little bit in new grad nurses, and you think, “How did we get here? How, over the last 20 years have we become less effective at the bedside when we graduate?”
Part of that is the unpredictability of where your students land, and so much is dependent upon not only the strength of the clinical instructor, but the environment itself—the patients, the staff, and the willingness and interest of the nurses. You also have nurses out there who don't know the clinical judgment model because that's not what they learned.
So, we have to ensure that our students are getting that full experience and that we have measurable outcomes. One of the best things about virtual experience is that it can be very intentional and have very specific outcomes that are assigned and aligned with whatever's happening in that course. And you can ensure that all your students are getting that experience from end to end, which feels a lot better than the uncertainty of just sending them out.
HL: Virtual learning seems to provide a less stressful environment where students can make mistakes without endangering a patient. How does this aid in their learning?
Casteel: It’s absolutely a part of their learning. That freedom to fail and the formative assessment that we can complete in this type of environment is so critical to their own self-confidence when they go out and are working with live patients, so it's almost necessary. They need to explore, because at the heart of clinical judgment is decision-making and how we determine next steps. For students to be able to think that way, they have to start thinking about not only the decisions they're making, but why they're making them, what the risks are, and making alternative decisions.
That's exactly what virtual simulation provides is the opportunity to explore and make a decision. Maybe it's not the right one, but now you've got this opportunity, this excellent opportunity, to explore that decision in a more meaningful way, so that you can try again.
HL: What does the new vrClinicals for Nursing technology bring to your students that previous platforms don’t?
Casteel: Primarily, the concept of having multiple patients, diverse patient experiences, and that idea of learning to multitask. So often, virtual products are focused on a single patient at a single time and there's a lot of limits to that. We can do a lot to enhance even those experiences and we do because we love all virtual clinical experiences.
But this is unique because it is much more like what you would expect in an actual facility or on the job: multiple patients, diverse conditions, and things to consider. They’re fully built out, so there's their story, their history, the chart, and everything else, so students get to dive in and learn a lot about the patients before coming into clinical, which is extremely important and something they can’t do currently.
The level of urgency is a little different. With most virtual experiences, the student has a little bit more control over that urgency and that feeling of stress, because they can hit a pause button and they’re focused on one single patient. This experience really does require them to be in a mode of thinking, “What is the next best thing to do if I've got 10 conflicting priorities?” They have to think that through and articulate that to their instructor. It’s so much more complex, but in a positive way.
What’s really interesting about this experience is the way it weaves in and out of clinical urgency and then into contemplation and reflection, and then back into clinical urgency and back out into reflection, contemplation, and discussion. That’s good for a lot of reasons, but mostly for the deeper learning that can occur in that guided experience.
HL: How do the students feel about using virtual simulation technology?
Casteel: For a decade or so, we've had this interesting group consisting of very experienced techies and also some who didn’t want anything to do with it. But what we're seeing now, especially post-pandemic, is even those who were a little late to the game are now accustomed to using technology for everything.
We use our phones for everything, so there’s much less resistance. They’re almost drawn to it because that is now the norm. If the experience itself is meaningful, students report that not only did they learn something, but they were given that brain space to think about what they were learning so it sticks a little bit more. And they're going to be able to go tomorrow and explain that to somebody because it was an experience and not simply following a nurse and trying to mimic behavior. So, when it's done well, students really like it.
Legislation to bolster rural hospitals includes provision to give CRNAs autonomy.
The recent bipartisan Save America’s Rural Hospitals Act includes a provision to permanently remove physician supervision of Certified Registered Nurse Anesthetists (CRNAs), under Medicare Part A conditions of participation.
That provision, along with another to include non-medically directed CRNA services as a mandatory benefit under the Medicaid program, is being cheered by the American Association of Nurse Anesthesiology (AANA).
CRNAs have been practicing without this regulation for nearly three years under healthcare flexibilities issued during the public health emergency.
"Today more than ever, rural communities must address accessibility issues, including a lack of healthcare providers, the needs of an aging population suffering from more chronic conditions, access to healthcare, and larger percentages of uninsured and underinsured citizens," said Angela Mund, DNP, CRNA, president of AANA.
"As a CRNA who grew up in a small town in far northwestern Minnesota, I know firsthand the challenges of recruiting healthcare providers and how important the solo CRNA was to ensuring that we could provide surgical services to our community,” she said.
More than 170 rural hospitals across the country have closed their doors since 2005, and 453 rural hospitals are vulnerable for closure, according to the National Rural Health Association.
"This legislation would permanently end Medicare cuts that have devastated small-town hospitals,” said U.S. Rep. Sam Graves (R-Mo.), who reintroduced the bill along with U.S. Rep. Jared Huffman (D-Calif.),to rescue rural hospitals on the brink of bankruptcy and get them back on solid ground.
"CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it," said Mund, in encouraging AANA members to contact their local U.S. Representative to support the bill.
"Often, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures," she said
The importance of CRNA services in rural areas was highlighted in a study that showed that compared with anesthesiologists, CRNAs are more likely to work in areas with lower median incomes and larger populations of citizens who are unemployed, uninsured, and/or Medicaid beneficiaries.
Protective elements of a foam dressing may benefit other patients, as well, a new study says.
By adopting a revised clinical process and using a polyurethane foam dressing, a New York City hospital reduced the incidence of medical device-related pressure injuries (MDRPIs) following a tracheostomy to zero for four years, according to a study published in AACN Advanced Critical Care.
About 2.5 million patients experience hospital-acquired pressure injuries (HAPIs) each year, costing about $11 billion, according to the study. Nearly 24% of those incidents occur in ICU patients, as compared to up to 18% among general admission patients.
MDRPIs associated with a tracheostomy account for up to 10.9% of hospital-related incidents, the study notes.
NewYork-Presbyterian Westchester’s quality-improvement initiative used evidence-based resources from the Preventing Pressure Injuries Toolkit funded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.
A key part of the new process was a revised PDT tracheostomy procedural kit and documentation, with the foam dressing placed under the tracheostomy flange during insertion. Both were secured with sutures and a flexible holder.The foam dressing remained in place for seven days, with primary care nurses assessing the site at least every 12 hours, the study says.
The dressing was then changed to a standard nonwoven gauze drain sponge after seven to 10 days as clinically instructed.
The results showed that suturing a foam dressing as part of PDT tracheostomy insertion can reduce the incidence of associated MDRPIs.
"When COVID-19 increased demand for healthcare equipment, we were able to refine our processes, transition to a revised PDT tracheostomy kit and maintain the integrity of the initiative," says Hazel Holder, DNP, MSN, RN, ACCNS-AG, CCRN, a critical care clinical nurse specialist and study co-author.
"We took a multidisciplinary approach that engaged all related specialties, with surgical site assessment and any clinician concerns discussed during daily rounds," says Holder, who conducted the study with Brittany "Ray" Gannon, PhD, MSN, AGPCNP-BC, a nurse scientist.
Prior to the initiative, in 2018, the incidence of HAPIs at the hospital was 1.39% for all ICU patients, with tracheostomy MDRPIs accounting for 0.19% of the incidents—15 HAPIs, including two MDRPIs in 1,077 patients. Of the two PDT tracheostomies performed, both patients experienced MDRPIs.
In 2019, the overall HAPI incidence decreased to 1.30%, with nine tracheostomies and no MDRPIs. The tracheostomy MDRPI incidence remained at zero for the next three years.
During the four years of this project, a total of 22 PDT tracheostomies were performed in the ICU, with the foam dressing placed at the point of insertion in all procedures.
That placement of the foam dressing can reduce the incidence of tracheostomy MDRPIs, and may benefit other patients as well, the study concludes.
“Although some process modifications may be necessary, the protective elements of the polyurethane foam dressing may benefit other patient populations as well,” the study says, “including pediatric, neonatal, and surgical.”
'Rising stars' focus research on underrepresented and low-income groups.
Five Johns Hopkins School of Nursing (JHSON) faculty members whose research focuses on underrepresented and lower-income groups will be able to grow their research after being named as the inaugural holders of the Baltimore-based university’s newly established Term Professorship for Rising Faculty (Rising Professorship).
The Rising Professorship is a three-year period of funding to support faculty members in research, collaboration, policy involvement, and leadership within nursing and beyond.
“This significant investment in faculty underscores our commitment to offering rising stars a place where they can both succeed in their careers and build the science, research, and networks needed to further nursing and improve health,” said Sarah Szanton, PhD, RN, FAAN, dean of the school of nursing.
Alexander examines such complex issues as intimate partner violence (IPV) that leads to sexual health outcome inequities in marginalized communities, HIV resilience, and societal gender expectations.
Alexander is inaugural chair of the Nursing Initiative of the Mid-Atlantic Center for AIDS Research (CFAR) Consortium, lead faculty for the Violence Working Group at the Johns Hopkins Center for Injury Research and Policy, and chair of the HIV/STI Committee of the Society for Adolescent Health and Medicine.
Kamila Alexander, PhD, MSN/MPH, RN
Alexander has been honored with the 2020 Johns Hopkins School of Nursing Dean’s Award for Outstanding Nurse Researcher, the 2020 Betty Irene Moore Fellowship for Nurse Leaders and Innovators, and the 2018 Johns Hopkins University Catalyst Award, Office of the Provost.
Long-term goals for her research are to “develop and implement new conceptual frameworks across national and international settings that prevent IPV and promote sexual well-being among women and their emotional partners,” according to Alexander.
Brockie seeks to achieve health equity through community-based prevention and intervention of suicide, trauma, and adverse childhood experiences among vulnerable populations.
Teresa Brockie, PhD, MSN, RN, FAAN
Brockie, a member of the White Clay (A'aninin) Nation from Fort Belknap, Montana, is a leader of the Young Medicine Movement, which introduces Native youth to health science careers and provides mentorship by Indigenous researchers and clinicians to Fort Belknap scholars.
Her intervention called Little Holy One is rooted in understanding that high rates of historical and current trauma in Native communities compromise caregivers' mental health and parenting, which in turn affect early childhood behavior problems and adverse events that increase children's risk for suicide and substance use in adolescent and young adulthood.
In 2020, she received the Brilliant New Investigator Award, Council for the Advancement of Nursing Science-American Academy of Nursing and received the RADM Faye G. Abdellah Award for Nursing Research, The United States Public Health Service (USPHS) in 2016.
Commodore-Mensah is looking to reduce cardiovascular disease risk among Africans in the United States and in sub-Saharan Africa through community-engaged research and implementation.
She is a cardiovascular nurse epidemiologist and co-founder and president of the Ghanaian-Diaspora Nursing Alliance, a nonprofit organization that advances nursing education in Ghana. Her research expertise includes immigrant health, global health, cardiovascular disease epidemiology, and social determinants of health.
Commodore-Mensah is CEO of the African Research Academies for Women, a nonprofit seeking to address gender disparities in science, technology, engineering, and mathematics in Africa. She also is principal investigator of the LINKED-BP and LINKED-HEARTS programs, two trials aimed to improve hypertension control and management of chronic conditions in community health centers.
Commodore-Mensah, who was named to the 2020 World Heart Federation Salim Yusuf Emerging Leaders Programme, is a fellow in the American Academy of Nursing as well as the American Heart Association, Council on Cardiovascular Nursing.
Samuel addresses socioeconomic disparities by advancing health equity for individuals and families with low incomes. Her current research examines the pathways that link low income and financial strain to physiologic aging.
This includes investigating the health impact of policies and programs related to economic well-being for low-income households. Samuel’s research also looks at aspects of neighborhood and household environments that may influence health disparities.
Laura Samuel, PhD, MSN, RN, FAAN
Samuel also evaluates the health impact of programs and policies intended to improve economic well-being for low-income households and her research has shown that greater participation in the Supplemental Nutrition Assistance Program (SNAP) and higher benefit amounts are associated with improved health outcomes for low-income adults.
Her research interests stem from her clinical experience as a family nurse practitioner where she regularly witnessed the myriad of ways that a lack of financial resources can be detrimental to health.
Taylor identifies and addresses pain disparities with older women from underrepresented racial ethnic groups and helps individuals with disabilities increase social participation and independence.
Taylor, whose research is strongly connected to her 10 years of clinical practice in long-term care and women’s health settings, is principal investigator of a study that addresses unmet needs of caregivers aging with and into disabilities.
Janiece Taylor, PhD, MSN, RN, FAAN
She is co-associate director of JHSON’s RESILIENCE Center, designed to improve the health and function of people with disabilities and their caregivers by adapting and scaling two award winning evidence-based programs for children and older adults with disabilities—Chicago Parent Program and CAPABLE—and is principal faculty of the school of nursing’s Center for Equity in Aging.
Taylor was selected as the first nurse in the Robert Wood Johnson Harold Amos Fellowship Program and throughout her career, has received funding from the John A. Hartford Foundation, National Institute of Nursing Research, Mayday Foundation, and more.
Teamwork, along with communication and awareness, can build an effective infection prevention program.
Infection prevention and control is fundamental to providing safe and high-quality patient care. A poor infection control program can result in increased rates of infections, significant illness, and death, and raise the likelihood of multidrug-resistant bacteria.
Awareness is the key to a successful infection prevention (IP) program, says Carol Vance, MSN, RN, PHN, CIC, the multi-site prevention director for Advocate Children’s Hospital in Chicago, a 381-bed facility that is one of the largest network providers of pediatric services in Illinois.
Vance spoke to HealthLeaders about how communication, awareness, and teamwork can contribute to an effective IP program.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What are the most common hospital-acquired infections?
Carol Vance: Central line associated bloodstream infections (CLABSIs), along with catheter associated urinary tract infections (CAUTIs) and surgical site infections (SSIs).
HL: What are standard infection control precautions every hospital needs?
Vance: Obviously, hand hygiene is one of the most important things, but I think it's also important to look at things that are not what you hear all the time. There's another component from an executive level that's important, and it’s how those measures are applied and making sure that processes are created with minimal barriers.
An important component is the communication both ways to ensure that if there is some sort of barrier to hand hygiene—a barrier to actually doing the evidence-based bundles—then that is heard by leadership and is actively worked on with the front line to gather to minimize those barriers or challenges.
HL: Can you give an example of how that might apply?
Vance: From a hand hygiene perspective, it might be a situation where the hand hygiene dispensers are in the right place, so when it comes to auditing, it doesn’t take more time for that frontline person to do the right thing.
Also, evaluating the process to do a dressing change or to do anything that is part of the evidence-based bundles. And asking if there is a way to create a better flow that minimizes the extra work to do the right thing.
HL: What else can hospitals do to reduce infections?
Vance: Along with communication, awareness always needs to be top priority and that is challenging when there are so many competing priorities. It involves trying to find what works with the culture of the hospital to create awareness that is every day with every patient and every frontline person and that will look different at each institution.
The core of IP is the same. We know what works; hand hygiene, using the evidence-based practices, making sure your protocols are standardized and they’re easy to replicate. But there's another component to that, especially post-COVID. There's a lot of burnout and additional stress outside and inside the hospital, so communication at all levels is important. Healthcare has had a lot of turnover, and those core components of communication and increasing awareness are vital to get the post-pandemic crew up and running.
Carol Vance, MSN, RN, PHN, CIC
HL: How has the pandemic enhanced safety protocols?
Vance: It was hard on healthcare, but it also allowed healthcare to grow very quickly in certain areas. We learned how important it is to work with our supply chain team members and for systems to work together to get the appropriate personal protective equipment. In the beginning of the pandemic, that was very eye-opening.
There’s also been an enhanced understanding of what isolation precautions are, and the “why” behind them. Due to the fact that hospitals were inundated with COVID patients, they had to understand the “why” behind the PPE and how it can protect them, so it definitely allowed a lot of opportunity for education. It also brought different departments together within the acute care setting to work together on creating processes that helped.
HL: Nurses traditionally have had a large role in infection control. Who else should be responsible for infection prevention?
Vance: We always like to say infection prevention is everyone's role—physicians, respiratory therapists, supply chains. Infection prevention is part of the entire continuum of health.
It is particularly important to make sure each location has the knowledge of infection preventionists; someone who can help translate what the latest guidance is coming out. During the heat of the pandemic, we were gaining all of our knowledge as we went, so it was very important to have an infection preventionist who could decipher and work with the different types of specialty areas—oncology, bone marrow transplant, behavioral health—to navigate and apply it to those areas. Infection prevention is everybody's job, but you need to have that strong IP leader to help answer those questions that the front line may have.
HL: How is your facility doing with IP?
Vance: We are a very large organization, and we have a very strong IP system team. Most hospitals throughout the US took a hit during COVID with an increase in infections, but from an Advocate Aurora standpoint, we talk about infections all the time. It is always on the forefront of discussions: What can we do to improve? How do we share our best practices between hospitals? How do we educate our IPs to ensure that they are truly the experts?
I'm very proud of our system team; the majority of them are all certified and the site IPs share with each other and work collaboratively with the frontline teams. It’s great to see the buy-in, the increased awareness, and putting patient safety first. We have a great process, but we’re always looking to improve and that's important.
HL: What role does technology have in IP?
Vance: Integrating technology to get the front line working with the patient more is always important. They have hand hygiene technology that can give data back on how well each person is doing on hand hygiene.
Also, we do a lot of audits and the one thing that is important is they utilize audit technology to help decrease the amount of steps to get the data. So, if they're doing central line auditing or if they're doing catheter auditing, they can use different types of platforms to have their auditors enter the data and get real-time feedback, and having that real-time feedback is important to make those adjustments.
Despite record-level turnover and low unemployment rates, employers can improve their hiring system.
Navigating the current hiring environment is a challenge and healthcare recruiters are feeling the heat.
Faced with record-level turnover, historically low unemployment, and job openings above 10 million, organizations have never faced a more challenging labor market, says a new report from
Employ, Inc., a provider of recruiting and talent acquisition solutions.
Add inflation uncertainty, massive rounds of layoffs, and interest rate increases to the mix, and it’s easy to see why healthcare organizations and other companies are finding it difficult to respond in this challenging talent landscape.
The report, based on Employ’s proprietary recruiting data and findings from a survey of more than 1,200 HR decision-makers conducted last November, revealed that more than 65% of HR decision-makers think recruiting is more stressful now than it was a year ago, primarily because there are not enough qualified candidates (59%), there are more open roles to fill (51%), competition from other employers (44%), and more employees are leaving the organization (43%).
Workforce shortages have become an urgent issue at health systems and hospitals across the country. Healthcare organizations are facing severe nursing and physician shortages, along with deficits in other areas, as well.
Indeed, workforce challenges were ranked No. 1 on the list of hospital CEO top concerns in 2022, according to an annual survey conducted by the American College of Healthcare Executives.
The largest recruiting challenges in attracting and hiring quality talent, according to the report, are:
Not enough talent to fill positions: 56%
Competition from other employers: 54%
Inability to compete with salary requirements: 33%
Poor communication from candidates in the hiring process: 29%
The hiring process takes too long: 28%
Not able to work from home: 27%
Hiring professionals’ top recruiting priorities are improving the quality of candidates (61%), improving speed of the hiring process (44%), and getting more candidates for each open role (41%).
Other priorities include improving the onboarding process (38%) and having a more diverse talent pipeline (31%).
Job candidates, on the other hand, have their own motivations in seeking new employment. Their primary motivations are getting more money (34%) and the ability to work remotely (21%), according to the report.
Improving recruiting outcomes
The report offers three strategies to help organizations improve their hiring system:
1. Deliver positive experiences: Invest in the needs of hiring managers, recruiters, and candidates, and deliver positive experiences for these audiences. Shorten feedback loops and improve communication and collaboration. Ensure the hiring process delivers positive experiences that enhance the company’s employer brand.
2. Identify where to optimize processes: Keep a clear eye on applicant flow and the talent pipeline to uncover insights into where the recruiting process can improve.
3. Leverage purpose-built recruitment technology: Adopt recruitment software and talent acquisition technology that is tailor-made for the complexity, size, and hiring needs of the organization.
“Companies of every size and recruiting complexity must stay the course and remain resilient as they plan for 2023 and beyond,” the report notes.
Surveyed nurses rate employers low in perceived support and concern about their well-being.
Nurses need much more support than they are getting from their leadership and employers, a new American Nurses Foundation survey reveals.
Nurses continue to be stressed, exhausted, and feel lack of support from their employer, according to the comprehensive survey of more than 12,500 nurses nationwide last November as part of the Pulse on the Nation’s Nurses Survey Series. For example:
84% recent of nurses say they are stressed or dealing with burnout.
57% report feeling exhausted.
32% of nurses with less than 10 years of experience indicated being either not or not at all emotionally healthy.
61% of nurses under 35 indicated feeling anxious in the previous 14 days.
19% intend to leave their position in the next six months; another 27% are considering leaving.
Workplace violence in various forms is also a top issue, with 53% of nurse respondents saying verbal abuse has increased, the report says. Another concern is that 43% of nurses say they either don’t have a reporting mechanism in place at their healthcare system or they are unsure if they have one, according to the survey.
Perceived support
Respondents said they continue to feel unsupported or not supported enough by their employers—particularly those employed in large and mid-sized acute care settings, and the younger generation of nurses.
The nursing survey applied the Survey of Perceived Organizational Support (SPOS), a validated measure of the general belief held by an employee that the organization is committed to them, values their continued contributions, and is generally concerned about their well-being.
The foundation tracks five indicators regularly to measure how nurses perceive the support they receive. They scored their employer support on a range of 0 to 5, with 5 being the highest:
My organization really cares about my well-being – 2.8
If I did the best job possible, my organization would notice – 2.7
My organization takes pride in my accomplishments at work – 2.9
My organization values my contributions to its well-being – 2.8
My organization responds to my complaints – 2.6
Indeed, a generational divide is evident throughout the data. Overall, nurses 25-34 provided the lowest scores across all SPOS indicators, followed by nurses 35-44 and under 25. The pivot toward higher SPOS scores begins with nurses 45-54.
“This is consistent with reported feelings, with younger nurses feeling less supported and less valued,” the report reads.
“The insights we’ve gleaned from Millennial and GenZ nurse respondents, as well as nurses of color, demonstrate that employers must dramatically shift their approach to supporting nurses, taking into account that different demographics of nursing have unique needs,” says Kate Judge, the foundation’s executive director.
“Nurses leaving the profession, leaving acute care, and being burned out puts our health as a nation at risk,” she says.
That may seem evident as nurses have staged several strikes in the last year at health systems across the country, citing staffing concerns, including:
More than 7,000 nurses at two of New York City’s busiest hospitals walked out for three days last month.
Some 15,000 Minnesota nurses went on strike for three days in September.
About 800 nurses at St. Vincent Hospital in Worcester, Massachusetts, ratified a new contract after a 301-day strike.
One survey respondent expressed frustration: “Employers see nurses as expendable. There's no retention plan in place, and I feel like the unit wouldn't care if I left nursing altogether.”
Another shared, “I have seen more nurses recommend other career choices to friends and family. I have seen many caring people step aside from nursing, because they have found it is no longer worth it.”
Perception gaps
Besides the generational divide evident throughout the data, the survey also revealed a considerable gap between nurses and nurse leaders.
When nurses were asked whether they feel their team is better prepared for a future variant, surge, or pandemic, only 30% said “yes,” with 29% “maybe” and 41% “no.”
When the same question was asked in an October 2022 survey fielded by the American Organization of Nursing Leadership (AONL), 65% of nurse leaders said “yes,” they felt their team was better prepared for a future variant, surge, or pandemic.
“The divide has real consequences,” the report says, “that go beyond work culture.”
'It truly has proven to be an additional layer of support to enhance patient care and outcomes,' nurse executive says.
What began as an innovative way to monitor and care for COVID-19 patients at the height of the pandemic is evolving into a growing virtual nursing program at Atrium Health.
The North Carolina-based health system, now part of Advocate Health, launched its virtual nursing program in March 2021 when, like other health systems, nurses struggled to meet staffing demands.
Nurses loved it, patients loved it, and the health system noticed positive outcomes: decreased medication errors, decreased falls, increased patient satisfaction, and more, says Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL, vice president of nursing operations, professional development and practice.
Mook spoke with HealthLeaders about how Atrium Health’s virtual nursing program benefits both nurses and patients and how a care model prompted by COVID has become a permanent part of the health system.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How did Atrium Health begin its virtual nursing program?
Patricia Mook: We began by gathering together some innovative nursing staff who had previous history with working with virtual patient observation and asked, “How can we support our nurses at the bedside at a time when we don't have enough nurses because of the pandemic and be able to virtually watch these patients?” We very quickly put up a pilot and it was absolutely fantastic.
We found lots of benefits. We were able to keep nurses who couldn't really function physically at the bedside but had great skill, so we put them behind the camera to be our virtual nurses. We were able to help new nurses do their work at the bedside with an experienced nurse behind the camera.
We saw staff engagement, a decrease in medication errors, a decrease in falls, and an increase in patient satisfaction. We also see this as a retention tool for nurses; it’s a reason for nurses to want to come to work at Atrium.
HL: What are the virtual nurses’ responsibilities?
Mook: The virtual nurse behind the camera observes about 10 patients and can do an admission assessment; they’re able to do hourly rounding; they can do RN/MD rounding with the medical doc when they come in the room; they can do medication teaching; discharge instructions; and work with families on family instruction.
They can monitor vital signs that are being taken in the room because the camera is so sensitive that they can zoom in on the technology in the room to monitor what's going on there. They have the ability to assist pharmacy with medication reconciliation. There are a lot of things that they're able to do.
In addition, sometimes nurses have medications or even administer blood that requires a second nurse check, and the nurse behind the camera can be that person and provide that check. There are so many ways that the nurse behind the camera can help the patient and help the nurse, physician, pharmacist, or any care provider who comes into the room.
HL: How does virtual nursing create efficiency for the floor nurse?
Mook: Every single time you go into the room of an infectious disease patient, you have to put on your gloves, your cap, your mask, and your paper gown, and that takes a good two minutes to get it all done. If you look at studies, the number of people who go in and out of the room is a lot.
When a nurse who's at the bedside doesn't have to go in and out of the room every hour, we calculated that they saved probably two hours of going in and out of rooms. It saves a lot of time and it saves energy. It's more efficient.
Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL
HL: What benefits does virtual nursing offer patients? What do they like about it?
Mook: If they had a need, somebody was right there with them in an instant because the virtual nurse could zoom in to that patient, click on the button, and say, “How can I help you?” We were able to help them feel safer when they were alone in the room. During COVID, patients often weren't able to have visitors, so this was a person who was there to comfort them quickly.
One of the reasons we think we saw an improved patient satisfaction score was most of our patients during the pandemic were on isolation and the only face they saw was the nurse on the camera who didn't have to wear a mask. We were very encouraging of that nurse behind the camera to keep a smile on their face for their patients because that really was the only facial expression that patients would see the entire time they were in the hospital because everybody was masked. And that facial expression means so much to patients, so we saw a higher patient satisfaction score on the patients who were being seen with virtual nursing.
Finally, response time to call bells was a tremendous improvement for our patients, which also led to safety and patient satisfaction advances.
HL: What have been some of the outcomes that you’re seeing with virtual nursing care?
Mook: We are still collecting and analyzing data, so we don’t currently have specific information to share. The virtual nurse allows for early recognition of any changes in patient status, so attempting to get up would certainly be among those things we’re watching for. It has also provided us an earlier notification of when the rapid response team needs to engage, and in instances where the patient has coded.
The patients are truly winners here. We’ve seen a 56% reduction in the number of call bell responses and scores for patient experience have risen dramatically. It’s also useful in helping avoid mistakes; if you have a novice nurse on the floor, having an experienced nurse “in the room” with them via video can be a huge comfort and ensure that all elements of care are provided appropriately. It truly has proven to be an additional layer of support to enhance patient care and outcomes.
HL: How widespread is virtual nursing now across Atrium Health?
We’re currently covering 20 beds at Atrium Health Pineville Progressive Care unit and 30 beds at Atrium Health Cleveland. We’re looking at additional locations to expand, with a focus on med-surg and med-tele units.
We’re also working on electronic dashboards and other options to improve analytics and data collection.
