71% of long COVID claimants to workers' compensation insurer were unable to return to work for six months or more.
The effects of long COVID are keeping needed employees out of the workforce, a recent study indicates.
Some 71% of claimants with long COVID were still receiving treatment and unable to return to work for six months or more, according to data from the New York State Insurance Fund (NYSIF), the largest worker compensation insurance fund in the state.
The study analyzed more than 3,000 COVID-19 workers’ compensation claims received by NYSIF between January 1, 2020, and March 31, 2022.
Other study data revealed:
About 18% have been unable to return to work for more than one year.
The percentage of long COVID among female workers (37%) was 11% higher than in male workers (26%).
Nearly one-third of all workers compensation claims in 2022 were for long COVID.
Most claimants in this group are under 60 years of age—the primary age for people in the workforce.
Essential workers may have long COVID rates higher than the data suggests.
The total number of people affected by long COVID likely is undercounted by this study, because it focused on patients requiring medical attention or out of work for 60 or more days, the study’s authors said.
The numbers aren’t capturing people who have gone back to work and didn’t seek medical attention, but are toughing it out at work, while dealing with symptoms such as brain fog, the authors said.
Indeed, brain fog associated with long COVID is the most common reason patients are unable to return to work, one COVID doctor said.
roadly reflective, these findings begin to fill information gaps about the labor market, including an underappreciated reason for the many unfilled jobs and the declining labor participation rate since the emergence of the pandemic,” the authors wrote.
“They also highlight the emerging challenges that employees of all ages and employers across all sectors face as a growing number of people return to work while still reeling from the effects of COVID-19.”
Long COVID symptoms
The post-COVID syndrome known as long COVID is associated with multiple organ systems, tissue damage, and wide-ranging symptoms that can vary in duration, type, and severity.
Of the four major patterns detected, one featured heart and kidney problems; another included respiratory problems, anxiety, and sleep disorders; a third consisted of musculoskeletal symptoms; and the fourth was dominated by nervous system symptoms.
Given long COVID’s potentially debilitating effects, the Biden Administration has organized a governmentwide response to address long COVID, and federal agencies now recognize the condition as a disability under the Americans with Disabilities Act of 1990.
“We are in high demand and that is because we have 99 million Americans today that are lacking access to primary care and wait times are longer than ever before,” she says.
“NPs are stepping up to meet those needs in terms of access. You’re seeing the rise in NPs because we're helping to meet that demand and that's across all settings—rural settings, urban settings, in the hospital, the clinic, through telehealth, mobile sites, skilled nursing facilities, and schools.”
NPs’ focus on preventive healthcare also is a driver in demand, Kapu says.
“Nurse practitioners are focused on meeting the patient where they are and engaging people in healthcare. We're very focused on the reduction of healthcare disparities, increasing access to care, and healthcare equity,” she says. “The reason for that is, if we have high-quality healthcare immediately available where we're working with individuals and families on a regular basis, and providing screenings, immunizations, and regular chronic disease management, this helps to prevent urgent care visits and emergency department visits.”
With nearly 90% of nurse practitioners educated and trained in primary care, “We're focused on healthier lives for everyone everywhere,” Kapu says.
2. Nearly 100 million people live in primary care shortage areas, and the numbers are rising.
Primary care shortages are more severe in rural areas, where more than 130 hospitals have closed in the past decade, with nearly 20 in 2020 alone, according to AANP.
A recent AANP survey found nearly 50% of patients waited longer than one month—and 25% waited more than two months—for a healthcare appointment in the previous 12 months.
A 2020 study on the importance of building a strong rural workforce noted that NPs in 2016 represented more than 25% of providers in rural areas—an increase from 17.6% in 2008. During this time period, the percentage of physicians practicing in rural areas declined 12.8%.
With the decline of physicians practicing in rural areas, NPs are purposefully stepping into those underserved areas, Kapu says.
While, as the study says, NPs represent 25% of the primary care providers in rural practices, that percentage is even greater in the states that allow NPs to practice to the full extent of their education and clinical training—Full Practice Authority (FPA), she says.
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing, rather than requiring them to hold a state-mandated contract with a physician as a condition of state licensure.
“For those states that allow NPs to practice to the full extent of their education training, we’ve seen an increase in the NP workforce, and we’ve seen an increase in people working across all settings,” Kapu says.
“Arizona is a great example of a state that moved to FPA in 2001,” she says. “Within five years, they saw their workforce of NPs double across the state, and they saw a significant increase in NPs working in healthcare provider shortage areas.”
April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, president, AANP
3. NPs are taking on leadership roles in research and the diagnosis and treatment of illnesses.
NPs are leading the effort to diagnose and treat illnesses of all types, as well as participating in research to develop new treatments and combat emerging diseases, Kapu says.
“We've seen NPs rise in terms of their clinical expertise, so organizations and associations are seeking out NPs to help with putting out studies and articles or present the findings of their research on a national level through publications and presentations,” she says.
AANP emboldens its members to take on leadership roles by offering ongoing courses in developing leadership skills.
“It's so important that NPs have a voice not only in their practice setting but that they have a voice in their healthcare system, in their state, and on a federal level,” Kapu says. “So, we encourage NPs to take leadership positions, certainly on boards, in health policy, and health systems management. The perspective of the NP is very important.”
Indeed, at the recent 2023 AANP Health Policy Conference, attendees heard from Jennifer Kiggans, an NP serving her first term in the U.S. Congress as a representative from Virginia.
“We think it’s wonderful that NPs are stepping into different types of leadership roles,” Kapu says.
4. More states are giving patients full and direct access to NPs.
More states—26 plus Washington, D.C., so far—are granting FPA, which gives patients full access to NPs without requiring a practice agreement with a physician.
Momentum for FPA increased during the pandemic, when states temporarily suspended practice agreements and allowed NPs to practice at the top of their education, giving patients direct access to care.
Though some states allowed that executive order to expire, four states— Massachusetts, Delaware, Kansas, and New York—elected to adopt FPA permanently.
“[These] states put into place those executive orders and that continues to show that we provide high-quality care,” Kapu says. “The momentum is definitely there, because several states have legislation in action now to move their state toward full practice authority.”
FPA makes a difference in the health of a state’s residents, she notes.
“The states that have the healthiest outcome are states that have full practice authority,” Kapu says.
“Many of the states that have the lowest healthcare outcomes are states that still have restricted, outdated laws in place that are completely unnecessary, such as retrospective chart review or collaborative contracts where you have to pay fees,” she says. “Those fees can be a barrier to an NP being able to practice in the community.”
5. Mental health NPs are increasing access to mental health services.
With 158 million people living in Mental Healthcare Health Professional Shortage Areas, NPs are leading the charge to meet this demand for care.
Nearly 100 new psychiatric mental health nurse practitioner (PMHNP) programs have been added to U.S. schools of nursing in the past 10 years, producing more than 13,000 new providers, according to the American Association of Colleges of Nursing Enrollment and Graduation Reports 2012-2022.
The number of NPs treating Medicare beneficiaries for psychiatric and mental health conditions grew 162% between 2011 and 2019, compared with a 6% decrease in the number of psychiatrists treating Medicare patients, according to a 2022 study.
“We have nurse practitioners who are educated, trained, and national board certified as mental health NPs, and they are providing those vitally needed services, but there are still barriers [to practicing],” Kapu says.
“Anything we can do to increase the amount of workers out there to provide mental healthcare and anything that we can do to reduce unnecessary barriers are the only ways that we're going to be able to address the mental health challenges that we're seeing today.”
A standardized handoff can prevent inconsistent and inaccurate discharge summaries, a new study says.
Transition of patients from hospital to a skilled nursing facility (SNF) often results in treatment delays, medication errors, and patient harm, but a standardized handoff can improve communication and correct those problems, a new study says.
Systems to improve nurse-to-nurse communication in different handoffs, such as during shift change and unit transfer, are effective in acute-care settings, but efforts to improve communication during the nurse-to-nurse handoff from hospital to SNF have not been widely implemented, according to the study by Wayne State University.
One out of 5 hospitalized patients are discharged to a SNF and are vulnerable and at high risk for functional and clinical decline, making a seamless transition critical, study authors wrote.
Patients’ transfer forms and discharge summaries from hospitals often contain mismatched, missing, inconsistent, and inaccurate information, including patient histories, allergies, instructions for care, and medications lists, the study says.
22% of the hospital-to-SNF handoffs needed clarification about antibiotic prescriptions
42% of prescriptions for narcotic medications were missing
Patients transferred to SNFs had to wait at least 24 hours to receive critical medications
As a result, medication discrepancies increase SNF nurses’ workload and cultivate a “sense of mistrust” of the information received from the hospital, the study says.
Ensuring accurate information
The literature supports the significance of standardizing handoff to ensure clear and accurate information is exchanged, the study says.
For example, effective handoff tools include The SBAR (situation, background, assessment, and recommendation), I-PASS (illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver), and checklists have successfully improved handoff during the shift-to-shift and unit-to-unit report, the study notes.
“These structured communication tools have demonstrated effectiveness in ensuring complete, accurate, and organized patient information is discussed, avoiding confusion and delays, reducing preventable adverse events and medical errors, and encouraging seamless nursing workflow,” the researchers wrote.
However, standardized handoff tools should be developed based on the unit’s needs, the study says.
How the study worked
Before the study began, researchers conducted a one-month chart review of 76 SNF patients, which revealed 56 events of delayed controlled medications and IV antibiotics administration in that month because they were not promptly sent or called into the pharmacy, according to the study.
SNF staff nurses were interviewed about handoff structure and processes and researchers also observed randomly selected hospital-to-SNF handoffs. Data gathered were used to create the standardized handoff tool used in this project. Existing handoff tools were not used because they are not comprehensive enough for SNF needs.
A chart review after the six-week study indicated the wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration. Wait time for IV antibiotics decreased 94%, with a 77.8% reduction in late administration.
“Handoff communication conveys patient information and transfers the responsibility of care from one nurse to another or from one setting to another,” the study says. “The communication between healthcare settings should pass on important patient information that the receiving facility will utilize to seamlessly continue the patient’s care.”
Neonatal nurse practitioner (NNP) training programs don't include enough underrepresented groups, affecting care of the tiniest patients, study says.
Racially diverse nurse practitioners offer valuable perspective in caring for underrepresented patients, yet "glaring health disparities" exist in neonatal ICUs because neonatal nurse practitioner (NNP) training programs lack racial minorities, a recent survey says.
Indeed, nurse practitioners (NPs) of color in general are underrepresented in the workforce, with less than 7% being Black, according to employment recruiter Zippia.
Nurse researchers Desi M. Newberry, DNP, NNP-BC, of Duke University School of Nursing, Durham, North Carolina, and Tracey Bell, DNP, NNP-BC, of Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, designed a survey to determine the racial/ethnic composition of NNP faculty and students in accredited NNP programs in the United States. The findings from 23 responding accredited education programs were then compared to available data on the racial/ethnic composition of newborns admitted to US NICUs.
There was no significant difference in the racial and ethnic composition between neonatal nurse practitioner faculty and students, as indicated in this data of 198 NNP faculty and 403 NNP students:
2.8% Latin American
0.9% "other" race/ethnicity
5.7% Latin American
However, there were discrepancies in the rates of underrepresented groups among NNP students compared to national data on newborns admitted to US NICUs.
All racial/ethnic groups showed significant difference, particularly:
19.5% of NICU admissions were Latin American, compared to 5.7% of students
18% of newborns admitted to NICUs were Black, compared to 6.5% of NNP students
"Underrepresented infants are born prematurely at higher rates and have increased rates of mortality and morbidity,” Newberry and Bell said in their study.
Despite recommendations to increase diversity among nurses and other healthcare providers, an "ethnic discordance" remains between NICU providers and patients, they wrote.
“The discordance between neonatal nurse practitioner students and neonates in the neonatal intensive care unit is important in addressing disparities,” the study says.
Diverse nurses offer a valuable perspective to nursing care by bringing shared life experiences with their patients and the ability to understand the culture and establish partnerships and communication with their minority patients, the authors wrote.
Most nursing schools are working to diversify their student population to address and rectify ethnic discordance. For example:
Frontier Nursing University in Versailles, Kentucky, has tripled its student of color population in the last decade by changing to a holistic admissions process and adding measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas.
Recognizing and addressing the barriers faced by underrepresented nursing students and faculty will "increase the diversity of NNP students and faculty and ultimately practicing NNPs," Newberry and Bell conclude. "The ability to diversify the NNP workforce will result in improved neonatal outcomes."
Flexibility and innovative practice models can enhance retention of nurses reaching retirement age.
Most nurses aged 55 and older have such passion for their work that providing schedule flexibility and different practice models to focus on their strengths could go a long way in keeping them in the workforce, a new study says.
Slusser spoke with HealthLeaders about her study’s findings that could help healthcare organizations retain their seasoned nurses.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What, generally, is the perception of the current nursing profession by nurses over 55?
Kim Slusser: They're very concerned about the nursing shortage and that it puts a stress on them and their ability to perform the things that they know make a difference for patients, just like we all are. But for this group of nurses, as we found in the study, the whole joy of their work as a nurse is what keeps them in the workforce, so all of these stressors that we're feeling right now from a nursing shortage can put that at risk.
In our study, they talked a lot about rising patient acuity and how that continues to be a challenge for healthcare systems. They, over the years, have seen that acuity increase yet, because of their experience and their expertise, we rely heavily on these nurses to do so much for us beyond patient care.
These are the people we're asking to precept new nurses, who are the charge nurses on units who manage the patient flow and how assignments are made, the troubleshooter for everyone. In academic hospitals, they are the resource to residents and interns who rotate onto their unit. These are things they enjoy doing, but with the rise in patient acuity, staffing challenges, and having all of these competing roles, it adds a lot of stress to the work every day.
HL: What are some challenges unique to them in today's workplace?
Slusser: Wearing a lot of hats in addition to taking care of patients. They also talked about the physical demands as you get older and how they used to be able to work long shifts but how that gets harder over time.
Many of them would like to continue to work because it's such a part of their identity—it’s what brings them so much value—so they're looking for ways to be able to do that in ways where physical demands would not take such a toll on them.
They brought up a lot of things such as more flexible hours. Some of the nurses we interviewed said they’ve stayed in nursing because they’ve been able to have flexible work assignments. Other recommendations are a lesser- or no-patient assignment. We need to see how they contribute to the next generation of nurses in a different way than the way we are asking them to do today.
HL: So many nurses over 55 opted to retire or quit during the pandemic, but others chose to stay on. Why?
Slusser: Their absolute love of what they do, that they feel they are making a difference, which brings them a lot of joy, and commitment to their career.
They did say that flexible scheduling was helpful in the decision to stay, so when you can put things like that in place, you have a better chance of retaining these nurses that are so valuable for our care delivery and the training of our future nurses.
HL: What are the benefits of retaining retirement-age nurses?
Slusser: They bring such a richness of experience to the organization. They are the people who we rely on to train more novice nurses. So many of the nurses, at least in this study, have worked for the same organization for a long time, so they have a commitment to the organization and they can foster that hospital’s culture.
Even beyond clinical experience, these nurses know how to develop relationships with patients, how to develop relationships with other clinical team members like physicians, social workers, and pharmacists. It takes a long time to be confident in your practice as a nurse, and these nurses have developed that confidence in their practice and they're able to help instill that in newer nurses coming onboard.
HL: What are specific accommodations that nurse leaders can make to encourage seasoned nurses to stay?
Slusser: We have to think differently about how our entire nursing workforce works. In this study, we focused on the nurses near or at retirement age, but we've learned with the younger generations of nurses that they want similar things. They want flexibility in their schedules. They want non-traditional shifts, as well, so it’s a win-win for the entire nursing workforce that many of the things that our nurses from this study wanted are similar things that we found in younger nurses.
We can become more creative and offer our scheduling, shifts, and even our roles part time. During peak times of clinical care activity, does everyone have to come into work at the same time? Right now, we’re traditional in how most of our hospitals schedule their nurses, so it’s going to require nursing leaders to take a step back and look very creatively.
Nurses can help inform how to do that well; hospitals that have strong nursing shared governance groups can lean on the nurses to help accomplish that so that the nurse leaders don't have to come up with these ideas all on their own.
Another recommendation of nurses in the study was to find a way to coach, precept, and educate more novice nurses in a way where they don't have to continue their other responsibilities such as maintaining a full patient assignment or being the charge nurse on the unit. There are ways we can relieve them of some or all of those duties so they can focus on coaching.
It is more expensive to take nurses and reduce their responsibilities to give them more time to coach novice nurses, so as nurse executives, we have to figure out a way to measure the return on investment for doing that. How can we measure that from a patient-outcomes perspective, retention of nurses, job satisfaction of nurses, and their confidence, which makes them a stronger clinician?
I do think there's cost avoidance if we stand up programs like this, especially around reducing turnover. Back in 2020, the nursing turnover rate was as high as 18% in some places, and turnover for new graduates was anywhere from 17% within their first year up to 30% within two years. If we can keep nurses in their profession by having nurses near retirement focus on coaching them, there could be a huge return on investment.
In FPA states, the NP workforce tends to be more diverse and better racially and ethnically aligned with the state's overall population, a new West Virginia study says.
Granting full practice authority (FPA) to nurse practitioners (NPs) is a “costless” way to help communities of color address healthcare access disparities, say authors of a new West Virginia University study.
More than half of US states have granted FPA, which is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing, rather than requiring them to hold a state-mandated contract with a physician as a condition of state licensure.
Though NPs of color are underrepresented in the workforce—less than 7% of NPs are Black, according to employment recruiter Zippia—states permitting FPA tend to have NP workforces that are more diverse and more racially and ethnically aligned with the state’s overall population, the study says.
The study addresses three healthcare industry concerns:
1. The worsening shortage of US primary care providers, particularly in marginalized communities.
2. The importance of enabling patients from communities of color to choose primary care providers who share their racial and ethnic background.
3. The debate over allowing nurse practitioners to exercise FPA.
“In every state, NPs may all meet with patients, but that’s where the similarities stop,” Plemmons says. “Some states require physician supervision for NPs, while others simply require collaboration agreements. Some limit NPs in diagnosing patients or developing treatment plans, others limit making specialist referrals or ordering imaging services. Probably the most contentious restriction is prescribing medication.”
Reflecting patient demographics
The study compared the backgrounds of NPs, patients, and overall state populations nationwide, focusing on Black, Asian, and Hispanic communities and found that FPA states had higher concentrations of NPs from communities of color.
Representation varied among different communities, according to the study, but the data for Black NPs and patients in FPA states stood out: Black NPs in FPA states served 2.8% more Black Medicare beneficiaries than Black NPs in non-FPA states.
That’s significant because a nursing workforce that reflects its patient demographic makes healthcare more comfortable for every patient, several studies, including a Joint Commission report on cultural diversity, have shown.
But finding a doctor, especially a Black doctor, isn’t always easy, particularly in diverse, poor, or rural communities where doctors generally won’t work—but NPs will.
Regardless, many states continue to limit NPs’ FPA, often on the basis of physician concerns about quality of care. The American Medical Association and other physician groups argue collaborations are needed for patient safety.
“Recent data finds 84% of registered nurses are experiencing burnout and only 42% of nurses feel their employer values their mental health,” she said. “ANA wants to help our members by making a great resource easily available.”
Nearly 7,000 ANA members signed up for the program during last summer’s trial, with these results:
52% of members surveyed claimed the program reduced their sense of burnout.
86% applied the strategies they learned to their work or personal life.
90% were satisfied with the Burnout Prevention Program.
95% asked ANA to add it as a permanent member benefit.
The program, developed by SE Healthcare, a healthcare data analytics provider, gives nurses on-demand access to more than 190 “bite-size” videos on real-world challenges faced by nurses, with such topics as Building a Better Day Off; Delegation—What a Revelation; Shared Governance; and Ethical Dilemmas.
The program, available on a mobile app, also includes a continually updated reference library of peer-reviewed, scholarly articles that support evidence-based interventions, Cole said.
“Not only can you create an individualized well-being care plan, but you can also earn up to 22 free continuing education credits,” she said.
“We chose the SE Healthcare program because it uses real-world clinical data by nurses who understand the day-to-day experiences of our members,” said Stephen Fox, ANA’s vice president of membership and constituent relations.
“We were also pleased to see that 86% of nurses said they have actually used a strategy in their work or personal life, which is a tremendous result for any program,” Fox said.
A confidential four-question assessment tool also assists in identifying the nurse’s top stressors that are a result of the work processes or environment, which are analyzed by demographics and location, and supported by a visual data dashboard, according to SE Healthcare.
The tool’s Summary of Findings report can help nurse leaders properly address and lower, or even prevent, burnout in their staff.
The burnout program also includes access to an anonymous survey, which Cole encouraged nurses to take, to “enable us to use the findings to advocate on behalf of nurses and drive change at the national level.”
USC's online program scored high in engagement, faculty credentials, peer assessment, and more, U.S. News & World Report says.
The University of South Carolina’s online masters in nursing program ranks No. 1 among online nursing master’s programs in U.S. News & World Report’s 2023 Best Online Programs, released today.
The No. 2 spot was a three-way tie. Duke and Ohio State University, who previously were No. 5 and No. 1, respectively, tied with the University of Alabama, which previously was No. 11. Saint Xavier University rounds out the Top 5.
The purpose of the Best Online Programs rankings is to measure whether online degree programs’ academic standards are consistent with quality brick-and-mortar programs and properly adapted toward the unique learning of distance education.
U.S. News ranked nursing schools using five categories. The categories, with its weight in the ranking formula were:
● Engagement (30%): Aspiring advanced practice nurses can readily collaborate with fellow students in their classes and clinical settings. Instructors are accessible, responsive, and help students stay enrolled and complete their degrees in a reasonable amount of time.
Factors included graduation rate, best practices, class size, one-year retention rates, and time to degree deadline.
● Faculty credentials and training (20%): Instructors’ academic credentials mirror those of instructors for campus-based programs, and they have the resources to train these instructors to teach distance learners.
Factors included preparedness to teach distance learners, terminal degree faculty, and tenured faculty.
● Peer assessment (20%): A survey of high-ranking academic officials in nursing helps account for intangible factors affecting program quality that statistics do not capture.
Factors included the school’s weighted mean of scores on a 1 to 5 scale as rated by administrators and academics at online master's in nursing degree programs.
● Services and technologies (20%): Programs that incorporate diverse online learning technologies allow greater flexibility for students to take classes from a distance. Strong support structures provide learning assistance, career guidance, and financial aid resources.
Factors included student indebtedness, support services, and technological infrastructure.
● Student excellence (10%): Student bodies entering with proven aptitudes, ambitions, and accomplishments can handle the demands of rigorous coursework.
Factors included acceptance rates, experience, and undergraduate GPA.
Flexible scheduling and new care models can help provide nurses the work-life balance they demand.
Getting creative with staffing and offering flexible scheduling to nurses are among the strategies that acute-care hospitals can adopt to keep the nurses they have and attract new ones, says a health system executive.
"Double shifts, erratic and inconsistent scheduling, and menial tasks are contributing factors that have led to a sense of imbalance and job dissatisfaction among nurses,” Bayless says. “This situation has worsened mainly due to COVID-19's ongoing impact on healthcare workers."
Bayless spoke with HealthLeaders about how flexible scheduling and new care models can help solve those contributing factors.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: What care models are being adopted to help with nurse retention?
Jill Bayless: Healthcare has eased into mostly an RN-driven staff model in hospitals and as COVID drove a lot of nurses out of hospitals, many retired, and a lot of them went traveling. It made hospitals look at different ways to take care of patients.
Hospitals within our systems are doing different models. One of them is what we call the dyad model, where you have a care team of an RN and certified nurse's aide or a PCT [patient care technician]—someone who is not licensed—working together. We’re using those models right now in some of our long-term acute-care facilities.
At our acute-care hospitals, we had to start looking at how we could still take good care of all these patients without having the RNs we had in the past. We call that the triad model. Some people who are senior careerists like myself used to call that the team model, which can be a variety of mixtures of staff. Generally, it is an experienced RN, and then inexperienced RNs or LPNs or LVNs—depending on what state you are in they are called different things—and then a PCT or certified nurse’s aide.
Some of our facilities were doing this before COVID because they couldn’t get enough RNs in their rural communities, but a lot of our larger hospitals that had shifted to all-RN staffing are, as they have an RN vacancy, asking, “Do we really need an RN for that? Can we use a very green, brand-new RN or could we use a seasoned LPN?”
Others are adding a respiratory therapist to that team so there’s a team of three people—two RNs and a respiratory therapist—taking care of sick patients. A lot of ICU patients are ventilated and require skills related to mechanical ventilation or CPAP machines and a respiratory therapist can do that. Respiratory therapy personnel are also very experienced in dealing one-on-one with patients.
HL: How do these care models benefit nurses?
Bayless: They know they are supported by someone who has more experience than they do. During COVID, brand-new RNs were coming out of school with very little hands-on experience and being put in situations where maybe they had the didactic knowledge, but none of the practical experience, so this model allows for those new RNs to learn under someone who is very seasoned and experienced.
That also allows for that charge RN to not be doing what I'm going to call mundane tasks—that doesn’t mean they aren’t important, but they’re things like doing blood sugar, taking linens, and helping patients to the bathroom. A certified nurse's aide or a PCT can do that.
It does involve the charge RN going around and meeting every patient at least twice a shift and then more often if they have something more critical going on, so they would still be assisting that LPN or new grad RN and assessing that patient and helping them understand the care needs or whatever that diagnosis is.
HL: When nurse leaders are considering changes, how should they best effectively adopt a new care model into their organization?
Bayliss: I don't know that this is the best way, but I can tell you how we are doing it here. We've engaged all of our CNOs, and our focus is to have a triad model or a dyad model, depending on what kind of hospital they are.
It really has to be driven by the CNO at the local level, along with the director of the unit where that change is being implemented, and you have to get input from your staff on that. The director of the unit and the CNO will talk about anticipated changes with their unit and listen to staff and hear their ideas about how it could work best there.
There’s no one-size-fits-all, and there never is in healthcare. Staffing, size of the unit, makeup of the unit, experience of the staff on all levels—all that has to be taken into consideration.
HL: How can flexible staffing create a more satisfied and engaged workforce?
Bayliss: Generally, what we see now is that staff are scheduled three 12-hour shifts, so for a single mother who has a daycare that’s open only 10 hours a day, they can't work those 12-hour shifts, or they have to find some interim solution that will allow for that child to be cared for in the hours outside of that daycare’s opening. Some facilities are looking at whether they can offer eight-hour shifts in addition to three 12-hour shifts to staff, and then someone to work all weekends, which is an old model, called the Baylor Model.
Other ways are hiring tele-nurses to help with things like admissions and discharges and medication reconciliation, all of which are time-consuming for the nurse on the unit. Nurses who can't do long shifts can work within a tele-nursing position.
I implemented “mother’s hours” some years ago to fill voids during the busiest time of day. We had busy times from about nine in the morning until about 2:30 in the afternoon and a lot of mothers with children in school were able to fill those positions because they could come in after they got their child on the school bus or dropped them off at school, and then they got off in time to be at home or to pick that child up.
Some facilities are doing a seasonal nurse schedule. Typically, in ICUs and intermediate care units, their busiest times of the year are September or October through about April or May. Based on the volumes of the unit, some facilities are offering seasonal work schedules where nurses could work about nine months, get full benefits, get full pay, but then be off in the summertime or whatever months are not as busy for those units. It still gives the staff that flexibility of having them when the volumes are hot, but not having them when they're not needed.
Those are all ideas, but what works in one market may not work in another market. You have to look at things that give some relief to that staff on the unit.
The Children’s Healthcare of Atlanta rooming-in program helps nurses to know 'we're not sending babies home into unsafe environments.'
An innovative rooming-in program for families of infants with critical congenital heart disease (CCHD) provided greater peace of mind not only for families, but for nurses as well, in preparing the infants for discharge, a new study reveals.
Children’s Healthcare of Atlanta’s pediatric cardiac acute care unit developed the program in 2019 so nurses could help the infant’s mother or caregiver learn and get comfortable with specific skills required for their complex care—safe medication administration, feeding regimens, respiratory management, wound care, and recognizing early signs and symptoms of worsening issues.
Indeed, taking home an infant with CCHD can be overwhelming for parents; research suggests that caregivers of children with CCHD experience higher levels of distress than do parents of healthy children, according to the study.
Many parents have said they were emotionally, physically, and educationally unprepared for discharge and felt fear and worry about the ability to properly care for their ill infant, the study says.
Rooming-in is designed to allow the mother to remain with their infant for 24 hours prior to discharge, as they learn a large amount of information in a short time and practice those unfamiliar skills under nurses’ guidance.
“Nurses must feel confident and competent in their ability to provide training and education to caregivers of infants with medically complex conditions,” Shackleford said.
“The quality of discharge education and care coordination are important elements for a successful transition to home, and participants pointed to how this program improved both family and nursing outcomes,” she said.
An unexpected outcome of the rooming-in program was improved organization of the discharge process, notably between nurses and the discharge coordinator, paving the way for a smooth transition home, the study says.
Participants also identified ways to improving the rooming-in program, such as developing a more consistent way to measure caregivers’ abilities, beyond simply passing or failing specific skills tests, and customizing the program so each family receives the training that matches their needs.