The number of nurses leaving direct care has bumped up 10 percentage points in less than 10 months, new study says.
Staffing, pay, and lack of support are the reasons why 32% of RNs surveyed in the United States in November say they may leave their current direct patient-care role, according to research by the McKinsey & Co. consulting firm.
Indeed, while staffing shortages aren't a new concern for healthcare executives, it took the No. 1 spot last year as the top issue that hospital CEOs faced in 2021, according to The American College of Healthcare Executives' (ACHE) annual survey.
In the past, CEOs had listed financial challenges as their top concern.
Other findings from the survey include:
Of the surveyed nurses likely to leave their current roles, only 29% would continue direct patient care in some form.
Nurses in years one through five and six through 10 of their nursing careers are more likely to say they intend to leave their current role than those with 11-plus years of experience.
A safe environment is the top priority for surveyed nurses, followed closely by work-life balance and caring and trusting teammates.
To retain frontline clinicians, healthcare leaders are creating strategies focused on supporting their workforce. McKinsey offers two key implications for healthcare organizations to consider going forward:
1. Tailoring workforce retention strategies to employee needs and preference, including more personalized programs and support, including:
Doubling down on environmental factors—i.e., team dynamics, feeling valued by the organization—flexibility, and professional development opportunities.
Ensuring the total rewards offering is aligned with organizational strategy and meets a holistic set of needs, such as mental health services and dependent care.
Strengthening continuing education programs, roles, and resources that support novice clinicians and "in need" skill sets, such as behavioral health.
Offering training and resources for leaders to support the needs of their team members, as well as the entire team.
2. Minimizing workload strains will require innovation but provide much-needed relief. Innovation includes:
Using analytics to improve accuracy and timeliness of demand forecasting, workforce alignment, and real-time labor management.
Redesigning roles and processes, through digitization and automation where appropriate, to reduce friction points, increase flexibility, and enable top-of-license practice.
Figuring new ways to grow the talent pipeline via efficient hiring processes focused on highest need roles/skill sets, untapped pools of talent, and diverse cohorts.
Legislation to benefit nurses and other clinicians will offer 'a lifeline to those who often put their patients before themselves,' NPPA president says.
New legislation passed by the Senate late last week may save lives among nurses, physicians, and other healthcare workers overwhelmed by the relentless load of working on the front lines of the COVID-19 pandemic.
The Senate, with clear bipartisan support, passed the Dr. Lorna Breen Health Care Provider Protection Act last Thursday, which will earmark funding to provide mental health wellness to those frontline workers.
Among the bill’s provisions are:
Establishing grants for training healthcare professionals on ways to reduce and prevent suicide, burnout, substance abuse, and other mental health conditions
Grant funding for employee education, peer support programming, and behavioral health treatment
Creation of a national education and awareness campaign focused on encouraging healthcare workers to seek support and treatment.
"Our country’s mental health crisis has only worsened during the pandemic, and emergency nurses can certainly attest to the stress, fatigue, and burnout they’ve experienced," Schmitz says. "Passage of the Dr. Lorna Breen Act will deliver help to healthcare workers, ultimately saving lives and preserving their ability to provide the best care possible to patients."
The bill was named for Breen, a physician at New York Presbyterian Hospital in Manhattan, who died by suicide on April 26, 2020 after working around the clock for weeks to treat COVID-19 patients.
She declined getting help for the stress and burnout she was experiencing because she feared seeking mental health help would end the only career she ever wanted and that she would be ostracized by her colleagues, according to the foundation established in her name.
"The importance of passing this bill can’t be overstated. By providing much-needed mental health services and support to NPs, registered nurses, physicians, and other healthcare providers, we are offering a lifeline to those who often put their patients before themselves," Kapu says. "Taking care of healthcare providers’ mental health positively impacts their ability to serve others and will help prevent suicide among so many who are feeling extreme burnout."
The bill now goes to President Biden to be signed into law.
Nurses from all sectors can take a leading role in preventing and controlling hypertension, thereby preventing high rates of cardiovascular disease, new study says.
With hypertension (HTN) as a leading cause of cardiovascular disease (CVD), affecting nearly one in two adults in the United States, a new study has developed a "Call to Action for Nurses" to take a leading role in improving cardiovascular health.
The paper was published online last week in Worldviews on Evidence-Based Nursing.
Nursing leaders from 11 national organizations identified the critical roles and actions of nursing in improving HTN control and cardiovascular health, in response to the 2020 Surgeon General's Call to Action to Control Hypertension.
Within weeks of the release of the Surgeon General's report, the nursing leaders formed a work group to review the literature, synthesize the evidence, and make recommendations.
"Evidence-based interventions exist for nurses to lead efforts to prevent and control hypertension, thus preventing much CVD," the study says. "Nurses can take actions in their communities, their healthcare setting, and their organization to translate these interventions into real-world practice settings."
The call to action is for multiple sectors of nursing—registered nurses, advanced practice nurses, schools of nursing, professional nursing organizations, quality improvement nurses, and nursing researchers—and outlines specific actions that various nursing sectors can take.
For example, RNs can:
Ensure BP is measured accurately
Provide health coaching
Assess and address social determinants of health (SDOH) and mental health
Schools of nursing can:
Ensure BP measurement competence
Teach HTN and CVD risk prevention and management
Instruct about SDOHs and their role on cardiovascular outcomes
Professional nursing organizations can:
Make cardiovascular health a priority for national conferences and meetings
Promote evidence-based interventions
Mobilize members to support HTN policy changes
Advance research
Though CVD remains the leading cause of morbidity and mortality for both men and women across the United States and around the world, a 2020 study indicated that only 77% of individuals were aware that they had hypertension and only 44% of those with hypertension had their BP controlled.
Uncontrolled hypertension is an independent risk factor for CVD, stroke, kidney disease, and cognitive decline and significantly contributes to complications of pregnancy and mortality, the study says.
Resources that nurses from all sectors can use include:
Million Hearts®, a national initiative co-led by the U.S. Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services to prevent 1 million heart attacks, strokes, and other cardiovascular events over a five-year period.
Target: BP™, an initiative of the American Heart Association and the American Medical Association (AMA) in response to the prevalence of uncontrolled BP.
The Preventive Cardiovascular Nurses Association (PCNA), a nursing organization preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.
The websites of these organizations offer numerous tools to assist nurses.
The peaceful protest, sponsored by Nurses Against Violence, also will focus on safe staffing ratios.
Nurses Against Violence will take its message that violence in the workplace is not acceptable or "part of the job," on May 12 with the United Nurses March in Washington, D.C.
Violent incidents can range from disrespectful verbal confrontations where an individual—usually a patient—directs profanities, threats, or slurs toward healthcare workers to physical altercations where they hit, kick, punch, or spit on them.
Violence means more than physical attacks on nurses and other healthcare workers, according to Nurses Against Violence, which is sponsoring the march; it also includes racism, incivility, and discrimination.
In addition to raising awareness of nurse and frontline healthcare worker violence—including that of first responders—the peaceful protest also will focus on safe staffing ratios.
Even before the COVID-19 pandemic, staffing shortages and ratios have been at issue for hospitals and health systems.
Congressional Democrats introduced a bill last May that sets minimum nurse-to-patient staffing requirements and provides whistleblower protections for nurses who report violations to those rules.
The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act gives hospitals two years—and rural hospitals four years—to develop and implement nurse staffing plans that meet minimum RN-to-patient ratios; adjust staffing levels based on acuity, nursing care plans, and other factors; and ensure quality care and patient safety.
California is the only state now requiring minimum RN-to-patient ratios. Its ground-breaking safe-staffing standards took effect in 2004.
"These are serious issues," according to Nurses Against Violence. "This march is for the healthcare worker that feels alone, silenced, and left behind. Incivility in nursing, including racism … has to be addressed, along with discrimination, poor morale, mental illness, addiction, and the rising suicide rates among nurses alone."
A new AACN teaching tool draws upon the lessons and genuine person-centered care shown in the early 1980s by the nurses and other clinicians of the country's first AIDS ward.
The nurses who took extraordinary action to care for patients in the country's first AIDS ward in the early 1980s have inspired a new teaching resource that motivates future nurses to follow in their risk-taking, problem-solving, and patient-advocating footsteps.
The Trailblazing Innovation Faculty Tool Kit centers on themes highlighted in the documentary 5B, which features first-person accounts from nurses and other professionals who, without existing protocols, cared for patients most other clinicians were afraid of treating and forged a new, person-centered approach to patient care in Ward 5B at San Francisco General Hospital.
The tool kit, developed by a team of experts led by Edilma Yearwood, PhD, PMHCNS-BC, FAAN, chair of the Department of Professional Nursing Practice at the Georgetown University School of Nursing & Health Studies, centers on 17 core themes central to nursing practice, including allyship, compassionate care, moral courage, respect, trauma-informed care, and wellness.
HealthLeaders spoke with Yearwood about the new tool kit and the documentary's influence over it.
Thistranscript has been edited for clarity and brevity.
HealthLeaders: How and why did the concept of the tool kit originate and how was it tied in with the 5B documentary?
Edilma Yearwood: Some schools of nursing showed it to some of their students … and the feedback wasoverwhelmingly positive. Johnson & Johnson thought that because of the feedback from the faculty and the students, this might be a good opportunity to use the documentary to develop some skills and tools for nursing schools to use to assist students in a variety of different ways. AACN formed an advisory group to work on the toolkit, and we worked on it for about a year.
HL: How innovative is something like this for nursing schools? Aren't they teaching person-centered care already?
Yearwood: A lot of what we have taught in nursing is patient-centered care. And if you look at the difference in how they describe "patient" versus "person," person-centered care is much more holistic, and includes other elements. Now, I'm an old nurse, so when I heard patient-centered, I would think about that individual patient in front of me. But person-centered care really asks you to see that person in front of you, in the context of home, community, their illness, all of that.
HL: What are some of the points that make this tool kit unique and valuable?
Yearwood: For me, as somebody on this committee, it was helpful for us to work together to identify some of the themes that we saw in the documentary and walk people through what those themes meant and mean, and how we can translate that in our work with our students.
If you're going to be innovative, and if you're going to be a leader in driving care, you have to understand what leadership is. You have to understand that sometimes you have to have moral courage to make a decision that you're going to drive. So, the different pieces that we came up with that we identified as what we call themes include things like allyship—how do we look at the environment, the clinical environment, and who are the allies to help move the needs of the patient forward? It's not the individual nurse by himself or herself; it's about who are those other folks who we need to bring along with us to make the plan work for this particular patient and/or their family.
Sometimes, you have to take a stand if you feel strongly that Plan A is a good way to go, and everybody else on the team might say, "Well, we only can afford Plan B." If you think Plan A is going to be the best path forward, how do you step up and have moral agency and moral courage to execute, given your conviction? How do you deliver compassionate care? Within all the frames of what we're doing, you've got to keep the person at the center and understand that you have to listen to them and be compassionate about what they're telling you they need.
HL: What is it about the documentary that made it figure so prominently in this tool kit?
Yearwood: We all looked at the documentary multiple times and what we each did, independently and then collectively, is we identified snippets from the documentary that held a particular message. And we made a list of those snippets. So those pieces are tools that the educator can use to explore a concept in their teaching of students. They're like sparks to having a conversation and having an opportunity to do a deeper dive on some of these concepts.
HL: What snippet from the documentary particularly resonated with you?
Yearwood: One of the nurses had a needle stick and she became HIV positive. That was one that particularly touched me because in talking with students, that piece is important—your vulnerability in the healthcare environment where there are things going on that we know very little about. COVID is a great example.
When COVID first came out as a prominent issue in our lives in 2020, we were unclear about transmission. We were unclear about how long this was going to go on. And we were unclear about the risk for the staff. And in the documentary, this nurse was vulnerable because she contracted HIV as part of her work, but it didn't deter her from her work. She clearly was still passionate about her work with this vulnerable group of individuals who were sick and dying.
It was a lesson for me that I can talk with students about how sometimes we don't know how things are transmitted, and sometimes we become more at-risk or vulnerable. Does that mean that we avoid the bigger picture, which is the need to deliver compassionate care and moral agency about doing the right thing? That, for me, was memorable.
HL: How effective are the tool kit's lessons in courage, ingenuity, and compassion in encouraging new nurses to stick with the profession?
Yearwood: I'm a psych nurse and one of the things I talked to my students all the time about is the importance of self-care and paying attention to your own well-being. When you get to the point where you're feeling like you're getting depleted, double down on self-care, but it's also okay to make a change.
There are so many facets of nursing that one can go into that one does not need to get to the point where they're totally burned out from being in an acute, high-risk kind of environment. Sometimes, it's okay to take a pause … and at another point in your life, you might want to return to that early passion, but you can be as effective by moving on and doing something different.
Yearwood: I wrote the [tool kit] piece on health equity and this is a central place nursing has to feel comfortable with and incorporate, and for us to have better health outcomes for all, we have to understand that we also are responsible for the equity and the treatment access issues that all patients have. So, it's a very central theme in not only the documentary, but also in the tool kit that we developed.
We talk with students in the tool kit about not limiting their perspective on what the term "helps" means or looks like, that in order to forge health equity for all we have to really understand the person's lived experience and determinants of health factors that impact them and their illness and/or their road to well-being.
Once we know what those factors are that might be contributing to an illness, we have to address all of those factors as much as we can.
HL: What is the overarching idea that student nurses can take from the tool kit?
Yearwood: That there are ways to understand and to grow within the profession and to be their best self as a compassionate clinician. They can use some of the things found in the tool kit to move forward as a moral agent, and I think even new nurses can be moral agents.
They don't have to stay silent; they can take risks, and they can lead when they know that what they're trying to do is the right thing to do. They don't have to just follow; they can actually lead when they are looking after the best interest of the consumer or the person.
"Demands for mental health practitioners have steadily grown in California due to COVID-19," says Christy Cotner, DNP, RN, FNP-BC, PMHNP-BC, who serves as the College of Graduate Nursing's Psychiatric Mental Health Nurse Practitioner program director. "The nurse practitioner really can play an important role in the psychiatric field."
A shortage of nurses for COVID-19 patients is commonly known, but psychiatric nurses are in short supply, as well, particularly when more than 75% of all U.S. counties have a shortage of any type of mental health worker and 96% of all counties have an unmet need for mental health prescribers, according to the American Psychiatric Nurses Association (APNA).
The care gap is most profound in rural states where 111 million Americans live in mental health professional shortage areas, the APNA says. COVID-19, with the isolation and other issues it has caused, only further proves the need for access to mental health services, says a press release from WesternU.
WesternU's new program is designed for nurses with a master’s degree in nursing, or nurses who are earning their Master of Science in Nursing degree.
"A lot of times nurses will go into the psychiatric field having only been a psychiatric nurse," Cotner says.
"They really don’t have that medical piece, which you really must be able to rule out those organic causes before you can even think about the psychiatric causes," she says.
"We really look at the whole picture. Our training is holistic," she says. "And that’s really what we need for psychiatry. We need a holistic look at the patient."
Being a nurse executive in today's healthcare environment requires much more than clinical expertise.
As nurse leaders' responsibilities have evolved into managing complex healthcare systems, collaborating across specialties, leading strategy, and budgeting, nursing educators are responding by adapting their curriculum.
Mercy College of Health Sciences in Des Moines, Iowa, recently began offering the first graduate program in its 123-year history—a Master of Science in Nursing (MSN) with an emphasis on Organizational and Systems Leadership—joining other colleges and universities in preparing nurses to lead.
Seton Hall University, for example, offers an MSN degree in Health Systems Administration; Walden University offers the MSN-Nurse Executive; and nursing students at the University of Wisconsin-Green Bay can earn an MSN in Nursing Leadership and Management in Health Systems.
"We've heard from nurse executives about the complexities of being a nurse leader in today’s healthcare environment," says Nancy Kertz, PhD, FNP-BC, Mercy's vice president of Academic Affairs and provost.
"Our MSN in Organizational and Systems Leadership recognizes these changes and offers students a relevant curriculum," she says, "and empowers them with the necessary tools to become the next generation of nursing leaders."
Mercy's new program reflects nurse leaders' evolving responsibilities, preparing graduates to be experts in the operations, finances, and evolution of healthcare delivery systems, with such courses as health systems leadership, translational research, statistical methods, finance, quality improvement, planning, management and evaluation of programs, and health policy.
"It is my opinion that nurse leaders who have a deep knowledge and a framework in organizational and systems leadership will be in high demand," Kertz tells HealthLeaders.
"The COVID-19 pandemic has demonstrated that strong nursing leadership is required for the nursing profession. The pandemic has forced nurse leaders to respond to a rapidly changing and increasingly complex healthcare environment."
A benefit to patients
Such progression in nurse leader responsibilities can only help patients, according to a 2018 study.
"The need for highly educated nurses to manage complex healthcare systems, build relationships with healthcare teams in order to collaborate and coordinate across all specialties and professions within the healthcare industry is paramount to achieve better patient outcomes," the study says.
"This will be accomplished by reinventing the nursing curriculum to include all aspects of competency in leadership, health policy, systems, research, and evidence-based practice," the study advises.
Swanson was in nursing school in the early 1980s studying for her associate degree when she realized that her chosen profession would require more than instruction in patient care.
"I could see that healthcare was a business and that nursing didn't have some of the tools that it needed to actively come to the table and be heard amongst other business professionals who were non-clinical," Swanson says.
"If I'm going to speak their language and get what I need for my team or the care of my patients, I have to at least communicate with them in a language that they understand and know," she says. "You're able to walk into a meeting and be heard, as well as you have a greater ability to understand where other individuals may be coming from."
"Nurse leaders control the largest part of a hospital labor budget, in some cases the largest part of the overall budget," Douglas writes. "The effectiveness of overseeing this responsibility can mean the difference between an organization’s financial stability and financial turmoil."
Indeed, nurse executives are more sought out for their leadership abilities, education, and competencies rather than on clinical expertise, according to Kathleen Sanford, DBA, RN, FACHE, FAAN, executive vice president and chief nursing executive (CNE) of CommonSpirit.
"The competencies include specific actions and abilities under the domains of communications and relationship management, professionalism, knowledge of the healthcare environment, business skills and principles, and leadership, as outlined by the American Organization of Nurse Leaders (AONL)," Sanford wrote in a piece for the Journal of the Catholic Health Association of the United States.
Those competencies will best serve the healthcare organization, according to Kertz.
"A master’s prepared nurse with a specialization in organizational and systems leadership may serve in senior and mid-level positions within healthcare organizations," Kertz says, "making sure its goals and mission are carried out in day-to-day operations."
Technology provides a path to better healthcare and nurse leaders need to be well-informed.
Besides staffing schedules, overseeing budgets, and staying current on nursing practice issues, nurse executives must also stay on top of the organization's bigger picture, which increasingly involves healthcare technology.
Technology advancement offers numerous opportunities for nurse leaders, such as improving clinical outcomes, reducing human error, tracking data, enhancing nurses' well-being, simplifying care coordination, and promoting practice efficiencies, to name a few.
Indeed, nurses are natural healthcare innovators, and their understanding of patients, families, and communities provides a unique perspective to the use of technology and other innovative processes to promote health and well-being, prevent disease, and manage acute and chronic conditions, says an article recently published in the Journal of Professional Nursing, authored by three nurse leaders at the University of Pennsylvania School of Nursing.
These five technology stories from HealthLeaders editors will help nurse leaders keep on top of evolving industry developments:
Baptist Health is one of many health systems using digital health to improve its ICU services and connect care providers throughout the Arkansas-based 11-hospital network, improving care at the bedside and enabling small, rural hospitals to reduce transfers and care for more patients
It will be important beyond COVID-19, as hospitals look to move services onto virtual platforms and reconfigure inpatient care so that those occupying hospital beds are the ones who really need hospital-based care.
"This isn't just about how we use technology," says Danny Kennedy, the health system's IS field services manager. "It's about how we use our hospitals."
An EHR tool that uses AI to predict vital signs could be used in hospitals to reduce nighttime check-ups and give patients a better chance to get a good night’s sleep.
Researchers analyzed data from more than 1,900 patient encounters and created an algorithm that measures sleep promotion vitals, or normal nighttime vital signs. When embedded in the EHR, the algorithm could alert care team members that the patient has a 90% chance of maintaining normal vital signs overnight.
"The intervention group experienced 31% fewer vital sign checks per night with no change in the rates of intensive care unit transfer or code blue alarms," researchers reported.
Imagine having the conversational functionality of a digital assistant like Amazon Alexa that not only understands medical language, but also can respond, record, transcribe, translate, and interact with the electronic health record (EHR). With patient permission, the technology could be embedded in exam rooms, the OR, call centers, the patient bedside, and the patient's home.
Conversational artificial intelligence (AI), while still in its infancy, holds the potential to deliver the next significant wave of innovation in healthcare and has the potential to reduce the administrative burden on clinicians, improve clinician-patient interactions, and reduce financial pressure on healthcare enterprises, says Brian Kalis, managing director, health strategy at Accenture.
"Conversational AI technology allows people to use natural voice or text to interact with systems," Kalis says. "There's been a growing trend of artificial intelligence moving beyond a back-end tool for the healthcare enterprise to the forefront of the clinician and consumer experience."
Children's Mercy Kansas City has launched a new program that uses predictive analytics and digital health technologies to help young patients living with diabetes manage their health and address concerns before they become serious.
Called the Rising T1DE Alliance, the program brings together clinicians, patients, caregivers, and researchers to harness the data being gathered throughout the healthcare experience and use it to predict and improve health outcomes.
The program uses Cyft's predictive analytics technology as the backbone for its treatments, which use data and technology to predict outcomes and map out the protocols to reach those goals. Among the interventions being developed through Rising T1DE are a remote patient monitoring platform that allows patients to connect with their care providers to share data and hold virtual visits, a virtual program called PEEPS (Patients Encouraging and Engaging Peer Support) that pairs teen with young adults for mentoring, and an mHealth platform that delivers personalized "nudges" through one's mobile phone to support positive habits and goals.
A Philadelphia-based university and health system's digital health platform is designed to help students and staff access behavioral health and self-care resources.
Thomas Jefferson University and Jefferson Health is offering employees, faculty, and students the NeuroFlow mHealth app and platform, which offers digital access to surveys, reminders, symptom trackers, exercises, and other tailored content aimed at helping people dealing with behavioral health concerns.
Healthcare administrators say digital health tools not only allow staff to self-manage and move at their own pace, using resources tailored to their concerns, but also allow the organization to expand its reach and push resources where they’re most needed—either in terms of treatments needed or areas where employee stress and burnout is high.
Nurse leaders craft 5-year plan to address staffing challenges.
Faced with a nursing shortage expected to stretch well into the next decade, CommonSpirit Health has launched a five-year strategic plan designed not only to attract and keep nurses, but to provide care in an innovative way that effectively stretches nursing resources.
"We started our five-year strategy pre-COVID," says Kathleen Sanford, DBA, RN, executive vice president and chief nursing executive (CNE) of CommonSpirit, which has about 45,000 nurses in more than 1,000 care sites across 21 states.
"We had a large meeting with nurse leaders from across the entire system and we talked about what our vision would be and about where we would be going with nursing in five years," Sanford says. "We then made a long, long list of things that we thought needed to be done to get there."
What emerged were the top three plans that CommonSpirit aggressively began implementing:
A systemwide nursing residency for new graduates
Establishment of an internal staffing agency
Virtually integrated care
Sanford and other nurse leaders have good reason to get creative with nurse staffing.
With slightly more than 3 million registered nurses in the United States, demand will grow by at least 5% over the next five years, according to analyzed labor market data. In that same period, however, more than 900,000 nurses will permanently leave the profession and coupled with retirements, employers will need to hire more than 1.1 million nurses by 2026.
1. Systemwide nursing residency
"There is a very high turnover among new grads across the entire country in all healthcare systems and we're not immune to that, [where] they just leave within the first year or the second year," she says.
In questioning new graduates and other nurses, they learned that new grads don't feel that they get enough orientation and don't feel supported, Sanford says.
"They didn't feel like they had enough expertise, and it was just overwhelming to many of them to work in an acute care hospital, so we decided that it had to be a priority to help these new grads, to make sure they're prepared, that they're comfortable, and that they feel supported," she says.
The one-year residency begins this spring.
"It will be a different program than most of them probably would have gotten in other orientations or residency in that we will be (a) making sure that all preceptors are training the same way across this very large company so that we have the same expectations among our preceptors [and] (b) besides learning what you do on the unit, which is the largest part of what young nurses need to learn, we'll be having didactic courses—things that most people haven't included in their residencies," she says.
Instruction includes what new nurses should do if they're bullied, where they should go if they need support, who to see with ideas on how the company can do something better, and who to talk to if they're feeling overwhelmed.
"It's teaching them not only how to take care of patients, but how to take care of themselves and how to take care of the people around them," Sanford says.
"The second part that makes it different is because we do so much virtually at CommonSpirit Health and are moving so fast virtually, a new grad will not only have a preceptor onsite, but they will also have access to virtual preceptors," she says.
A virtual preceptor would be available when a new nurse can't get in touch with their full-time preceptor, because, for example, they don't always work the same hours.
The virtual preceptor is available to walk them through any issues or questions they may have so the new nurse always feels fully supported.
"We know that we won't be able to totally change all the turnover, but we believe we'll put a huge dent in the number of nurses that turn over during their first year," Sanford says, "and not only help them with their careers so they will have joyful, wonderful careers, but help the whole system and help the whole profession of nursing to have people that don't get lost to us who have been educated as nurses."
2. Internal staffing agency
Part of the health system's staffing strategy depended on travel and local agencies to supplement the full-time nurses as needed, Sanford says.
"Then along came COVID and this upset the applecart," she says.
Subsequently, nurses retired earlier than planned, hospitals competed for agency nurses, and agency costs were vastly rising.
"We had already put in our strategy that [an internal staffing agency] was something we needed to do before COVID started, but it made us realize that we really needed to get going a little bit faster on it," she says.
"If you have your own agency ... these are your own staff," she says. "They can keep their seniority, they can choose to travel when it works for their lives, and they can choose to be stationary somewhere when it's better for their life, so it gives your nurses more opportunity without having to leave the organization."
It benefits patients, as well, she says.
"As we standardize more of our care across this large system, it is better for the patients if the nurses who come in know the policies, know the procedures, know how we do things here, know where you go to get best practices. And that's not to denigrate the travel nurses who are not our own employees," she says. "We just think this would be better to have your own nurses have that choice and already know the system be able to come in ready to go."
The approach is a nod to Sanford's military service as a U.S. Army officer.
"I would get orders on Friday that I needed to be somewhere else on Monday," she says. "Because we were standardized and I was going from an army hospital to an army hospital, I could walk in and work and be comfortable and be competent, completely working at the top of my license because it was the same thing. So, we're going more like that."
There may be times when they must use outside staffing agencies, "but our first place to go will be to our own agency where our own staff is employed," she says.
3. Virtually integrated care
CommonSpirit is adapting virtually integrated care (VIC), an innovative virtual care program that uses videoconferencing technology and dedicated devices in each patient room, allowing the hospital's virtual nurses to assist bedside nurses by monitoring the unit from a remote digital center.
"You still have nurses in the hospital taking care of patients and touching patients," says Sanford, the architect of the model, "but you also add to that a virtual nurse who can do things virtually, [so] nurses who are onsite can concentrate on the patient and taking care of each of those individuals and not doing some of the things that could be done virtually."
Virtual nurses, for example, will handle admissions and discharges, both of which are time consuming, she says.
"That allows the staff that is onsite to concentrate on all the other things—all the other care that has to be done," Sanford says.
The model can incorporate more than the nursing staff. For example, in its growing VIC program, MercyOne Des Moines, which is part of CommonSpirit, includes pharmacists, according to Linda Goodwin, MSN, MBA, FACHE, senior vice president of clinical operations, integration, and innovation, who piloted the program inspired by Sanford's virtual care model.
"These pharmacists are taking medication reconciliation off the backs of nurses. They make sure there's no duplication of med orders, they stop a lot of errors, and they do all the patient education around new medications or diabetic education," Goodwin says. "They are a phenomenal piece of this team. It isn't just a nurse model anymore; it is a multidisciplinary model."
CommonSpirit will examine each of its markets to see what staff can be incorporated into VIC to create custom models for each hospital, Sanford says.
"In some of our other markets, they're looking at adding licensed practical nurses and more nursing assistants," she says. "It really depends on what's available in your market. The whole idea is to work as a team but to be sure that you are also using virtual nurses to do the things that don't have to be done by nurses and others on the unit."
Insomnia due to work stress can further exacerbate nurses' anxiety and depression, new study says.
Working the front lines of the early COVID-19 pandemic led to sleepless nights, anxiety, and depression for more than half of nurses surveyed for a new study.
"Nurses are already at risk for higher rates of depression and insufficient sleep compared to other professions, thanks to the stress of patient care and the nature of shift work," said Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the study's lead author.
"The pandemic seems to have further exacerbated these issues to the detriment of nurses’ well-being," Witkoski Stimpfel said.
On the frontlines of the pandemic, nurses have faced staffing shortages, an early lack of personal protective equipment (PPE), intense fatigue, and being witness to unparalleled suffering, death, and grief, and these ongoing stressors have taken a toll on their mental health and well-being.
The study's researchers, who surveyed 629 nurses and interviewed 34 nurses, found high rates of insomnia (55%), anxiety (52%), and depression (22%) among nurses. Notably, difficulty sleeping was both a contributing factor to and an outcome of poor mental health, researchers said.
Sleeping for only five hours or less before a shift increased the odds of depression, anxiety, and insomnia. Nurses also described how anxiety and thinking about stressful working conditions led to difficulty falling asleep and waking up at night, according to the study, which was published in the Journal of Occupational and Environmental Medicine.
"We found that sleep problems were interwoven with anxiety and depressive symptoms," said Witkoski Stimpfel. "Prior research supports this bidirectional relationship between sleep and mental health. We know that getting sufficient sleep fosters mental and emotional resilience, while not getting enough sleep predisposes the brain to negative thinking and emotional vulnerability."
What employers can do
"Healthcare employers should strive to create healthy work environments and follow evidence-based staffing and scheduling guidelines set forth by the National Academy of Medicine, the American Nurses Association, and sleep researchers," Witkoski Stimpfel told HealthLeaders.
This includes:
Eliminating mandatory overtime
Monitoring staff schedules, and allowing working no more than two or three consecutives shifts
Limiting shift length to no more than 12 hours in a 24-hour period and no more than 60 hours in a seven-day period)
Allowing scheduling flexibility for nurses who need to take time off to be evaluated for a sleep disorder, mental health care services, or other healthcare services.
What nurses can do for themselves
"Ruminating about stressful work events, especially during COVID-19, has exacerbated sleep problems, like insomnia," Witkoski Stimpfel said.
"In addition to routine sleep hygiene—such as sleeping in a dark, cool, and quiet environment and avoiding alcohol, nicotine, exercise, and bright light before bed—nurses could benefit from healthy coping strategies to de-stress," she said. "That could include meditating, practicing yoga, or participating in other types of mindfulness-based stress reduction techniques."
Exercising and being outside and in nature on days off are healthy ways to cope, she advised.
"Talking to peers, friends and family, or a therapist could benefit nurses," she said, "and ultimately lead to more restful sleep."