Two goals of Aldrich's project are to bring transparency to PPE supply across the country and to eliminate the common problem of one hospital having a PPE surplus while neighboring hospitals scramble.
Aldrich is working with four second-year data science students to leverage artificial intelligence and data modeling for this large-scale analysis and reporting effort.
"We’re conducting data analysis on a medical organization’s average consumption rates to figure out if they have enough PPE and other essential items to provide for their teams," Aldrich said. "In analyzing the data with advanced analytics, we will be able to find patterns that were not seen before. I think because of that, it will have a true impact on supply chain management for the country."
The research was spurred by pandemic-related lack of access to PPE due to supply shortages or prohibitive costs.
In the early stages of the COVID-19 pandemic, the World Health Organization (WHO) called on industry and governments to boost PPE manufacturing with a warning of "severe and mounting disruption to the global supply of personal protective equipment—caused by rising demand, panic buying, hoarding and misuse."
The WHO called it correctly. Months into the pandemic, PPE shortages among hospitals, nursing homes, and medical practices across the U.S. put healthcare providers and patients at heightened risk of exposure to COVID-19.
The TOGETHER for PPE project phase connected 78 hospitals and thousands of real-time data points allowed for predictive modeling and other data analysis which helped hospitals and the CDC examine exactly what PPE they had on hand, enabling hospitals to develop solutions that kept caregivers and hospital patients safe.
A paper on the project phase, Lessons Learned from the Development and Demonstration of a PPE Inventory Monitoring System for U.S. Hospitals, was published in the journal Health Security on Nov. 9.
Aldrich’s project will restart and amplify the TOGETHER for PPE effort. The data collected by Aldrich’s team in 2021 will focus on N95 face masks, surgical face masks, and face shields.
"Collaboration with the Data Science Institute in data modeling and data analysis with predictive and artificial intelligence models are of high priority," said Aldrich, also the director of Vanderbilt’s new Nursing Informatics Innovation Lab within the Vanderbilt School of Nursing and the chief clinical transformation officer for the Center for Medical Interoperability.
"This collaboration is a terrific example of bringing researchers together with diverse areas of expertise and distinct backgrounds to discover new information," she said. "We are excited about the progress to date."
Strong diversity programs at the education level improve healthcare equity, research says.
Increasing diversity in nursing is considered essential to improving health equity, according to research that indicates benefits to communication, access to care, and patient satisfaction.
Cultivating such diversity must begin in nursing schools, where they can partner with the K-12 education system and diversify areas from where they accept students, says Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer (CNO) and senior vice president of patient care services for Children's Minnesota in Minneapolis.
"If your nursing college matches your [homogenous] city, you're not seeing the bigger world," she says. "It might mean that you look at a different community or county that is more diverse to try to see how you can bring in those students to your institution."
These three nursing schools are among those that are strengthening their diversity and inclusion programs:
Chamberlain University
Chamberlain University, with the largest school of nursing in the country, has developed a research-based framework—the Social Determinants of Learning™—to advance nationwide efforts in creating a more diverse pipeline of students entering the nursing profession.
The framework connects with social determinants of health, the widely accepted model that outlines conditions influencing health status and which serves as a reference point for healthcare leaders to define patient-focused community health solutions.
The Social Determinants of Learning framework identifies six core factors for schools of nursing to build a more diverse pipeline for school of nursing graduates:
Student admissions: Holistic admissions processes evaluate factors beyond standardized test scores and GPA. Chamberlain, based in Chicago, has adopted practices using personalized and data-driven approaches to assess student potential and outcomes.
Student success: Personalized learning approaches, developed through the Chamberlain Care Student Success Model, encourage strong student outcomes. Pre-licensure BSN graduates experienced nearly a 13% increase in NCLEX pass rates from 2016 to 2020, and in 2020 the rates were above the national average, according to the team’s analysis.
Mindfulness: An eight-week program integrated into Chamberlain’s pre-licensure BSN program was designed to support student psychological health as part of managing stressors that can be a barrier to student progress. More than 60 percent of participating students reported a reduction in stress levels.
Columbia University School of Nursing
The recently established Center for Sexual and Gender Minority Health Research (CSGMHR) at Columbia University School of Nursing in New York City is designed to help eliminate health disparities among sexual and gender minority (SGM) populations.
"While recognition of LGBTQ people's unique needs is growing, we lack solid evidence on how marginalization, stigma, and discrimination impact health," says Tonda Hughes, PhD, executive director of the CSGMHR, associate dean of global health, and the Henrik H. Bendixen Professor at Columbia Nursing.
"The center [supports] rigorous interdisciplinary research on the social, political, and economic determinants of health for SGM populations," she adds, "which will, in turn, inform practice and form a knowledge base for interventions to address health disparities."
Lack of access for SGM people to respectful, affirmative health care is well documented. Many LGBTQ individuals report having experienced discrimination by clinicians, including outright refusal of medical care, surveys have found.
In 2019, the school hosted the first National Nursing LGBTQ Health Summit to create a national health action plan to raise awareness of and improve LGBTQ health.
Frontier Nursing University
While hospitals and other healthcare organizations work to rectify the health disparities and inequities revealed by COVID-19, one Kentucky nursing school has steadily contributed toward a more diverse, culturally competent healthcare system for more than a decade.
Frontier Nursing University (FNU), in Versailles, Kentucky, has strengthened its nationally recognized Diversity Impact Program to triple its student of color population from 9% to 28% in the last decade to better provide racially concordant care, or having a shared racial identity between a healthcare provider and patient, according to Geraldine Young, DNP, APRN, FNP-BC, CDCES, FAANP, FNU's chief diversity and inclusion officer.
Increasing that percentage has been intentional and strategic, Young says.
"When you have programs that focus in on diversity, equity, and inclusion, then you create an atmosphere of belonging, and you're doing things for diversity that are intentional," she says.
Frontier changed to a holistic admissions process and added in measures to ensure the inclusion or admission of students from a diverse backgrounds and rural and underserved areas by, for example, attending such conferences as the National Black Nurses Association or The National Association of Hispanic Nurses.
"The Diversity Impact Program became a part of the Office of DEI in 2018," Young says. "Creating the Chief Diversity and Inclusion Officer leadership role as a member of the President's Cabinet and the Office of DEI along with the activities of the HRSA Nursing Workforce Diversity Grant has been impactful as well. The holistic admissions changes noted were a result of the grant."
To retain students, Frontier provides mentoring programs, scholarships for students of color, tutoring, and peer mentoring, Young says.
"Not only do we look at bringing them in," she says, "but we … assist them in making sure they sustain throughout the process to be able to successfully graduate."
Burnout, contract labor opportunities, family care, retirement, and more are intensifying the shortage, experts say.
There's no reprieve in sight next year for the ongoing nursing shortage that has been exacerbated by COVID-19, experts say.
A shortage of nurses will be intensified as employees leave because of burnout, retirement, contract labor opportunities, taking care of family, or refusing to take the COVID-19 vaccine, according to a recent report by report released by Moody's Investors Service.
But the need for nurses will also intensify into 2022, particularly as patient acuity related to both COVID-19 and non-pandemic cases rises, requiring more advanced care, the report says.
More than 500,000 seasoned RNs are anticipated to retire by 2022. The U.S. Bureau of Labor Statistics is projecting the need for 1.1 million new RNs for expansion and replacement of retirees, the ANA says.
"Over the past decade, the average age of employed RNs has increased by nearly two years, from 42.7 years in 2000 to 44.6 years in 2010," according to the ANA. "These factors, combined with an anticipated strengthening of the economy, will create a renewed critical shortage for nurses."
Part of the solution to the shortage is for nurse leaders to consider different staffing models, says Rachel Polhemus, a senior partner with WittKieffer, a global executive search firm headquartered in Chicago that specializes in senior-level, mid-level, and interim executive search.
HealthLeaders spoke with Polhemus about what nurse leaders can expect with staffing next year.
This transcript has been lightly edited for length and clarity.
HealthLeaders: How critical is the shortage going to be in 2022?
Rachel Polhemus: It's going to continue. It's an issue now and it doesn't feel as though there's any relief right now. So much is driven by the "Great Resignation" that's occurred, and I think there's a burnout factor for nurses as well. You've got both of those issues, and the vaccine mandate, which is an issue. COVID is not going away, so you have that factor. I don't believe there will be a change in the future, or at least for the next year.
HL: Do you see it getting worse?
Polhemus: Yes. The burnout factor alone is a huge issue. Nurses are frustrated because people have a choice to get vaccinated, but they're not getting vaccinated and they're showing up at hospitals, putting pressure on the staffing issues that they're already having. Nurses are finding more balanced nursing opportunities, whether they're becoming travelers, going to another organization, working with a private surgery center, going to a doctor's office, or working telemedicine. They're making sure to de-stress themselves.
HL: What is nursing's job growth expected to be next year?
Polhemus: There are a lot of programs being implemented [at healthcare organizations]. Pre-COVID, the focus was around having a staffing workforce that was all RNs, and now organizations are taking a step back and thinking about using LPNs and CNAs and looking at all the different types of staffing models. They're going to have to staff differently because you just can't find enough RNs. You've got to look at other types of nursing practice where you can plug them in, in a place where they will be practicing at top of license.
HL: One of the partial solutions has been travel nurses; what do you see happening with that industry next year, regarding growth?
Polhemus: That will continue to grow. Nurses have the opportunity to pick where they want to work and live, and I believe the travel industry will continue to grow based on the demand and the need for backfilling for the staffing services.
HL: How likely is it that travel nursing pay rates will begin to level out in 2022?
Polhemus: Unfortunately, we've not seen them level out. It's a continual issue. The financial stress of using [agencies], regardless of scale, is a huge burden. And that's really where your cost is. And so, organizations, unfortunately, continue to need to be supported by staffing agencies. Unfortunately, it's a model that they're in a place where, because they have a supply and there's a real need for it, [agencies] can continue to demand the prices
HL: How do you anticipate nursing schools to help solve the staffing crisis over the next year or two?
Polhemus: They're already doing that. Hospitals and health systems are building relationships with community colleges and universities across the board and finding ways to start with recruitment at an earlier age, about the high school level, to encourage new graduates to look at nursing school and take a step at the associate degree or some type of nursing assistance degree. There's a real push there and there are opportunities where they're doing a lot to provide financial support. You'll see organizations say, "We'll pay for your college or your university or your degree, but you need to commit to us for a period of time." We're seeing a higher volume of this and it's a definite strategy to retain the staff and a way to build them as well.
HL: What is going to be the key to staffing, going forward?
Polhemus: It comes down to leadership. Even at the director level, there's a real need to continue to have great leaders help support the organization and, frankly, just build talent and retain the talent. It's a top-down and bottom-up approach for leaders to do what they can to provide an environment where their staff feels valued, where their staff has balance, and where the staff has wellness. It's not just about recruiting; it's about leaders engaging staff at all levels. That's really important.
COVID-19 has made nurses more in demand than ever, forcing some hospitals to pay traveling nurses as much as $12,000 weekly and prompting the American Hospital Association (AHA) to ask the Federal Trade Commission (FTC) to investigate reports of anticompetitive pricing by nurse-staffing agencies.
"The AHA has received reports from hospitals across the nation that nurse-staffing agencies, which supply desperately needed staff to care for patients suffering from the COVID-19 virus and other conditions that require hospitalization, are engaged in anticompetitive pricing," Melinda R. Hatton, AHA general counsel, said in a letter to Rebecca Slaughter, acting chairwoman of the FTC.
"Such outrageous rate hikes appear to be naked attempts to exploit the pandemic by charging supracompetitive prices to desperate hospitals," the AHA letter stated.
With newly licensed RN turnover rates ranging between 17% and 30% their first year, and 30% to 57% by their second year, according to different studies, one nurse leader has taken a vigorous approach to handling her nurses' concerns long before they become disenchanted enough to leave.
Brigitte Nastally, MSN, RN, clinical operations manager for Indiana University Health, schedules regular and frequent one-to-one meetings with first-year nurses, going far beyond the number of meetings recommended by the health system's human resources (HR) department.
HR's onboarding includes 30-, 60-, and 90-day meetings with managers, but Nastally extends that to four, five, and six months, and beyond, and follows annual performance reviews with additional post-reviews at three months and six months, she says.
"We schedule these meetings as priorities in my calendar," she says. "These are not 'extra' meetings in my mind, as it's so important to get to know my team and their strengths."
A Congressional bill was introduced in May that sets minimum nurse-to-patient staffing requirements and provides whistleblower protections for nurses who report violations to those rules.
A hospital would be required during each shift, except during a declared emergency, to assign a direct care RN to no more than a particular number of patients in designated units, including:
1 patient in an operating room and trauma emergency unit
2 patients in all critical care units, intensive care, labor and delivery, post-anesthesia, and burn units
3 patients in ante-partum, emergency, pediatrics, step-down, and telemetry units
As nurses quit across the country, hospitals and health systems that rely more on contract labor and are finding ongoing volatility in contract wages.
Online job postings in ICUs across the country have weekly salaries listed of up to $6,000 a week, making imperative that hospitals understand how their rates compare to others within their market.
Hallmark Health Care Solutions (HHCS), a healthcare consulting and technology firm headquartered in New York City, is providing the industry with real-time hourly nurse rates as well as benchmark rates for more than 300 clinical and non-clinical roles.
Upon request, organizations automatically receive two separate reports. The first report contains real-time nurse rate data which is immediately actionable; the second is the Einstein II Semi-Annual Rate Report which contains three benchmarking data sets—clinical rates, allied-health rates, and non-clinical rates.
For the first time, nurse practitioners (NPs) topped the list of most recruited providers in an annual report on physician and advanced practitioner recruiting trends.
The report indicated that 18% of search assignments were for advanced practitioners, including NPs, physician assistants (PAs), and certified registered nurse anesthetists (CRNAs), up from 13% the previous year. This is the highest percentage in the 28 years the Review has been conducted.
In the 27 years prior, physicians held the top spot of the report; in the last 14 years, the No. 1 position was held by family physicians.
Edge Runners are nurse-designed, innovative models of care or interventions with significant, demonstrated outcomes to improve health, impact cost, and influence policy.
Nurses continue to struggle with psychological stress and trauma from the harsh effects of the COVID-19 pandemic and the conditions it has caused, so the aim of preventing nurse suicide is vital to the health and future of the profession.
The Suicide Prevention in Nursing model is an evidence-based suicide prevention program for nurses, backed upon investigator-initiated research to quantify incidence and characteristics of nurse suicide in the United States.
The new model aims to increase education and outreach to dispel the stigma around mental health, thereby advocating for better resources to support the mental health of nurses and ultimately save lives.
This is the first program of its kind, according to the academy. Prior to this model, the profession did not have proactive screening.
The team that developed the model was aware that a suicide prevention program, the Healer Education Assessment and Referral (HEAR), was launched at UC San Diego School of Medicine in 2009 for physicians and medical students, but no program existed specifically for nurses.
In addition to filling this interprofessional gap, the Suicide Prevention in Nursing model utilizes an Interactive Screening Program (ISP), which offers nurses a safe and confidential way to conduct a brief screening and connect with mental health services to receive support and access to treatment options.
"Proactive and personalized support for nurses protects our colleagues and gives them the tools to continue providing excellent care to others," Davidson said.
"Our interprofessional model of care provides support to nurses while protecting their identity through the option of anonymous screening, treatment, and referral. One-on-one therapy, often through encryption, is coupled with group emotional process debriefings after crisis incidents to further encourage healing, self-care, and eliminating stigma surrounding mental health."
In 2016, during the first year of the program’s launch, 40 nurses received counseling and 17 were successfully referred for continued treatment. Over a five-year period, between 2016 and 2020, the Suicide Prevention in Nursing program has identified and transferred nearly 300 nurses into treatment, according to a press release from the academy.
Additionally, more than 1,000 nurses have benefited from group emotional process debriefings after critical events—support that is integral to a team-based approach to healing and strengthens the caring community.
"The Suicide Prevention in Nursing program is paramount to fortify the mental health of the nursing profession, at any stage in their career, without stigma given the emotional and moral distress nurses experience in their efforts to provide care—particularly during the past two years of the COVID-19 pandemic," said academy president Kenneth R. White, PhD, AGACNP, ACHPN, FACHE, FAAN.
As the stress of the COVID-19 pandemic continues, nurses must focus some of their attention on their own well-being, Davidson said.
"Through educational outreach, we have the potential to shift the culture to caring for ourselves, in addition to our patients, and decrease stigma around seeking treatment for mental health disorders," Davidson said. "We can make an incredible impact on the mental health of our colleagues."
New survey explores nurses' perception of 'buddies' or 'patient care extenders.'
The Buddy Staffing Model (BSM)—where a RN is temporarily redeployed to a new area to meet surge capacity—may serve as a valuable logistical staffing tool for nurse leaders, along with other benefits, according to a new article by two nurse executives.
Indeed, Middlesex Hospital in Middletown, Connecticut, where Molle is a nurse scientist and Allegra is director of the Center for Professional Development, revised its care delivery model from primary nursing to a BSM to meet surge capacity, the article says.
"Evidence supports that pairing non-critical care nurses (i.e., medical/surgical) with experienced nurses can help effectively manage critically ill patients," according to the article, which adds that leaders interchangeably use the terms "patient care extenders" and "buddies."
The researchers created a five-item buddy staffing model perception scale, measuring the nurses' perceptions in relation to efficiency, patient safety, teamwork, fundamental nursing care, and feeling supported by leadership.
Of the 164 nurses surveyed for the project, they perceived the BSM overall as beneficial, with the two most beneficial aspects being providing fundamental nursing care and efficiency, the article said.
"Our findings showed that nurses perceived efficiency as a benefit from the BSM, especially when used in critical care. Using buddies allows nurses to provide care quicker because it provides an extra pair of hands in the patient room for repositioning patients, especially proning ventilator-dependent patients," the article reads.
"It allows primary nurses to remain donned and in the room while the buddies can serve as runners to gather extra medications or supplies. Donning and doffing takes time and hinders efficiency."
Buddies also were vital for fundamental nursing care, the article said.
"One common fundamental task, positioning patients, became essential during this pandemic. Proning vented patients prevents complications, but requires a team approach to avoid tube dislodgement," the authors wrote. "Nurse leaders may find BSM helpful to manage challenging patient care tasks such as proning and complex dressing changes."
Prior to the COVID-19 pandemic, nearly four out of 10 nurses reported they felt burned out because of long work hours, greater workloads, poor environments, and caring for significantly ill patients, according to the Well-Being Index. By January 2021, that figure had grown to 70%, according to a study by the International Council of Nurses.
During the second half of 2021, hospitals and health systems battled a tsunami of patients whose respiratory systems were attacked by the highly contagious and deadly delta variant. There's no telling where the burnout rate currently stands.
But nurse leaders are looking out for their nurses and providing ways to ease the overwhelming hardship wrought by the pandemic. Zen rooms, mindfulness activities, and pet therapy have found their way into many hospitals since the pandemic began.
Many providers started programs pre-pandemic, such as the Care for Caregivers program at SSM Health Cardinal Glennon Children's Hospital in Saint Louis, which provides peer-to-peer support to a colleague who is having a stressful reaction to an event or outcome, according to Michelle Romano, MSN, RN, NEA-BC, the hospital's vice president of patient care services and chief nursing officer over 800 nurses.
The program began when nurse leaders noticed high turnover and conflicts among staff and wanted to provide a way to help them care for themselves and each other, says Romano.
"It's grown to extend support for all members of our hospital," she says. "Providers, nonclinical staff, clinical staff—anybody who works within the walls of our facility."
"With this latest wave [of COVID-19], patients are young, they're for the most part unvaccinated, those who are extremely ill, and many of them to the end are not believing in the vaccine, and that is probably the most conflicted piece of the pandemic right now for staff," Fiore-Lopez says.
After three recent successive deaths of young people in the ICU, Fiore-Lopez asked the hospital's director of psychology to meet with the staff.
"I had met with them, but they needed someone who had that expertise," she says. "And so, that's the kind of episodic assistance we try to give our staff, as well."
HealthLeaders spoke with nurse leaders about three ways they've chosen to combat nurse burnout and how they've been successful.
1. Time management brings order to the COVID chaos
When COVID-19 brought chaos to nurse leaders at Allegheny Health Network (AHN)'s 14 hospitals, a time management course designed just for them helped them feel less overwhelmed about their day.
"They were saying, 'We work really hard all day, but we feel like we don't accomplish anything.' And that is a hit on their morale," says Claire Zangerle, DNP, MSN, MBA, RN, FAONL, NEA-BC, chief nurse executive for AHN, based in Pittsburgh. "They live in chaos all day, and the issue for them is, 'How do I control the chaos?' "
Nurse leaders indicated that they couldn't get enough time and engagement with their team because of other tasks such as staffing schedules, disciplinary actions, overseeing budgets, developing their team, and self-care, Zangerle says.
Claire Zangerle, DNP, MSN, MBA, RN, FAONL, NEA-BC, is the chief nurse executive for Allegheny Health Network in Pittsburgh. Photo credit: Photo by Justin Merriman.
Zangerle had recently taken an effective time management course and thought that might be a solution.
She worked with Carol Perlman, PhD, a cognitive behavioral therapist specializing in time management, who surveyed nurse leaders about their time management strategies and how they felt about how they managed their workday. From those responses, Perlman then created a word cloud chart, which is a clustered list of words mentioned by the nurse leaders, portrayed in different sizes. The bigger, bolder words are those that are mentioned the most.
"The biggest two words were 'busy' and 'chaotic,' " says Zangerle.
Perlman provided a customized time management course for the nurse leaders with the objectives of teaching them to create a daily schedule, helping them attain skills for centralizing a task list and prioritizing daily tasks, encouraging them to incorporate time for self-care, and creating a plan for engaging and developing their staff.
"The goal was to reduce their stress level and to help them feel that they were in more control of their day, which would lead to them being able to spend some time on themselves to eat right, plan their meals, take time for exercise, take time for meditation, or whatever would contribute to their health and well-being while in a chaotic environment," Zangerle says.
AHN provided the course for CNOs, nursing directors, and nurse managers at all the health system's hospitals.
Each participant was given an 18-month planner, customized with AHN's colors, along with a workbook. The 21-day course included daily self-paced work that generally took less than five minutes, plus weekly virtual sessions.
For one of those weeks, each individual discipline group—all CNOs, directors, and nurse managers—met with their peers to share information related to their leadership level, Zangerle says.
They also set up a Google classroom where the instructor posted lessons and participants could post their work, ask questions, and offer hacks, she says.
"Now, the nurse managers want their assistant nurse managers and supervisors to take the course," Zangerle says. "They recognized the need to cascade the same valuable information to this group of newer nurse leaders so they could also learn how to prioritize tasks, deal with the unexpected, and block out time appropriately."
For the 300-plus nurse leaders who have completed the time management course, "They feel that they're a lot more in control, and that contributes significantly to their wellness," says Zangerle.
The time management course resulted in collateral benefits as well, Zangerle says.
Allegheny Health Network CNOs pulled together directors from their hospitals and worked on lessons together, learning how to delegate and do succession planning, says Zangerle.
A post-course questionnaire revealed:
62% of nurse leaders rate their current time management strategies as "very good," as compared to 29.61% before the course.
76% felt they got many targeted tasks done by the end of the day, as compared to 35.9% before the course.
46% felt that time management affected their overall job performance "a lot," as compared to 32.45% before the course.
58% use a master list to organize their tasks every day, as compared to 26.2% before the course.
28% felt their ability to create and implement a leadership development plan for their staff was "extremely effective," as compared to 7.3% before the course; 54% felt their ability was "very effective" post-course, as compared to 28.7% before the course.
60% felt they used strategies to manage procrastination that interferes with their productivity "very well," as compared to 30.92% before the course.
78% can use a system to address unexpected demands "very well," as compared to 24.68% before the course.
A second word cloud created by Perlman after the course also revealed changes in how the nurse leaders felt about their day. Instead of "busy" and "chaotic," the biggest, boldest words in the post-course word cloud were "productive" and "good."
"The chaos is still there, but they feel like it's controlled chaos," she says. "We're going to have chaos for a while here, and the value is in de-escalating the chaos to control what you can, so that you can better manage the things you cannot."
2. Half-day haven hands nurses tools for mental health wellness
A half-day retreat that takes frontline nurses off the floor of UAMS Health at the University of Arkansas for Medical Sciences and to a serene riverside setting to learn about the importance of self-care seems to be working, says the CNO who engineered it all.
"Skeptical people go in saying, 'I don't know about this,' and they come out thanking us," says Trenda Ray, PhD, RN, NEA-BC, the Little Rock, Arkansas, health system's CNO and associate vice chancellor for patient care services.
The Caring for the Nurse Retreat originated from a survey about two years ago—before the COVID-19 pandemic—by a UAMS researcher who was focused on physician wellness and burnout. Inexplicably, he included nurses in the survey. The results were eye-opening.
"They were so surprised in that RNs led the way in burnout," Ray says. "Nurses surpassed residents, students, and attending physicians, and that became the signal for us that we needed to do something."
At a conference she was attending, Ray heard another organization speak about nurse retreats, and she took the idea back to UAMS with her.
"In October 2019, pre-pandemic, we had our first Caring for the Nurse Retreat and we modeled it based on what I had heard from another organization, but modified it a bit to fit our needs," she says.
Open to all frontline RNs, advanced practice RNs, and licensed practical nurses (LPN), the monthly half-day retreat is held off-site in a large, windowed conference room at the Department of Arkansas Heritage, which sits on the Arkansas River.
The hospital system's director of wellness and Ray's assistant facilitate each session, which is limited to 12–14 participants.
"Each session, I try to do the welcome. If I can't do it in person, they play a video where I explain the premise behind the retreat and why it's so important to us that we want healthy nurses not just at work, but we want our healthy nurses back at home with their families," she says.
Yoga is a large part of the retreat, so they start the day talking about the importance of movement, followed by a yoga session focused on mindfulness and gratitude, she says.
A healthy cooking demonstration from a UAMS culinary medicine faculty member shows the nurses healthy, easy foods they can cook for their families and bring for lunch. During a healthy lunch, participants also learn about journaling and how it can be an effective tool in managing mental health.
Evaluations from retreat attendees have consistently ranked high, Ray says.
"It's early and they're still looking at the data, but we have had a total of 14 retreats so far over the past year with a total of 149 participants. The average satisfaction score is 4.89 on a 5-point scale and, post-retreat, nurses reported significant improvements in self-care—nutrition, physical activity—and in management of stress," she says.
Feedback from nurses includes such statements as:
"Thank you for valuing us and our time [nurses are paid for the four hours they spend in the retreat]."
"Thank you for investing in our wellness and giving us tools to use in everyday life."
"This was much needed, especially after the past year in the pandemic. I have become so focused on work and school that I've lost focus on what matters."
"And those are a few of the comments from just one session," Ray says.
'Focused on wellness'
The nurse retreats are sponsored by the Chancellor's Circle, the annual giving society for the entire UAMS system that provides funds to support key mission areas in healthcare education, research, and patient care.
"I didn't know how to get the financial backing, and when the Chancellor's Circle awards came through, we are so fortunate that our chancellor is focused on the wellness of our nurses and of our campus," she says.
Additionally, UAMS' foundation office has made the retreats part of its philanthropy efforts, and the Caring for the Nurse Retreat received more than $10,000 in donations in just a few weeks.
"Everyone has recognized this as something very special," Ray says.
Of the health system's roughly 2,000 nurses, nearly 150 have attended the retreat, which is why Ray plans to expand it to twice a month. And the retreat program that started out as a pilot is now being designed for other staff members across the medical center campus, she says.
How to get started
Nurse leaders interested in starting a nursing retreat at their hospital should first review what resources are available within their institution, Ray says.
"One of our nursing leaders was a yoga instructor, and we started with her," she says. "We're lucky that we have a wellness program here and someone who teaches mindfulness."
The retreat location at the Department of Arkansas Heritage is free because both are state institutions.
"The cost of this is low. We bought yoga mats and we buy food every time and a few other supplies here and there, but the cost is so low considering the benefit that we're seeing," Ray says. "I would suggest they look internally, that they talk to one another and ask who in their organization are experts around mindfulness or nutrition, and then find ways to partner."
3. Virtual reality transports frontline nurses from the COVID floor to paradise
A California hospital with a national reputation in virtual reality (VR) for pain, patient stress management, patient education, and maternal care has deployed that same technology to help its frontline nurses combat stress, anxiety, and burnout.
Nurses at Hoag Memorial Hospital Presbyterian in Newport Beach, California, who experience high levels of stress, particularly from treating COVID-19 patients, began finding relief in March through CenteredVR, a virtual reality–based mindfulness and stress management program developed especially for them by BehaVR.
"We have seen the power of virtual reality–enabled programming to support the mental health and well-being of our patients, so it was a natural fit for us to offer [this] tool to our nurses," says Dr. Robert Louis, chief of neurosurgery, under whose leadership Hoag has become a leader in healthcare VR.
"Mindfulness practices are shown to reduce chronic stress, and CenteredVR combines those principles with the neurological and psychological power of virtual reality, offering our nurses new resources to reduce stress and improve their overall health," Louis says.
CenteredVR was developed in collaboration with Johns Hopkins Medicine, says Kim Mullen, MSN, RN, Hoag's director nursing professional development, research and Magnet program director.
"It guides users into a soothing, immersive VR environment that helps alleviate stress through educational elements and mindfulness practices," she says.
Over the course of six 20-minute sessions, which can be done in the privacy and comfort of their homes, nurses learn to become less reactive and more resilient to stressors.
"You learn those mindfulness concepts by practicing and training your brain. You learn how to cope better and be more resilient versus go down that negative pathway in helping you cope with stress," Mullen says.
The VR kits are sent to each nurse's home. Including a headset, headphones, and remote control, each kit arrives in an appealing, scented box to conjure a relaxing, spa-like environment, Mullen says.
"It's all about the personal experience," Mullen says.
When Hoag introduced the CenteredVR program, nearly two-thirds of the nursing staff in the COVID-19 unit signed up to participate.
Crystal Watson, RN, initially was unsure about the VR technology.
"We've always had other ways of dealing with stress, but none that had a visual element, so I wasn't sure what to expect," she says.
But once she put on the goggles and plugged in her headphones, she was "floating high above the ocean like a bird," she says.
As Watson began to use CenteredVR regularly, her stress-induced headaches gradually subsided, she says.
Watson and other nurses can choose which session they want to experience based on the level of stress they are feeling, from options designed to target specific feelings of anxiousness, sadness, or hopelessness.
"I fell in love with the 'Body Scan' series," she says. "One minute I was on my couch stressing, the next minute I was watching a beautiful waterfall or meandering through a lush green forest."
Once she focused on the breathing exercises, tension in her neck and shoulders began to relax, she says.
Though many of Hoag's nurses use the technology to decompress, Watson often uses it before work to prepare her for the day ahead, so she can better handle the stressful challenges of a 12-hour shift, she says.
Early results on CenteredVR's impact on users' stress levels have been positive. Among the 70 nurses who have used the program to date, stress levels decreased, on average, by a reported 34%.
The hospital is also currently conducting a nursing research study to determine outcomes, Mullen says.
Further data has been gathered and submitted to the Institutional Review Board, Mullen says.
Nurse feedback has indicated that CenteredVR not only has decreased stress levels, but has helped dispel feelings of isolation and pain caused by stress and anxiety, Mullen says.
"They've said it's almost a getaway or escape, and you don't have to go anywhere," Mullen says.
Some, like Watson, say that VR has helped relieve chronic headaches, muscle tension, and anxiety.
"I always say, who wouldn't relax when you can lay and look at a beautiful waterfall and hear the sound, or walk through a beautiful, lush forest, or be at the beach?" Mullen says. "It's being able to travel when you can't."
Kentucky Gov. Andy Beshear has issued a state of emergency because of the nursing shortage in his state.
"Like the nation at large, the Commonwealth of Kentucky is experiencing a dire nursing shortage," the executive order reads. "Kentucky's nursing shortage in the midst of a once-in-a-century global pandemic is nothing short of an emergency."
The Kentucky Nurses Association (KNA) has indicated the state is operating 12%-20% short of the needed nursing volume, according to the order.
"In fact, during the pandemic, the Kentucky Hospital Association called on all licensed nurses, including those retired or no longer in the industry, to assist hospitals," it reads. "Furthermore, at the rate of projected exodus from the nursing profession, Kentucky will need more than 16,000 additional nurses by 2024."
"Notably, an October 2021 survey conducted by the KNA found that in a sample of more than 800 nurses, 1 in 4 responded that it would be likely that they would leave their jobs in the next three months."
In his order, Beshear directed the state Board of Nursing to approve requests for enrollment increases from schools that can accommodate more students.
The order allows nursing schools to open new campuses more quickly if they have sufficient resources and directs nursing schools at full capacity to refer qualified student applicants to other schools with vacancies.
"Increasing enrollment in Kentucky nursing schools that meet the criteria for such increases is crucial to addressing the nursing shortage and providing quality healthcare to our citizens," Beshear said in the order.
Beshear's order also allows nurses who are licensed in other states to practice nursing in Kentucky.
More exposure to nursing politics and the headache of staffing and scheduling are the main reasons why nurses are not pursuing nurse leadership, says a new survey.
Just one in 10 nurses (11%) says their idea of a successful career in nursing involves advancing into nurse administration and leadership roles, a new survey says.
Additionally, only 7% of nurses say they plan to move into nurse leadership in the next three years, which will create a vacuum at the top, according to the 2021 Nurse Career and Satisfaction Survey released by Trusted Health, a healthcare workforce management platform.
The survey was conducted by Trusted Health in October 2021 with a sample of 3,357 nurse respondents, of whom 54% currently work as travel nurses, 37% as staff nurses, and 9% in per-diem or other types of nursing roles.
Instead of pursuing leadership roles, the nurses surveyed intend to take other career paths:
28% want to deepen their clinical care experience
20% are not sure what they'll do
16% want to obtain an advanced practice nursing degree
The remaining respondents indicated they want to move into nursing leadership (7%) leave nursing for another profession (6%), move into education or research (6%), move into non-clinical nursing opportunities (6%), move into nursing-related entrepreneurship (5%), and move into outpatient practice (5%).
Nursing politics/culture (66%) is the main reason nurses are not pursuing nurse leadership, according to the survey.
The nurses see leadership as a trade-off between what attracted them to the profession in the first place—patient care—and more exposure to nursing politics and the headache of staffing and scheduling, the survey said.
Other reasons they are not pursing nurse leadership include:
Poor experiences with nurse leadership (37%)
No desire to manage people (27%)
Don’t want to be associated with a single hospital/clinic system (21%)
Don’t want to step back from direct patient care (21%)
Believe leadership spends too much time on staffing/scheduling (14%)
Would only consider nurse leadership if money/skills were not factors (11%)
No leadership options have been discussed (7%)
Not enough training/support offered for leadership (5%)
Introducing better incentives for leadership, is one solution for creating a stronger nurse leader pipeline, the survey recommends.
Hospitals need to root out cultural issues—including bullying and incivility—within their nursing staff, the survey recommends, so they can draw younger nurses into leadership and embrace technology that frees nurse leaders from the challenges of staffing and scheduling so they can have time for more meaningful work.
The decision to vaccinate is highly influenced by opinions of healthcare workers' colleagues and others close to them.
About three in 20 healthcare workers surveyed reported being hesitant about getting their COVID-19 vaccinations—and vaccine decisions were likely to be influenced by their colleagues, according to a new study by researchers at the University of Illinois Chicago.
Survey results showed that 85% of healthcare workers either received or expected to get the COVID-19 vaccination.
Respondents were asked to answer questions about their perceived susceptibility, severity, barriers, and benefits of COVID-19 vaccination, along with internal and external factors that would affect their decision to get the COVID-19 vaccination.
They also provided sociodemographic information, including political affiliations and occupation.
Healthcare workers who were vaccine-hesitant tended to be younger, non-physicians, Black, Republican, or had concerns about the vaccine’s effect on their bodies, said study author Dr. Stephanie Toth-Manikowski, UIC assistant professor of medicine in the College of Medicine.
Some respondents cited insufficient evidence for the vaccine’s effectiveness, she said.
"People who were not vaccinated perceived COVID differently and saw more barriers to getting the vaccine," Toth-Manikowski said. "As a whole, healthcare workers saw more benefits than barriers."
Of the survey respondents, 99% of physicians were planning vaccination, while only 82% of nurses were.
The reasons for such a disparity are unclear and highlight the need for further investigation, Toth-Manikowski said.
The decision to vaccinate was highly influenced by what the healthcare workers' colleagues and others close to them thought about the vaccine and least influenced by mass media marketing, the study said.
"How we disseminate knowledge is so important," Toth-Manikowski said. "People may be more likely to listen to a trusted supervisor or colleague than someone they’ve never met."
The study's authors suggest a key way to communicate the vaccine’s importance.
"Rather than focusing on generalized, impersonal outreach advertisements from hospital administration or the mainstream media, hospitals should work internally to foster relationships and trust building among employees across departments and job roles, especially among nurses and physicians who remain highly trusted in their communities," the paper stated.
Toth-Manikowski used herself as an example.
She was breastfeeding her infant when she received the COVID-19 vaccine. When questioned about the vaccine’s safety for pregnant or lactating women, she didn't hesitate to share her story.
"One of the reasons I chose to vaccinate is because research shows that antibodies are getting to babies, whether in utero or via breastmilk," she said. "We also know that unvaccinated pregnant women have poorer outcomes with COVID-19 infection."