'This is a transformational time for the field of nursing,' says co-author of a new report.
Nursing over the next decade will demand a larger, more diversified workforce prepared to respond to future public health emergencies and address systemic inequities that have fueled health disparities, says a report released yesterday from the National Academy of Medicine.
By 2022, all state and federal policy changes in response to the COVID-19 pandemic that expanded scope of practice should be made permanent, along with telehealth eligibility, insurance coverage, and equal payment for services provided by nurses, says The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity.
Nurses in the next 10 years will face such demands as caring for an aging population, responding to increased behavioral and mental health conditions, conducting research, and helping shape healthcare policy. Building an able workforce requires a significant increase in the number, types, and distribution of nurses across geographic areas, specialties, and care settings, the report says.
Particularly needed are nurses in specialties with significant shortages, such as public and community health, behavioral health, primary care, long-term care, geriatrics, school health, and maternal health, along with those who hold bachelor’s and PhD degrees, the report says.
"This is a transformational time for the field of nursing," Mary Wakefield, PhD, RN, FAAN, co-chair of the committee that wrote the report and visiting professor at The University of Texas at Austin, said in a press release. "While the pandemic has changed nearly every aspect of healthcare, the impacts on nursing may be the most profound, as demand for their skills is at an all-time high."
Full practice authority
In the 23 states and Washington, D.C., that permit full practice authority, access to primary care has improved, especially considering the ongoing pandemic and physician shortages, according to the report.
Despite considerable progress in waiving scope of practice regulations, 27 states still do not allow full practice authority for nurse practitioners, so federal authority should be used to supersede restrictive scope of practice state laws, the report says.
'A duty and responsibility'
Nurses already play a significant role in addressing social needs and the social determinants of health (SDOH) such as access to healthcare, physical environment, and housing stability.
"The committee believes that all nurses, at all levels, and no matter the setting in which they work, have a duty and responsibility to work with other health professionals and sectors to address SDOH and help achieve health equity," says the report.
As such, government agencies, healthcare and public health organizations, and payers should ensure nurses have the resources and support to address SDOH in a more comprehensive way, and that payment models recognize the value of those services and offer adequate reimbursement, the report says.
"Nurses are often the first to check if patients have enough to eat, if they can afford their medications, whether they need housing assistance, and if they have reliable internet access for telehealth visits," said David Williams, co-chair of the committee, professor of public health and chair of the department of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health, and professor, department of African and African American studies at Harvard University. "When we invest in nurses, more people and communities will have the opportunity to live their healthiest lives."
The report identified several priorities to meet the needs of the U.S. population and the nursing profession for the next decade:
Strengthening nursing education: In addition to hospital-based care, schools of nursing should also emphasize primary care in community settings, rural health clinics, schools, workplaces, and home health. They should also prepare students for new technologies, particularly telehealth and big data.
Promoting diversity, inclusivity, and equity in nursing education and the workforce: Nursing students and faculty not only need to reflect the diversity of the U.S. population but also need to help dismantle structural racism prevalent in education and the workforce.
Investing in school and public health nurses: A school nurse may be the only health professional some students see regularly. However, about 25% of schools do not employ a school nurse, and school nursing remains underfunded, especially in schools serving children in low-income homes.
Protecting nurses’ health and well-being: As more nurses are expected to address both health and social justice issues, they will have to take on more emotionally taxing work, and employers need to provide adequate space and support.
Preparing nurses for disaster and public health emergency response: The Centers for Disease Control and Prevention should fund a National Center for Disaster Nursing and Public Health Emergency Response, along with regional centers, to provide relevant education, training, and career development.
Increasing the number of PhD-prepared nurses: PhD-prepared nurses can conduct research, serve as faculty and focus on the connection among SDOH, health disparities, and health equity to help build a knowledge base for other nurses to translate to practice.
"Nurses are powerful in number and in voice, and the world needs their dedication and persistence more than ever," said Victor Dzau, president of the National Academy of Medicine. "I am confident that the nursing community and other important stakeholders will use the report recommendations to unleash the power of nurses and usher in a new era of health equity and well-being."
Part 5 of a 5-part series commemorating nurse executives who have led through the pandemic.
HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes. Each nomination included comments from the colleague, which are featured here.
Afton had been a prime example of leading from the front. She is a main organizer of our mass vaccinations while juggling her normal everyday duties of the hospital in our rural area. She has put countless hours into ensuring swift notifications and safety practices for mass vaccination clinics on a weekly basis, as well as keeping track of those names that are vaccinated and when they are due for their next vaccine dose.
She spent many hours calling and speaking with patients to ensure they are signed up and fit the appropriate phases to ensure the most compromised people are taken care of first. She reports our state vaccination numbers as well as testing numbers and positivity rates for our area/site. She is a true example of leadership.
AnnMarie Papa has been an exceptional leader during this global COVID-19 pandemic. She has remained accessible and engaged, starting from the beginning of the pandemic last year.
She makes daily rounds on the nursing units, keeping herself engaged with staff and situationally aware. AnnMarie has continued to foster personal resilience and professional growth in her staff during the pandemic.
Kit’s contributions extend well beyond the organization. His professional colleagues have described him as an exemplar of academic and professional excellence through leadership, advocacy, and practice. These attributes enhance his ability to lead and positively influence others through creative and visionary leadership.
This influence was seen throughout the pandemic when Kit was featured in interviews with local, state, and national media outlets, including Texas Nurses Association, Nurse Leader Journal, Petrie Dish Podcast, and NPR.
During National Nurses Week, we have run stories recognizing dedicated nurse leaders who have made sacrifices as they've led their nursing staffs through unprecedented and difficult times.
Part 4 of a 5-part series commemorating nurse executives who have led through the pandemic.
HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes. Each nomination included comments from the colleague, which are featured here.
Handling the influx of COVID-19 patients and the deadly virus that brought them to hospitals required much more than bedside treatment; it required strategy, communication, agility, collaboration, and more day after day to take command of the crisis.
These three nurse leaders have done what it takes to guide their nurses through an unparalleled situation by stepping up and living up to the term "nurse leader."
Carole's unit was the first designated in-patient COVID+ care unit. She had to organize and facilitate a whole new type of care that changed numerous times over the course of the past year.
She kept her staff uplifted and she cared about every patient who came through the doors. She represents the best in healthcare and management in good times and bad. She is very admired.
Director of nursing services, Ferrell Hospital, Eldorado, Illinois
At the beginning of the pandemic, Jessica was transitioning from the educator/safety director into her current position of the director of Nursing Services. She was truly a leader during this time, taking command of the hospital's response to COVID-19 while ensuring her nursing staff was prepared for what was ahead.
She continued to expertly manage both positions until May, when the educator/safety position was filled. Jessica is the reason for our hospital's efficient and safe response to the COVID pandemic and without her leadership we would not have as effectively navigated the challenges that COVID brought to our hospital.
Cindy led the South Central Regional Indiana University Health nursing team during the pandemic. She increased COVID bed capacity by selecting the right team from frontline leaders to executives. She remained calm and created a sense of urgency within the regional nursing team while also assuring and creating urgency within the executive team.
She led with passion, creativity, purpose, and resiliency. She kept safety at the center of our work with patients, team members, and families. Her professionalism and sense of purpose were and are appreciated daily.
Be sure to visit HealthLeaders each day during National Nurses Week to see new stories recognizing dedicated nurse leaders who have made sacrifices as they've led their nursing staffs through unprecedented and difficult times.
Along the way, she was named Cleveland Clinic's first-ever Associate Chief Nursing Officer (ACNO) of Advanced Practice Nursing (APRN); steered Cleveland Clinic's APRN growth from 750 APRNs to more than 1,900; and led nursing quality and practice integration for multiple new hospital acquisitions.
Foxx easily acknowledges that she stands on the shoulders of other nurse executives who each played an important part in her trajectory to the C-suite. For National Nurses Week, Foxx talked to HealthLeaders about those nurse leaders who influenced her most and how her management style reflects that influence.
Mary Beth Modic, a clinical nurse specialist, has been a colleague and mentor to Foxx since she started at the Cleveland Clinic in 2004.
When Foxx transitioned to be a clinical nurse specialist at the Cleveland Clinic, Modic was one of her peers and mentors.
"I have learned a tremendous amount of humility from her, and she is probably one of the most compassionate, empathetic nurses I've worked with throughout my career," Foxx says. "She's so sensitive to other people's needs."
"She always recognizes folks for their accomplishments, no matter how small or how big that accomplishment is, and if people have had something happen to them in their personal life, she's very aware of that, and I really appreciate that about her."
Foxx has replicated one of Modic's practices of giving books.
"She's always been an avid reader, and I've always loved to read but sometimes I wouldn't always make time or find time to read," she says. "She loves to give books as gifts, and I've always loved that about her because it's made me read things that I normally wouldn't read. I've also picked up on doing that because she's given me some very powerful things to read over the years to influence my leadership path."
When Foxx started at the Cleveland Clinic as a clinical nurse in pediatric ICU, she met Janie Burke, an approachable clinical nursing director who listened to her goals and helped make them happen, she says.
"One of the reasons she shaped my career and my leadership journey is that from day one of meeting her, she has always [been] super-supportive of anything I wanted to pursue and really opened up that pathway for me," she says.
Foxx, as a new staff nurse, approached Burke about working as a clinical nurse specialist, for which she had been trained. "She was able to create a position for me as a clinical nurse specialist within eight months of me starting," she says.
"If it weren't for her being open to me developing and growing, I wouldn't be here now," Foxx says. "She wasn't my direct supervisor—we reported centrally somewhere else—but any time I had an idea or wanted to do something within the Children's Hospital, she never said no."
Joan Kavanagh, associate chief nursing officer, Nursing Education and Professional Development, was Foxx's leader when she secured her first director job at Cleveland Clinic and helped her develop and hone her leadership skills.
"I had tremendous growth opportunities under her," Foxx says.
"She's just the type of person that is inspirational," Foxx says. "She pushes you to be innovative and have new ideas, and she also wants you to grow and develop your own leadership style as well as leadership skills."
Kavanagh recognized the Foxx's potential and helped her sharpen her skills.
"She would say, 'I know you're a great leader; you make great decisions. These are the things I want to help you polish to get to that next level,' " Foxx says.
"She's been the utmost mentor and my role model for years, but even more so in the past five or six years," Foxx says of Kelly Hancock, Cleveland Clinic's chief caregiver officer, who was the health system's ECNO just prior to Foxx.
"She took on a larger role in the organization and I report to her still, but she's been such an influential Cleveland Clinic nursing leader for so long," Foxx says. "Even before we had a direct relationship, I looked up to her as a leader and then was fortunate in my leadership journey to have her as a mentor and a role model."
"Even before I was reporting to her on advanced practice nursing projects and the development of the advanced practice nurse role within the Cleveland Clinic, I was fortunate that she recognized my leadership abilities and also recognized the importance of elevating advanced practice nursing at the Cleveland Clinic," Foxx says. "It was under her leadership as the executive chief nursing officer that she created the first associate chief nursing officer role for advanced practice nursing, which was my first ACNO job."
Hancock has skill in identifying management material and creating success in that person, Foxx says.
"She has a keen eye for leadership," Foxx says. "She sees the best in others and she wants to elevate folks that she sees as bright spots, and can see success in, and she knows that it's for the betterment of the organization, the nursing profession, and then ultimately our patient care."
From each of these nurse leaders, Foxx has taken pieces and parts of their management styles to develop her own unique leadership approach.
"I'm working on being a good listener and an active listener so I can understand where others are coming from," she says, "and what they may need."
EDITOR'S NOTE: HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes. Each nomination included comments from the colleague, which are featured in each of the stories.
Part 3 of a 5-part series commemorating nurse executives who have led through the pandemic.
HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes. Each nomination included comments from the colleague, which are featured here.
Vice president, Patient Care Services/chief nursing officer, St. Joseph Hospital, Nashua, New Hampshire
Andrea put on her scrubs and became a bedside nurse to help with patient care of the sickest patients. Andrea continually checked on staff to make sure their mental health and was so supportive of all of the employees.
Andrea came in during all shifts to hand out healthy snacks and goodies and was a shoulder to cry on. We are all so lucky that a leader worked side by side with us.
Mona has led by example throughout this pandemic. She has spent countless hours at our little rural hospital, even sleeping on the floor of her office, to ensure that the nurses were being supported through the staffing issues and the hurricane, because our little town was out of power for several days following Hurricane Laura.
She has always been there to back up the nurses to make sure our patients are cared for. She never expects more of the nurses than she is willing to do herself.
Nikki Thunder is an exceptional leader who didn't allow the pandemic to stop her from being the best leader she could possibly be for her team. Nikki not only supported her team by ensuring that they had everything they needed to be successful during the pandemic (i.e. PPE, team nursing support, etc.), she also ensured that she was at the bedside, elbow to elbow with her staff every step of the way.
In Houston, we also experienced a winter freeze upon which we went on lockdown as a facility. Nikki slept very little during the lockdown as she spent time supporting her team while also lending a hand to the ED team. Nikki is a remarkable leader who consistently goes above and beyond for her patients, their families, our colleagues, providers, and the community we serve.
Be sure to visit HealthLeaders each day to see new stories recognizing dedicated nurse leaders who have made sacrifices as they've led their nursing staffs through unprecedented and difficult times.
Part 2 of a 5-part series commemorating nurse executives who have led through the pandemic.
HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes.
Each nomination included comments from the colleague, which are featured here.
As frontline nurses treated and comforted critically ill and dying COVID-19 patients, their nurse leaders focused on keeping the staff safe from the effects of the highly contagious, deadly virus.
From securing adequate Personal Protective Equipment (PPE) to making sure frontline nurses were correctly informed about COVID to providing empathy when it was needed, these three nurse leaders have supported and taken care of their staff during the most trying of times.
Kim was already the enterprise director of an extremely busy cardiac service line when COVID-19 hit. She assisted with the coordination of the hospital, university campus, and regional COVID site.
Kim was a key figure within the university in assisting to keep us safe and informed. Her diligence to work with other key individuals kept the staff up to date and prepared for an everchanging pandemic.
Cori led the entire organization in a multi-disciplinary response to the pandemic in our hospital, as well as representing us across a large and complex, world-renowned health system.
Cori made sure that our entire hospital team had the equipment and knowledge to safely care for very sick and complicated patients. Cori was able to communicate effectively with the entire organization to coordinate staff redeployments and assure that patients received the competent, compassionate care they deserved.
Cori also went above and beyond to provide compassionate support and understanding to colleagues who needed to recover from traumatic events during this crisis. She is a true leader, in every sense of the word!
Renea provided exemplary leadership to all of our nurse leaders through COVID-19. She did this through her commitment to each of us, and ensuring we had all the tools we needed to care for our teams.
She kept each one of us ahead of our game and made sure we had balance and support. Often as leaders, we feel the weight of the world on our shoulders, and it was so meaningful to feel the support from above that allowed us to remain strong and resilient through such uncertain times.
Be sure to visit HealthLeaders each day to see new stories recognizing dedicated nurse leaders who have made sacrifices as they've led their nursing staffs through unprecedented and difficult times.
Part 1 of a 5-part series commemorating nurse executives who have led through the pandemic.
National Nurses Week, which kicks off today with National Nurses Day, recognizes the service, selflessness, and commitment that nurses provide. Given the demanding season healthcare workers have endured, this year's commemoration is particularly of note.
HealthLeaders is celebrating National Nurses Week, May 6-12, by highlighting nurse leaders each day throughout the week who were among healthcare workers nominated by a colleague for HealthLeaders' "Leading Through the Pandemic" sweepstakes. Each nomination included comments from the colleague, which are featured here.
Be sure to visit HealthLeaders each day to see new stories recognizing dedicated nurse leaders who have made sacrifices as they've led their nursing staffs through unprecedented and difficult times.
The word "tireless" best describes these nurse leaders who jumped in and stayed to safeguard their staff and patients as COVID-19 filled hospitals, sickened nurses, and created heartbreaking working conditions.
Noreen Brennan utilized strategic planning to accommodate the increased number of critically ill patients by opening three additional Intensive Care Units, procuring extra life-saving equipment, and onboarding 321 agency nurses to provide excellent care to our patients when New York City was at the epicenter of the COVID-19 pandemic. She worked every day to support the staff, ensure adequate personal protective equipment to keep the staff safe, provide a respite center for the staff to rest and meditate, and provided meals to staff every day.
Dr. Brennan utilized innovation to enhance communication between patients and their families via FaceTime or Google Duo on iPads, when visitors were restricted from visiting hospitals. Dr. Brennan transformed the Rehabilitation unit into a Palliative Care Unit to allow family members to be present with their loved one to provide compassionate end-of-life care.
Dr. Brennan facilitated education and supported best practices to improve patient outcomes using new technology, such as Continuous Renal Replacement Therapy for patients with kidney injury, and prone positioning patients with Acute Respiratory Distress Syndrome, and disseminating best practice education at conferences.
Jenny Gojmerac-Owens has been amazing nurse practitioner in the Emergency Department at Methodist for 20 years, which is impressive in itself. But in addition to her amazing skills as an NP, she is a tireless leader.
She has built the APP program into a robust group of extremely high-functioning groups spanning multiple sites. She has developed programs to continue to train APPs across the state and even the country. In the last year during the pandemic, she worked innumerable hours to keep her team safe and staffed. She continued to work at the bedside covering shifts and maintaining the wellness of her team.
Melissa Hall, along with two colleagues, has headed up the Infection Control Team for COVID-19. From the onset she has worked diligently on behalf of all the staff and for the county to ensure all were safe and followed the guidelines set forth. She and the team have given tirelessly to this endeavor.
We quickly found ourselves in the midst of a "hot spot" at the beginning and she and the team stepped in and established screening guidelines to keep everyone as safe as possible. Countless hours, at all hours, were put in to maintain our safety. It has been impressive to see how the team has functioned to provide leadership at all times.
A bold wellness program is not a 'warm and fuzzy,' but a foundational way to boost the health of nurses, patients, and a hospital's bottom line, study author says.
Even before the COVID-19 pandemic began, critical care nurses (CCN) were experiencing alarmingly high levels of stress, anxiety, depression, and poor physical health—factors that correlated with an increase in self-reported medical errors, according to a new study by The Ohio State University College of Nursing.
Nearly two-thirds (60.9%) of the CCNs reported having made medical errors in the past five years, according to the study. Occurrence of medical errors was significantly higher among nurses in worse health than those in the better health categories. For example, 67% of the nurses with higher stress scores versus 56.5% of the nurses with no or little stress reported having made medical errors in the past five years.
However, critical care nurses whose organizations put strong emphasis on their well-being are more likely to be fully engaged in patient care and make fewer medical errors, according to lead author Bernadette Melnyk, chief wellness officer and dean of Ohio State's College of Nursing.
Accurate estimates of deaths from preventable medical errors in U.S. hospitals vary widely because of inconsistent reporting methods:
Johns Hopkins Medicine research in 2016 placed the number as high as 250,000, making medical error the third leading cause of death, behind heart disease and cancer.
Notwithstanding the numbers, errors occur more frequently in critical care units because of complex patient cases and multiple-system illnesses, which introduce more opportunity for human error, the new study says.
"These errors are made by very dedicated, caring, committed nurses who are experiencing their own symptoms of depression, anxiety, or poor physical health," Melnyk says. "It's important that hospitals fix systems issues and offer evidence-based programs and support to equip their clinicians with resilience, because we know that's a protective factor for their own mental and physical health, as well as their ability to provide optimal care to their patients."
About 61% reported suboptimal physical health. Nurses tend to like working three days per week, but that requires 12-hour shifts with limited breaks to rest properly, often resulting in sleep disruption, headaches, cardiovascular disease, gastrointestinal symptoms, and musculoskeletal disorders.
About 40% screened positive for depressive symptoms and more than 50% screened positive for anxiety.
Those who reported worse health and wellbeing had between a 31% to 62% higher likelihood of making medical errors.
Nurses who reported working in places that provided greater support for wellness were more than twice as likely to have better personal health and professional quality of life compared with those whose workplace provided little or no support.
Stress, anxiety, and depression are likely even higher in the current environment than before the pandemic, when the study was conducted, the authors say.
The 'hard evidence' of wellness
An engaged, dynamic wellness program will enhance nearly every corner of a hospital or health system, according to the study.
"The major implication of this study's findings for hospital leaders and policymakers is that critical care nurses whose well-being is supported by their organizations are more likely to be fully engaged in patient care and make fewer medical errors, resulting in better patient outcomes and more lives saved," researchers wrote.
Wellness also contributes to higher productivity levels, less absenteeism, and less turnover—all of which translate into the hospital or health system's bottom line, Melnyk says.
"Wellness is not a warm and fuzzy thing to do," Melnyk says. "We have such hard evidence [that] not to do it is not good for a population's health and well-being, but it also adversely affects healthcare quality, safety, and cost."
Building a wellness strategy
The solution, Melnyk says, is for hospitals and health systems to boldly promote the well-being of their critical care nurses—and all their employees—by appointing a chief wellness officer and giving that executive strong resources.
"This is an important component of an organization's vision and strategic plan, so they've got to invest in a leader to spearhead their population's health and well-being," Melnyk says.
"A hospital's investment in the well-being of their healthcare professionals will lead to better quality and safety of care and fewer preventable medical errors," she says. "It's critically important that we understand some of the root causes that lead to those errors and do everything we can to prevent them."
Just having a wellness program isn't enough, she says; some 90% of hospitals implement employee wellness programs, according to an American Hospital Association survey, but there's great variance among programs.
"A lot of hospitals will run employee wellness through HR, so they may have an online web portal where they collect personal health assessments or do wellness challenges, but then there are other [organizations] like Ohio State that really invest in a comprehensive, multiple-component wellness strategy," she says.
The Ohio State Wexner Medical Center has several programs to promote clinician well-being, including its Employee Assistance Program which offers confidential mental health resources and services such as counseling, mindfulness coaching, and its Stress, Trauma and Resilience (STAR) Program that offers the Buckeye Paws pet therapy program to promote coping and resiliency skills-building.
Nurse executives also can take the lead to guide their nurses away from burnout and toward wellness, Melnyk says.
"From a nursing perspective, I would give some leaders in my nursing organization FTE time to focus on wellness for my critical care nurses," she says. "Somebody's got to be looking at this—watching outcomes and providing programming specific to these critical care nurses because the care, as my study shows, can cause medical errors if your clinicians are not in good mental or physical health."
Screening programs are essential
Previous research also has linked medical errors with clinician stress, quality of life, burnout, and physical and mental health, according to the study, which notes that critical care nurses are known to experience higher levels of stress than nurses in other specialties because of their taxing clinical environment. Indeed, research indicates a 24% prevalence rate of posttraumatic stress disorder in CCNs, compared with 15% in nurses working in other clinical areas.
Stress and unresolved depression can lead to suicidal ideation and action, which have been on the rise and occur at a higher rate in nurses than in the general population, another prior study shows.
For those reasons, healthcare leaders should implement screening programs that detect depression in their nurses and other clinicians, the new study advises.
One successful program, for example, is the HEAR (Healer Education Assessment and Referral) screening program, patterned after a program developed by the American Foundation for Suicide Prevention, which provides anonymous online depression screening and treatment referral. Since its inception, the program has successfully identified a substantial number of suicidal nurses and connected them with treatment options, the study says.
Such results point to the reality that focusing on critical care nurses' well-being is critical.
"It's clear that critical care nurses, like so many other clinicians, cannot continue to pour from an empty cup," Melnyk says. "System problems that contribute to burnout and poor health need to be fixed. Nurses need support and investment in evidence-based programming and resources that enhance their well-being and equip them with resiliency so they can take optimal care of patients."
Study shows telehealth doubles the tasks nurses complete to assist patients with chronic diseases.
More hospitals and health systems are pushing forward with telehealth initiatives, but a new study indicates that telehealth doubles the tasks nurses complete to assist patients with chronic diseases, significantly impacting their workload amid a nationwide nursing shortage.
The University of Missouri study found that nurses remotely monitoring patients with Type 2 diabetes and hypertension were doing more work than nurses who provide in-person care programs.
After comparing the results with nursing activities completed during traditional, in-person healthcare appointments, she found the use of telehealth leads to twice as many activities completed by nurses.
For her study, 786 nursing activities were coded for 36 in-home monitoring group patients and 38 traditional care group patients over the 12-week study duration.
The number of nursing activities per patient ranged from 1 to 38 in the in-home monitoring group and 2 to 19 in the traditional care group, averaging 14.1 nursing activities performed for in-home monitoring group patients and 7.3 nursing activities for traditional care group patients, the study says.
"Telehealth can be an effective and convenient service for patients managing chronic diseases such as diabetes or hypertension, but what often gets overlooked is all the work being done by the nurses on the back end to assist patients," Howland says in a press release. "They are entering the data they receive into medical records, identifying instances when patients have abnormal blood glucose levels, reminding patients to self-monitor and submit their data, requesting input from primary care providers, and making referrals to other providers for more specialized care."
While the patients who attended in-person appointments followed up once every three months on average, the telehealth patients submitted their blood glucose and blood pressure levels multiple times a week. Because of increased communications with nurses, the telehealth patients received more guidance to help them monitor their chronic disease more closely, leading to more medication adjustments and lifestyle changes, ultimately resulting in better health outcomes.
"As telehealth continues to become more popular, it can be used to get health behavior intervention tools to the people who need them most," Howland says, "but we also need to keep in mind the strain it puts on nurses that are going above and beyond to make this possible."
Howland's research is unique in that published telehealth studies have included nurses within telehealth's intervention component, such as in a randomized controlled trial using telemonitoring, but none have been done on nurses in a real-world primary care clinic setting, she says.
As such, this study also reveals how nurses have integrated new telehealth systems into their daily routines.
"We can't expect nurses to use these tools successfully without better understanding the impact it will have on their workload," Howland says. "Going forward, this research can provide the framework for quantifying how much time nurses spend on these telehealth tasks, especially with the current nationwide nursing shortage."
"If the nurses are completing twice as many tasks via telehealth," she says, "should they be responsible for half as many patients?"
Staffing, space, and supplies should be considered to integrate critical care-specific needs into disaster response planning, article says.
Disaster drills focus on the immediate aftermath of catastrophes—natural disasters, mass shootings, terrorism attacks—by managing the initial triage and patient surge in the emergency department and testing the hospital incident command system.
However, a disaster also may require critical care capacity to expand in a rapid and sustained fashion.
"Hospitals need to have an ICU-specific disaster plan as part of their larger facility plan, due to the unique requirements for expansion of ICU space, staffing, supplies, and equipment," co-author John Gallagher, DNP, RN, CCNS, CCRN-K, TCRN, RRT, FCCM, says in a press release. "It's crucial that ICU providers anticipate challenges before an actual disaster."
"Disaster planning can take a general all-hazard approach or one that focuses on a specific hazard that the facility may be at higher risk for, due to its location and other factors," says co-author Jennifer Adamski, DNP, APRN, ACNP-BC, CCRN, FCCM. "Thinking through the ramifications of an incident, preparing for worst-case scenarios, and practicing the response can literally save lives when a disaster happens."
Adamski, an assistant professor and director of the adult-gerontology acute care nurse practitioner program at Emory University's Nell Hodgson Woodruff School of Nursing, Atlanta, and a critical care nurse practitioner on the Cleveland Clinic critical care flight team, also has responded to mass casualty incidents. She also serves with Gallagher on the national board of directors for the American Association of Critical Care Nurses (AACN), which publishes the journal.
Predisaster planning includes inventorying space to expand ICU as needed. When ICU is full, external or remote ICU expansion and field hospitals may be needed, the article says.
Staffing considerations, particularly in sustained conditions, include the use of creative, tiered staffing models and just-in-time education for clinicians and support staff to quickly increase the number of capable personnel, the authors say.
"A tiered approach allows critical care providers to oversee a larger number of noncritical care providers who then provide direct care to the patients," they write. "In this model, an intensivist may oversee up to 4 nonintensivist providers, who, in turn, work with advanced practice providers experienced in critical care to treat a maximum of 24 critically ill patients."
Besides space and personnel, health systems and hospitals must identify supply and equipment needs and vulnerabilities. These include personal protective equipment (PPE), ventilators, redundant oxygen, point-of-care ultrasound, and emergency blood components.
They also must plan for transfer and transport considerations, the article says, as well as anticipating the potential needs of special populations within the community.
