Something’s Got to Give: Bold Changes to Address Nursing Shortages

Thinking creatively to get nurses back to what gives them joy

By Christy Dempsey, DNP, MBA, RN, CNOR, CENP, FAAN

As the old saying goes, the definition of insanity is doing the same thing over and over again yet expecting a different result. In many ways, that’s what we are doing now in the healthcare industry in the face of a persistent nursing shortage.

Do more with less. Work smarter, not harder. Here’s some pizza to celebrate your heroic work.

The impacts of this shortage continue to compound, and historical responses are not sufficient. Organizations are being forced to close beds, scale back services, address persistent staff burnout and mental health challenges, and labor costs continue to rise. A Health Affairs study published in April 2022 found that the RN workforce fell by about 100,000 by the end of 2021. The same study identified that this is the largest drop in four decades. Further compounding the problem, over 90,000 qualified applicants were turned away from nursing programs across the country due to lack of faculty and clinical placements. The National Council of State Boards of Nursing released a study that found about 100,000 registered nurses left the workforce during the past two years due to stress, burnout, and retirements, and another 610,388 reported an intent to leave by 2027. This is a disturbing trend not only for the nursing profession, but also for the people that nurses care for every day in every community.

The lack of nurses has a clear and frightening impact on patient care. The Michigan Nurses Association conducted a recent poll, involving 400 nurses in which they found that the percentage of respondents who knew of a patient’s death being caused by nurse understaffing nearly doubled in the past seven years. It grew from 22% in 2016 to 42% in 2023. Of the 4.2 million nurses in the U.S., 2 million are inpatient nurses, and it seems understandable that 45% of them reported a likelihood to leave their roles in the next six months.

The stark reality is that the number of people who need care isn’t going to shrink, no matter how many nurses we have available—it’s going to increase as Baby Boomers continue to age. Staffing shortages are likely to remain a challenge for at least the next 10 years, making today’s environment a prime opportunity to introduce innovation into care delivery. Innovation in care models and innovation in technology will be key to survival in this time of transition from the status quo of nurse-to-patient ratios and the rightsizing of staffing and care models to best meet patient needs where they are. Keeping and attracting nurses requires our healthcare system as a whole to embrace what makes nurses feel satisfied in their work: Nurses want to spend more time with their patients, participate in professional-growth activities, coach and mentor their fellow nurses, and share in decisions about the work they do.

Embrace team-based care

For decades, nurse-to-patient ratios and productivity have determined the number of nurses on an inpatient unit—regardless of support staff, experience, number of shifts worked, or acuity, agency, or permanent staff. All these things change how realistic a simple ratio is for quality patient care. Putting the right mix of skills on each unit enables nurses and other healthcare professionals to work at the tops of their licenses.

Data shows that having an RN lead the care team for each patient makes a positive difference in care quality. With the RN as the conductor, all the other care professionals—LPNs, pharmacists, lab and radiology technologists, respiratory, physical, and occupational therapists—contribute their expertise, working in sync toward shared care goals. Thus, it is the quality outcome of the care that dictates the number of nurses and other professionals necessary to deliver that quality outcome. How can we ensure that the right people care for the right patients at the right time and in the right place?

Thoughtful clinical workflow automation  

Automation technology has proven itself capable of removing manual, repetitive tasks from clinical workflows and, more importantly, makes them safer. For example, automating medication delivery and dispensing have made this process much more efficient and much less error prone. The key is to apply automation with care teams, not to them. The people delivering care at the bedside must drive how to apply automation to support best practices while ensuring it doesn’t increase their burden or cause other unintended consequences.

Some of this technology has proliferated as a result of the COVID 19 pandemic. Virtual nursing, virtual medical appointments, and virtual hospitals have demonstrated that this type of technology augments (not replaces) the staff in the room and on the unit, especially when so many novice nurses are now left without mentors and experienced coworkers due to retirements and departures post-pandemic.

With so much disparate technology, a nursing shortage, sick patients, and lack of coordination, care team-enabled electronic orchestration is needed now more than ever.

With care orchestration technology in conjunction with the electronic health record (EHR), the entire care process can often be managed in one place. Automation can remove tasks or delegate them to the most appropriate resources. Everyone on the care team, including virtual care clinicians, can view the patient’s status, care plan and data in one place, allowing better coordination of care, efficiency at scale across teams and disciplines, and more time with patients.

Data to enhance efficiency

Data transparency has become a key component within shared governance, quality, and reimbursement. However, while data accessibility has grown exponentially, organizations are often challenged to use the data in a way that is efficient and drives safe, quality outcomes. Data is key to driving improvements in care quality, workflow processes, and patient engagement. But to be truly valuable, the data needs to be consolidated, aggregated, and displayed in a meaningful way. Data that is inefficient or insufficient to support efficient processes results in more work, more phone calls, and more follow-ups, which often land on the plate of nursing staff.

For example, in perioperative care, patient data is often spread across multiple systems. Patient information is often contained in provider records, perioperative records, the hospital EHR, and other clinical systems and locations. Care orchestration technology ensures that information is delivered seamlessly across platforms. Before scheduling a patient for surgery, if imaging is required and the patient’s record shows a recent result that has already been obtained, an unnecessary image is avoided, the nurses do not have to track down that information, and cost of care is reduced. Discharge planning is another way in which care orchestration improves quality and safety while decreasing cost. With automation, the discharge process can be launched more quickly and details such as the patient’s transportation home, prescriptions, therapies, and follow-up appointments are taken care of to ensure a smooth transition home or to the next level of care.

These care orchestration technologies exist today. Assuring that coordination of care by the right people at the right time in the right place addressing the right things according to their skills and abilities to drive optimal outcomes should be our singular focus.

Foster a positive work environment

While technology is an enabler, it is not the only way to optimize outcomes for patients and for nurses and other healthcare professionals. Indeed, nothing will improve outcomes in an environment that is not healthy or safe for the people working in it. While staffing is important, a growing body of literature demonstrates that the work environment is, or is even more important, than staffing. Building and fostering a positive work environment through shared governance help to retain nursing staff. The most useful insight into how to establish best practices and deliver care most efficiently will come from the care teams working at the bedside: nurses, therapists, support staff, etc. Further, data transparency, shared decision making, meaningful recognition, and trust drive a positive work environment and, ultimately, better quality outcomes at lower cost. Nursing leaders must set the example by modeling boundaries and self-care; insist that nursing staff protect time away from the bedside by actively disengaging to take breaks and meals; insist they take vacation time; insist that they protect their most rewarding time at the bedside, giving personal care to patients and their families. These seemingly small actions add up, giving nurses the ability to refresh and recharge to deliver the best possible care.

Caring for caregivers is worth the effort

A recent report by McKinsey found that technology enablement, such as automation, and improved delegation could free up to 15% of nurses’ time—that’s nearly two hours in a 12-hour shift. The combination of real-time savings, improved workflows, and true workplace improvements could be a gamechanger.

Ultimately, though, caring for our caregivers has the biggest impact on patients. When they feel known and safe, patients are more trusting and willing to follow their care plans, leading to better experiences and outcomes. A care team all on the same page, working together to help them feel better, is a care team that isn’t frazzled and has time to interact in meaningful ways. Well-orchestrated care delivered by a highly coordinated care team allows nurses to focus on why they became nurses in the first place.

Christy Dempsey, DNP, MBA, RN, CNOR, CENP, FAAN, is an accomplished nurse leader, author, and educator, and a Thought Leadership Council member for Lumeon.