By Monica Weekes and Frances Dare
Two realities face hospital executives that must be addressed in tandem to insure operational and financial viability.
First, demand for nurses will exceed capacity for the foreseeable future. Second, unremitting financial pressures are forcing hospitals to reduce the cost of care. Staffing drives most of those costs because healthcare is a labor-intensive industry. The need for more nurses and the demand to cut costs may seem at odds, but there’s a way to address both while maintaining high standards of care. Healthcare systems can reimagine and redesign nursing practice to be more fulfilling, improving recruitment and retention. Simultaneously, these redesigned practices can create larger capacity for high-quality patient care from an institution’s existing workforce, resulting in healthier top and bottom lines.
An unsustainable nurse staffing model
In the past, the physical and emotional demands of hospital nursing have been balanced by the satisfaction nurses experience caring for patients and the sense of community and collaboration found with their nursing colleagues. Nonetheless, before the onset of the COVID-19 pandemic, nursing practice was already becoming more difficult, with hospitalized patients increasingly sicker and more medically complex. With the pandemic, those issues were significantly exacerbated. Nurses became overwhelmed and exhausted, with little time left to support one another. Pandemic-driven burnout led to record-setting numbers of nurse resignations and retirement, exacerbating the decades-long nursing shortage.
Even in better times, nearly one third of new nursing graduates left the profession within the first year. The problem isn’t going away, with one recent analysis showing that younger nurses continue to leave the profession at higher rates than their more experienced counterparts. It continues to impact hospital revenues and margins -- with too few nurses to staff needed beds and high-costs for the temporary staff needed to fill as much of the patient care gap as possible.
The future of nursing is connected and collaborative
How can nursing be reimagined and redesigned? The answer is connected, collaborative nursing. In this model, bedside and offsite nurses (or other team members) share patient care responsibilities with an assist from existing and emerging technologies. Connected collaborative nursing maximizes the time available for hands-on care from bedside nurses by leveraging both off-site team members and intelligent machines to do three things: shift work, share work, and streamline patient care management. On their own, each of these technology-enabled approaches can free up time for hospital nurses. Leveraging all three in concert can act as a force multiplier.
About half of common nursing patient care responsibilities – including medication reconciliation, patient and family teaching, consultation coordination, care plan creation and more -- can be performed away from the bedside. An offsite team member can complete those tasks, collaborating with the bedside team and interacting with patients. According to our analysis, the combined responsibilities performed offsite can free up approximately 6.5 FTEs of nursing time. For an average hospital, that can mean six additional beds staffed, increasing revenue approximately 2.6 percent.
Intelligent machines can also pick up work. Nurses spend an inordinate amount of time searching for equipment and supplies across the hospital. Studies have shown this can add up to as much as 60 minutes per shift. It’s also been estimated that nurses typically walk between four and five miles each shift including delivering items to other departments. That work can shift to technologies. Intelligent robots can deliver samples to the hospital lab while smart tracking tags on infusion pumps, wheelchairs and other equipment means they can be located with keystrokes.
Other nursing responsibilities can be shared. The bedside nurse and offsite nurse both perform part of the task. Examples include admission assessments, nurse call system response, code support and patient discharge management. Enabling technologies include shared access to the EHR, secure communication and messaging systems, and high-quality video solutions. Increased use of remote monitoring technologies with trend and alert reporting can expand the support offsite nurses can provide to the bedside. Offsite nurses can cover many more beds than onsite nurses, a cost advantage with one-to-many scale.
The one-to-many care model isn’t new to healthcare. Tele-ICU is a well-proven model where intensive care nurses and physicians support hospital ICUs from a distance with both patient monitoring and clinical support to beside teams. Offsite nurses have more time to observe patients and proactively manage care plans. The onsite and offsite nurses all act as a single, coordinated team, and the bedside nurse remains the team leader.
In addition to patient care support, experienced nurses based offsite can mentor and coach less experienced nurses during patient assessments, new procedures or clinical decision making. That guidance could reduce stress and improve patient outcomes. In our research with nurses, development and mentoring was cited as one of the three top contributors to job satisfaction.
Streamline patient management
Digital communications can help streamline how nurses and team members locate and connect with each other. Nurses report spending approximately two hours each shift searching for other team members to coordinate and manage patient care. Research indicates that the time spent by nurses on in-hospital patient transfers in a single month is the equivalent of 11 FTEs. Transfers often take longer than necessary due to communication delays.
The right technologies can make communication and collaboration easier and more efficient. Communication devices small enough to fit in a lab coat but with easy-to-read screens can meet nurses’ needs for team member location and status information. The devices can support flexibility across secure message, voice or video channels. Imagine if even five FTEs could be freed-up for other patient care responsibilities.
The next steps toward connected, collaborative nursing
Initially, more responsibilities can be shifted and shared with other humans, based off-site. Over time, more work can be shifted to technology as clinicians become more comfortable with the care model and as technologies evolve. For example, today ambient clinical artificial intelligence (AI) can listen to conversations between clinicians and patients, and create draft clinical notes, care plans or discharge plans. . Humans—including medical scribes or nurses--quality check and correct the drafts. Over time, AI will become smart enough to reduce the needed human review. Similarly, “virtual humans” — life-like, conversational, computer-generated characters — can help with patient teaching, call light responses, discharge management and more.
Transforming nursing practice to become connected and collaborative requires joint leadership from nursing, operations, and technology executives. Engage nurse team members with human-centered design approaches to define new models and prioritize which nursing responsibilities should be shifted and shared near- and longer-term. Create an information architecture and illustrate clinical workflows to identify technology requirements for the hybrid working model. These steps will best position the organization to identify existing technologies that can enable the transition and which technology investments will be needed for the future.
Simultaneously, the economic impact of additional nurse capacity on revenue and margin, based on the clinical roadmap, can be modeled. This helps create a business case for the transformation while freeing up cash needed for technology investments. As the new model is implemented, the initial months will involve refining the new care model and the joint clinical, technology and economic roadmap over time.
With connected, collaborative nursing, the profession promises to become more attractive and rewarding while also addressing the financial pressures facing hospitals. Nursing practice that creates more care capacity, better quality care, and better nurse and patient experiences is the prescription for a lasting solution to the nursing shortage.
About the author: Monica Weekes is the vice president, health sciences consulting practice lead at Cognizant. Frances Dare is the senior director of Cognizant’s health sciences consulting practice.