HealthOctober 20, 2022

Crisis response leads to promising new care delivery models

The COVID-19 pandemic shed a spotlight on gaping holes in the US healthcare system, while worsening a nursing shortage that is expected to go on for years.

Yet in a few bright corners of healthcare, a burst of innovation has led to the formation of new nursing care delivery models, including team-based care, which optimizes nurse workforce staffing and innovative uses of telehealth. Nurse leaders must respond by learning about these models and adapting them for use in their own healthcare settings.

Nursing challenges during the COVID-19 pandemic

2020 was a reality we weren’t ready for. Early in the pandemic, the levels of acuity and severity of illness among patients with COVID-19 were like something we’d never seen. Patients with acute respiratory failure required advanced oxygenation and ventilation support in order to have a chance for survival. In addition, patients developed multi-organ system failure that required advanced interventions. Given the circumstances, traditional primary nursing models created a true supply-and-demand problem: there were simply not enough specially trained nurses to meet the needs of critically ill patients descending on the healthcare system all at the same time.

Desperate for coverage, some ICU nurses trained their med-surg colleagues to deliver basic nursing care in the ICU, freeing ICU-trained nurses to deliver more complicated care – launching a collaborative model of care that could flex with increases in critically ill patients. In a Wolters Kluwer podcast, “Sharing What We’ve Learned: A conversation with Wendy Hutchinson Palma, BSN, RN,” a critical care nurse, she called these pairings a “silver lining” that created a cohort of nurses ready to help in critical care at a moment’s notice.

This ICU example is a model of team-based care that holds the potential to optimize nurse workforce staffing and empower all nurses to work to the top of their licenses. The model is characterized by an interdisciplinary approach to managing patients, with a team leader overseeing nursing colleagues and other assistive or support personnel who become the direct caregivers.

Optimize nurse staffing through team-based care

Historically, many healthcare systems have used what is considered a traditional primary nurse model to deliver care. Traditional care models lacked the element of collaboration that was required during a health crisis like COVID-19.

As a result, the two most profound changes to the delivery of nursing care when it comes to coping with the demands of the COVID-19 pandemic have included:

  1. a return to the team-based nursing model, which permits fewer registered nurses and more support personnel to manage a larger number of patients
  2. the concept and adoption of telehealth, which expanded during the pandemic so care could safely be extended to people in their homes.

The approach enables healthcare organizations to be agile and efficient in their medical staffing, ensuring safe care for large numbers of critically ill patients. Healthcare organizations should now build on lessons learned during the pandemic and institutionalize early efforts to bring those learnings into the team-based nursing delivery approach.

Five key attributes of alterative care models

The team-based model should take advantage of each team member’s talents and experience, and provide an alternative framework to deliver care — especially in a disaster or crisis situation. The team-based model gives increased flexibility and agility and allows nurses to work at the full scope of their practice and licensure.

The key attributes of alternative care models include:

  1. Strong interdisciplinary collaboration
  2. A culture of knowledge sharing
  3. Task sharing and shifting
  4. Identifying and expanding core competencies
  5. Improved communication and coordination

The team-based care approach: Back to the future

Many healthcare professionals have never heard of — much less worked in — a team-based care approach, but it is a care model that more-experienced nurses know well. In fact, the concept dates back to World War II. The military faced a shortage of nurses to care for patients, so trained ancillary healthcare staff and medics were deployed to work with nurses in a team-based model. That model was later adopted by the Veterans Administration health system and eventually spread to other hospitals.

The more current version of that model is similar to the traditional team model but it’s different in two important ways. First, it relies more on an interdisciplinary approach to care by expanding to other healthcare professionals beyond nurses to manage critically ill patients. Second, teams are managed by a team leader who has knowledge and experience in critical care or specialty care and can oversee nurses and other personnel who are moved to the unit to assist with care. The newly onboarded healthcare professionals can become the direct caregivers.

Because the model accommodates staffing agility, hospitals can quickly train support staff such as unlicensed assistive personnel, physical therapists, respiratory therapists, and others to assist with patient care.

Telehealth training for nurses is essential

Telehealth, which exploded during the pandemic, can improve access to care, especially for patients who struggle to attend appointments in person. It can also help address social determinants of health (SDoH), which play a part in 80-90% of healthy outcomes for a population, by enabling providers to use virtual home-based visits to assess how patients’ living conditions affect the care they receive.

Effective telehealth, however, requires training. An overwhelming majority (77 percent) of faculty members at nursing schools believe that they need such training themselves, before they can begin to incorporate what they learn into classroom content, simulations, and clinical experiences. Similarly, Chief Nursing Officers (CNOs) must implement training to help staff members understand why, when, and how to use this technology. They must anticipate potential barriers and carefully consider how to integrate telehealth into existing workflows. Because telehealth provides a window into patient and caregiver living conditions, staff can observe people in their home environments. Those being trained for telehealth visits must understand the nuanced dynamics of delivering care remotely.

CNOs must recognize that implementing these new models of care depends on three pillars:

  1. improved access to evidence
  2. a commitment to health equity
  3. support for nurses’ resilience

Embrace the creativity that crises generate

The path forward will necessitate a more agile care-delivery approach that ensures nurses are proficient in both care-delivery models so hospitals can quickly switch between the traditional primary care model and team-based nursing, depending on the situation. Healthcare organizations must also ensure that nurses are trained in the nuances of care delivered remotely via telehealth.

The healthcare system’s uneven pandemic responses and struggles to respond to the nursing shortage have created a true crisis. Yet as Winston Churchill once said, we should never let a good crisis go to waste.

This article summarizes a couple of emerging care delivery models, as well as key support pillars that can ensure we make the most of this crisis. Links within describe these models in more detail. Yet the point is simple: Healthcare leaders must evolve based on lessons learned from the pandemic. And they must act. Lives depend on it.

Download the Transforming the Nursing Workforce: Keys to Delivering Health Equity and Fostering Resilience to discover the key anchors for transforming care and implementing alternative care delivery models.

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