HealthSeptember 07, 2022

Rebuilding quality and improving outcomes amidst the pandemic

The ongoing impact of the COVID-19 pandemic has caused many healthcare organizations to reexamine their workforce strategies in order to rebuild quality and improve patient outcomes. While organizations navigate ongoing surges and new variants, many are now looking ahead at how they can create a culture of safety for patients, increase nurse staff competency, drive productivity, and retain staff.

While the nursing shortage has been looming for decades, it took the COVID-19 pandemic to transform a challenge into a full-blown crisis. Amidst the public health crisis, hospitals have found it difficult to recruit and retain staff as nurses leave the profession in record numbers. In addition to a number of other issues the shortages have created, many hospitals have had to cut services and scale back patient care. Equally challenging, higher patient acuity due to the pandemic, combined with fewer nurses at the bedside, has meant many hospitals have had to reexamine everything from how care is delivered to methods of onboarding and cross-training staff.

In a recent HealthLeaders Nursing NOW online summit for nursing leadership, "Rebuilding Quality and a Culture of Safety in the Wake of the Pandemic," sponsored by Wolters Kluwer, a panel of top nursing experts from some of the most prestigious health systems explored nurse burnout, workforce shortages, and the pressing need for more competent bedside nurses.

The HealthLeaders panel, led by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Wolters Kluwer, Health, Learning, Research and Practice, and critical care nurse practitioner at Penn Medicine Health System, discussed what healthcare organizations must take into account in order to maximize positive patient outcomes. She was joined by fellow panelists, David Marshall, JD, DNP, RN, FAAN, Senior Vice President and Chief Nursing Executive at Cedars-Sinai Medical Center; Shannon Pengel, MSN, RN, NE-BC, Chief Nursing Officer at Cleveland Clinic; and Phyllis Doulaveris, DNP, RN, NEA-BC, CPHQ, Senior Vice President of Patient Care Services and Chief Nursing Officer at Banner Health. Here are five priorities nurse leaders need to focus on to transform care.

1. The path to innovation: Team nursing

The ongoing workforce shortage, combined with the lack of adequately trained competent nurses at the bedside, was cited by the panelists as some of the most significant challenges many hospitals face during the pandemic. "While there have been challenges, we've also proven that we can innovate quickly and safely," said Dabrow Woods. "We've seen a spirit of collaboration across disciplines that has been unprecedented and that ability to work together as teams has meant that we have been able to cultivate a safer work environment even during the most challenging times."

Dabrow Woods explained that the implementation of new, team-based care delivery models made it easier for nurses to care for the influx of high-acuity patients they were seeing. More experienced nurses, working in collaboration with novice or nurses new to critical care, were crucial to ensuring that institutions were delivering the safest quality care.

2. Nurse experience level impacts quality metrics

Citing published research that analyzed nurses' levels of experience relative to quality outcomes, Dabrow Woods stated that a nurse's competence directly impacts the safety and health of patients. For example, novice nurses may not have the quality outcomes that nurses with more experience have, requiring what she calls "guardrails" that pair novice nurses with more experienced nurses so they have adequate support to deliver the safest quality care.

"Before the pandemic, what came out loud and clear in the literature is that the level of experience and education nurses have directly impacts outcomes. We need to consider whether the nurse is oriented to feel comfortable and competent to follow standards of care,” Dabrow Woods emphasized. But ensuring a well-prepared staff also has other positive implications. She added that organizations that invest in continuing professional development for their staff have better nurse retention than those hospital systems that don't because it demonstrates they truly value the nurse and what the nurse can achieve.

3. A new model to transfer expertise

As the pandemic raged on, many hospitals met the demand by rapidly recruiting and onboarding nurses. The panelists agreed that the types of rigorous nurse cross-training programs that existed prior to the pandemic have just not been possible over the last few years. Whether the nurse is new to the profession, a travel nurse, or a nurse reassigned from another unit, onboarding is crucial. Panelists pointed to the "expert model of care" that allows hospitals to take experienced nurses in a unit to share their expertise and embed critical thinking in nurses who may not have experience or who may be new to the profession. The panelists agreed that while the nurse orientation and onboarding process may have changed, the ability to share expertise across the staff has been an effective way to transfer knowledge.

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4. Taking on the mental health of nurses

All the panelists agreed that the ongoing COVID-19 pandemic has taken a brutal toll on the mental health of nurses. Many organizations have employee assistance programs, but these are often off-site and hard to access. "While they mean well, so many times staff just can't get to our employee assistance programs," explained Dabrow Woods. Thus, many healthcare organizations have been offering assistance directly to their nurses through their organizations. The nurse wellness programs include counseling available by phone and on-site.

Doulaveris from Banner Health explained a program the hospital launched called, “Talk to Me,” meant to help nurses debrief after traumatic events. To better support the workforce longer term, panelists shared their focus on giving nurses emotional support and employee assistance.

5. Technology's impact on patient outcomes

The panelists also agree that healthcare organizations can use technology to help improve nurse staffing. Dabrow Woods referenced a recent workforce study conducted by Wolters Kluwer and UKG, a large staffing organization, in which nurse leaders reported on their use of technology and automation to optimize nurse staffing and as a way to improve retention and deliver better outcomes. "Scheduling needs to take into account the needs of the individual nurse, patient acuity, and must be competency informed," according to Dabrow Woods. Considering nurses' competency levels on each shift can make a difference in how units staff each shift. Having an adequate number of competent nurses can also help improve patient outcomes for the long term, she noted.

The panelists emphasized that technology can also support nurses at the bedside and give patients more control of their environment. Marshall from Cedars-Sinai Medical shared examples of how the hospital innovates with technology to improve the patient experience and outcomes. Hospital rooms equipped with Alexa, for instance, offer nurses and patients digital voice assistants that can support administrative functions such as routing calls or delivering patient education at the bedside. Cedars Sinai also uses robots for point-to-point delivery to relieve staff from pick-up and drop-off tasks. "The robots — I think we have four of them in our organization — have traveled more than 3 million steps and saved 3 million steps for our staff. They've kept our nurses at the bedside," said Marshall.

To hear more from the panel, watch "Rebuilding Quality and Safety in the Wake of the Pandemic."

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