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.