Enhanced communication key to reducing nurse burnout, improving care
"Nursing is a work of heart." It's a perfect way to describe the passion and dedication nurses have for their profession, which Americans have ranked as the most honest and ethical for 14 consecutive years.
The fact is the role of the nurse has never been more important than it is today. But nursing has also never been more intense, and when you take a closer look at a day in the life of a nurse you'll see they're being tasked to do substantially more with less.
Twelve-hour shifts are commonplace as nurses care for more patients with the influx of 17 million previously uninsured since 2010 through the Affordable Care Act. They're also caring for older patients – 3 million baby boomers are projected to reach retirement age annually for the next 20 years and the number of Americans over the age of 85 is on a path to double by 2030. Moreover, with half of U.S. adults afflicted by a chronic health condition (and a quarter by two or more), nurses are caring for sicker patients at a time when healthcare reform is mandating shorter length-of-stay.
It's no wonder that nurses are increasingly experiencing burnout and dissatisfaction with their jobs, and that nurse shortages loom.
The best way we can help our nurses overcome these issues is to provide resources that help them more efficiently and effectively follow their passion for providing care. One area we need to address is improving nurse-physician and nurse-nurse communication, especially during care transitions.
Communication failures between clinicians are one of the most common causes of adverse events, with an estimated 80 percent of serious medical errors involving caregiver miscommunication during the transfer of patients, according to the Joint Commission. Considering the average five-day hospital stay includes at least 24 patient handoffs, coupled with the major increase in physician and nurse workloads due to an influx of more and sicker patients, it's no wonder that these lapses can occur.
The good news is hospitals and health systems have been working feverishly to improve care team communication.
UF Health enlisted the help of University of Florida coaches to develop Gatorounds, a multidisciplinary approach to medical rounds that incorporates athletic principles. Gatorounds focuses on improving care delivery through enhanced care team communication, including development of a universal language to avoid hand-off lapses and better manage care over shifts, and ensuring respect and trust among clinicians. Having more integrated and aligned care teams has helped UF Health reduce 30-day readmissions and length-of-stay.
In addition, providers such as Mission Health, Penn State Hershey Medical Center, UCLA Health and University Health System (San Antonio) have programs in place that rely on veteran nurses or nurse SWAT teams to help more novice nurses. Even though they're at a patient's bedside, a nurse's voice still isn't always heard. With a third of all current nurses expected to retire within the next five years, this issue will be compounded as inexperienced nurses enter the field. By sharing proven strategies around what works and what doesn't when it comes to communicating with veteran doctors and clinicians, these more seasoned nurses are helping new nurses be more proactive, confident and vocal about their care decisions and instincts.
Technology can also play a key role in enhancing care team communication. Though electronic health records (EHRs) are an important part of the equation, a survey of 13,650 nurses suggests 94 percent believe EHRs have not improved communication among care teams. What clinicians need is the ability to seamlessly interpret existing data and use it to benefit patients at the bedside.
Nurses and physicians at Houston Methodist Hospital and Yale New Haven Health System are using a predictive algorithm called the Rothman Index to enhance communication and create a common language about patient condition. The software pulls and translates EHR data into a patient condition score displayed on color-coded graphs stratified by risk. Scores and graphs can be accessed directly in the EHR, as well as displayed on large monitors in common areas such as nursing stations. Having this information readily available allows clinicians to quickly visualize and communicate a full picture of patient condition across care transitions, and promote intervention when needed.
Use of the Rothman Index helped Houston Methodist reduce risk-adjusted mortality by 32 percent and sepsis mortality by 8 percent in nine months, while a Yale New Haven Hospital nurse rapid response team accessing the Index achieved a 30 percent reduction in mortality.
Nursing truly is a work of heart. We need to do more as an industry to make our nurses' day-to-day lives less stressful and support them in following their passion for caring for people. We owe it to them, and to the patients and communities they serve.
Stephanie Alexander is a 30-year healthcare veteran, recognized internationally for her work in standardized performance measurements for hospitals and health systems. She currently serves as CEO of PeraHealth.
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