Infusion centers across the country are facing more patients, more complex regimens and fewer nurses to treat them.
Inova Health System’s adult infusion center in Northern Virginia confronted those pressures after rapid growth and understaffing. By shifting to a “Nurse Pull” scheduling model, the center was able to sustain the 152% increase in daily completed patient hours they’d experienced from years prior while operating with five to eight fewer nurses than usual. Improvements contributed to roughly $2.5 million in annual ROI.
During an Oct. 19 webinar hosted by Becker’s Healthcare and sponsored by LeanTaaS, Monica Cfarku, RN, senior director of oncology nursing services at Inova, and Tricila Ronquillo, RN, nurse manager, shared how they overcame staff skepticism, implemented Nurse Pull through LeanTaaS’ iQueue for Infusion Centers and maintained patient access and staff morale during a critical staffing shortage.
Here are four key takeaways from the session.
1. Overcoming nurse skepticism
Inova’s infusion nurses had worked from pre-assigned patient lists for years and viewed that routine as a source of control. When leadership proposed assigning patients dynamically throughout the day, nurses questioned whether the approach could work with complex oncology patients.
“These weren’t superficial concerns. They came from experienced oncology nurses who had seen what happens when systems fail and we had to take those concerns seriously, not dismiss them,” Ms. Ronquillo said.
The center was already at maximum capacity, could not add nurses overnight and could not turn patients away. Burnout compounded the challenge. Nurses arrived 30 to 45 minutes early to review charts, stayed late to complete documentation and saw their schedules disrupted whenever a patient experienced a reaction or required unexpected care.
“Nurses felt overwhelmed and reactive rather than in control, and that feeling of being out of control was unsustainable,” Ms. Ronquillo said.
2. Putting nurses in control
Inova built its Nurse Pull rollout around three pillars: leadership partnership, operational strategy and nurse well-being. Ms. Ronquillo and her unit supervisors met regularly with staff, including separate conversations with nurses who expressed the greatest concerns about the change.
“We wanted nurses to feel heard and not managed through the change,” Ms. Cfarku said.
Through the unit’s shared governance model, nurses helped shape how Nurse Pull would work on their floor. During the first two weeks, leaders pre-assigned new starts and more challenging patients to prevent any one nurse from carrying a disproportionate workload. When challenges emerged, the team adjusted the process rather than abandoning it.
“From the start, we made it clear that success wasn’t about asking nurses to do more,” Ms. Cfarku said. “It was about creating a smarter, more efficient process that better matched resources to demand.”
3. Sustaining volume with fewer nurses
Since implementing iQueue in 2019, Inova has seen a 149% increase in daily completed volume and a 152% increase in daily completed patient hours. Infusion wait times fell 56%, while drug wait times declined 15%. The system values these improvements at roughly $2.5 million in annual ROI.
The model faced its greatest test when staffing declined. Since going live with Nurse Pull, adult infusion has maintained 89% chair utilization despite operating with five to eight fewer nurses than usual. The unit’s workload balance score also improved from 74.3 to 80.4.
“We did not achieve these outcomes because we suddenly had more resources,” Ms. Cfarku said. “We achieved them because we used our existing resources more effectively.”
Nurse Pull also reduced scheduling disruptions. When a patient experiences a reaction, the assigned nurse can focus on that patient’s care without worrying about another patient waiting on a pre-assigned schedule. Charge nurses can also accommodate same-day additions wherever capacity is available.
4. Nurse happiness is an ROI metric
Beyond operational gains, Inova’s leaders emphasized the importance of staff engagement in sustaining change. Their approach centered on listening first, demonstrating the benefits of the new model, celebrating early successes and giving nurses meaningful control over their workflows.
Looking back, the leaders said they would begin staff engagement even earlier.
“Nurse happiness is an ROI metric. Measure it, track it, value it the same way you value throughput and utilization. Happy nurses stay. They recruit their friends. They provide better care,” Ms. Ronquillo said.
Inova is now expanding Nurse Pull to its remaining adult infusion sites.
“The one thing I would absolutely do again is to implement nurse pull,” Ms. Ronquillo said. “Looking back, I wish we had made the change sooner.”
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