Health systems reshape nurse workflows: 4 trends to know

Health systems are increasingly reimagining nurse responsibilities and workflows in response to staff shortages and high levels of employee burnout, among other challenges.

The nursing workforce has stabilized in recent months, with some employment numbers higher than before COVID-19, but systems are still prioritizing retention efforts.

Health systems are trying to retain nurses by streamlining daily workflows and reducing administrative burdens and allowing them to practice at the top of their licenses. These efforts can take many forms, including virtual nursing, reworking nursing teams and and scrutinizing nurse-to-patient ratios.

Here are four ways health systems are changing the way nurses work, as reported by Becker's in the last month.

Redefining the nurse care team: Telemedicine use has been on the rise since the COVID-19 pandemic began and many systems are turning to virtual nursing as a way of keeping nurses in the field.

Some hospitals are taking it a step further by redesigning nursing and care teams to include one virtual and two on-site support direct patient care members. Livonia, Mich.-based Trinity Health launched its TogetherTeam Virtual Connect Care at 21 hospitals across 10 states.

Another example comes from BJC HealthCare and Washington University School of Medicine. Thomas Maddox, MD, vice president of digital products and innovation at BJC, told Becker's their virtual nursing program supported 4,951 inpatient admissions and has given nurses 1,650 hours back for direct patient care, improved admission documentation rates to greater than 85% and helped reduce nurse adjusted voluntary turnover to 6.4%.

Leveling up student nurse training: From new graduates to leaders, systems have changed the way nurses work and the perception around some positions.

Mercy Fort Smith (Ark.) Hospital launched a new 18-bed unit, which will have a 4-to-1 patient-to-nurse ratio. The unit is designed to provide close-contact, hands-on training for student nurses by allowing them to care for medical telemetry patients under the supervision of an experienced nurse. The team, consisting of one Mercy nurse and two students, cares for up to four patients at a time with the additional aid of a clinical rotation preceptor.

Unlike traditional clinical models, "this allows for additional support and enhanced communication for our patients and gives the nursing student a more enhanced learning experience with at-the-elbow support and instruction from experienced Mercy nurses," Stephanie Whitaker, MSN, RN, chief nursing officer at Mercy Fort Smith, told Becker's.

Shifting the perception of medical-surgical nursing: Among nurses, a history of stigma attached to med-surg can make it difficult to retain staff. The specialty — often considered a steppingstone to other positions — requires a range of knowledge and typically holds higher patient ratios. Hospitals are attempting to change the perception of med-surg by providing additional support to these team members through patient care assistants, virtual nurses and technology that can reduce non-nursing tasks.

Shifting perspectives on med-surg can save staffing costs for hospitals that employ agency staff for those positions.

"You can generally employ one and a half nurses for the cost of an agency nurse, and sometimes even two," Deana Sievert, DNP, RN, chief nursing officer at The Ohio State University Wexner Medical Center in Columbus, told Becker's

The hospital is analyzing whether a shift to a sole RN model where nurses could expect a standard patient load of three patients, with an occasional flex up to four or five, would be comparable to the current model, which involves a lot of agency nurses and patient care assistants.

Prioritizing nurse leaders' well-being: While most hospitals have focused on the well-being of front-line workers, the need to focus and provide better work conditions for nurse leaders has become more apparent.

"Managers and nurse leaders have always been forgotten from the conversation," Jennifer Mensik Kennedy, PhD, RN, president of the American Nurses Association, told Becker's

A recent report found 35% of nurse leaders are considering leaving their roles: 12% said they intend to leave and 23% said they may leave within the next six months. Leaders who are considering leaving pointed to not having the resources to do their job and work having a negative effect on their health and well-being as the primary reasons — which parallels what bedside nurses consistently point to as drivers of burnout or reasons they have stepped away from the job. 

Some systems are turning to workload optimizations and scheduling flexibility to alleviate manager burnout. Systems such as New Orleans-based Ochsner Health are considering offering four-day workweeks for nurse leaders that would consist of four 10-hour shifts per week.

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