Providing quality patient care with increased demand and staffing shortages

Health systems are facing increased demand for care while continuing to deal with nursing shortages.

Creative solutions to recruit and retain talent, while optimizing workflows, compliance and clinical quality, are required to deliver high-quality patient care. During Becker's 10th Annual CEO + CFO Roundtable in a session facilitated by Alexi Nazem, MD, co-founder and CEO of Nomad Health, three nursing professionals discussed the challenges faced and explore innovative solutions.

Panelists were:

  • Kyle Case, BSN, RN, nurse, Nomad Health
  • Aundrea Styles, BSN, RN, director of nursing, South City Hospital (St. Louis)
  • Michele L. Williams, senior project, Bayhealth Medical Center (Dover, Del.)

Four key takeaways were:

1. An aging population and chronic health problems mean growing demand for care. According to the U.S. Census Bureau, 10,000 people will turn 65 every day until 2030. Dr. Nazem noted that this population consumes three times as many healthcare resources as those under age 65. The Population Reference Bureau predicts that 2.3 million senior citizens will require nursing home care in 2030, a 75 percent increase over 2010. 

2. Nurses are retiring and resigning, resulting in a staggering number of openings. The American Association of Colleges of Nursing predicts that one million nurses will reach retirement age within the next 10 years. In addition, the turnover rate of RNs between 2017 and 2021 was 26 percent, according to NSI Nursing Solutions. Both factors will contribute to projected openings for RNs of 195,000 per year between 2020 and 2030. 

3. While travel nursing provides one solution, health systems must find other ways to recruit and retain nursing staff. "About 50 percent of our staff right now are travel nurses," Ms. Williams said. 

In an effort to retain staff, Bayhealth is trying to convert travel nurses to full-time staff. "We hope to recruit them with benefits such as sign-on and stay bonuses and tuition reimbursement programs," she said. "We have an international nursing program that can help with visas." In addition, the health system is recruiting at college and high schools.

Bayhealth has also started a healthcare summit designed to increase communication between management and staff. "If the staff sees that you're really listening to what they're saying . . . that goes a long way," she said. "With the younger generation, you have to find out what resonates with them, which may include hybrid or remote work."
Since South City Hospital is a small facility, its recruitment and retention strategy is very personal. "We offer that personal, family environment," Ms. Styles said. "We have to make those personal connections."

4. Find creative ways to allow staff to work at the top of their licenses — and new ways to drive efficiency. As a travel nurse, Mr. Case has the benefit of observing many different environments and seeing what solutions best maximize efficiency. He shared two innovative solutions that have worked successfully in ERs. "Some facilities have hired paramedics for the ER," he said. "They can start IVs, monitor blood and give certain medications within their scope of practice. By differentiating those skills, we can work better as a team and cover more patients."

He's also seen creative triage workflows, which allow staff to start tests and labs as patients are waiting. "Some ER physicians came up with predefined order sets for patients coming in with abdominal or chest pain," Mr. Case explained. "The triage staff could do the blood work, give basic medications, run EKGs, take urine samples and order predefined labs. It also results in quick turns when the doctor comes in because all the results are already in the computer."

Health systems are faced with the challenges of an aging population and chronic health problems, at the same time that many nurses are retiring and resigning. These challenges aren't going away. To address the growing demand for care, health systems need to employ a variety of solutions to boost their efficiency, from travel nursing to finding creative ways to recruit and retain nursing staff, so that they can focus on their mission of consistently delivering high-quality patient care at the bedside.


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