The U.S. will grapple with a critical nursing shortage for at least the remainder of the decade. Thus, health systems are now looking for ways to more efficiently ensure that patient needs are met, while recruiting and retaining qualified clinical staff. Many successful health systems are turning to telenursing to supplement and enhance traditional bedside care.
Across the country, healthcare organizations are experiencing difficulty recruiting, higher labor costs, and increased staff burnout. In a 2021 letter to HHS Secretary Xavier Becerra, the American Nurses Association noted that states were challenged by unfilled positions and failure to recruit enough replacements. Louisiana reported 6,000 unfilled positions even prior to the Delta variant, Tennessee had 1,000 fewer nurses than when the pandemic started, Mississippi lost 2,000 nurses between January and August that year, and Texas recruited 2,500 nurses outside the state but still did not meet its staffing need. These shortages feed on themselves, since working in a chronically-understaffed setting takes its toll.
In the first quarter of 2021, 36% of hospitals experienced an RN vacancy rate above 10%, according to the NSI National Health Care Retention & RN Staffing Report. RN turnover in 2020 was 19%, about three points higher than in 2019. Unsurprisingly, burnout is a big reason that almost half of nurses are changing roles, reducing hours, becoming “travelers,” and retiring. Conservatively, one-third of nurses reported being “burned out” or “very burned out” in 2021. This shortage of nurses and other qualified staff is increasing hospital and health system costs by $24 billion per year, averaging $17 million in additional costs for a 500-bed facility.
Approaching the shortage: a series of stop-gaps
Some health systems use travel nurses as a stop-gap to help staff more shifts. This does not actually solve the problem, though, as added expenses limit the long-term sustainability of this approach. Other hospitals are increasing their patient-to-nurse ratios, with some facilities relying on patient care techs and nursing aides to ease the burden. Unfortunately, thousands of qualified would-be nurses have been turned away from nursing schools due to shortages of faculty, clinical sites, classroom space, preceptors, and financial support.
While schools implement strategies that enable them to add student capacity, health systems must find ways to do more with less, without sacrificing care quality. With declining margins due to the pandemic, it is all the more difficult to simply hire more aides, even presuming they are available.
Besides actual procedures and hands-on care, bedside nursing includes charting, consulting with team members, accessing supplies, coordinating with other departments, and speaking with family members and friends. However, given the understaffing on many floors and unit, patients often interact with a variety of care team members on each shift. This fragmentation in turn makes it more difficult for patients and their visitors to decipher “who’s who,” and to bring forward important concerns.
Dividing to conquer
The pandemic accelerated acceptance of telehealth, along with more comfort with wearables, Bluetooth-enabled physical assessment, and virtual monitoring from patients, clinicians, and healthcare systems.
Incorporating telehealth programs within acute care facilities allows floor nurses to cover more ground. Virtual patient observation, for example, can support a number of goals, from greater patient safety to an improved patient experience.
Patients have long complained about the sleep deprivation caused by clinicians entering the room, along with the background noise from nurses’ stations and hallways. In addition to the discomfort and disorientation that interrupted rest entails, when a series of staff intrusions occur with no prior warning nor way to ask questions, the patient can easily feel like an “object,” with little control over the situation — not an ideal environment for healing.
With on-demand access to nurses and supporting care team members, patients can have their questions answered remotely, allowing floor staff to be notified and physically intervene only when needed; thus systems have seen their room entry needs, often with attendant needs for PPE or other precautions, significantly reduced.
With some basic concerns addressed by virtual nurses, the floor nurses can also cultivate an improved relationship with patients, providing more concentrated time for in-person care to focus on their needs. This is obviously a more desirable situation for a high-performing bedside nurse.
The best solutions are those that address a number of pain points, and virtual patient observation is gaining traction as a core workflow. Facilities have learned that consistent monitoring and early intervention, as is facilitated by virtual observers, can reduce wandering, falls, self-harm, and visitor security incidents.
Health systems can also reduce labor expenses by leveraging virtual infrastructure. For example, one 900-bed hospital reported a $3 million annual unbudgeted expense for bedside sitters alone. Furthermore, just one hospital-related fall injury can cost up to $30,000 (not to mention legal and reputational exposure).
Telenursing: more efficient delegation and workflows
Collaboration among virtual and on-site nurses can enable floor staff to spend more value-added time with patients at the bedside. Telenurses with “eyes on the patient” can address tasks such as admission and discharge planning, medication reconciliation, patient and family education, and some student/trainee preceptorship. Meanwhile, floor nurses can focus on the tasks requiring hands-on skills and in-person availability, including supervision of aides and less experienced staff.
Tele-nurses can train, mentor, back up and otherwise support bedside nurses, coaching them through unfamiliar tasks or procedures, while also being available for advice and counsel. Of course, they can also coordinate communication in urgent and emergent situations, and can instantly activate alarms on the floor.
Thus, telenursing does not solve the nursing shortage, but it can support optimal outcomes of care, staff development, retention, and morale — with fewer RN FTEs.
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