Nursing in Crisis

The long-projected nursing shortage is now upon us. To gain a better understanding of the impact it’s having on frontline nurses, Hospital IQ recently surveyed over 200 registered nurses working in hospitals. While not completely surprising, the survey results are alarming. Here’s what we learned:

• Chronic short-staffing is having a negative impact on both patients and staff. 
• The staffing crisis is systemic and goes much deeper than the Covid patient surges.
• Without deliberate action, the cycle of nurse burnout is very likely to get much worse. 

Nursing leaders have seen how the mental health of their staff — and their own personal well-being — have been impacted by the increased and ongoing exposure to patient suffering, isolation, and death. For many frontline nurses, there is a feeling of hopelessness and a loss of a sense of purpose that is compounding the impact of the nursing shortages.

Six key survey findings:

1. Nurses are considering leaving, and it’s not just a Covid issue:

90% are considering leaving the nursing profession in the next year, with 71% of RNs that have over 15 years of experience thinking about leaving as soon as possible or within the next few months. 72% said they were experiencing nurse burnout prior to the pandemic.

2. Workloads are increasing and staff is decreasing:

43% said a shortage of technicians meant they were doing more tasks like cleaning units, procuring supplies, and clerical duties as part of their workload. 39% said they were experiencing more serious mental health issues, like anxiety or depression, due to their increasing job demands.

3. Patient-to-nurse staffing ratios are rising:

45% of RNs said the estimated patient-to-nurse staffing ratios across shifts are currently 5:1, above the standard of 4:1. 84% of emergency room nurses and 96% of intensive care or critical care nurses have 4:1 ratios, double the optimal target of 2:1.

4. High ratios impact nurse burnout and patient care:

Rising patient-to-nurse ratios mean that nurses spend less time with individual patients, which can lead to less than optimal outcomes. Overworked and overstressed, many nurses are trying their best but are making mistakes they don’t usually make. 38% of nurses said that they had seen patients return to their hospital for post-discharge, secondary care. Medication errors or delays (38%), sharps injuries (33%), and healthcare associated infections (31%) are other impacts nurses have seen due to critical staffing shortages.

5. Care is less accessible for patients:

Understaffing and delays are also impacting hospitals’ ability to provide care. 36% of nurses said that they had seen patients with acute health conditions walk out of the ER because they had to wait excessive amounts of time for an inpatient bed. 37% said that surgeries had to be rescheduled because of bed shortages.

6. Manual tasks are a critical source of nurses’ frustration:

Nurses are looking for improved communication and better operational workflows. They cited multiple steps hospital leadership can take to ease nurses’ workloads, help deliver better patient care, and increase the likelihood of staying at their current hospital.

Many of these steps nurses cited would not have a financial impact; they could be achieved through existing resources and better processes. 53% overall want streamlined processes that ensure visibility into patient needs and communication. Another 45% said better communication and coordination across departments, and 40% said improved and expanded communication and representation with hospital leadership would improve satisfaction.

Automating manual processes would go a long way toward improving staff satisfaction. 45% of nurses said that referrals and transfer processes were the most manual, while 42% said updating paperwork and 42% said orchestrating patient discharges.

How Can Health Systems Reduce Nurse Burnout?

As also revealed in our survey, there are strategies that can help address these challenges. In addition to revealing negative and worrisome trends, we also uncovered practical strategies that can help neutralize the threat. 

The operational flaws and staffing coordination issues that have been building up over time have reached a breaking point due the stresses of Covid. However, it’s not too late for hospitals and health systems to remedy this dire situation and solve the systemic operational issues that are plaguing nurses and leading to mass burnout, fatigue, and turnover. The key to achieving peak operational performance that improves patient health outcomes and the productivity of frontline staff, including nurses, is establishing system-wide coordination to streamline patient flow and optimize staffing resources across the entire enterprise.

Use Technology to Reduce the Burden on Nurses

Where’s the best place to start? Those manual tasks and process bottlenecks that further strain an already overworked nursing workforce are clear indicators of an increased need to focus on strategies that align patients, beds, and staff to optimize productivity and patient flow. This requires improvements focused on people, processes, communication, and technology to boost workflows, performance, patient care, and staff satisfaction.

Hospitals and health systems can effectively use technology to achieve these goals by leveraging proactive recommendations and critical, real-time information such as accurate forecasts of patient census, the units most likely to be impacted by both physical and staffed capacity challenges, and patients that should be prioritized for discharge. This makes it less likely that a hospital will reach overcapacity. Additionally, hospitals and health systems can streamline and automate manual workflows, such as no longer relying on archaic communications strategies like using phones or paper notes to assign staff or coordinate patient discharges. That will ease the burden on nurses and allow them to spend more time on what they do best, which is caring for the patient at the bedside.

The time to begin putting these recommendations into action is now. The spiraling issues caused by nursing shortages have been ignored for far too long, and Covid has made a bad situation far worse. Outdated, manual interventions cannot address these issues. Click here for a deep dive on all of the survey results, and what it means for the healthcare industry.