Walk the floors of a busy hospital today and you’ll see signs of a healthcare workforce in crisis. It really doesn’t matter which hospital, or where. The signs are the same across the country.
The first thing you’re guaranteed to notice is nurses scrambling to care for their patients. In many cases, they’re caring for more patients than they can comfortably handle. You’ll see them navigating the floor with a palpable sense of urgency as they respond to a cacophony of alerts. You’ll notice how many faces are etched with fatigue. You’re more likely to notice this in nurses with a few years under their belt who have been tasked with even more clinical and administrative responsibilities in recent years. Somehow, they still manage to provide quality care with skill and empathy.
Wherever you are in the hospital, there are patients in need beckoning for attention from a shrinking pool of nurses. The nursing shortage—the most severe to date—means fewer hands to lift the burden of demand for care, leading to longer hours and more patients per nurse. Moments for rest or reflection are fleeting, replaced by the constant need to administer medications, update charts and offer comfort to those in their care.
Nurses have been pushed to the limit. Their dedication and resolve is tested every day against the stark reality of an overburdened system. This current state is unsustainable. It’s a vicious cycle, as tired nurses become burned out nurses and, eventually, former nurses.
The term “burnout” is overwrought, and fails to describe the depth of despair plaguing our nursing workforce. For most nurses, a tangible specter haunts their every shift, threatening to turn a passion for healing into a resignation letter.
It’s a persistent and pervasive crisis, and the healthcare system has so far failed to adequately address it. Instead, nurses are forced to sit idly by while everyone else points fingers at the source of the shortage. Unions say there is no shortage, just a shortage of nurses who want to work under current conditions. Hospitals say there still wouldn’t be enough nurses, even if they doubled their wages. Others say there are nurses, but hospitals aren’t hiring them.
There's truth in each perspective, but none of them touch on the root cause of the crisis: the current structure of nursing just isn’t working anymore.
A new approach to nursing
There are a tremendous amount of archaic, systemic issues hospitals and nurses need to grapple with to make the structure of nursing work moving forward. Time isn’t going to make them disappear. Ignoring them is a disservice to nurses and the patients in their care. It’s time for hospitals and health systems to begin the process of changing the system of work for nurses.
Healthcare facilities should begin by addressing staffing standards. This issue has been overly politicized in recent years, but the truth of the matter is that all hospitals need a standardized way to ensure nurses have a manageable workload. It doesn’t necessarily need to be staffing ratios; the industry needs to come together to figure out what safe standards look like in order to ensure there’s enough nurses at the bedside to provide high quality care.
Most importantly, these decisions can't be made solely by leaders and managers. The best solutions for bedside nurses and their patients will differ from hospital to hospital, but they will only be devised in partnership with bedside nurses themselves.
A consensus on staffing ratios will improve retention and satisfaction among nurses, but much more needs to be done to allow nurses to work at the top of their license. Over the past few decades, demand for care has changed—people are getting older and sicker faster as our population ages and the prevalence of chronic disease increases. Care delivery is evolving to accommodate but staffing isn’t.
If hospitals want their workforce to thrive, they’ll need to embrace and expand innovative models like virtual and in-home nursing programs that allow nurses to practice at the top of their license. Likewise, the continued exploration of LPN-inclusive care delivery models will ensure RNs are able to focus more on top of license work.
This will require hospitals and health systems to re-evaluate their labor distribution methods. Every hospital in America is grappling with the nursing shortage, but many don’t realize that the call is coming from inside the house. Few hospitals are able to properly allocate the nurses they do have across their facilities when demand for care fluctuates.
The result should sound familiar to any healthcare leader: too many nurses in a facility with low demand and too few nurses in a facility with high demand.
Solving this requires nothing short of revisiting labor strategy to embrace flexibility. Healthcare’s workforce model is antiquated, rigid and expensive; nurses have worked three-day 12-hour shifts for decades. Their work is supplemented only by external talent—often travel nurses—who sign on to work in the same model for a fixed 12-week period. Neither strategy takes fluctuation in demand for care into account, and both are contributing to skyrocketing labor spend.
Hospitals should feel encouraged to experiment with the number of hours nurses work per shift, to question how long they really need nurses on the floor, and to consider the benefits of offering six- or eight-hour shifts during busy periods. Creating a more flexible labor model, one designed for short-term needs, will work to the benefit of hospitals, nurses and their patients.
Overhauling the structure of nursing will undoubtedly be uncomfortable and expensive, but there are few alternatives. If hospitals can’t find ways to attract new nurses and retain existing staff, refraining from anything short of a transformation will be a much more costly measure.
Susan Pasley is the Chief Nursing Officer at CareRev.