That’s why in the summer and fall of 2021, Wolters Kluwer and UKG conducted interviews and an online survey to better understand nurse leaders’ perspectives on staffing and evolving care delivery workforce models. We were surprised to find that while these compassionate leaders fully grasp the day-to-day challenges this shortage is imposing, they seem less sure about how to drive the changes necessary for tackling the crisis. Some believe small steps are enough. Others simply seem paralyzed by the enormity of the problem.
These reactions are understandable in the present moment. Most of us who work in healthcare are struggling just to tread water as the latest Omicron-driven surge overwhelms our care settings. Nurse leaders sometimes have to close their office doors and put their heads down merely to stay on top of urgent tasks. Yet one could argue that spending more time on the front lines offers inspiration and insights for solutions that could relieve the burden on their nursing staff and other clinical colleagues.
Because here’s the thing: the pandemic won’t last forever, but the nursing shortage will only worsen unless we take dramatic action. The US Bureau of Labor Statistics projects that more than 500,000 RNs will retire by 2022, leaving a shortage of 1.1 million RNs across the country by 2030.1
Novel, evidence-based innovations born of wide-ranging collaboration are the path out of this crisis and towards care models better suited to healthcare’s future. A three-pronged effort – approached with ferocious creativity – can simultaneously develop more efficient staffing models, improve recruitment and retention, and optimize productivity.
Deploy more efficient and effective nurse staffing models
Our recent survey showed that an overwhelming majority of respondents across care settings (92%) predict they will be short of budgeted headcount over the next 18 months. And not just among RNs, which is where the media has been focused, but also among LPNs and unlicensed assistive personnel.
Worse yet, financial constraints may make it difficult to offer the pay increases and signing bonuses that will attract nurses who deserve more. That doesn’t mean nurse leaders have nothing left in their arsenals.
In the short-term, more settings must deploy alternative care models that enable RNs and licensed practical nurses (LPNs) to spend the preponderance of their time performing the duties for which they have been trained and licensed. This will require unlicensed assistive personnel (UAP) and administrative staff to relieve nursing staff of the non-nursing burdens that currently consume far too much of their time.
It won’t be easy, as there are shortages across the board, but by distributing appropriate duties to LPNs, UAPs, and less-experienced RNs under the direction of an experienced RN, this team-based care model has shown it can enable care settings to do more with less. A companion advantage is that it gives hospitals and health systems the flexibility they need to scale and retract staffing, depending on patient load and acuity.
Float pools offer a complementary alternative. In some, nurses work exclusively between units as needed, but during the pandemic, these models were extended across a facility and sometimes even across hospitals in a health system. Creative scheduling and cross-training enhance the value of this model, which creates another layer of much-needed flexibility while largely averting the excessive costs of traveling nurses.
Down the road, care settings must more closely collaborate with nursing schools, training programs for unlicensed providers, and state and local governments to increase the talent pool where the needs are most urgent, both now and in the future.
Nurse recruitment and retention rely on fostering resilience, satisfaction
Nurses are burned out and frustrated for reasons that go beyond the current pandemic. Many have been leaving the profession or moving to settings that can offer better pay, more flexible schedules, and higher levels of job satisfaction.
A recent article in The Atlantic noted, "Morning Consult, a survey research company, says that 18 percent of health-care workers have quit since the pandemic began… The same survey found that 31 percent of the remaining health-care workers have considered leaving their employer, while the American Association of Critical-Care Nurses found that 66 percent of acute and critical-care nurses have thought about quitting nursing entirely."2
In the Wolters Kluwer and UKG survey, a majority of respondents (59%) indicated that staff burnout is a top workforce challenge. Yet the survey also found a disconnect in that nurse leaders worried about their staff resigning, but were not as concerned about their emotional health and well-being. Nurse leaders must consistently recognize that connection and do something about it. Research has demonstrated building an environment that fosters nurse resilience and job satisfaction is key to recruitment and retention, both of which leaders must vigorously pursue to end this crisis.
How to create such an environment? Flexible scheduling and as much autonomy as possible are good places to start.3 Nurses are human beings with lives outside of the workplace who desire a healthy work-life balance. That's why healthcare organizations must offer more flexible shift options rather than insisting on traditional 12-hour shifts in acute care settings and 8-hour shifts in other settings. Wherever possible, nurses should have some control over their schedules.
Practicing to the top of their license and not being bogged down with ancillary duties can also increase nurses’ job satisfaction. Consider that a recent survey conducted by The Advisory Board found medical-surgical nurses spend more than a third of their time on non-value-add activities.4 That’s where the team-based model described above offers another real advantage.
Finally, two-way communication, as well as a culture that enables nurses to grow and learn, can further increase job satisfaction and nurse resilience.
Smart scheduling technology will optimize productivity
Many of the items outlined to this point depend on the use of advanced tools and technology that puts the right people in the right care settings at the right time. Especially in dynamic settings, like the surgical and intensive care units, being able to confidently realign resources on the fly is a must-have.
In fact, in any care setting, nurse leaders need a transparent real-time window into nurse-to-bed ratios, acuity, hours per patient day, and nurse competency to optimize productivity. Our interviews with nurse leaders found this data helped them predict how many nurses are needed per shift and unit, minimized nurse frustration regarding assignments, helped identify staff issues early, and helped justify budget requests.
Yet the Wolters Kluwer/UKG survey found that despite many respondents having access to scheduling technology, only 38% plan to increase usage over the next 18 months and the majority of respondents still do day-to-day staffing manually. That must change, as today’s scheduling software for the healthcare industry offers enormous benefits that include:
- Support for predictive scheduling with volume-based workload forecasts
- Machine learning to analyze historical trends
- Increased staff satisfaction through self-service, fatigue management, and mobile capabilities
- Equitable distribution of workload based on patients’ unique care requirements and nurse competency
- Whole-house views to see key coverage indicators and transfer employees between units
- Real-time visibility into staffing and productivity data.
Act now. Be bold. Be smart.
If this pandemic has taught us anything, it is that waiting for a crisis to hit – whether an unpredictable virus or a predictable nursing shortage – is a recipe for disaster. The nursing crisis is unavoidably here, and it has worsened at a time when most organizations can do little beyond survive each day’s clinical challenges. However, the crisis will only intensify unless nurse leaders can dig deep to find the energy and boldness required to tackle it.
The good news is that there are known solutions. Now we must find the will and the way to put these solutions in place and make them work.
- The Nursing Workforce | American Nurses Association (nursingworld.org)
- Young E. Why health-care workers are quitting in droves, https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/. Accessed January 19, 2022.
- 3 Tri-Council for Nursing. Transforming Together: Implications and Opportunities from the COVID-19 Pandemic for Nursing Education, Practice, and Regulation. January 2021. Tri-Council COVID-19 Report - FINAL.pdf (wsimg.com).
- The Advisory Board, Hard truths for the C-Suite on the future and current state of the nursing workforce, December 16, 2021.