Q: What are the biggest obstacles to the virtual workforce model?
Bell: The industry is going to have a gap of as many as 450,000 nurses by 2025. There is not time to bridge that gap in the timeframe it will take to develop them. Because of this shortage, a virtual model will be imperative. The hardest part about embracing a virtual model is getting people to fundamentally change their work, how they do it, when they do it and who they do it with. Even when looking at clinical practice, the gap can be 15 to 20 years from new evidence to implementing that practice. Healthcare can't afford to move that slowly.
O'Connor: There are obstacles, but I think some are false. Some leaders assume that patients won't want an eye/voice from the ceiling watching over them because it's intrusive, and that they don't want to interact with technology that way. But in looking at recent consumer surveys, patient populations are getting very comfortable with technology in all settings if it has a purpose. If they can get more attention as a patient or be discharged quicker, they are for it.
Q: How can different support services alleviate the burden on over-taxed nurses?
Bell: When you think about lift, transport, IV and phlebotomy teams — the ratio of unlicensed support personnel in comparison to RNs has gone back and forth over the years, and the latest trend has been to eliminate a lot of those support services. There are not enough RNs, and they are the ones absorbing all the extra work. There's been a huge push to get all RNs to be bachelor's degree prepared. But the level of scope that they can operate at is higher than what is often asked: At least 50% of the work doesn't require an RN licensure. Utilizing unlicensed assistive personnel who can help the patient to the bathroom, can get them water, go find an IV pole — tasks that don't require a registered nurse — can help nurses feel safe and avoid burnout.
Q: What innovative care delivery models from the Think Tank Report stand out to you as sustainable options for the future?
Bell: Virtual anything — nursing, physicians, specialists — that can be incorporated into a remote world in this new working environment is key to evolving and transforming the care delivery model. For example, a healthcare organization in the Southwest shared that their virtual wound care program resulted in 38% increase in number of patients seen with same number of staff in prevention rounds and one of their sites offering a virtual acute care and ICU surveillance program reported a decreased incidence of code blue by 70% and had saved 111 lives over a five-month period. Additionally, if nurses can live in an area where the cost of living is significantly lower than where they are providing their services, they're likely willing to work for less. When you have these opportunities to leverage technology, it is a benefit to the workforce and organization.
O'Connor: Also, this same organization surveyed their nursing staff and found overwhelming requests for job sharing flexibility to eliminate burnout and build new skills. For example, oncology nurses wanted to work two days a week in the more intense IP bone marrow transplant unit and three days a week in the outpatient infusion clinic. Others wanted to split time between a lower acuity med/surg unit and learn skills to enable part-time work in the ICU.
Another innovative approach: an academic health system in the Southeast modernized their float pool to increase shift fulfillment and worker engagement by adopting Shifts' cloud-based software with mobile app capabilities. One hundred percent of their float pool workers use the app on their phones to accept open shifts at 133 of their locations. They've seen success with this approach for just-in-time RN, CNA, LPN and admin staffing, and are expanding it to other roles as well.
Q: Why is it important to tie investments in a healthy work environment to increasing revenues and/or decreasing costs?
O'Connor: Workforce is typically 60% to 70% of the expense base for any hospital. So, if organizations are going to do something different, it's typically an added expense. In 2022, healthcare systems wrapped a year of negative margins. Any investment requires an extensive justification, even when it's the right thing to do. So how do systems recoup this investment? Averting turnover in the workforce yields immediate and obvious cost savings — reduced recruiting and onboarding costs as well as decreased contract labor expenses. Hospital executives should also keep in mind that studies routinely link nurse satisfaction and turnover to clinical outcomes and patient experience, which has financial implications in today's value-based payment schemas.
Bell: Healthcare is a human-element industry, requiring hands at bedside to deliver care. 4% of 25- to 35-year-old nurses left the industry in 2021. It's not that they moved, went from inpatient to outpatient, inpatient to corporate or retired. They gave their registered nurse licensure up during the year. Let's take a hard look at how to utilize them appropriately, not creating more work for them, but allowing them to work at the top of their scope.
Q: Despite the current challenges of the nursing workforce, what affirms your hope that this industry will thrive?
Burch: Nursing has a real tenacity to adapt. I see a lot of passion within the profession that will translate into newer and innovative models to better approach team care. Allowing nurses to work more at the top of their license and really embrace technology is an opportunity to expand the way care is delivered.
Bell: As a society, we expect that we're going to get great healthcare. I am cautiously optimistic that as an industry we are working to meet those expectations by accelerating workforce innovation and transformation. Recognizing the need for change and providing the resources to accelerate that change will help us navigate our way through this.
O'Connor: There's much being written about workforce. As a former student from the University of Illinois, I recently read in my alumni magazine about a university partnership with Carle Foundation Hospital that created a new medical school that is anchored in engineering principles — with the idea of combining medicine and engineering to innovate healthcare. The first graduating class this year is creating new tools, devices and apps to address better care and many have workforce implications including a smartphone app to bridge non-English speaking patients and their medical staff. This is a great example of empowering our healthcare innovators of tomorrow in new and different forums. The future is promising.