Opinion by: Katie Boston-Leary Ph.D., MBA, MHA, NEA-BC
Katie Boston-Leary, Ph.D., MBA, MHA, NEA-BC is the director of nursing programs at the American Nurses Association and an adjunct professor at the University of Maryland School of Nursing
The challenges nurses face are many – shortage of nursing and non-nursing personnel, leadership attrition and turnover, budgetary pressures, documentation burden, workplace violence, and physical and emotional tolls, to name a few. Many of these challenges are not new, most are relabeled or termed and have become more complicated and critical over the years with the introduction of new technology, high patient acuity, and regulatory requirements.
If that weren’t enough, advanced practice nurses are facing unreasonable calls from colleagues at the American Medical Association (AMA) for dual regulation from nursing and medical licensing boards which makes no sense during a time when the demand of independent practitioners outpaces the supply.
A recent study by McKinsey and the American Nurses Association Enterprise (ANAE) revealed that nurses believe that their time and workload could be better supported through better technological enablement and with more delegation of responsibilities.
Nurses believe that their time could be more efficiently managed if documentation, medication administration, turning and positioning patients, equipment, personnel, and supply management were more technologically enabled. Of course, most organizational leaders believe that some of these technologies already exist and are working, but is that based on the user experience?
The study revealed that there could be a 10% net time reduction during a typical shift if nurses were able to delegate medication preparation and administration, drawing labs, toileting patients, procedural support with taking patients for testing and imaging, cleaning patient rooms, and restocking, to name a few. We recognize that there has been a chronic shortage of nursing assistants, patient care technicians, administrative support, and other support personnel in food and nutrition services, housekeeping, and other lower-paid positions which has worsened since the pandemic.
Healthcare has not treated or paid these professionals well over the years. Most of these individuals were barely earning over states’ minimum wages for physically taxing roles. Some were also at the poverty line and in government safety net programs or worked excessive hours, overtime, or two to three jobs. Today, these professionals are in high demand in other industries like retail and hospitality offering better pay and benefits and safer work environments creating unexpected competition for the healthcare industry (particularly hospitals and long-term care).
We Need More Resource Nurses
The Models of Care Insight Study conducted by Quint Studer, ANA, American Organization of Nursing Leaders (AONL), and Joslin Insights unveiled the importance of re-introducing the resource nurse role to reduce nurses’ workload. Resource nurses were known as the “extra pair of hands” roles, excluded from staffing assignments, and were readily available to manage codes, rapid responses, IV therapy, and conduct assessments. Both nurses and nurse leaders agreed that these supportive nursing roles would be additively positive for the care delivery model redesign. However, we recognize that over the years these are some of the first positions that get eliminated because they seem costly and are not included in productive time.
Until these issues are rectified, there isn’t any care delivery model design that will effectively improve recruitment and retention on a sustained basis. Otherwise, nurses’ environments will continue to feel very factory-like, burdened, and industrial. Over-responsibility happens when nurses continue to take on more work and tasks beyond the typical and the most important task of all – caring for their patients. Our nurses have spoken – they would like to be able to spend more time with their patients and they leave every day feeling as if they were not able to provide the care their patients deserve and need (ANF). Instead, most nurses find themselves in environments where the simplest tasks require so much effort.
A recent nursing graduate who is now in her 4th career told me that she has never had or seen any role in her lifetime where so much is required from one person within such a relatively short period of time. Any care delivery model redesign that doesn’t have a tri-brid approach of supporting nurses providing direct care, leverages technology (device integration, transcription) and roles (scribes, resource nurses, non-nursing personnel) to reduce nurses’ workload and introduces an overlay of support through surveillance, virtual care and robotics with user input and experience management, would not address these critical concerns.
As much as we have cautioned nurses to not say they are “just a nurse”, all nurses are asking at this point is that they want to practice nursing and not be the “organizational sponge” that absorbs all other tasks that other professionals will not, cannot or are unavailable to complete. In other words, can nurses just be nurses today and every day? This is how we start to rebuild and reform work environments that are healthy – where nurses and patients will thrive and flourish.