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Your Nurses Are Worried. Are You???

July 24, 2009
by Mark Hagland
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The American Nurses Association recently asked nurses to participate in what it called a “Safe Staffing Poll” on its website. And the results are concerning, even if you take into account the fact that the ANA is almost certainly going to be using the results for advocacy/lobbying purposes, and the fact that the nurses participating in the survey knew that.

Here’s what’s interesting, though: when 14,993 nurses were asked questions on staffing levels and their impact on patient safety, during the period from March 31 to June 5, large numbers of staff nurses, who made up the bulk of the respondents to the survey (74.7 percent) indicated strong worries about staffing-related patient safety.

Asked, “Do you believe the staffing on your unit and shift is sufficient?” a full 71.9 percent said “no”; asked, “Would you feel confident having someone close to you receive care in the facility in which you work?” a full 49.5 percent said “no”; and, asked, “Are you currently considering leaving your position?” a whopping 52.7 percent said “yes.”

So there you have it: most nurses don’t think there are sufficient nurses on their shifts, don’t feel confident enough to recommend their own facilities to others for care, and are considering leaving their current positions. Yikes. Indeed, even accounting for the nature of the survey involved, such figures should be viewed as deeply concerning.

Now, we’ve known about the problem of nurse burnout for a very long time, and as an industry, we’ve been working on that problem in various ways, often unsuccessfully. But these kinds of results—again, taking into account that the respondents to this survey almost certainly knew the results would be used for lobbying and persuasional purposes—are rather alarming. Indeed, let’s look at a couple of other questions for added reinforcement of our perceptions. Asked, “How often are you able to take your full meal break?” 11.7 percent of respondents said “never”; 24.1 percent said “rarely” (defined as “less than monthly”); and 24.7 percent said “sometimes” (defined as “once a month”). Put another way, only 41.1 percent (actually, fewer than that, since 4 percent didn’t respond at all to the question) of nurses were able to take full meal breaks more than once a month. Again, yikes.

What’s more, it doesn’t require surveys like this one to easily uncover anecdotal evidence of nurse burnout nationwide, as well as of nurse concerns over patient safety. And this, at a time when healthcare purchasers, payers and policymakers are more determined than ever to force improvements in patient safety in hospitals and health systems across the country.

Of course, there are two fundamental sets of solutions to the problem, both of which I’ve written about extensively both in the pages of Healthcare Informatics, as well as in my two books, Paradox and Imperatives in Health Care and Transformative Quality: The Emerging Revolution in Health Care Performance. The first set of solutions clusters around the intensive efforts that pioneering hospital organizations are making, using performance improvement methodologies like Lean management, Six Sigma, and the Toyota Production System, to fundamentally remake care delivery by examining underlying processes. One organization I wrote about in my first book, VirginiaMasonMedicalCenter in Seattle, completely reworked its nurse staffing strategy. Leaders there looked at the standard accepted form of nurse deployment, which is based on caring for individual patients during shifts, and found that it actually made things much worse; so they reworked everything, and implemented a purely geographical staffing system that not only made the nurses dramatically more efficient, it also saved on hiring additional nursing staff.

And the other set of solutions clusters, of course, around information technology. When intelligently deployed, the full range of IT solutions, from automated meds administration solutions to wireless communications devices, can dramatically improve nurses’ efficiency, effectiveness, and workflow. But it is important to underscore that such solutions only reach their full potential when they are deployed as part of broader initiatives that yoke together performance improvement and IT implementation. Otherwise, technology can actually make things worse, by simply adding another layer of stuff on top of sub-optimized processes and workflow.

But if one thing is clear during the current federal debate on healthcare reform legislation, it is that the current costs of the healthcare system are completely unsustainable. And that means that, in addition to working to cover the millions of Americans who lack health insurance, federal lawmakers are inevitably going to have to press down even harder than they have previously, on hospitals and other healthcare providers, in order to have any impact on spiraling healthcare costs system-wide.

And here’s where healthcare CIOs can be real heroes. Working with clinician leaders in their organizations, they can help plan and deploy information technology that turbocharges nurses’ efficiency and effectiveness, thus averting the need to hire ever-larger staffs of nurses, something most hospitals are straining to do these days. At the same time, the gains coming from improved efficiency, effectiveness, and clinician workflow, will strongly boost patient safety, a key goal for all stakeholders in healthcare. And such advances are sorely needed, especially at a time when few hospitals can afford significantly increased staffing costs, and when formalized, legislated nurse staffing-level mandates (such as attempted in California) have not worked out as some had hoped, and have additionally created the problem of hampering the planning flexibility available to hospital executives and clinician leaders. So, deep performance improvement work, combined with intelligently deployed IT, must perforce come to the rescue of a nationwide nurse staffing situation that is calling out for game-changing improvements.

And maybe, on top of everything else, if such strategies are executed well, nurses will at least be able to take a lunch break more than once a month. Now, wouldn’t it be great to have highly satisfied nurses at your organization, nurses who won’t bail out on you because you’ve burned them out, and who are on top of their game clinically and charged up to provide the best care they can for patients? I thought you’d agree.

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