Electronic Health Reporter

By Jori Short, RN, COO, Ally Medical.

The COVID-19 pandemic highlighted the bravery and commitment of health care professionals in the face of danger and tragedy. Unfortunately, the continued stress of the crisis took a severe toll on the heroic nurses who provided invaluable care and hope to our communities. It also further exposed the crippling nurse shortage that is plaguing the health care system nationwide and in Texas and increased the call to think outside of the box to address the crisis.

Some hospitals in Texas and across the country are taking steps to address the shortage, and they’re doing it by making changes for a more inclusive and friendly environment – providing nurses with better engagement and empowerment to shape operations and improve patient care.

Addressing the causes

The nursing shortage is a long-standing challenge, but the pandemic has significantly worsened the problem. Nurses and physicians have left in record numbers, due to fatigue and exhaustion. High turnover has severely affected employee morale, creating a snowball effect that could encourage more nurses and other staff to leave. It can also have an impact on attracting new talent.

The difficulties of COVID-19 created a wave of early retirements due in part to the extended period of limited access to medical facilities for both patients and staff. Because hospitals stopped doing elective surgeries – and many patients made it a point to stay away for safety reasons – hospitals had less income and needed to reduce staff to stay afloat. A 2015 study reported that more than 1 million RNs would retire from the workforce between now and 2030. As they go, they take with them their invaluable accumulated knowledge and experience.

Unfortunately, the critical nursing shortage shows no sign of abating, and experts project that 1.2 million new RNs will be needed nationwide in the next eight years in order to address the shortage. According to the Texas Workforce Commission, there are already 23,000 more unfilled RN jobs, and that number is expected to increase 50% by 2030. What’s more, the shortage of RNs will only intensify as baby boomers age and the need for health care grows.

 The impact

A heavy workload doesn’t just take a toll on nurses – it can also have a significant impact on the care their patients receive.

High caseloads mean nurses are more likely to:

• Experience higher stress levels.
• Spend less time with their patients.
• Make more mistakes.
• Be put in a position to have to take shortcuts.

Numerous studies have found a direct impact on patient care and results, including:

• Higher hospital readmission rates.
• Increased likelihood of urinary tract infections.
• Increased likelihood of surgical site infections.
• Higher patient mortality rates.

High nurse turnover also has a significant financial impact on hospital and health system budgets. According to the 2019 National health care Retention and RN Staffing Report, it costs between $40,300 and $64,000 to replace one clinical nurse, resulting in average hospital losses of between $4.4 million and $6.9 million each year.

Nursing schools make a change

Compounding the issue of the nurse shortage is the fact that nursing schools across the country are struggling to attract enough students to meet the growing need for care, given the national move toward health care reform. As the shortage grows, nursing schools and graduate nursing programs are working to accommodate the rising demand for skilled nurses and nurse leaders but face many challenges.

The American Association of Colleges of Nursing (AACN) is working with schools, policymakers, nursing organizations and the media to shine the spotlight on health care concerns. AACN is leveraging its resources to activate lawmakers, identify strategies and form collaborations to address the shortage. To keep stakeholders in the loop, AACN experts developed a detailed fact sheet about the nurse shortage that has informative companion resources.

Steps to mitigate the nursing shortage

There is no silver bullet to solving the national staffing crisis. For hospitals to increase retention rate, it will require direct action and investment from policymakers and greater outreach and incentives from nursing programs, as well as policy changes. But there are more straightforward steps that can have an immediate impact.

According to the Texas Nursing Association, nurses feel underappreciated, at risk for violence and lack decision-making authority over staffing and patient care. Providing nurses with a more significant role in the workplace environment – particularly by providing them a greater voice in operational and care policies – positively affects staff satisfaction, burnout and turnover.

At Austin-headquartered Ally Medical, implementing a more inclusive and nurse-friendly environment has shown promising results.

DeAnna Gillespie, a nurse with 30 years of experience across Texas, including at Dell Children’s Hospital Level 1 Pediatric Emergency Room, now works at Ally Medical’s Bastrop facility. She has seen that improving the workplace environment and empowering nurses has improved overall staff satisfaction and reduced turnover.

“Doctors at Ally Medical are extremely nurse-friendly,” Gillespie said. “They seek out and value our opinions and foster a culture where doctors, nurses and clinical staff all work well together. Nurses value doctors who value them and want to stay, and our patients benefit from a stronger team.”

Gillespie said she believes the most significant difference in her current working environment, compared to some other health providers, is the ability to affect change to improve care.

“At big hospitals, you could make a suggestion and wait two years before getting a response, (with) much less action being taken,” Gillespie said. “At Ally Medical, nurses are encouraged to make recommendations to improve patient care. If you have something that works better, the doctors work directly to help to create change.”

Making a difference

Increased burnout due to the ongoing pandemic is making an already difficult nursing situation a national crisis. More must be done – by policymakers, nursing schools and health care professionals – to recruit and retain skilled nurses. Hospitals and health care facilities have the power to do that. By empowering the nurses who work for them and giving them more engagement, creating a positive impact on patient care and the bottom line.