From hospitals to nursing homes and from urgent care to home care, a scarcity of nurses and supportive care personnel is having a devastating impact on the entire healthcare system — and we need to find the path forward. This was the purposeful goal behind one of UKG’s most recent research endeavors: A survey of more than 300 nurse leaders in the U.S., completed in partnership with Wolters Kluwer, provides a critical wake-up call for the nursing industry.
Our study found that most healthcare organizations — roughly 75-90 percent of those surveyed, depending on care setting — are short of budgeted headcount today, while 74 percent are dealing with a shortage of full-time registered nurses (RNs). And the labor shortage is likely to get worse: 92 percent of nurse leaders expect they will be short of budgeted headcount through at least early 2023*.
Similarly, month-over-month data reported by the UKG Workforce Activity Report reveals a consistent combination of lackluster growth and signs of struggle for shift work in the healthcare industry — across all care settings and frontline roles — since March 2020.
This timeline confirms how severely the system is cracking: The supply of nurses is dwindling at the same time the need for higher-skilled nurses is growing. Pressure to effectively use and support nursing staff has never been greater.
Let’s Get Creative: Alternative Labor Models
COVID-19 made a bad situation worse: It’s been difficult to attract, train, re-train, and retain nurses and support personnel at the speed at which the pandemic demands. In response, the health leaders we surveyed said their facilities implemented different strategies to fill urgent staffing gaps, including replacing primary care models with alternative models that allow for greater agility.
Team-based nursing is one example that’s been around for decades (or more) and is an effective way to deliver care with a finite number of staff. This model enables hospital resources to work at the top of their license and leverages their skills appropriately. With its resurgence, we are witnessing the evolution of team dynamics and collaboration in hospitals. There is a new generation of practitioners who view the nursing profession as a “team sport” and will be using technology and the expertise of others to support a seamless care journey.
Float pools represent another collaborative model to accommodate patient surges or to cover staff vacancies shift to shift. Nurse float pools exist in at least half of the acute and ambulatory care settings that were surveyed (i.e., hospitals, as well as outpatient settings). Many have expanded existing float pools by cross-training staff to support needs across care units, or otherwise created float pools of new nurses hired exclusively to work across adjacent specialties, and sometimes across hospitals within a health system. We even spoke with one nurse leader who organized a cooperative that gave nurses an option to float between hospitals in their area and gave neighboring facilities an opportunity to share resources and realize a common benefit. Our study finds that 71 percent of nurse leaders working in acute care will expand and 21 percent will establish float pools by early next year*.
Telehealth or Virtual Care
With a goal to shift care to a less acute or urgent setting, many are turning to telehealth or virtual care. Our research shows 20-30 percent of respondents across care settings have plans to hire nursing staff to support telehealth services between now and early 2023*. In acute settings, this mode of care is extending the favored team model: Providing critical care via an e-ICU, RNs monitor patients at a distance and in a centralized fashion; teams don’t need to be physically connected or even geographically adjacent to support each other. With telehealth, organizations can also improve the cadence and quality of complex care or increase access to preventative care, including behavioral health services.
Nurses can’t do more. Leadership must enable them to work more efficiently.
Our research shows that healthcare leaders have a grasp on day-to-day challenges in their organization, but not on all the potential levers of change available to them, including staffing levels, workforce flexibility, and technology implementation to optimize productivity. Nurse leaders must stay engaged with other executives across the organization to identify the right metrics to measure nurse productivity — and they must look for ways to take a more active role in understanding the challenges on the frontlines of care to inform future strategies that will achieve the quality, safety, and financial outcomes desired.
Many nurses in the last two years have left the profession because they felt they didn’t have enough adequately trained, competent nurses working beside them — they didn’t feel like they had a safe working environment. Let that sink in.
Nurses make a difference in the lives of so many, every day. We owe it to them to continue to innovate with work process improvements and technology solutions that will demonstrate we value their work, their courage, and their commitment to saving lives.
Check out the NursingCenter Podcast, where my co-researcher from Wolters Kluwer, Anne Dabrow Woods, and I explore the care models described here in greater detail. The episode is titled: “Supporting the Nursing Workforce with Alternative Care Models.”
*The UKG and Wolters Kluwer Nursing Workforce Survey was conducted online from September to October 2021 and respondents were asked to indicate their plans “over the next 18 months.”