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April 5, 2022

Is the nurse shortage putting patients at risk?

Daily Briefing

    As hospitals and health systems struggle with staffing shortages, industry experts warn that these shortages may be threatening patient safety and care.

    Hard truths on the current and future state of the nursing workforce

    Hospital staffing shortages hamper patient safety

    Staffing shortages have strained both the health care workforce and hospitals' resources, and many experts warn that they may negatively impact patient safety and quality of care. In fact, ECRI last month chose staffing shortages as the top patient safety concern for 2022.

    "Adverse events that we found were happening because the staff they did have were exhausted, and that contributes to contributes to human error" said Sheila Rossi, director of ECRI's Institute for Safe Medication Practices. "You can't think clearly you have too many tasks to do, and that's a common theme that we were seeing."

    During the pandemic, many hospitals have also grown increasingly reliant on travel nurses, who often have a steep learning curve when they join new organizations. Because of increased workloads due to Covid-19 surges and delayed treatments, many travel nurses have been thrown immediately into bedside care instead of going through weeks-long training courses first.

    According to Kert Anzilotti, CMO at Christiana Care, when nurses are unaware or unsure of all the individual steps an organization takes to prevent different infections, adverse outcomes may increase. "The traveling nurses and the people that we've redeployed have done an outstanding job for us, but it was tough learning a new environment and quite honestly doing it while you were scared and worried about your own health and the health of your family," he said.

    In addition, a recent study published in the American Journal of Infection Control found a correlation between increased infection rates and the use of travel nurses and overtime hours during the pandemic. For the study, researchers from Northwestern Medicine charted hospital-acquired infections (HAIs) at two Illinois hospitals with a combined 1,000 beds over a three-year period ending December 2020. For every 1% in premium pay hours towards travel nurses or overtime, there were 0.13 more HAIs after adjusting for both state- and county-level Covid-19 cases and deaths.

    "The increase in [HAI] rates has been a real wake-up call across the United States and internationally," said Linda Dickey, the 2022 president of the Association for Professionals in Infection Control and Epidemiology.

    How to improve patient safety

    To help improve patient safety, Angela Zuick, director of clinical services at Medline, recommends hospital leaders provide clear instructions for specific procedures that all nurses can access. This can be through short how-to videos that nurses can watch on their phones or signs next to medical supplies.

    "We need to be more proactive and think about what our needs will be when we have to use travelers, and put together some solutions, almost like a first aid kit," Zuick said. "This just-in-time education is something we should continue to focus on to prepare ourselves to provide success for our travelers or outside staff."

    In addition, Dickey recommended hospitals prioritize their day-to-day infection control practices again. "It doesn't have to be a miracle to turn the ship," she said. "It's amazing how much those nudges add up." (Gillespie, Modern Healthcare, 4/1; Reed, Axios, 3/28)

     

    Advisory Board's take

    Now is the time to reignite your focus on quality and safety—here's how

    In recent months, our research team has had candid conversations with health care organizations who report experiencing one of the worst fears of any clinical enterprise: lagging patient safety and quality indicators. Stories and studies like the ones outlined above are increasingly validating these anecdotal concerns. Now is the time to reignite a focus on quality and safety.

    No serious commentator could fail to mention the recent verdict in the case of the former Vanderbilt nurse, RaDonda Vaught, and the impact her trial has had on placing patient safety squarely within a tragic spotlight.

    Though the challenge is multifactorial, quality concerns are top of mind. The tightening nursing labor market is making the difficult-even-in-the-best-of-times task of staffing hospital units and clinics that much more difficult—the effect of which has the potential to jeopardize safety. As it relates to staffing levels, overtime, and contract labor, researchers over the years have reported the following:

    The overlap between patient safety and nurse retention strategies

    Nursing leaders understand the critical importance of prioritizing tried and true retention strategies and streamlining the backfill of roles to stabilize the workforce. In fact, there is an argument to be made for the overlap between patient safety, how staff perceive safety, and the effectiveness of an organization's retention strategy. As the nursing supply-demand imbalance intensifies staffing-related challenges, data belie the possible emergence of a vicious cycle of nurses leaving their current position (including exiting the profession altogether) due to the perception of unsafe staffing. Data published in May 2021 and February 2022 show a consistent trend. Insufficient staffing levels is the #1 factor influencing nurses' intention to leave their current position. This at a time when safe staffing levels have arguably never been harder to ensure. 

    How to ensure a strong recommitment to patient safety and trusted integrity

    As organizations pivot away from just-in-time pandemic management as Covid-19 cases and hospitalizations wane, leaders have both an opportunity and an obligation to revitalize their staff's awareness of their organization's approach to issues of patient safety. Though the following recommendations are not new, health system leaders should advance all of them as part of their recommitment to the cornerstone priority in health care: do no harm.

    • Recommit to a high reliability safety culture in which every patient receives the known standard of care, every time, in every setting.
    • Hardwire 'just culture' through mechanisms to report and investigate safety lapses from the standpoint of systems vs. individual failings.
    • Convey to unit leaders and nursing staff the actions your organization is taking to stabilize the workforce and safeguard safe staffing levels, including the necessary investments you're prepared to make.
    • Prioritize education on fundamental safety protocols in new nurse orientation and, in cases where new nurses must take on a patient assignment starting day one, ensure a plan is in place to provide that education at the earliest available opportunity.
    • Investigate the potential use cases of virtual care technology as part of your patient safety strategy, for example remote patient monitoring or the addition of a virtual care nurse on units with a predominantly novice workforce.

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