The current nursing shortage and its impact on healthcare organizations served as a central theme throughout the American Organization for Nursing Leadership (AONL) 2024 annual conference.
During his keynote at AONL 2024, nurse and healthcare economist, Dr. Peter Buerhaus, illustrated historical precedents, highlighting similar trends leading into the early 2000s. According to Buerhaus, it took a consortium of interconnected marketing efforts, legislation and involvement from professional organizations and accreditors to right the ship.
Read on for new strategies to improve processes and leverage technologies to drive safer, more connected care delivery.
The current state of nursing in the U.S.
Today’s nursing ecosystem reflects a more educated and diverse population of professionals than ever before. There is also widespread public support for nurses, resulting in a more positive perception and growing calls to expand the role of nursing across the industry. And yet, in the aftermath of the pandemic, the number of RNs working in hospitals is trending toward an all-time low.
While the pandemic offers some explanation for current workforce concerns, it's hardly the sole cause, and many nursing leaders point to existing structural issues that COVID simply exacerbated — including an aging workforce, lack of behavioral health resources for patients, workplace violence and a need for more flexible work-life schedules.
In a recent episode of The Beat, Anne Louise Puopolo, RN & BSN, President of the RLDatix Safety Institute, addressed this topic. "I think there's a misperception that COVID created the mass exodus and the burnout — in all honesty, it was there well before COVID happened. COVID enhanced it.” Puopolo said. “[As] nurses take on more, a lot of the functions they’re doing are probably not really working at the top of their license.”
Given that some organizations interpret “operating at the top of a license” to mean forcing staff to do more with less or push the boundaries of their credentials, Puopolo clarified that this “jack of all trades” approach is likely contributing to widespread burnout. Instead, the industry's collective goal should be to provide nursing professionals with the tools they need to thrive and enact the cultural and operational improvements to enable them.
How to (actually) empower nurses to operate at the top of their licenses
Throughout the conference, numerous strategies emerged, highlighting ways to address the systemic overwork and chronic under-resourcing that can lead to emotional exhaustion and, often, turnover.
Assess whether policies and procedures are supporting staff and patients
A quick scan of industry news will showcase the breadth and impact of unproductive policies and procedures. This ranges from technical and task misalignment or overload to more blatant, bad faith violations and unfair labor practices.
Healthcare organizations have an obligation to implement more employee and patient-centric policies, such as ensuring alignment between skillsets and job tasks, regular workload assessment, comprehensive peer support and limitations around work-related technology use after hours.
This also means reviewing policies and procedures to ensure they're not unnecessarily creating more work, taking nurses away from patients or simply the status quo.
For example, while teams may be beholden to certain staffing mandates, relevant departments can look to long-term trends and real-time patient demand to quantify what effective and adequate staffing looks like and enact dynamic "rightsizing" to set everyone up for success.
Explore innovative practices to empower nursing leaders
Over a quarter of the average nurse manager's day is focused on administrative tasks, with significantly less time allotted to teambuilding and professional development-related activities. Realigning systems and processes to prioritize managerial duties, staff education and advisory oversight will allow leaders to allocate more energy and attention toward patient care, operational improvement and cross-team growth.
Some effective strategies might include proactive huddles with attention to specialty needs, leadership rounding to amplify shared learnings and self-service scheduling to reduce administrative burden. These initiatives can help reengage nursing leaders, provide useful metrics and validate the importance of frontline leadership in driving success.
Leverage data to support progress, validate assumptions and inform strategy
In order to replicate the success of previous nursing campaigns, actionable data and more connected healthcare operations will play a central role. Moving forward, healthcare organizations must collaborate internally and across the industry to inform new models of care, strategic staffing and prioritization of social and cultural initiatives.
As such, healthcare organizations will need the right people, process and technology in-place to identify gaps, opportunities and areas for realignment.
Despite staffing shortages, progress is still possible
Given what we’ve learned following the first days of the pandemic and the industry's demonstrated ability to rapidly deploy alternative staffing and care delivery models, we know we’re not necessarily stuck with “the way we’ve always done things” — particularly when the need to change is so drastic.
A true system-wide view of care team staffing will be critical for allowing nurses to operate at the top of their license without introducing new factors that contribute to burnout.
By leveraging cross-functional input and implementing consistent, value-based methods across sites and departments, healthcare organizations can make the most of the resources they do have while addressing day-to-day needs, quantifying what success looks like and driving continuous improvement along the way.
As you explore the future of nursing at your organization, consider which of these strategies is the best place to start and how you can help everyone operate at the top of their license.
