New care model uses a ‘virtual nurse’ to interact with the patient in ways appropriate to the level of care
Clinical laboratories and pathology groups aren’t the only healthcare organizations currently experiencing critical industrywide shortages. A chronic nursing shortage is prompting hospitals like Covenant Medical Center in Lubbock, Texas, to invent unique ways to circumvent this issue while still managing to provide exemplary patient care.
Covenant, an affiliate of Providence—a 51 hospital/1,000 clinic healthcare network spanning Alaska, California, Montana, New Mexico, Oregon, Texas and Washington—piloted a hybrid nursing model called “Co-Caring.”
The model “uses virtual nursing to care for patients and support the bedside team through two-way audio and video telehealth technology,” according to a Providence news release. This allows nurses to focus on more vital roles, such as administering medication and assessing patients’ conditions, while day-to-day tasks are performed by assistants and virtual nurses.
After operating successfully for one year at a 30-bed unit within the 381-bed Covenant, the Co-Caring model was expanded to 10 other units in hospitals operated by Providence where it reduced the workload for bedside nurses, increased caregiver collaboration, and resulting in financial benefits for the facility.
“This pilot is not about one unit in one hospital,” Julie Wright, RN (above), who at the time was a Nurse Manager at Covenant, in a Providence news release. “It is about taking the first steps to changing how we care for our patients. We are working on creating an environment where burnout is the exception and not the rule, and where joy is the expectation.” Clinical laboratories might use a similar approach to enable pathologists and clinical laboratory scientists to dedicate their time to higher-value tasks. (Photo copyright: LinkedIn.)
Elevating the Practice of Nurses
“The past three years dramatically transformed our industry and workforce in ways that accelerated the modernization of care,” said Providence SVP and System Chief Nursing Officer Sylvain Trepanier, RN, in the news release. “Co-Caring represents an innovative solution to one of healthcare’s most pressing issues—the increased need for nurses, which for the United States is currently estimated at more than 200,000 new nurses required each year to account for population growth.”
“By creating a new team that would share responsibility and accountability with a nurse that would be working virtually, we have people showing up every day doing the work that they love to do and removing some of the barriers that they had in doing it the old traditional way,” Trepanier told the Catholic Health Association of the United States (CHAUSA).
“Quite frankly, when we embraced this, even if we could cover our costs and it would be cost neutral, it would be a great proposition,” he continued. “The pleasant surprise of this is that we’re elevating the practice of nurses, the technicians feel a part of the team, and the patients are having a good experience. We’re having great operational outcomes and decreasing the total cost of care.”
Virtual Nurses
Virtual nurses are utilized through a bi-directional audio/video telehealth platform to support the bedside team in caring for patients. These virtual nurses assist with tasks like admission processes, discharge preparation, pre-procedural checklists, and medication reconciliation. Interdisciplinary Team Meetings, which include the virtual nurses alongside charge nurses, physicians, and case managers, are held daily to ensure the best patient care.
The Co-Caring model increased patient and caregiver satisfaction while simultaneously having positive financial significance. The first-year turnover rate (FYTO) among registered nurses decreased by 73% and by 55% for all staff involved in the program. Covenant was also able to decrease the amount of travel nurses it needed, which enabled it to hire more nurses, CNAs, and PCTs.
“On a 30-bed unit, we ended up having a return on our investment of roughly $450,000,” Trepanier told CHAUSA. “Our patients are happier, our nurses are happier, and we’re decreasing our total cost of care, which is what everyone should be after.
“If we don’t do this, we are going to run out of time in healthcare,” he continued. “I recognize that not everyone has the resources and not everyone has the capability of pulling something off like that. I also am very cognizant that the status quo is not an option. For the sake of our patients and for the sake of the health of the communities that we serve, we all need to lean in and figure out how to approach the work differently.”
Lessons for Clinical Laboratories
This innovative approach identifies which tasks need to be performed by skilled individuals and which can be done by lesser qualified personnel. Tasks are then assigned accordingly. Clinical laboratories may be able to take advantage of similar types of opportunities.
By reorganizing workflows, pathologists and clinical laboratory scientists could devote their time to higher value tasks, while the lesser tasks could be performed by pathology assistants. At a time when the number of laboratory professionals appears to be decreasing, it is imperative that lab managers develop ways to operate labs more efficiently.
It is more than a shortage of nurses, as most clinical laboratories report the same shortages of medical technologists and increased labor costs
Just as hospital-based clinical laboratories are unable to hire and retain adequate numbers of medical technologists (MTs) and clinical laboratory scientists (CLSs), the nursing shortage is also acute. Compounding the challenge of staffing nurses is the rapid rise in the salaries of nurses because hospitals need nurses to keep their emergency departments, operating rooms, and other services open and treating patients while also generating revenue.
The nursing shortage has been blamed on burnout due to the COVID-19 pandemic, but nurses also report consistently deteriorating conditions and say they feel undervalued and under-appreciated, according to Michigan Advance, which recently covered an averted strike by nurses at 118-bed acute care McLaren Central Hospital in Mt. Pleasant and 97-bed teaching hospital MyMichigan Medical Center Alma, both in Central Michigan.
“Nurses are leaving the bedside because the conditions that hospital corporations are creating are unbearable. The more nurses leave, the worse it becomes. This was a problem before the pandemic, and the situation has only deteriorated over the last three years,” said Jamie Brown, RN, President of the Michigan Nurses Association (MNA) and a critical care nurse at Ascension Borgess Hospital in Kalamazoo, Michigan Advance reported.
“The staffing crisis will never be adequately addressed until working conditions at hospitals are improved,” said Jamie Brown, RN (above), President of the Michigan Nurses Association in a press release. Brown’s statement correlates with claims by laboratory technicians about working conditions in clinical laboratories all over the country that are experiencing similar shortages of critical staff. (Photo copyright: Michigan Nurses Association.)
Nurse Understaffing Dangerous to Patients
In the lead up to the Michigan nurses’ strike, NPR reported on a poll conducted by market research firm Emma White Research LLC on behalf of the MNA that found 42% of nurses surveyed claimed “they know of a patient death due to nurses being assigned too many patients.” The same poll in 2016 found only 22% of nurses making the same claim.
And yet, according to an MNA news release, “There is no law that sets safe RN-to-patient ratios in hospitals, leading to RNs having too many patients at one time too often. This puts patients in danger and drives nurses out of the profession.”
Seven in 10 RNs working in direct care say they are assigned an unsafe patient load in half or more of their shifts.
Over nine in 10 RNs say requiring nurses to care for too many patients at once is affecting the quality of patient care.
Requiring set nurse-to-patient ratios could also make a difference in retention and in returning qualified nurses to the field.
According to NPR, “Nurses across the state say dangerous levels of understaffing are becoming the norm, even though hospitals are no longer overwhelmed by COVID-19 patients.”
Thus, nursing organizations in Michigan, and the legislators who support change, have proposed the Safe Patient Care Act which sets out to “to increase patient safety in Michigan hospitals by establishing minimum nurse staffing levels, limiting mandatory overtime for RNs, and adding transparency,” according to an MNA news release.
Huge Increase in Nursing Costs
Another pressure on hospitals is the rise in the cost of replacing nurses with temporary or travel nurses to maintain adequate staffing levels.
In “Hospital Temporary Labor Costs: a Staggering $1.52 Billion in FY2022,” the Massachusetts Health and Hospital Association noted that “To fill gaps in staffing, hospitals hire registered nurses and other staff through ‘traveler’ agencies. Traveler workers, especially RNs in high demand, command higher hourly wages—at least two or three times more than what an on-staff clinician would earn. Many often receive signing bonuses. In Fiscal Year 2019, [Massachusetts] hospitals spent $204 million on temporary staff. In FY2022, they spent $1.52 billion—a 610% increase. According to the MHA survey, approximately 77% of the $1.52 billion went to hiring temporary RNs.”
It’s likely this same scenario is playing out in hospitals all across America.
Are Nursing Strikes a Symptom of a Larger Healthcare Problem?
“But the problem is much bigger,” Fortune wrote. “Care workers—physicians, home health aides, early childhood care workers, physician assistants, and more—face critical challenges as a result of America’s immense care gap that may soon touch every corner of the American economy.”
Clinical laboratories are experiencing the same shortages of critical staff due in large part to the same workplace issues affecting nurses. Dark Daily covered this growing crisis in several ebriefings.
We also covered in that ebrief how the so-called “Great Resignation” caused by the COVID-19 pandemic has had a severe impact on clinical laboratory staffs, creating shortages of pathologists as well as of medical technologists, medical laboratory technicians, and other lab scientists who are vital to the nation’s network of clinical laboratories.
Hospitals across the United States—and in the UK, according to Reuters—are facing worker strikes, staff shortages, rising costs, and uncertainty about the future. Just like clinical laboratories and other segments of the healthcare industry, worker burnout and exhaustion in the wake of the COVID-19 pandemic are being cited as culprits for these woes.
But was it predictable and could it have been avoided?
“One of the big things to clear up for the public is that … we saw the writing on the wall that vacancies were going to be a problem for us, before the pandemic hit our shores,” Christopher Friese, PhD, professor of Nursing and Health Management Policy at the University of Michigan (UM), told NPR. Friese is also Director of the Center for Improving Patient and Population Health at UM.
Effects of the COVID-19 pandemic, and staffing shortages exasperated by it, will be felt by clinical laboratories, pathology groups, and the healthcare industry in general for years to come. Creative solutions must be employed to avoid more staff shortages and increase employee retention and recruitment.
