Nursing Shortages and Burnout Continue To Be Top Challenges
Chief Nursing Officers (CNO) around Arkansas see nursing shortages as continuing to be one of the biggest challenges they face today.
"In fall 2015-summer 2016, Mercy Hospital Northwest Arkansas in Rogers had more than 80 open RN positions, forcing us to rely on temporary staffing agencies," said Charlotte Rankin, CNO & Chief Operating Officer, Mercy Northwest Arkansas (NWA). "Although we received exceptional dedication and service from our agency nurses, they were not as engrained in our culture. Agency nursing as a solution for staffing is also very costly to a healthcare organization. Our nursing leadership has been intentional around a plan to close the gap by reducing open positions."
Rankin said some organizations have chosen to initiate mandatory overtime along with agency nurses to supplement the deficit. Rankin said they have never resorted to adding additional stress by making overtime mandatory. And today they have only 25 open RN positions and six agency nurses, and plan to fill the remaining positions this summer and be agency-free.
"Overall morale in our units is excellent," Rankin said. "We focus heavily on ensuring adequate staffing ratios and keeping up with market compensation. Our success also comes from ensuring our co-workers have a voice. We attempt to eliminate stressors to our co-workers so they can concentrate on providing quality care and exceptional service. Our positive culture comes naturally because we are intentional about hiring the right people. I'm proud to be part of a community that puts our co-workers first."
Lee Anne Eddy
Arkansas Children's Senior Vice President and Chief Nursing Officer Lee Anne Eddy, said burnout is among the biggest challenges faced by nurses--and that can be exacerbated when there is a nursing shortage.
"Contributing factors to burnout include the constant state of rapid change, the demand for high tech skills and advanced education, the fatigue of long shifts, and the high emotional toll of the work," Eddy said. "Nurses are caretakers who readily put other's welfare ahead of their own. These factors need to be mitigated to protect the wellbeing of nurses and to preserve the passion that drew them into nursing. At Arkansas Children's Hospital, we are putting strategies in place to protect and safeguard our nurses, from relaxation stations and employee wellness events, to leadership development and innovative recruitment and retention efforts."
Angie Longing, CNO
Angie Longing, CNO of Conway Regional, feels the biggest challenge for nurses is finding balance.
"On any given day, a nurse may face multiple challenges: new technology, staffing opportunities, quality improvement, constant learning, patients/patient families with unrealistic expectations and training new staff members," Longing said. "How do nurses provide outstanding care with all the challenges they face? How do they meet the needs of their full patient load when one patient might be dying and the person in the next room is upset because you kept them waiting too long? How do they prioritize their time so they can meet the needs of all and still have time to go the bathroom and eat lunch?
"Many nurses go home and have a family to take care of after taking care of so many others. How do they find time for themselves so they can rejuvenate and keep a positive attitude to answer the call? Overcoming these challenges is all about finding balance and creating a proactive team that works together and supports one another."
Nurses also have the challenge of charting Electronic Medical Records (EMR) rather than spending time with patients at the bedside.
Alesha Collins, CNO
"Nurses have made several comments to me about the EMRs and feeling inadequate in patient care," said Alesha Collins, CNO for Howard Memorial in Nashville. "They know they are getting the task done, but sometimes patients require a little more time and teaching and nurses feel the EMR makes them feel rushed because in the back of their mind they know they have to chart in the EMR."
Collins said simplifying record-keeping would at the top of her list of things that could be done to improve healthcare.
"Eliminate Meaningful Use, PQRS, MIPS, MACRA, etc.," Collins said. "It is making it difficult for physicians and nurses to take care of patients. It isn't really improving anything. It is just making care more tedious."
Paula Grimes, CNO
Paula Grimes, CNO, NEA Baptist Memorial in Jonesboro, said nursing leaders are challenged with meeting safety and quality standards, reducing readmissions and mortality rates and meeting patient experience expectations, all while keeping cost down.
"My wish for healthcare is that continued improvements should remain patient-focused and there is a strong focus placed on recruitment into the field of nursing," Grimes said.
The nurse/physician relationship is extremely important when it comes to patient safety and outcomes, Grimes said.
"I would like to see the nurse/physician relationship be more collaborative with the foundation being patient-centered that allows for an environment of continued learning," Grimes said. "Challenges for both physician and nurses today is time because both are independently busy, which is a barrier for improved communication between the two. The healthcare community needs to spend time investigating the barriers to improving this relationship which will in turn continue to improve patient outcomes."
Collins said if she could improve relations between nurses and doctors, it would be encouraging more mutual respect.
"The nurses have said that some physicians--not all--feel nurses are their secretaries versus part of the care team," Collins said.
Rankin said at Mercy NWA they have an integrated hospitalist physician group that supports their nurses and allows autonomy within their scope of practice.
"Communication is key to maintaining harmony between these two groups of professionals," Rankin said. "Our patient satisfaction score related to overall teamwork between doctors, nurses and staff has been on a fast and steady incline, in fact doubling in percentage of those who rated us 'excellent' since January 2016."
Longing said the most successful doctor/nursing relationships are those where they view each other as peers and create a culture of mutual respect.
"I have a lot of admiration for the physicians who see their nurses as teammates and seek input regarding care for their patients," Longing said. "These doctors will tell you the nurses spend a great deal of time with the patients and can give valuable insight when it comes to a plan of care. Establishing mutual trust and respect benefits all parties involved in healthcare, especially our patients."
Rankin said her wish to improve healthcare would be for affordable, quality healthcare to be available for everyone. "Maintaining a healthy life through disease prevention is as important as food and water," Rankin said.
Eddy said with their focus on championing children, Arkansas Children's Hospital seeks to fundamentally transform healthcare delivery for children. "To further improve healthcare, I wish to realize a singular focus on children, regardless of competing priorities, resulting in unprecedented improved child health," Eddy said.
Preparation Helps Nurses Deal with Combative Patients
It can be a major challenge for nurses when they encounter combative patients who may be mentally ill, intoxicated, or overdosed on drugs.
Alesha Collins, chief nursing officer for Howard Memorial in Nashville, said with their hospital being rural, they call police when there is a problem with a combative patient. But it takes time for police to arrive. The hospital has each emergency room nurse certified in Crisis Prevention Intervention (CPI) that teaches nurses to feel more confident in situations like that. That can include ways to safely take down a patient, but that is the last resort.
"Nurses also learn effective communications techniques," Collins said. "You don't want to bait that patient, you don't want to be a trigger and you don't need to act afraid.
You reassure patients that you are there to help them, not hurt them. Usually they will calm down. Situations with combative patients were getting more frequent two years ago before we did CPI. We have had no more situations since nurses have been trained. I would encourage any facility to do that. It has really helped. It has also helped in outpatient behavioral health."