Nurses operate within a highly competitive job market, and as is the case in other high-stress fields, there's a fatigue starting to set in. Burnout is a very real danger, and much like physicians, nurses are prone to leaving when they've finally had enough -- and that turnover can have detrimental effects on everything from a hospital's financial strength to the quality of patient care.
Will Eadie, vice president of sales and strategy at employee engagement outfit WorkJam, said nursing fatigue occurs in part from a lack of communication and messaging infrastructure, whether from a technological or policy standpoint.
With that lack of coordination, a stressful job becomes even more so. By way of example, Eadie cited the recent flu outbreak in Texas, which forced hospitals in Dallas and other areas to set up triage units to handle the overflow. From a workforce management standpoint, it was an extremely difficult situation.
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That inability to coordinate nurses on the front line with the needs of the hospital system is a recipe for creating burnout, and according to Eadie, that has a hard, direct correlation to hospital finance. After all, after someone quits, their position can't go unfilled.
"You have to fill that shift," he said. "A nurse leaves, so now you have to bring another nurse in, and best-case scenario, they're going to be annoyed that they have to pick up a shift. But you also add to your overtime pay."
There are also implications for patient care -- the mortality rate is reduced when the nursing staff is full -- and that also impacts the bottom line, as federal reimbursements to hospitals and providers are increasingly linked to quality as the healthcare system gradually shifts from fee-for-service to value-based payment models.
"There are cost savings from a safety standpoint," said Eadie. "When you have a skilled nursing force, keeping those people affects the numbers in terms of cost and reducing overtime, but a nurse who's been there three years as opposed to one year not knows your system, but is familiar with the arena and provides better patient care."
To date, he said, health systems have generally done a good job installing backforce work management systems, but these systems are focused on back-office functions. The lack communication, and do little to facilitate collaboration.
Nurses are more easily retained, said Eadie, when they're ensconced in a culture that mirrors the broader, on-demand culture on display outside a hospital's doors: People watch Netflix when they want, and do their banking when they want, and nurses likewise benefit when there are technological mechanisms in place to make their jobs easier. Giving them the ability to pick their own schedule for instance, makes them happier, and improves overall hospital compliance.
"Let's say there's something as simple as a new uniform policy," said Eadie. "You can send out pictures of what that outfit looks like, or send out reminders for trainings. This really affects managers and frontline nurses. If a nurse calls off, the manager has to find that replacement, and traditionally they go to a list and say, 'Who can see this patient?' and 'Who has the right of first refusal?'
"That can be completely automated," he said. "The key to this all: It's all integrated with that back-end. It takes manual processes out of it and adheres to compliance, because it takes into account skill, expertise and availability."
Retaining staff becomes even more important when factoring in the aging baby boomer population, which sees thousands of Americans reaching Medicare age each day. And with a looming shortage of physicians being predicted by many researchers and hospitalists, nurses are growing in importance -- meaning communication and accommodation are long-term workforce strategies every hospital should consider.
"When you have that physician shortage, now you're putting pressure on nurses to handle more of the total patient solution," said Eadie. "Now that communication between the physician and the nursing staff becomes even more stressed, and we all know what happens to relationships when you add more work and less time. You get a lot of people who say, 'This field is no longer what it was.'"