Staffing: Improving patient flow with LPNs

Editor's Note

Balancing a limited nursing staff without compromising quality patient care or staff satisfaction can be a delicate balancing act. One large midwestern hospital experiencing inadequate nurse staffing levels and a spike in discharge delays tested a new staffing model in which LPNs supported medically stable patients through a very defined process and set-up. Findings from this work were published in the November issue of The Journal of Nursing Administration.

Leaders at the hospital piloted a one-year team-based model of care consisting of 40% LPNs and 60% unlicensed care personnel, who were supervised by a single lead RN and supported by a virtual RN. The new staffing model launched with a consistent cohort of travel LPNs who were hired for the first 3 months of the pilot. A nursing education expert worked with the team to develop an orientation plan and training resources that covered specific LPN responsibilities, team collaboration among LPNs and RNs, care expectations, and training to bring all roles to the top of their scope of practice. An existing approach with virtual RNs supporting an average of 50 to 70 inpatient beds was expanded for the virtual RNs to also provide patient education and assist with discharge activities, per the report.

As part of the pilot study, patients with a discharge delay were selected to be co-located to a new long-stay unit (LSU). When comparing the costs of the standard care model using only RNs with those of the LSU model leveraging RNs and LPNs, the LSU had an estimated yearly nursing staff cost reduction of 58.5%, without adversely impacting patients or staff. A survey of RN and LPN staff members after pilot initiation, reflected positive results with a decrease in burnout and an increase in staff finding meaning and achievement in their work. The study authors concluded that nursing leaders can create positive change when they are open to new, innovative models of care to meet the challenges of staffing levels, patient volumes, and acuity.