April 22, 2022

Innovation Spot: Leveraging technology to address gaps in staffing

By: Christine Havlin, MBA, BS, RN and Kim Haines, BSN, RN, CNOR
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Is technology part of the answer for nursing staff woes?

As COVID-19 patients continue to fill hospital beds, caregivers are feeling exhausted, burned out, and unappreciated. OR nurses have been especially hit hard, as shifts in surgeries and overflowing patient wards stretch OR nurses beyond their limits and comfort zones. Five OR managers discuss the staffing and morale challenges facing the industry during this difficult time, and how the use of technology can help nurses advance patient care and lessen administrative burdens.

More patients, heavier burdens

Elina Lazo, DNP, MSN, RN, NE-BC, CPHQ, is the director of surgery and interventional services at a Seattle-based health system. Lazo says the pandemic has pushed people over the edge, both professionally and personally. The use of traveling nurses has hollowed out the ranks because travelers can make double or triple the hourly wage of hospital staff. The focus now is to reengage stronger efforts on retention of permanent staff to make them feel valued.

Restricted visitor policies at hospitals due to COVID-19 restrictions push more of the patient-care burden onto nursing staff, resulting in patient dissatisfaction and nurse burnout. “Nurses feel pulled in five different directions, and three of the directions are super urgent,” Lazo says.

She believes healthcare lags other industries in incorporating technology into workflows beyond interacting with electronic health records. “I feel like there are ways mobile technologies can help where we may not need as many resources,” Lazo says. “And it’s not just technological advances, it’s also partnering with our patients and families, using tools that work for both.”

Doing more with less

Lack of staff also plagues Miranda Woods, DNP, RN, NE-BC, NPD-C, perioperative services director at University of Louisville Health, Jewish Hospital, in Louisville, Kentucky. On a Friday afternoon in the fall, she reports 11 patients being held in the postanesthesia care unit (PACU) at her hospital awaiting inpatient beds, with another 15 patients in surgery.

Holding patients in PACU beds overnight stretches nursing staff and compromises patient care. PACU record systems are not designed for ongoing patient monitoring. “We have PACU nurses taking care of floor patients, and it’s just a different environment,” Woods says. It is difficult to determine proper medications, and ancillary staff—such as food service and therapists—have trouble finding patients.

Engaging patients with appropriate technology can cut through some of the clutter of a procedure, including preoperative and postoperative instructions, registration, and day-of expectations. “I think most people expect technology that helps communicate with them better,” Woods says. “And there are a lot of other technologies used outside the healthcare industry that we just haven’t thought about in healthcare.”

Lack of timely care will reverberate

The impact of reducing timely access to care remains to be seen, says Katherine Frederick, DNP, MSN, MBA, RN, CNOR, CPHQ, NE-BC, regional quality peer review nurse at Kaiser Permanente, Roseville, California. “The ramifications aren’t going to be seen in full for at least another 15 or 20 years,” says Frederick. “But at this moment in time, all we can do is just handle it in the moment, try and be smart, and still be human about it.”

She agrees that technology where people can self-serve would benefit healthcare—if designed and deployed properly. Any technology must support nurses and patients and advance patient care. As frontline workers, nurses are the best judge of emerging technology—not the C-suite or the IT department, Frederick says.

“But if you’re going from the perspective of replacing someone, or anything that’s going to do the work of a medical professional, you’re dead in the water,” Frederick says. Artificial intelligence cannot emulate nursing, with its humanistic, social, and psychological touchpoints. Technology should also incorporate the patient journey, from surgery to therapy, medical equipment, and other aspects, she adds.

Loss of institutional knowledge

Jennifer Misajet, MHA, RN, CNOR, CSSM, Trinity Health FirstChoice interim executive, Livonia, Michigan, and consultant for HCA Healthcare, decries the loss of institutional memory that sustains many hospitals and health systems. She likens it to trying to play baseball when half the team is new every day. “Healthcare requires exclusive communication and teamwork, and that’s hard to do when the team is always reforming,” Misajet says

Besides sufficient staff, the experience level of that staff is decreasing as nursing education fails to keep up, she notes. Any technology that can keep nurses working at the top of their licenses would be appreciated. Mobile apps exist that help patients prepare for procedures and that interact with electronic health record (EHR) systems, allowing nurses to manage exceptions rather than an entire patient cohort. If the patient reads the prompt and registers that the appropriate action has been taken, that shows in the EHR as a completed task. Uncompleted tasks are elevated to staff for follow-up.

If presented correctly, patients are comfortable with all types of technology that can make the process easier, including telehealth, preoperative educational videos, mobile apps, online chat, and more.

“I personally don’t think technology takes away from caring one bit,” Misajet says. “In fact, I think it adds a whole new layer to patient care that we didn’t have before.”

Radical new approach needed

Sami L. Placer, PhD, BSN, RN, CNOR, NPD-BC, believes a more radical approach is needed. “I think we have to explode nursing completely. I think we have to get really down deep and just tear it apart,” says Placer, senior system director of perioperative services at Upper Allegheny Health System, Bradford, Pennsylvania.

Hospitals are not doing enough to retain competent nurses, such as offering flexible schedules to appeal to more workers. Placer’s rural system has considerable issues attracting and retaining staff. She notes that perioperative throughput continues to suffer with the necessary precautions to test and monitor for COVID-19 infections. Patients are sicker, too, and require more care per nurse. Those myriad factors result in nurse frustration and staffing shortages.

“I think technology can help a lot. We need to make it easier for patients to get education and schedule their procedures,” Placer says, mentioning health system-branded mobile apps that simplify scheduling and provide electronic instructions versus the thick sheaf of paperwork most patients receive. “Technology can help on the back end to verify that blood work and EKGs are done and that every box is checked.”

Conclusion

Nursing shortages are nothing new, but the increased demand for nurses and greater, pandemic-driven burnout have created an untenable situation that can be partially alleviated by increasing nursing school enrollment and taking a close look at hiring and retention policies. Technology also can benefit both patients and clinicians, empowering patients to become more involved in their own care while reducing the administrative burden on nursing staff.

—Christine Havlin, MBA, BS, RN, is chief marketing officer of MobileSmith. She has served in various roles including product management, sales, and marketing in both large corporate and startup environments.

 


How can technology support nurses in today’s challenging labor market?

The healthcare sector continues to face immense labor-constrained challenges as we continue navigating through the pandemic. As health systems focus on retention and recruitment, there are ways to ease workload strain and empower staff to feel better supported amid the challenges exacerbated by the pandemic—today and in the future. One way to combat burnout and provide nurses with the resources to perform their duties is to enhance how they work.

Below, I dive into the different ways technology can be implemented in the OR for better safety outcomes, streamlined processes, and eased workload so nurses can focus on what they are most passionate about—delivering excellent patient care.

Optimize inventory management strategy with data, analytics

Too often, there are band-aids put on supply management challenges, which can lead to increased inventory levels. With the rising costs for labor, in addition to staffing shortages, helping health systems uncover labor activity gaps that fuel inefficiency is the first step in addressing the problem. Preference cards are the foundation that drives supply management activity and are utilized in the OR to ensure supplies are stocked and ready when needed. Yet, many preference cards are not regularly managed, resulting in nearly 40% of supplies going unused during surgery as well as countless dollars tied up in supporting this cycle of ordering too many “backup” resources.

To help ensure preference cards are being reviewed, updated, and utilized correctly, many health systems are turning to cloud-based technology that provides actionable data-driven recommendations based on supply consumption activity. The solution utilizes data to identify practice trends and gives actionable recommendations and insight into what supplies to add, hold, or remove on a preference card. This builds a more reliable and cost-effective supply management process, freeing nursing staff from unnecessary inventory management tasks.

So, how do you know if you have too many or few surgical packs with the right supplies to run an efficient OR? Using data to drive supply efficiencies by analyzing the right mix of custom surgical packs based on the current landscape is another solution to optimizing inventory management. A comprehensive program review using data-driven procedural analysis can identify an optimal mix of packs to support your procedural needs. In addition, more health systems are utilizing apps that allow nurses and clinical staff to access data anytime, anywhere. These apps are helpful when managing inventory and keeping up with supplies because they can provide real-time information and notifications about a hospital’s custom pack supply inventory, which is a vital lifeline for an effective supply management process.

During a perioperative discovery assessment with one of our customers, we found that two full-time Central Sterile Services Department (CSSD) staff members were dedicated to putting back unused items, which accounted for about 16 hours a day, 80 hours a week, and almost 4,160 hours a year. This put additional stress not only on an already labor-constrained system but also on the hospital’s bottom line. Incorporating technology to optimize those processes allowed for the reallocation of those resources, streamlining inventory and limiting nurses’ time from tracking down supplies and diverting that gained time back to patient care.

Leverage 3D, sensor technology to track, organize inventory

When too much inventory is ordered, health systems face the challenge of where to store the additional inventory, often needing to invest in more square footage of warehouse space. One observation with OR supplies is that many hospitals are seeking solutions about how to better organize their supplies onsite.

3D technology can evaluate ways to maximize storage room designs and get the best use out of space. The pandemic accelerated the need for inventory rationalization, which comes down to rightsizing PAR levels and organizing space using 3D technology to ensure clinicians have what they need, where they need it, and when they need it. Others are exploring technology using radio-frequency identification (RFID) on high-dollar items to track inventory, location, and expiration, although sometimes it is the lesser costing items that make the biggest dent. I foresee more advancements in inventory tracking and managing technology in the near future, as this can be the most disruptive for clinical staff.

Reduce risk with infection prevention focused technology

Manual auditing—also known as direct observation—of hand hygiene behavior is frequently used for measuring hand hygiene compliance in most hospitals, but it can be difficult to accurately monitor all surgical suites throughout a busy day. There are opportunities to adopt automation and sensor-based technology to assist with monitoring, ensuring all staff are foaming in and out each time they enter and leave a room. For example, the company Intelligent Observation offers a hand hygiene monitoring system that uses near-field magnetic induction (NFMI) technology to safely and accurately record every hand hygiene compliance event in a healthcare facility and compare it to the total number of opportunities, thus providing a compliance score or percentage. The technology provides data-driven insights on areas of opportunity to increase compliance, ultimately resulting in a lower risk of patient harm. Monitoring systems are also a great tool to educate staff on “back to the basics” techniques, like hand hygiene. Interest and adoption in this type of technology has been accelerated by COVID-19.

In addition, more hospitals are adopting UV disinfection technology, which uses ultraviolet light to kill microbes on surfaces. This technology became popular during the height of the pandemic, and today more health systems are ingraining it into their infection prevention processes. UV disinfecting technology is an excellent adjunct tool to enhancing routine cleaning measures. It can provide greater peace-of-mind to patients, visitors, and staff, but it cannot—and it should not—replace already established cleaning practices. Overall, evaluating disinfecting products and adopting standardized cleaning protocols will further enhance quality assurance outcomes.

To deliver better care, it is important to invest in those powering your health system: your frontline staff. Adopting technology and data-integrated tools can sometimes be intimidating and certainly requires an open mindset. However, optimizing how we work and embracing technology can better support and empower nursing staff in the long run, especially during times of emergency.

—Kim Haines, BSN, RN, CNOR, is director of perioperative clinical programs at Medline. Haines also runs Medline’s new “Peri-Op Performance Program,” which is committed to solving challenges in the OR.

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