Virtual Care May Be One Answer to Healthcare’s Nursing Shortage-The HSB Blog 5/10/22

Earlier this year we wrote a piece on how virtual care my be one anwer to healthcare’s labor shortages, please see: Virtual Care May Be One Answer to Healthcare’s Labor Shortages-The HSB Blog 1/31/22. This week in honor of Nurses Appreciation Week we have revised and updated it with a focus on the nursing shortage.

Our Take:

Leveraging virtual care is one way to deal with a number of the issues that healthcare’s workforce shortages have brought to light due to the Pandemic. Following huge spikes in demand in almost every part of the country as it deals with COVID, the industry has had to deal with countless labor issues and shortages due to burnout and the overwhelming physical and mental demands placed on caregivers. While healthcare workers are experiencing elevated levels of stress, patients may also experience a different type of stress when it comes to patient quality and overall care. It is important to understand the dynamics of the overlapping crisis we currently face as nursing professionals quit in overwhelming numbers and healthcare systems look to other solutions such as virtual care. As an alternative, many providers opted to provide virtual care. Although the future of telehealth is unpredictable, the flexibility and convenience that virtual care provides for both the patient and the provider may be here to stay.

Key Takeaways:

Hospitals lost approximately 2.5% of their nursing workforce in 2022, resulting in the average hospital losing between $5.2M-$9.0M according to the NSI Solutions 2022 NSI National Health Care Retention & RN Staffing Report
There is predicted to be a shortage of over 500,000 RNs by 2030 with the greatest shortages seen in the South and West, according to one 2018 study.
More than 1M registered nurses will leave the workforce by 2020 according to a 2017 article in Health Affairs, which was prior to the extreme stress and burnout of the Pandemic.
A study conducted by Wheel found that clinician burnout impacts 80% of patients and 1 in 3 patients believe burnout impacts their quality of care

The Problem:

The challenges of the pandemic have exacerbated and crystalized labor challenges and the preexisting labor shortages in healthcare. Nurses, like many health care workers, are physically and emotionally exhausted after working in what has been described as a “war zone” for the better part of the past two plus years. As noted in an article in The Conversation, “the global pandemic has only worsened problems that have long existed within the nursing profession…widespread stress and burnout, health and safety issues, depression and work-related post-traumatic stress disorder, and even increased risk of suicide.” In addition, the relatively non-stop confrontation with the Virus and its variants has forced clinicians to work long hours donning layers of PPE, which often can take 20 minutes or more each time to put on and remove. In addition, units are often short-staffed due to illness caused by COVID itself as well as employees who refuse to comply with vaccine mandates and other hospital protocols. Consequently, the stresses on clinicians such as the increased administrative burden and inability to focus on patient care have reached a breaking point. For example, according to a February 2022 report from McKinsey entitled, “Surveyed nurses consider leaving direct patient care at elevated rates”, 32% of registered nurses stated they may look to leave their current role, an increase of 10% compared to the prior year. The survey noted that the main reasons behind nurse’s desire to leave “included insufficient staffing levels, seeking higher pay, not feeling listened to or supported at work, and the emotional toll of the job.”

In light of the heightened demand during COVID, issues around the healthcare labor shortages have garnered nationwide attention. For example, during the so-called “Great Resignation,” where large numbers of working-age people have simply dropped out of the labor force, approximately half a million healthcare workers have quit since February 2020 according to a recent article in Forbes. Along those lines, per the NSI Nursing Solutions Report, 62% of hospitals are reporting a nurse vacancy rate of almost 8%. Understandably the stress of dealing with a continuous overburdened workload over two-plus years has taken a great toll on clinicians' emotional, and physical health leading to burnout. For many, this has left them with two options–either to step away or go digital. Many have chosen to go digital and work in telehealth or start their own virtual practices which provide flexibility and a work/life balance that many so desperately desire.

The Backdrop:

Healthcare is a service industry that depends on the dedication and manpower of the individual clinicians and support staff responsible for maintaining the facilities, diagnosing and treating t illnesses, and caring for the lives of patients. A key element in this equation is the hiring and support systems that go into creating a physically and emotionally safe environment for clinicians to operate in where they feel their concerns can be heard and addressed. If not, the burnout and stress associated with working long hours under severe emotional stress, such as those experienced during COVID, can negatively impact the quality of patient care. For example, while the medical profession has long been sought after for its high wages it had also enjoyed significant professional prestige which helped attract a growing labor pool. That may no longer be the case. For example, according to “Amid Rampant Provider Burnout, Marketplace Platform Companies Focus on Clinician Experience” a survey conducted by Wheel, approximately forty percent of respondents would not want their children to go into the field of medicine as it is not worth their time or investment.” In addition, in the aforementioned McKinsey study nurses cited safety, flexibility (ex: work-life balance, work schedule), and environment (a trusting/caring team, feeling valued by employer) as the top factors on which they based their decision to stay in their current role. Those factors are changing.

In addition to the stressors noted above, many practitioners are facing a working environment that is filled with aggression and constant abuse. According to “Nursing Shortages” approximately eight to thirty-eight percent of health care workers are at accelerated risk of facing emotional and physical abuse, which some attribute to insufficient staffing ratios. Following the explosion in digital care during COVID, digital has emerged as an option for many nurses and physicians. Going virtual is a way to create work-life balance and still practice their craft, optimizing the benefits for everyone involved. Many digital and virtual-first solutions are specifically designed to address administrative inefficiencies inherent in current electronic medical record systems (EMRs) and are designed to improve information flow for patients and providers.

Implications:

Addressing the void between provider flexibility and patient care is the future of telehealth. While there is still room for improvement in the delivery of virtual care such as patient privacy and broadband access, virtual platforms have the potential to move healthcare to a more consumer-centric omnichannel experience and address many of the issues of burnout. As we noted in “The Nursing Shortage Shows Why Industries Must Choose Tech Carefully” a number of studies have found that “nurses spend between 26%-41% of their time on documentation activities and that is a major source of what burdens them.” As a result, the article recommends providers consider technologies like natural language processing (NLP) to capture and search clinical notes as well as AI-based tools such as predictive analytics, to help risk stratify patients so they can focus on “providing human care for patients” and not paperwork. In addition, treating patients holistically and funneling them to the proper sites of care should help clinicians work “at the top-of-their” licenses and focus less on certain types of routine or chronic care which can be handled by other providers in the system or even prevented by higher quality care. Also, as some of the technical hurdles to providing these care delivery mechanisms are addressed, underserved communities and seniors can be given access and training on the technologies, so that virtual care can broaden the scope of care delivery, theoretically increasing provider satisfaction.

However, in attempting to design solutions it is increasingly important to emphasice that nurses need to be brought into the process to ensure that this is done correctly and with patients in mind. As noted in a recent article in the Journal of Clinical Nursing, the “pandemic highlighted the urgent need for nurses to become involved in technology design, acquisition and implementation, and to provide considerations for the complexities of technology use within all levels—micro, meso and macro—of the healthcare system.” As the authors go on to point out, “technology developers and those who implement the technology within hospitals need a deep understanding of the complexity of the care processes within an acute environment. Establishing the means to develop a shared understanding between developers and end-users has become increasingly important considering that COVID-19 may have permanently shifted many aspects of care to a virtual setting, which will likely usher in the use of more technology.” Importantly, product designers and developers need to recognized the role of nurses as closest to the voice of the patient in the clinical system and embrace the knowledge they have in delivering and improving care. In looking at how to design and develop products to reduce burnout and improve nursing satisfaction, product developers would do well to keep 3 things from a recent HIMSS roundtable in mind:

Consider deploying data-driven approaches to manage workforce scheduling and staffing.
Leverage technology to improve patient care and empower nurses to do their most fulfilling work.
Develop new approaches to patient care that improve the patient experience and support nurses.

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