Veronica Maras knew her hospital had to change if it was ever going to have a culture where nurses would feel that their top priority was patient care.
The 759 nurses at Hamot Medical Center, Erie, Pa., where Maras is senior vice president and chief nursing officer, were undergoing more and more stress and fatigue from doing more for their patients in less time. "The complexity of patients is so much different than the past," Maras says. "The patient comes (to the hospital) only when really, really sick.
"We are all about safe patient care. But a lot of that is rhetoric unless you put you money where your mouth is," she says.
At her urging, the 309-bed hospital invested $3 million in an effort to make it easier for nurses to do their jobs well. The money paid for new bedside technology, including an automated medication-administration system and wireless computers. The medication-administration check requires bar codes for medication, nurses and patients, ensuring that nurses will make fewer errors. With a simple scan, nurses learn if the medication matches the patient and the physician's order.
Nurses also benefited from wireless technology, as they were able to bring their laptop computers into the patient rooms so they could perform other functions, such as admissions work, while keeping an eye on the patients.
For nurses who are not computer-savvy, the hospital developed a team of computer system mentors that works with nurses to help them feel comfortable with the new technology, Maras says.
In part a result of the investment, nurse vacancy rates at the hospital have remained steady from 5% to 7%, lower than the national average of 13%.
The changes at Hamot have been repeated around the nation as the role of the registered nurse continues to evolve into a position that relies on new technology, more education and a renewed focus on patient care. Nurse executives say hospital efforts to change the image of nursing are crucial in their attempts to make the profession more attractive to young workers as well as keep current staff.
"Some of the best hospitals who are changing the role of nurses are doing so because it is the right thing to do and to prepare for the future," says Lillee Gelinas, vice president and chief nursing officer at hospital alliance VHA. "The future is here, it just hasn't been distributed" across the hospital industry.
In a study released last November, VHA published the top 50 ideas it received from hospitals on how to change the role of RNs, ranging from creating a care-team model led by a nurse coordinator to a back-to-the-basics clinical model that focuses on individual nurses caring for the patient.
Making simple changes in the work environment and introducing technology are just two easy steps hospitals are taking to change the image of nursing, Gelinas says. "This is about efficiency and effectiveness," she says. "We are talking about a few simple things. Nurses want to work at great places."
The VHA study on changing the role of nursing also included:
* Using magnet hospital criteria in an attempt to create a culture of quality patient care.
* Skill realignment, in which nurses delegate all tasks that can be performed by other workers at less-skilled levels.
* Changing nursing's image by publicizing best practices by nurses and showing that nurses can make wise clinical decisions.
Another facility working to change nurses' roles is Ball Memorial Hospital, Muncie, Ind. Faced with climbing nurse vacancy rates, Ball's chief nursing officer, Doreen Johnson, wanted to improve job satisfaction among her 800 nurses.
"The goal is to try to improve the quality of work life," she says. "Investing in improving the work environment improves the satisfaction of the staff and removes the barriers of getting work done."
At her 393-bed hospital, Johnson adopted a strategy she dubs "One Great Unit," which attempts to change the role of the RN and improve staff and patient satisfaction. Although Johnson hasn't done a study detailing the results, the program she launched in 2001 has reduced turnover and increased nurse job satisfaction.
Part of the satisfaction stems from a focus on teaching delegation, she says. Younger nurses have learned how to assign duties to their older colleagues, while licensed practical nurses and certified nursing assistants know their role in providing care.
"The complexity of the organization has evolved over time," Johnson says. "It was back to the basics to provide excellence in care."
Johnson's care model, which focuses on the nursing department within the hospital, is aimed at making nurses' jobs less complex and tackling the typical barriers they face in their work. It can be as simple as streamlining paperwork or making sure the right medical supplies are available, she says.
The increased attention hospitals are paying to the nursing profession comes at a time when a spotlight has been cast on the vital role nurses play in patient care and the shrinking number of nurses in the workforce.
A University of Pennsylvania study last year showed that death rates for patients undergoing surgery are higher at hospitals that employ a lower percentage of nurses with at least a bachelor's degree. In a review of 168 Pennsylvania hospitals, facilities that had less than 10% of nurses with at least a bachelor's degree reported almost 3% mortality among patients undergoing general, orthopedic or vascular surgery.
By comparison, at hospitals where more than 70% of nurses had at least a bachelor's degree, the mortality rate was 1.5%. Researchers said the difference might be because better-educated nurses tend to be more proficient in critical thinking.
A study by the federal Agency for Healthcare Research and Quality issued a report in May that showed hospitals with lower nurse-staffing levels and nurses who spent less time with patients tend to have higher rates of poor patient outcomes. Three studies by the agency revealed that pneumonia rates are sensitive to nurse-staffing levels, which were measured as the ratio of nurses to patients or nursing hours per patient per day.
Studies last year also showed there would be a great demand for nurses in the future. RNs top the U.S. Bureau of Labor Statistics list of occupations with the largest projected 10-year job growth. After several years of being on the list, 2004 is the first time nurses have topped the charts.
The bureau's latest projections put the demand for registered nurses at 2.9 million in 2012, up from 2.3 million in 2002. However, the total number of job openings, reflecting job growth and the need to replace nurses who have left the industry, will be more than 1.1 million from 2002 to 2012, the bureau says.
The demand for more nurses in the workforce is forcing hospitals to make changes to their work environments, says James Bentley, senior vice president of strategic policy planning at the American Hospital Association. About 13% of nursing positions nationwide are vacant, according to the AHA. Some healthcare experts predict that the rate will increase to 20% by 2015.
"We need as a field to say that we are going to need to figure new ways to do the work," Bentley says. "People at the local levels are trying things every day to see what works and what doesn't work."
Hospitals have increasingly been looking at ways to help the nursing industry, Bentley says, ranging from creating better floor plans with less obstructions to giving nurses more autonomy in their duties. Others try to boost morale by stepping away from hiring traveling nurses who are tempted by sign-on bonuses, only to head to a competitor a short time later, he says.
Chief nursing officers are not immune from the changing work environment, according to the VHA study. The nurse executives will need to improve their research skills in defining the effect nurses have on patient and financial outcomes.
CNOs will be required to have increased clinical and business knowledge to set the vision for the ideal healthcare system, the study suggested.
The CNOs also will develop their own business models for care. Future CNOs will become more fiscally independent and be knowledgeable in operating and financing activities. They also must work on communication skills by listening and bridging the gap between clinical and administrative areas. CNOs also must work on clinical improvement and operate proactively, according to the VHA.
"It creates a culture that results in performance excellence," Gelinas says. "We can't keep our eye off the ball."
This is the second annual report on the workforce shortage facing U.S. healthcare providers.