Tech helping to alleviate nurse shortage, experience gaps

Hospitals are revamping recruitment strategies and restructuring workflows for nurses, who are projected to be in steep demand in key markets and specialties within the next decade.

Some are looking toward technology—a force that’s overtaken almost every other aspect of our lives—to help to alleviate these challenges.

“I’m not sure that we can say that technology can fix the nursing shortage, but I do believe, if it’s designed well, we can make the job more streamlined, more efficient,” said Patricia Sengstack, Vanderbilt University Medical Center’s nursing informatics executive.

The supply of nursing professionals has been looking up in recent years, with employment projected to grow 15% between 2016 and 2026, according to the Bureau of Labor Statistics. However, the supply isn’t consistent nationwide: A 2017 report from the Health Resources and Services Administration projects a shortage of 44,500 full-time nurses in California in 2030, with a serious surplus of more than 50,000 in Florida.

That’s fueled by a few factors, including an aging nursing workforce that’s eligible for retirement, an aging population in need of geriatric care, competition from staffing and traveler agencies, and a scarcity of training programs and nursing instructors.

“That leaves gaps within our workforce,” said Kendra McMillan, a senior policy adviser with the American Nurses Association. “We need to develop methods and strategies for recruitment and retention of our younger nurses who are entering the profession, or who are at a point of midcareer, so that we can make sure that we’re filling those gaps.”

Not to mention, nurse shortages strain those working at health systems today, who now shoulder a disproportionate amount of work.

Here’s how some hospitals and health systems are using technology to recruit—and retain—the types of experienced nurses they need today.

In 2010, Duke Health made a decision: no more advertising nursing jobs in print. “When I first started in recruitment, we advertised our open positions in specialty publications, newspapers and print journals,” said Sylvia Alston, who has served as Duke Health’s assistant vice president of nursing recruitment, retention and supplemental staffing for 13 years.

Now, the health system focuses on social media, email marketing and “optimizing” the website, she said. Online marketing for recruitment helped the system recruit in areas where more nurses were looking for jobs, and let them track analytics on what possible applicants they were reaching. It was also part of their strategy to recruit at the system level by specialty, rather than by facility.

Yet, even with this shift, the Durham, N.C.-based health system hasn’t overcome all its challenges. As a health system in the South, a region that’s been hit by nursing shortages, Duke has faced issues recruiting nurses to fill its staffing needs, and has found it particularly challenging to recruit experienced specialty nurses for the operating room and critical care.

But with much of the recruitment process online, Alston said Duke has learned to make better use of analytics to improve its odds of finding the right fit with its nursing hires.

Now, when Duke posts a nursing opening online, it can track the number of hits and candidates who begin the application process. From there, staff can also assess how long it takes candidates to fill out various steps of the application process, as well as how many stop in the middle of the process—and if so, where.

Many “candidates drop off within the first minute of the process,” Alston added.

Those insights can help the health system ease the application process.

One tidbit Duke learned from studying the way candidates behave on its website is that many were filling out applications using smartphones or tablets, even though the website had been designed for those using a desktop. To make the experience more enjoyable, Duke revamped its online applications—making it easier to attach a resume from the cloud, for example.

Social media has played a growing role in Emory University Hospital’s recruitment strategy, too.

Nancye Feistritzer, the hospital’s chief nursing officer, said the hospital has felt the constraints of the nursing shortage, particularly because Atlanta is “rapidly growing.” She added that the hospital has roughly 80 open clinical nurse positions, and recently added more inpatient beds and operating rooms.

Social media and job recruitment platforms have become major sources of information for nurses looking for jobs, according to Feistritzer, making them an “opportunity for us to communicate who we are and what kind of environment we are.” Earlier this year, Emory Healthcare created a promotional YouTube video with nurses speaking about their jobs, which it posts to social media sites to promote its nursing program.

But as nursing shortages drag on, it’s not just about recruiting new talent. Health systems are increasingly forced to do what they can with the staff they have available.

One way health systems are tackling this challenge is with electronic scheduling tools that allow nurses to sign up for individual shifts they’re qualified to cover, as well as trade shifts with other nurses having the same skill set when needed. Nursing leaders say that ability not only helps with work-life balance, but also makes scheduling easier for the unit director.

Emory University Hospital uses Ansos, a staff scheduling product from Change Healthcare, formerly McKesson Corp., to schedule shifts across all its units. In addition to offering self-scheduling options, the tool monitors workloads—such as whether a unit was under- or over-staffed—to inform future scheduling decisions.

“It gives us much more specificity about managing staff scheduling,” Feistritzer said.

That’s one of a few self-scheduling tools in the market. Vanderbilt University Medical Center in Nashville uses a workforce management tool from enterprise software company Infor, while Stanford Children’s Health in Palo Alto, Calif., uses scheduling software from workforce management software company Kronos.

Intermountain Healthcare in Salt Lake City last year began testing an app to help manage the ebb and flow of nursing needs across its facilities. The app allows nurses to schedule themselves for open shifts—and while it’s initially limited to staff nurses in just three units, the vision is to one day allow caregivers to sign up for shifts at any of the health system’s facilities, even outside of their home department.

That has the potential to help address shortages on weeks when one hospital might be short-staffed, while a nearby facility cuts its nurses’ hours.

Health systems are also pairing their scheduling practices with external analytics to inform their coverage needs. Emory University Hospital uses tools from artificial-intelligence software company Qventus to predict emergency-department volume and admissions based on historical patient volumes and events in the broader community, such as if there’s a heavy flu season. “That helps us be tighter about when we need nurses,” Feistritzer said. “If we’ve got a bunch of (predicted) discharges on Thursday, but not so many on Tuesday, perhaps we can shift our resources to be smart about how we’re scheduling people.”

Scripps Health, which boasts only a 2.7% vacancy rate for nursing roles, uses an electronic scheduling tool from Kronos. It’s planning to combine that system with nursing workload acuity data from the electronic health record so that staffing managers can better forecast nursing demand, said Shane Thielman, the San Diego-based health system’s interim chief information officer.

Scripps uses these workload acuity tools to help make patient assignments for its clinical staff, taking into account factors like staff-to-patient ratios and where the patient is in the unit. By combining these tools with the scheduling program, Thielman said, Scripps hopes to provide demand forecasts to proactively manage staff.

Telemedicine can take staffing flexibility further, providing a way to help health systems distribute their specialty workforce where they’re needed, regardless of location.

This past spring, Vanderbilt University Medical Center launched a “virtual sitter” program from AvaSure, which allows a single nurse to monitor multiple patient rooms using telemedicine robots set up at the bedside. The program mainly observes patients who might have trouble getting out of bed, such as those with dementia, to ensure they get support when needed.

“Instead of having to have one human being for one patient … there can be eight of these robots deployed to eight different patients, and have one central monitor,” said Karen Hughart, Vanderbilt University Medical Center’s senior director of nursing informatics. The remote nurse can talk to the patient from afar and flag staff on the floor if needed.

That’s not insignificant for Vanderbilt, an academic medical center that’s been hit hard by nursing shortages. “We’re really struggling with having not enough nurses,” Hughart said. “That’s probably the No. 1 pressure that we’re dealing with right now—trying to maintain our quality in the face of expansion.”

At Emory University Hospital, telemedicine has proved particularly helpful for improving efficiency in the intensive-care unit. Emory Healthcare in 2014 opened an eICU—essentially a control room staffed by critical-care nurses and physicians at its Emory St. Joseph’s Hospital in Atlanta. These clinicians remotely monitor the status of patients staying in ICUs across the health system 24/7, including at Emory University Hospital, alerting on-site staff in the event of an emergency.

The eICU also helps hospital units onboard and mentor new critical-care nurses, by allowing experienced, remote ICU nurses to consult with newer nurses on the floor. That’s important, since roughly 20% of the nurses at Emory University Hospital will be eligible for retirement within the next three years.

“We’re working to leverage the expertise of those (experienced) nurses,” Feistritzer said, noting that through the eICU they can be available to “coach and support nurses in real time.”

Much is made of the documentation burden among physicians. But nurses also shoulder a significant portion of this administrative load.

One study of advanced-practice registered nurses found that half of nurses agreed that EHRs added to their daily frustrations, and insufficient time for documentation was a strong predictor of burnout in the population, according to research results published in the journal Applied Nursing Research last year.

But technology isn’t always the enemy. In fact, tech can help nurses be more efficient and practice at the top of their license, said Victoria Tiase, director of research science at the Value Institute at New York-Presbyterian Hospital.

Those initiatives can involve determining the minimum amount of essential data points that need to be collected from patients for their care, as well as figuring out how to streamline patient assessments, she said.

Becky Fox, chief nursing informatics officer at Charlotte, N.C.-based Atrium Health, expressed a similar sentiment. Fox said she’s felt the impact of nursing shortages firsthand, since the Southeast has been hit by them.

“We need to be able to leverage our technology to make things as easy as possible for the clinicians that we have,” as well as to help attract and retain nurses, she said. As part of this effort, Atrium revamped its admission documentation process. That means ensuring that all of the questions that nurses are told to ask patients before admission are necessary for patient care, and not seeking information that’s redundant, focused on outdated regulatory requirements or based on “best practices” that have since changed.

The process has saved nurses more than 4 million “clicks” per year when documenting patient admissions, which translates to more than 6,000 hours of saved time.

Stanford Children’s Health has embarked on a similar project as part of its nurse retention efforts.  Stanford Children’s hasn’t been significantly impacted by the nursing shortage, despite the fact that California is projected to have one of the nation’s largest shortages by 2030.

Its nursing turnover rate is just 6%, said Lisa Grisim, the health system’s associate chief information officer.

But to double down on nurse retention, Stanford Children’s established a technology and informatics council made up of 14 bedside nurses. These nurses meet monthly to discuss how technology could streamline workflows and improve efficiencies, and, like Atrium Health, one of its projects involved redesigning its admission documentation.

“The amount of documentation that was needed to be done on admission was a huge burden for nurses,” Grisim said. The project reduced the number of “clicks” it takes for a nurse to complete admission documentation from 225 to 57, and brought down the time it takes to document from 32 to 12 minutes. In hourly nurse wages, that suggests Stanford Children’s has saved more than $250,000 to date this fiscal year, Grisim added.

Ongoing education for nurses already in the profession also remains a key part of closing gaps in health systems’ nursing needs.

By some estimates, there’s not a projected nursing shortage, so much as a projected “experience gap,” said Simmy King, nursing director for clinical information systems and professional development at the Children’s National Health System in Washington, D.C.

That’s in part because as experienced nurses are hitting retirement age, they’ll increasingly be replaced by less experienced nurses—taking years of expertise with them. “We have nurses who have been at the bedside and teaching for decades, if not longer, and nearly half of that workforce is approaching retirement,” the ANA’s McMillan said.