Yale New Haven Hospital anticipated in March it would soon need as many as 500 more beds to treat an expected influx of coronavirus inpatients. Although the 1,540-bed Connecticut teaching hospital used staffing agencies in part to help with the heightened demand, the closure of operating rooms and clinics presented an opportunity to leverage those nurses, too.
In a matter of weeks, front-line nurses at Yale New Haven created a new staffing model relying on the competencies of nurses across the system to determine which units they should be assigned to and what roles they could perform safely. The result is a new option for leadership to deploy going forward on units that are understaffed or overwhelmed.
“Our model now is no unit left unstaffed,” said Ena Williams, chief nursing officer of Yale New Haven Hospital. “In the old days, we would send (the nurse) home if they were not an ICU nurse, but now we are saying: You don’t have to go home, you can function in this support role and here is how you can do that.”
The model assigns nurses colors based on their skill level and expertise. Red represents a current intensive-care unit nurse; orange is nurses with ICU experience within the last three years and yellow is nurses with ICU expertise more than three years ago. Blue indicates nurses who work on medical-surgical units, while pink is med-surg or ambulatory nurses who haven’t practiced in more than a year. Nurse’s aides, patient-care assistants and technicians are assigned the color purple.
Yale didn’t have the information readily available to appropriately assign nearly 400 nurses to a color, so staff had to reach out to managers asking about the experience and competencies of their staff, a time-consuming process and big learning experience, said Jeannette Bronsord, executive director of surgical services.
Now Yale is working on maintaining a database of all nursing staff. An email has been sent to nursing staff to validate the data collected and Yale plans to ask staff to review it regularly. “Going forward we will be much more prepared,” Bronsord said.
During Yale’s surge, nurses assigned the color red acted as primary nurses on the COVID-19 ICU units and nurses assigned the colors orange and yellow acted as their support nurses, available to get supplies, bathe patients, check vital signs, administer medication, offer emotional support to patients and conduct video visits with family. On the medical surgical units, nurses assigned the color blue acted as primary nurses while those assigned pink were support nurses.
The support nurses and staff received training, developed by Yale staff, before heading into the units, including a day to shadow a nurse to understand the workflow, a crash course on the inpatient electronic health record and simulated lab time to reiterate clinical skills such as fall and ulcer prevention practices.
The model went through iterations in its first few weeks, Williams said. Initially, staff received their assignment to a unit and team the same day as their shift, but that generated complaints from nurses that they weren’t forming bonds with team members. In response, nurses were scheduled more consistently with the same staff and units. About 370 nurses were involved in the new staffing model by the end of Yale’s COVID-19 surge in June. And the hospital added about 380 beds at its peak.
Nurses have responded favorably to the experience, Williams said, with some nurses even staying on ICU or med-surg units after operations returned to normal. Some nurses also moved up in color assignment as the pandemic wore on.
Williams said the key to success was front-line nurses leading the model’s development. The nurses “were part of the design; they were right at the table at the very beginning and because it was built for them and with them, the adoption was so much easier,” she said. “I thought it was going to be mayhem, but they responded brilliantly.”