True or false: the US suffers from a severe RN shortage which shows no sign of abating? The surprising answer, according to Jane Muir, PhD, APRN and her collaborators at the Leonard Davis Institute of Health Economics and the Center for Health Outcomes and Policy Research, School of Nursing, both located at the University of Pennsylvania, in an April 9 article in JAMA Network Open, is "false".
Wait. What?
Dr. Muir and her colleagues make the point that "...the US has never had more actively licensed nurses than it does today (5.6 million), with record-breaking graduations from nursing schools and a robust workforce forecast on the horizon, including encouraging growth projected to outpace retirements during the coming decade." Problem solved, yes? Not so fast. Muir et al go on to say "...the current nursing care crisis will not be resolved by producing more nurses because the US already has a healthy supply. Instead, solutions to the care crisis need to address the central reasons why health care employers are failing to attract and retain the current supply of nurses." And the employers which are experiencing the most difficulty retaining RN's? Hospitals. In fact, with an average annual turnover rate in hospitals of approximately 17% and 40% of RN's saying they intend to leave their employer in the next year, the nurse staffing crisis for hospitals looms large. If it's not a supply issue, then what's behind the headlines shouting "RN shortage"?
What's Behind the Headlines Shouting "RN Shortage"?
As regular readers of this blog will recall, while pay and benefits matter (especially when it comes to applying for a new job), the factors which impel one to remain with an employer are largely intangibles: does one feel seen, heard, and valued? Can members of the care team work at or close to the top of their license? Do leaders, starting with one's direct supervisor, show a personal interest in members of the front-line care team? Are staff given an opportunity to have meaningful input into their workflow, work environment, work schedule, and opportunities to improve them? Do they feel safe?
In a study of nearly 8,000 nurses in New York and Illinois between 2018 and 2021, the authors concluded "nurses primarily ended health care employment due to systemic features [emphasis added] of their employers." Systemic features or issues, of course, are what result in burnout and which fuel turnover. Burnout is not a medical condition but rather an occupational one; that is, it is an individual response to systemic issues in the workplace. As the authors of the JAMA Network Open article point out, "Nurses in the current study cited burnout as a primary contributor to leaving health care employment, and numerous other studies have linked better work environments to lower nurse burnout".
The conclusion of this former hospital CEO? If hospital leaders hope to change their current difficulty in recruiting and retaining nurses, hospital leadership teams will need to rethink organizational priorities; change the extent to which they seek out, deeply examine, and act upon systemic issues in the workplace; and recalibrate how they choose to spend their limited time and attention.
Organizational Wellbeing Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus to curing clinician burnout and staffing shortages runs through the c-suite. Here are examples of leadership-driven changes my colleague Paul DeChant, MD, MBA and I often recommend:
regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
create and require leader standard work (LSW).
develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.
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