A combination of patient surges in 2020-2022 and nursing shortages have forced healthcare organizations to pursue new strategies for care delivery, or alternative care models. Pre-pandemic care models are stretching thin during a nurse shortage, so many U.S. health systems are rethinking their labor resources.
Health systems are deploying alternative care models to address a nursing shortage, and its all-hands-on-deck! Team-based care is becoming a new reality. Team nursing allows for clinicians with varying skill levels to collaborate in providing patient-centered nursing care.
A team-based care approach brings together RNs, unlicensed assistive personnel, and LPNs with other disciplines (including physical therapists and rehab therapists.) By distributing appropriate duties to LPNs, UAPs, and less-experienced RNs under the direction of an experienced RN, a team-based care model has shown it can enable care settings to do more with less. Each unit will have to determine how many patients the experienced nurse/team leader can handle based on the acuity and number of patients.
A Case Study – Advent Health Celebration
Advent Health recently completed a study that looked at integrating LPNs to help nurses with care delivery needs (Click Here – The Impact of an Innovative LPN-RN Care Delivery Model). LPNs were hired into the acute care setting to work on a team-based nursing care model alongside RNs. Previous research provided evidence that LPNs’ unique skills can address escalated workloads, as well as enhance clinical outcomes and the quality of care provided. Advent Health’s research is evidence that implementing a new care delivery model can help address staff resource issues and provide adequate patient care.
Advent Health’s study also revealed that the model of care enhances the nurses’ work environment in the areas of autonomy, control over practice, and teamwork. Several campuses within Advent Health have now implemented LPN-RN programs. It will now start to develop standardized processes to train and orient more LPNs to enhance this model. There is some evidence that LPN models are not as effective in fast-paced/high turnover environments as those with longer patient stays, but the health system will continue to monitor this.
Besides altering care delivery to include unlicensed staff and moving to team-based care delivery, here are two other tactics to help fill in care gaps and minimize effects of a nurse shortage:
Cross-Training + Float Pools of Nurses/Staff
Hospitals are cross-training nurses in non-critical areas to fill labor needs on the critical care areas. Float pools can help to manage this issue. Utilizing and cross-training float pools can help redeploy labor resources easier and fast. This more agile labor model involves cross-training a pool to work across adjacent specialty areas and as a backup, having the full-time staff cross-trained to work across adjacent specialties in an emergency situation. This interdisciplinary team-based approach allows for rapid deployment of staff to areas of high need. Besides just helping with labor needs, when a hospital has more nurses trained to work in adjacent areas, it’s more feasible for staff to take time off and recharge.
If hospitals are only relying on staffing agencies to fill all vacancies it can be unsustainable and costly. Agency staffing should be used to fill in gaps, not the pillar for staffing an organization. For extra hands-on-deck, future care settings will likely collaborate with nursing schools and training programs (or even state and local governments) for unlicensed providers to increase the talent pool where the needs become urgent.
Strategic Investments in Staffing Data and Tech
Health systems are adding tech tools to handle labor-some tasks more efficiently. This includes robotics, telehealth, mobile-first technology, plus using professionals with specialized skills to minimize the supply issue.
Scheduling technologies allow for shift and vacation bidding to help balance personal and work life. Some acute care hospitals rely on manual scheduling models when handling day-to-day staffing needs, so this technology could be used more frequently.
Nurse leaders are saying that data is essential to adequate staff planning. It can help predict how many nurses are needed per shift/unit, minimize nurse frustration regarding assignments, identify staff issues such as burnout and weekend duty, and help justify budget requests.
For hospitals and health systems interested in nursing retention and healthcare career pathways, Catalyst Learning offers a variety of workforce development tools for your frontline team. Contact us at firstname.lastname@example.org or 502-584-7337.
“The Impact of an Innovative LPN-RN Care Delivery Model,” Advent Health Celebration, Marie L. Desir MSN, RN, CCRN-K, Deborah Laughon MSN-Ed, DBA, CCRN, CENP, AONL National Conference 2022
“Nursing’s Wakeup Call: Innovative Approaches to Talent, Technology, and Care Models,” Health Leaders Media, Anne Dabrow Woods DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, April 22, 2022
“The nursing shortage demands boldness and creativity. Now.,” Wolters Kluwer, April 1 2022
“Building Capacity in a Pandemic,: An Alternative Staffing Model,” AONL, Laura Jansen, MSN, RN, CNML, Kelly Poskus, MS, RN, CNRN, Jeannette Bronsord, DNP, RN, NEA-BC, Sept. 2020
“Bringing Back the Team Approach: It’s Time for Alternative Staffing and Onboarding Models,” Lippincott NursingCenter, Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, March 26 2020
“Cross-Training for Workforce Resiliency,” Minority Nurse, Michele Wojciechowski, September 14 2021
“Nursing’s Wake-up Call: Change is Now Non-Negotiatble,” Nursing Workforce Survey, UKG/Wolters Kluwer, Nursing Workforce Survey – Nursing’s Wake-up Call: Change is Now Non-negotiable (ukg.com)