Sep 14 2021

How Technology Can Alleviate Effects of the Nursing Shortage

Telehealth, artificial intelligence and texting are some of the tools that make daily workflows easier for nurses and nurse practitioners amid a shortage of clinicians.

Demand for nurses and nurse practitioners (NPs) is on the rise due to an aging population and workforce and, in the past year and a half, increased strain on the healthcare system caused by COVID-19 cases. In August, Tennessee deployed members of the National Guard to help hospitals fill staff shortages amid a surge in cases.

In addition, the U.S. could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, according to data from the Association of American Medical Colleges, meaning clinician shortages aren’t expected to go away.

The shortage is putting a strain on clinicians and hospital systems, but technology implementation can alleviate some of this pressure by improving workflows or making patient care easier.

What Effect Is the Pandemic Having on the Nursing Shortage?

The American Nurses Association recently wrote a letter to U.S. Department of Health and Human Services Secretary Xavier Becerra urging him to declare the nurse staffing shortage a national crisis.

“Nurses have remained steadfast on the front lines since the beginning of the pandemic, while overcoming challenges, risks to their personal health and safety such as limited personal protective equipment and the physical, emotional and mental health burden of the COVID-19 virus,” reads the letter. “Now, the Delta variant is causing cases to soar, overrunning hospital and staff capacity. These current circumstances have only exacerbated underlying, chronic nursing workforce challenges that have persisted for years.”

April Kapu, president of the American Association of Nurse Practitioners and associate dean for clinical and community partnerships at Vanderbilt University School of Nursing, also points out that the nursing shortage has been going on for years — the pandemic merely exacerbated it.

“It’s simple math. You need a certain complement of nurses and NPs caring for patients to provide high-quality care, but hospitals are completely full, so you’ll certainly have shortages,” she says.

Nurses and NPs are experiencing growing exhaustion and burnout from over a year of caring for patients in hospitals, clinics and patients’ homes, in addition to worrying about their own health and that of their families.

“Now they’re having to work overtime because we have sustained staffing shortages. We’re seeing a higher number of professionals, especially nurses and NPs, going into different types of jobs or leaving the profession altogether,” says Kapu.

Technologies Improve Nurses’ Daily Workflows

Several technologies are helping to alleviate the shortage’s effects on nurses and NPs by improving efficiencies in their daily workflows and how they care for patients.

Telesitting: Traditionally, a sitter, caregiver or nurse would be assigned to supervise patients at risk of falls or any other type of injury. However, having a 1-to-1 ratio of clinicians to patients is difficult to maintain amid a nursing shortage, not to mention the staffing cost, according to an article published by Harvard Law School’s Bill of Health website. Telesitting technologies allow one nurse to monitor several patients using cameras that provide live video and audio.

Telesitting technologies can be especially useful for senior care, freeing up nurses to provide more quality care.

Telehealth: Prior to the pandemic, many providers and patients were uncomfortable with telehealth technology, according to Kapu. The necessity of telehealth during the pandemic not only increased adoption but also led to a rise in comfort levels for those using the technology, she says, and now telehealth allows nurses and NPs to see more patients in a day.

It also gives nurses and NPs the ability to visually assess patients, providing a safe way to check in on how those with COVID-19 are doing. Kapu describes an NP who had a televisit with a patient in their early 20s who was experiencing shortness of breath but wasn’t sure if it warranted a trip to the ER. The NP asked the person to walk across the room, but they were so out of breath after walking half the distance that they had to stop. Upon seeing that, the NP told the patient to go to the ER.

READ MORE: How technology eases nurses’ day-to-day duties.

“It was lifesaving for that younger person. Without the visual image, it might not have been caught,” says Kapu. “That insight is hugely valuable, and telehealth has opened up a new level of care.”

Blockchain Credentialing: For clinicians working at multiple organizations, electronic or blockchain credentialing can make the process of receiving approval to work at a specific location much easier.

“If it’s electronic, it’s so much faster than having to do everything on paper, which can take 90 to 120 days. With electronic systems, it’s substantially faster,” says Kapu.

According to NursingCenter, blockchain credentialing allows for a nurse’s credential data to be stored on multiple servers, rather than just a single server, allowing organizations to see entries in real time. This creates a public electronic ledger, making it easier for healthcare organizations to look up a nurse’s credentials and speed up approvals.

    Mobile Staffing Apps and Staff Augmentation: “Staffing tools are huge,” says Kapu. “Because of the shortage, we have to be very efficient with our staffing. We have to modulate the staffing based on patient volume and acuity. So, staffing tools are incredibly important to ensure we’re not overstaffing that very precious resource or understaffing and unable to provide enough staff to care for patients.”

    Staffing tools allow nurses and NPs to see a hospital’s schedule, sign in, swap a shift or pick up holidays, Kapu explains.

    Staff augmentation allows healthcare organizations to supplement their support staff through third-party staffing to ensure operations run smoothly. With staff augmentation, clinicians are better able to focus on patient care and complete their day-to-day tasks efficiently.

    Artificial Intelligence: AI is often applied within healthcare to make sense of clinical data by identifying trends that can lead to better patient outcomes. Algorithms can be used to assess fall risk or detect tuberculosis in chest X-rays.

    Nurses are often the ones using these algorithms, and it’s important for them to understand how they work and how AI can be used to improve workflows and patient outcomes.

    “I’d like to hear nursing staff identify inefficiencies they deal with and think about the things AI and machine learning would be helpful in improving, allowing them to spend more time with their patients,” Dr. Erich Huang, former chief data officer for quality at Duke University Health System, told HealthTech earlier this year.

    DISCOVER: Why ‘nurses are essential’ to AI integration in healthcare.

    Huang, now chief science and innovation officer at digital health company Onduo, added that all clinical staff need to be included in the development and selection of these AI-based apps.

    Texting and chatbots are also on the rise, Kapu points out, in part due to new AI programs. After patients answer a few questions, the AI connects them with the right type of provider for a consultation.

    “We’re seeing this used a lot with mental health,” she says. “People feel more comfortable with texting and AI than they would on a phone.”

    What Will It Take to End the Nursing Shortage?

    While technology can help healthcare organizations reduce the burden on nurses and NPs, Kapu says getting more clinicians into the workforce is the best way to mitigate the shortage. She says more federal and state funding is needed for nursing education.

    “We also need states to update their laws. Only 24 states and Washington, D.C., have full practice authority for nurse practitioners,” she says. “The other states have restrictive laws under which NPs cannot practice to the full extent of their education and training. That limits access to care and limits what they can do.”

    Better access to mental health counseling for clinicians, as well as paid time off, is another way to reduce nurse and NP burnout during the pandemic.

    MORE FROM HEALTHTECH: Include nurses in the conversation to reduce EHR burden.

    “At the beginning of the pandemic, we saw a flood of general goodwill from the community, which provided meals, cases of water, hand lotion and sanitizer. Our practitioners felt buoyed up. But that’s not pouring in anymore,” says Kapu. “Now, 20 months later, we’re seeing the wear and tear of caring for very sick patients. It’s emotionally and psychologically distressing for nurses. Many have been liaisons for families who can’t come in to see their family member. NPs have been acting as a go-between, setting up a line of communication for families who are asking the NPs why they aren’t trying everything. The NPs tell the families that they are doing everything they can, but the families can’t be there to see it.”

    She explains that many clinicians can’t take care of their own basic needs, such as food, water, exercise and sleep, due to the workload, which is why time away and mental health support are needed.

    In its letter to Secretary Becerra, the ANA pointed out that the nursing shortage isn’t one that nurses can solve alone. The organization requested that key stakeholders from all segments of healthcare be convened to address the nursing shortage by:

    • Working with the Centers for Medicare & Medicaid Services on ways to promote payment equity for nursing services and remove unnecessary regulatory barriers
    • Educating the nation on the importance of the COVID-19 vaccine
    • Sustaining a nursing workforce to meet current and future staffing demands
    • Providing additional resources for nurses, including recruitment and retention incentives
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