Think Tank Addresses Nurse Staffing and Working Conditions

Nurses leaving the bedside isn’t a new issue. But over the past two years, hospitals have seen nurse staffing reach critical levels.

“The COVID-19 pandemic exacerbated the pre-existing crisis,” said Sarah Wells, MSN, RN, CEN, CNL, an emergency room nurse and founder of New Thing Nurse in Oakland, California. “We’re seeing nurses experience historic levels of stress and work strain.”

Wells was part of the Nurse Staffing Task Force and Think Tank launched this past January by the Partners for Nurse Staffing, a collaboration between the American Association of Critical-Care Nurses (AACN), American Nurses Association (ANA), American Organization for Nursing Leadership (AONL), Healthcare Financial Management Association (HFMA), and the Institute for Healthcare Improvement (IHI).

The think tank convened six times between January and March 2022 and brought together key stakeholders, including front-line nurses, to develop a toolkit that offers actionable strategies to address staffing ratios, nurse stress and burnout, and other workforce challenges.

“We identified six priority areas — a healthy work environment, diversity and inclusion, work schedule flexibility, stress injury continuum, innovative care delivery models, and total compensation, and offered recommendations in each of these areas that can feasibly be implemented within a 12–18-month timeframe,” Wells said.

In each priority area, Wells said the think tank recommended actions, breaking each step down into targets, scope of impact, accountable entities, timeline, and measurable outcomes. They also outlined steps for implementing each action item.

“All of the partner organizations realized that we had to do something to mitigate nurse staffing issues, especially on the inpatient setting,” Wells said. “The think tank met six times from January until March to develop bold and innovative solutions that were then given to our Nurse Staffing Task Force.”

Insights from the think tank will now be used to guide the efforts of the Nurse Staffing Task Force, which launched in May. In this next phase, the task force will focus on driving the conversation on a national level to support the recommendations and address solutions to the nurse staffing crisis.

Wells, who served on the think tank and now the task force, said the task force will provide recommendations on how each of the priority areas can be best implemented and offer support and assistance to hospitals as they begin the implementation process.

“The task force is composed of nurses, healthcare leaders, and patient advocates who have a wealth of experience and can help drive change in terms of increasing nursing workforce diversity, supporting nurses in their jobs, and solving pay inequities,” said Wells.

“As implementation begins, it’s important to remember that this is a marathon, not a sprint, and there are no quick and easy solutions as we strive for meaningful change,” she said.

As hospitals begin to address ways to meet the task force’s recommendations for recruiting and retaining nurses, some hospitals have emerged with alternative care models that could be easily implemented.

Several medical centers across the country began a voluntary paid program called Helping Hands over the past year. This opt-in, flexible staffing program allows bedside nurses to focus exclusively on patient care by assigning unlicensed assistive personnel and administrative staff to relieve nursing staff of non-nursing tasks such as answering phones, and transporting and observing patients.

Creating a healthier work environment for nurses

Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, CCTP, ANA Director of Nursing Programs, said now that the think tank’s recommendations have been finalized, the task force is working to set the course forward.

“We’re talking with nurses, nurse leaders, hospital leaders, and all key stakeholders and sharing the actionable strategies,” Boston-Leary said. “All of our recommendations are evidence-based, practical steps that don’t require a lot of money to implement.”

Boston-Leary notes that many front-line nurses don’t feel heard, but the think tank’s recommendations will allow nurses to help drive change by including them in all stages of planning and implementing innovative models for care delivery models, and more.

“We’re looking at making the work environment healthier for nurses and also improving staffing standards,” Boston-Leary said. “Our recommendations aren’t just for the immediate future, they also set the course for how we can move the nursing profession forward.”

Pamela Cipriano, PhD, RN, NEA-BC, FAAN, president, International Council of Nurses and a Professor of Nursing at the UVA School of Nursing in Charlottesville, Virginia, said eliminating workplace violence and offering nurses increased flexibility are two examples of the task force’s recommendations.

“Nurses have reported feeling powerless against increasing rates of physical violence,” Cipriano said. “Our recommendations address ways of implementing strategies such as developing and enforcing anti-violence principles, policies, and prevention for employee protection on an organizational level.”

Some hospitals have started putting signs in place stating that assaulting or abusing a healthcare worker is a serious crime. They are also implementing policies whereby violent acts that occur against staff members on hospital property must be reported to local authorities within 24 hours.

Lawmakers in several states are currently pushing for legislation to make attacking a healthcare worker a felony, the same penalty for attacking a police officer or other first responder.

Creating a healthy work environment is critical to retain nurses, according to a survey published this year in the journal Critical Care Nurse. The survey reported that most nurses said they had appropriate staffing levels on their unit less than half of the time. In addition, as staffing problems increased, nurses expressed dissatisfaction with their jobs. Two-thirds of nurses surveyed said they planned to leave their current job within the next three years.

“Nurses have been clear that they aren’t going to put up with the present working conditions,” Cipriano said. “It goes beyond adequate staffing numbers — nurses want to feel safe and supported in their work and have access to flexible schedules that allow them to avoid mandatory overtime and burnout.”

The think tank identified the health of the work environment for nurses as one of the top priorities and identified actions that hospitals can implement to ensure the physical and psychological safety of nurses and their colleagues.

To maintain direct care, the group recommended options for flexible scheduling, including variable start times and shift durations for nurses. In addition, they recommended increased opportunities for cross training and expanding float pools, as well as mandatory scheduling for staff breaks and professional development.

Cipriano said it’s important that hospitals pay attention to the think tank’s recommendations, noting that if no actions are taken, there will be more patients needing care than nurses available to provide it.

“Nurses are the key ingredient to maintaining the integrity of our health systems,” she said. “It’s important that health leaders realize that investing in their workforce and nurses’ well-being is the best way to deliver quality care. Nurses play an integral part in providing cost effective solutions and comprehensive care.”

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