Nursing shortages feature prominently in news reports[1] and studies of the healthcare sector. Many see it as a crisis that threatens care availability and quality. It was a key issue at the NoCo (Northern Colorado) Health Sector Quarterly All Partnership Meeting last week. It was also the central concern at NoCo’s Healthcare in Your Future Summit last November[2]. The shortage affects all practice areas from the ER and OR to doctors’ offices. The impacts extend beyond provider facilities. Nursing shortages also undermine community efforts to expand care, attract new providers, and prepare for future disasters. In this context, Covid was a wake-up call.
The emerging crisis
Talent shortages are not limited to healthcare. Other industries have faced and overcome similar problems. Still, healthcare faces unique challenges from high attrition due to record early retirements and nurses leaving the profession. Nurses point to burnout caused by working conditions that were aggravated by the Covid pandemic. Industry experts and many State authorities are predicting thirty to fifty percent attrition among front-line nurses in the next three years. If these trends continue, then we will soon have more patients in need of care than there are nurses available to help them[3].
Finding solutions
OPRHealth began studying nursing shortages over three years ago. We discussed the emerging crisis with clinicians and providers in the US and overseas. Some providers learned valuable lessons from industries that experienced similar talent shortages. Most relied on technological and business model innovations to improve efficiency and workforce productivity. They had few alternatives other than competing for scarce talent by raising salaries to unsustainable levels. It happened during the pandemic when the costs of temporary nurses skyrocketed above $300 dollars per hour.
Technological Innovation Solution: Case Study
Employers in industries experiencing long-term talent shortages must increase efficiency and workforce productivity to remain competitive. Technological innovations have been indispensable, but insufficient, for this purpose. Business model innovations are also indispensable because they influence how innovative technologies are used. For example, studies show that nurses can spend over a third of their time performing bureaucratic duties including paperwork and entering patient vitals into EHRs[4],[5]. These activities are managed and performed within established protocols that are components of each facility’s business model.
Innovative technologies don’t always change business models and workflows. Some make tasks easier without saving much time or improving quality. For example, the Sphygmomanometer used to measure blood pressure has been improved in terms of materials, design, and ease of use. Yet, the legacy cuff-based process remains largely the same: a pressure cuff on the upper arm inflates until the brachial artery is crushed and blood flow stops. Then the pressure is slowly reduced until the clinician or a sensor in electronic versions detects signs of systolic and diastolic blood flow. These are referenced to the displayed blood pressure to obtain their value. Pulse rate is also captured by this process, which has remained largely unchanged for over a century[6].
Biobeat's cuffless blood pressure and cardiovascular sensor is shown over legacy sphygmomanometers dating from the 1920s through 2022. The small
sensor weighing less than one ounce represents the first major upgrade in
accuracy, comfort, and capability in over one hundred years.
Sensor-artificial intelligence revolution
Biobeat’s disposable, cuffless blood pressure and cardiovascular sensors measure 3.3 by 3.3 inches and weigh about an ounce. They are worn as a sensor patch on the upper chest and as a wrist monitor. The FDA-listed sensors continuously capture and process an unprecedented panel of physiological vitals. These include respiration rate, temperature, blood oxygen saturation (SPO2), ECG, pulse rate, pulse variability, blood pressure, cardiac output, systemic vascular resistance, and stroke volume. Measuring frequency is configured for each patient from every five seconds to several times per hour. Readings can also be triggered from connected stations. Measurements are automatically uploaded to the EHR. Clinicians can securely access current measurements and review their history from local and remote stations.
Biobeat recognized that clinicians often struggle interpreting large sets of measurements. So, it formatted displays to be compatible with clinical workflows. Monitored patients are scored, ordered, and displayed accordingly. Configurable alarms attract attention to those with deteriorating conditions and highlight measurements that exceed alarm settings. Clinicians configure which and how patient vitals are displayed on their devices and can easily zoom in for more detailed measurements.
This innovative process reduces the time nurses spend measuring and entering patient vitals into EHRs. They also benefit from evaluating trends that better convey patient status. Continuous patient scoring highlights those who require immediate attention, which helps them respond where they are needed most.
Providers can leverage these innovations to improve efficiency and workforce productivity. They can also leverage continuous monitoring to improve care delivery and quality. Time motion and other studies can help identify opportunities to better manage nursing schedules and lower stress. The process can lead to continuing business model innovations to improve the quality of care and working conditions.
Tech, innovation, and attrition
Technological and care delivery innovations can help reduce nursing burnout. For example, reducing paperwork and bureaucratic overhead leave more time to focus on patients. Time-consuming tasks including countless cuff-based blood pressure readings are reduced. Static readings are replaced with trends that better convey patient conditions. These innovations in patient monitoring can help nurses work more closely with doctors.
Improved productivity and process efficiencies can help providers shape schedules to reduce work-related stress. Nurses who left the profession reported burnout as a major contributor. They point to long hours and stressful conditions as underlying causes[7] in their decision to retire and switch jobs. Technological and business model innovations can help providers and clinicians work together to improve patient care and working conditions.
Summary
The nursing shortage became a nursing crisis during the Covid pandemic. Causes include high attrition due to retirements and burnout and limited nursing school capacity[8]. Increasing the number of trained nurses will take years. Providers need practical, short-term, financially sustainable solutions to cope with the shortage.
Our three-year effort identified practical solutions based on innovative technologies and business model innovations. They can help providers improve efficiency, workforce productivity, and quality of care. They can also reduce nursing burnout by improving working conditions. Innovative technologies like Biobeat's sensors and monitors may also attract more young people to the profession. These findings and conclusions align with our previous experiences helping employers across industries cope with talent shortages.
For more information see Biobeat Cuffless Blood Pressure Monitoring, Ambulatory Profiling, and Remote Patient Monitoring Solutions on our Documents page.
Providers and clinicians can contact us for more information and demonstrations through our website and directly by reaching out to me at ozzie@oprhealth.com / 1+303-332-5363.
References
[1] Julia Haines, The State of the Nation’s Nursing Shortage, November 1, 2022, U.S. News and World Report, https://www.usnews.com/news/health-news/articles/2022-11-01/the-state-of-the-nations-nursing-shortage [2] Ozzie Paez, 2022 Healthcare in Your Future Summit, December 6, 2022, OPRHealth, https://www.oprhealth.com/post/2022-healthcare-in-your-future-summit [3] Gretchen Berlin, Meredith Lapointe, Mhoire Murphy, and Joanna Wexler, Analysis suggests potential instability and workforce gaps in the US healthcare sector, March 11, 2022, Healthcare Insights, McKinsey & Company, https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce. [4] Op cit, Ozzie Paez, 2022 Healthcare in Your Future [5]Yen PY, Kellye M, Lopetegui M, Saha A, Loversidge J, Chipps EM, Gallagher-Ford L, Buck J. Nurses' Time Allocation and Multitasking of Nursing Activities: A Time Motion Study. AMIA Annu Symp Proc. 2018 Dec 5;2018:1137-1146. PMID: 30815156; PMCID: PMC6371290. [6] Ozzie Paez, Defeating Hypertension, September 8, 2022, OPRHealth, https:// www.oprhealth.com/post/defeating-hypertension [7]Shah MK, Gandrakota N, Cimiotti JP, Ghose N, Moore M, Ali MK. Prevalence of and Factors Associated With Nurse Burnout in the US. JAMA Netw Open. 2021 Feb 1;4(2):e2036469. doi: 10.1001/jamanetworkopen.2020.36469. Erratum in: JAMA Netw Open. 2021 Mar 1;4(3):e215373. PMID: 33538823; PMCID: PMC7862989.
[8] Lisette Hilton, Nursing schools report hurdles to expanding enrollment, March 2, 2022, Nurse.com, www.nurse.com/blog/nursing-schools-report-hurdles-to-expanding-enrollment/
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