More than 100,000 registered nurses (RN) left the workforce in 2021. This is the largest drop in certified RNs over the past 40 years. Many have pointed to the increasingly heavy workload that nurses have to shoulder as one of the primary reasons for an exit. And that’s worrying. Until 2020, the number of nurses entering the workforce was almost enough to replace historic exit rates. And yet, those numbers were already falling short of the projected increases needed to keep up with aging populations, the rising rates of chronic conditions in the U.S.[i], and the growing number of people who require complex care. These pressures have created a feed-forward loop of bad staffing ratios and heavy workloads, which are now contributing to faster burnout and higher exit rates. What does this mean for healthcare? On the one hand, care delivery models have to adapt to the needs of the humans who deliver care by reducing workplace burdens and increasing satisfaction. At the same time, we need to get used to the idea of doing more with fewer (human) resources and finding ways to do this that ensure the processes, workflows, and technologies used prioritize the “human touch” of interaction between patients and their clinical care teams.
In a survey of nurses conducted by McKinsey in late 2022, the top three considerations that influenced decisions to stay in or leave their current position were all “human factors:” meaningful work, positive interactions, and caring and trusted teammates. At the same time, two of the top four reasons for leaving a job were related to working conditions: work-life balance and unmanageable workload. The other two were compensation and not feeling valued by the organization. Workplaces that actively try to fulfill these needs will be better placed to meet the challenges of the labor market, both now and moving forward.
Happy people = turnover reduction
Initiatives to make friendlier workplaces can range from the technologically complex to the simple. On the simple end, initiatives like Getting Rid of Stupid Stuff (and see Dr. Craig Joseph’s blog on the brilliance of GROSS) can reduce the more meaningless parts of work that contribute to burnout by giving staff a simple process for tackling issues directly. Investing in learning and development upskills staff, makes them feel valued, and helps them progress in their own careers at the same time as adding value for their employers. An important trend in the industry has seen spending on learning and development reach an all-time high in 2023, nearly doubling since January 2020, an undoubtedly positive development. At the more complex end of the scale, healthcare team management platforms can streamline monitoring and management for nurse leaders while providing a way to identify and then recognize staff achievements with digital notes and cards. A recent pilot of one such platform showed that a single high-quality interaction per team member per month can reduce turnover by as much as 36%.
While initiatives like these can play a critical role, improving retention and recruitment is only half the battle. During the pandemic, emergency measures across the industry helped to keep labor pressures lower than they otherwise would have been. With the ending of these exemptions on May 11, some major barriers to staffing have returned, including the requirement for increased oversight in many nursing roles, the loss of the flexibility that came with the suspension of state licensing requirements, and the return of a range of certification burdens. While we don’t know exactly what effect these changes will have on staffing shortages, we can be sure they certainly won’t make life easier. The long-term picture is even more concerning, with the rapidly increasing incidence of chronic conditions and complex cases adding a steady stream of pressure to staffing needs. These shifts in the healthcare landscape make it more urgent than ever to find ways to do more with less rather than assuming that workforce stresses will revert to the mean over time.
Tech advances reap rewards
Responding effectively to these challenges means making the most of the current wave of technological advances that are now reaching the point of usefulness. While the introduction of large language models like GPT-4 in healthcare are still nascent (to say nothing of legal venues!), other forms of machine learning are already being deployed to make scheduling and staffing easier for clinical care members. This adoption goes further, where machine learning is now assisting with rapid tumor identification during brain surgery. As healthcare takes steps to adopt technological advances, we should look to automate as many simple, repetitive tasks as possible to free up staff time and reduce unnecessary burdens. As Lyle Berkowitz, CEO of KeyCare said in a recent podcast: “If something is rules-based, then you should be able to automate and delegate it.”
Technologies that support remote and flexible working have an important role to play in resolving the industry’s labor pains. With data from the pandemic confirming that telehealth is an effective way to deliver care, this tool can be harnessed both to offer flexible working options (cited by 62% of nurses as an important factor in deciding whether to stay in a job) and to ensure that services can be scaled up and down rapidly to meet needs without relying on expensive contract labor. The remote delivery of certain types of care can also have long-term effects. The Centers for Medicare and Medicaid Services Chronic Care Management program, for instance, incentivizes providers to offer remote services for patients with two or more chronic conditions. Providing better, more easily accessible information and support can help increase medication adherence and patient compliance, in addition to serving as a foundation for preventive efforts. Programs like this have the potential not only to reduce patient visits now but to help turn around the trajectory of increasing chronic care needs.
We need to implement these changes with care. A human-centered approach to designing processes and workflows is needed to ensure that the use of technology enhances, rather than detracts from, the patient and staff experience. However, the need to get the design process right is not a reason to stall. There is too much at stake to just stand still. The healthcare industry has traditionally been slow to adopt innovations due to regulatory hurdles, concerns that any change might upset the delicate balances supporting patient health, and, of course, good old-fashioned small ‘c’ conservatism. But as we come out of an unprecedented healthcare emergency, there couldn’t be a better time to shake things up. We’ve all become used to doing things a little differently over the last few years, and we shouldn’t let that flexibility go to waste.
[i] Ansah JP, Chiu CT. Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health. 2023 Jan 13;10:1082183. doi: 10.3389/fpubh.2022.1082183. PMID: 36711415; PMCID: PMC9881650.