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Jun 2019

Nurses’ Critical – and Often Overlooked – Role in Provider and Patient Health

A Washington State senator recently garnered national headlines and created a social media storm when she said that nurses “probably play cards for a considerable amount of the day.” People were so incensed – and justifiably so – by this unfair and patently false characterization of nurses that they sent her decks of cards (close to 700 at one count) in protest. They also suggested that she shadow some nurses to see what they really do during their often 12-hour-plus shifts.  The Senator, Maureen Walsh (R), quickly apologized for her comment and said she would be delighted to work side-by-side with nurses to get firsthand experience of their daily professional life.

The truth is that nurses, far from playing cards all day,  play a critical role in assuring the physical and emotional health of patients as well as the financial and operational health of providers.  

Nurses and Community Health

It’s not an exaggeration to say that nurses literally make the difference between life and death for patients in all healthcare settings.  Whether in an acute care facility, a skilled nursing facility, a patient’s home or a community clinic, it is the nurse who is on the frontline of administering and monitoring a treatment plan.  In my opinion, no other member of the healthcare team has such broad and far-reaching roles as nurses.

Nurses are also a patient’s best advocate since usually, not even a patient’s family member knows more about a patient’s progress.  They also are usually the ones who will first notice health warning signs and communicate these to doctors. Many times, it is the nurse who makes a case to physicians and provider administrators to take a specific course of action to better treat a patient.  

A key element in helping patients, and their communities get and stay well is health education.  Again, it is the nurse who is usually tasked with working with patients and their families on after-care plans at the time of discharge, including how to take medications, continue with any rehab activities, adopt healthier eating habits and how to practice surgical or other wound care.  This education extends to community health education with activities such as new parent workshops, elder care, community center seminars, home visits and even health education in our schools. Nurses also educate the next generation of nurses therefore helping to ensure a continuity of the profession.  Many are actively involved in contributing to research on how to improve patient care and treatment outcomes. 

And last, but certainly not least, nurses provide invaluable emotional support to patients, their families and friends, ranging from how to handle an unexpected diagnosis to coping with death and dying.  This support can make a difference not only in the emotional health of patients and families but also in the eventual success of a treatment plan.

This role that nurses play, and how well they do it, does not go unnoticed by the general public.  Multiple studies have shown that nurses are the most trusted healthcare professionals. A recent Gallup poll showed that nurses have the highest rating for honesty and ethics with some 84 percent of Americans indicating high or very high levels of trust.  

Nurses and Provider Health

The bottom line is that nurses (especially in adequate numbers) are essential for the smooth running of our nation’s healthcare system and they make a significant contribution to the viability and profitability of providers.  Their interactions with patients, and their management of treatment plans, can play a key role in determining such metrics as patient satisfaction, survival and recovery rates, readmissions rates and payor reimbursement levels, all of which directly impact a provider’s operations and balance sheet. 

This claim is borne out by a variety of studies that show a demonstrable link between nurse-to-patient ratios and treatment outcomes, including patient mortality and readmission rates, and patient satisfaction rates.  One study suggested that the risk-adjusted 30-day mortality and failure-to-rescue rates of surgical patients increased by seven percent for every patient added to a nurse’s workload.   Other studies reinforced this finding by showing that a higher proportion of nurses was associated with lower patient mortality rates.  Combined, these studies have shown that adequate nurse staffing levels lead to better outcomes for both patients and nurses without negatively impacting provider financial performance.  A true win-win. 

Given this data, it’s clear that nurses provide one of the best returns on investment for a hospital’s staffing expenditures, and reducing nursing staff headcount to save costs could be counterproductive in the long run. In fact, maintaining adequate staffing levels usually contributes to improved provider financial performance. 

Critical Nursing Shortage Threatens Patients, Providers Alike

Arguably, the single biggest threat facing providers – and the health of the communities they serve – is the current shortage of nurses to which no short-term end seems in sight.  According to the U.S. Bureau of Labor Statistics, more than 1.1. million additional nurses will be needed to avoid a further shortage. This need is so dire that employment opportunities for nurses are projected to grow at some 15 percent – faster than all other occupations – for the next seven years.

There are a variety of factors contributing to this ongoing shortage, including:

  • An aging population that requires more care as life expectancies continue to increase – this same aging impacts the universe of nurses, many of whom are approaching retirement age themselves
  • High turnover of nursing staff of between nine percent and almost 40 percent, depending on region and nursing specialty due, in great part, to job burnout
  • Violence in healthcare settings continuing to play a role in the shortage given the ever-present threat of emotional or physical abuse, which makes an already stressful environment even more so
  • Technology that requires additional training or that requires that nursing resources be diverted from patient care to administrative responsibilities
  • Nursing school enrollment not keeping pace with need; not enough instructors at nursing schools which limits capacity

The shortage has a direct impact on both patient care and provider operations.  For patients, fewer nurses usually results in a decrease in quality of care with a corresponding impact on treatment outcomes including patient mortality.  For providers, having to increase nurses-to-patient ratios has been shown to increase readmission rates, increased urinary and surgical site infections, longer hospital stays and higher mortality rates.  

The resulting burn-out also increases turnover, resulting in avoidable additional expense. These costs can be truly staggering.  The American Organization of Nurse Executives, for example, estimates that turnover costs hospitals over $9 billion annually, much of which could be reduced if providers did a better job at retaining their current nursing staff.  Providers also should neither overlook the increased risk of malpractice lawsuits resulting from patient dissatisfaction nor the negative reputational impact, both of which could have financial consequences. 

What Providers Can Do

Given that the nursing shortage is not about to end any time soon, the best thing providers can do to reduce its impact on their operations and patient health fall into three key areas:

  • Maximize the value of recruitment efforts by including digital platforms, reference bonuses (that do not necessarily need to be monetary), community seminars that attract potential candidates, and enhanced candidate tracking especially of those who may decline an employment offer
  • Take tangible steps to reduce turnover, including reducing workloads, empowering nurses to make decisions, shared governance programs, more flexible scheduling, having a strong culture that increases loyalty and feeling of ownership/belonging, expanded training, soliciting feedback and taking action on it
  • Work with local nursing schools on student recruitment and capacity through such initiatives as student scholarships, strategic community partnerships, and mentoring programs, fellowship programs for nurse instructors

Given the important, and often unsung, role that nurses play in keeping our communities healthy, and in ensuring the hospitals and other providers are able to do so, they deserve support and thanks not only during the month of May, but every day.  There isn’t a better investment a provider can make.

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