August 19, 2019 | Modern Healthcare 17
unit. By combining these tools with the scheduling program,
Thielman said, Scripps hopes to provide demand forecasts
to proactively manage staff.
Distributing specialty talent where it’s needed
Telemedicine can take staffing flexibility further, providing
a way to help health systems distribute their specialty work-
force where they’re needed, regardless of location.
This past spring, Vanderbilt University Medical Center
launched a “virtual sitter” program from AvaSure, which
allows a single nurse to monitor multiple patient rooms us-
ing telemedicine robots set up at the bedside. The program
mainly observes patients who might have trouble getting out
of bed, such as those with dementia, to ensure they get sup-
port when needed.
“Instead of having to have one human being for one pa-
tient ... there can be eight of these robots deployed to eight
different patients, and have one central monitor,” said Karen
Hughart, Vanderbilt University Medical Center’s senior di-
rector of nursing informatics. The remote nurse can talk to
the patient from afar and flag staff on the floor if needed.
That’s not insignificant for Vanderbilt, an academic
medical center that’s been hit hard by nursing shortages.
“We’re really struggling with having not enough nurses,”
Hughart said. “That’s probably the No. 1 pressure that
we’re dealing with right now—trying to maintain our qual-
ity in the face of expansion.”
At Emory University Hospital, telemedicine has proved
particularly helpful for improving efficiency in the in-
tensive-care unit. Emory Healthcare in 2014 opened an
eICU—essentially a control room staffed by critical-care
nurses and physicians at its Emory St. Joseph’s Hospital
in Atlanta. These clinicians remotely monitor the status of
patients staying in ICUs across the health system 24/7, in-
cluding at Emory University Hospital, alerting on-site staff
in the event of an emergency.
The eICU also helps hospital units onboard and mentor
new critical-care nurses, by allowing experienced, remote
ICU nurses to consult with newer nurses on the floor. That’s
important, since roughly 20% of the nurses at Emory Uni-
versity Hospital will be eligible for retirement within the
next three years.
“We’re working to leverage the expertise of those (expe-
rienced) nurses,” Feistritzer said, noting that through the
eICU they can be available to “coach and support nurses in
real time.”
Retaining the nursing workforce
Much is made of the documentation burden among phy-
sicians. But nurses also shoulder a significant portion of this
administrative load.
One study of advanced-practice registered nurses found
that half of nurses agreed that EHRs added to their daily
frustrations, and insufficient time for documentation was a
strong predictor of burnout in the population, according to
research results published in the journal Applied Nursing
Research last year.
But technology isn’t always the enemy. In fact, tech can
help nurses be more efficient and practice at the top of their
license, said Victoria Tiase, director of research science at the
Value Institute at New York-Presbyterian Hospital.
Those initiatives can involve determining the minimum
amount of essential data points that need to be collected
from patients for their care, as well as figuring out how to
streamline patient assessments, she said.
Becky Fox, chief nursing informatics officer at Charlotte,
N.C.-based Atrium Health, expressed a similar sentiment.
Fox said she’s felt the impact of nursing shortages firsthand,
since the Southeast has been hit by them.
“We need to be able to leverage our technology to make
things as easy as possible for the clinicians that we have,” as
well as to help attract and retain nurses, she said. As part of
this effort, Atrium revamped its admission documentation
process. That means ensuring that all of the questions that
nurses are told to ask patients before admission are neces-
sary for patient care, and not seeking information that’s re-
dundant, focused on outdated regulatory requirements or
based on “best practices” that have since changed.
The process has saved nurses more than 4 million “clicks”
per year when documenting patient admissions, which
translates to more than 6,000 hours of saved time.
Stanford Children’s Health has embarked on a similar
project as part of its nurse retention efforts. Stanford Chil-
dren’s hasn’t been significantly impacted by the nursing
shortage, despite the fact that California is projected to have
one of the nation’s largest shortages by 2030.
Its nursing turnover rate is just 6%, said Lisa Grisim, the
health system’s associate chief information officer.
But to double down on nurse retention, Stanford Children’s
established a technology and informatics council made up of
14 bedside nurses. These nurses meet monthly to discuss how
technology could streamline workflows and improve efficien-
cies, and, like Atrium Health, one of its projects involved rede-
signing its admission documentation.
“The amount of documentation that was needed to be
done on admission was a huge burden for nurses,” Grisim
said. The project reduced the number of “clicks” it takes for
a nurse to complete admission documentation from 225 to
57, and brought down the time it takes to document from 32
to 12 minutes. In hourly nurse wages, that suggests Stanford
Children’s has saved more than $250,000 to date this fiscal
year, Grisim added.Building an experienced workforce
Ongoing education for nurses already in the profession
also remains a key part of closing gaps in health systems’
nursing needs.
By some estimates, there’s not a projected nursing short-
age, so much as a projected “experience gap,” said Simmy
King, nursing director for clinical information systems and
professional development at the Children’s National Health
System in Washington, D.C.
That’s in part because as experienced nurses are hitting
retirement age, they’ll increasingly be replaced by less ex-
perienced nurses—taking years of expertise with them. “We
have nurses who have been at the bedside and teaching for
decades, if not longer, and nearly half of that workforce is ap-
proaching retirement,” the ANA’s McMillan said. l