"Fix this hot mess!" These were the words a distressed frontline nurse wrote in a recent message to me about a deteriorating situation in her workplace. Severe staff shortages and a total breakdown of effective processes designed to promote patient safety were to blame. Most troubling, no one in leadership would listen to her concerns. She longed for the progressive nursing culture she once knew and now felt powerless.
Sound familiar? Similar scenarios are playing out throughout the country. Healthcare is in critical condition caused by an uncontrolled hemorrhage of experienced nurses. High nursing turnover and staff vacancies seriously threaten patient-care quality and safety-and lead to moral distress and more turnover. Many industries are fundamentally transforming their operations in response to profoundly different employee expectations and preferences born of the pandemic, but will healthcare institutions follow suit? Their survival and that of their patients may depend on it. Albert Einstein famously said, "Insanity is doing the same thing over and over and expecting different results." A nurse-driven workplace transformation-or perhaps revolution-is overdue.
Fixing this hot mess requires a complete revamp of corporate priorities that relegate the nursing workforce to an expense category that must be tightly managed. A model such as this can generate unrealistic and even dangerous expectations regarding budgeted nurse staffing ratios as well as the perception that nurses are "jacks of all trades" who can pick up the slack from personnel cuts in both nursing and unlicensed support roles, such as aides and housekeepers.
Dysfunctional workflows that nurses endure to obtain essential services, supplies, equipment, and medications must be overhauled to end the frustration and delays they cause. Likewise, cumbersome EHRs require redesign to be clinically valuable, including eliminating fields added purely to track compliance with nonessential nursing actions. Given the current state, it is no wonder that nurses are left with little time to perform vital nursing care.
The way to achieve engagement, retention, and stability is to intentionally design gratifying workplaces for nurses with embedded resources that enable the seamless delivery of efficient, high-quality care with both nurse and patient safety as high priorities. If that vision seems too expensive to be feasible, consider the extreme costs of nursing turnover, temporary staffing contracts, room closures from staffing shortages, lost revenue, poor quality, and liability. As nurses are foundational to quality patient care, the real cost of organizational complacency is much higher.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2021