Shawn Sefton, RN, has experienced first-hand the operational, staffing and scheduling challenges that plague the U.S. nurse workforce, having worked as a nurse and in various nurse leader roles for decades.

She spent her early career as a frontline ED and perianesthesia nurse in various hospitals. Then she served as manager of presurgical services and anesthesia at Boston Medical Center, and as clinical specialist nurse (perioperative projects) and clinical director at Beth Israel Deaconess Hospital-Needham.

Sefton followed those years up as a director at PriceWaterhouseCoopers' health advisory practice, where she led operational and financial improvement engagements at a number of health systems. Today she serves as chief nursing officer and vice president of client services at Hospital IQ, a vendor of predictive hospital operations automation software.

Healthcare IT News sat down with Sefton to get her expert and insider views on the findings of a recent Hospital IQ survey of U.S. hospital nurses. 

She discussed how technology can help solve some of the problems unearthed in the survey, told what she's been hearing from the field when it comes to burnout and turnover – and described some key actions are that hospital and health IT leaders can take now to address some of those challenges and increase nurse satisfaction and retention.

Q. What were the big findings of the November 2021 Hospital IQ survey of U.S. hospital nurses?

A. Hospital IQ surveyed more than 200 registered nurses working in U.S. hospitals to gain better insight into, and a deeper understanding of, the nursing shortage and the impact it's having on frontline nurses, hospitals, care delivery and patients. As one might expect given the breadth of the current healthcare staff crisis in this country, the results were both alarming and illuminating.

Key findings included:

1. Nurses are thinking about leaving, and the pandemic isn't solely to blame. Ninety percent of respondents are considering leaving the nursing profession in the next year, with 71% of nurses that have more than 15 years of nursing experience thinking about leaving as soon as possible or within the next few months. Seventy-two percent of respondents said they were experiencing nurse burnout long before the pandemic.
2. As staff shortages increase, so do the workloads of active nurses. Forty-three percent confirmed that due to a shortage of technicians in their hospitals, they are now tasked with even more things outside of their respective roles, including cleaning units, procuring supplies and clerical duties as part of their typical workload. Due to these increasing job demands and added burden, Thirty-nine percent of nurse respondents said they were experiencing more serious mental health issues, like anxiety or depression, as a result.
3. High patient-to-nurse staffing ratios and the resulting impacts. Forty-five percent of respondents said the estimated patient-to-nurse staffing ratios they're seeing and experiencing across shifts are currently 5:1, above the typical standard of 4:1. More specifically, Eighty-four percent of emergency room nurses and 96% of intensive care or critical care nurses have a 4:1 ratio, which is double the optimal target of 2:1.
4. Access to care is dropping for patients. The understaffing taking place in hospitals, along with the lack of beds, discharge delays and other resulting bottlenecks taking place, are impacting hospitals' ability to provide care to all who need it. Thirty-six percent of nurses said they've seen patients with acute health conditions walk out of the ER because of the wait times for an inpatient bed. And 37% said that surgeries had to be rescheduled because of bed shortages.
5. Administrative burden and manual tasks are among key drivers of nurse burnout. For many nurses, much of the workflows and processes involved in their day-to-day work are still predominantly manual – in large part, due to a lack of technology solutions, systems and automation. Lack of communication technology, poor processes, along with inefficient operational workflows and administrative burden are key drivers of frustration and burnout among nurses. Forty-five percent of respondents cited referrals and transfer processes as the most manual tasks they deal with; 42% said updating paperwork was highly burdensome; and 42% also cited orchestrating patient discharges as a challenge.

To improve the poor work environment that leads to nurse burnout and turnover, nurses suggested the following areas for technological or process-oriented improvements:

• 53% want streamlined processes that ensure visibility into patient needs and communication.
• 45% said better communication and coordination across departments.
• 40% said improved and expanded communication and representation with hospital leadership would improve satisfaction.

Q. How can health IT help solve some of the problems unearthed in the survey?

A. The systemic operational, procedural, coordination and technological issues that were raised in the survey are nothing new. While the COVID-19 pandemic served as the final straw for the industry and brought awareness to new heights, these problems plaguing the nurse workforce have been mounting for years.

For leaders across hospitals and health systems, we've reached a point where there is no other choice left but to respond with action, and swiftly, to solve the operational problems contributing to mass burnout and turnover.

It's no secret that improving operational performance at hospitals helps to improve staff productivity, morale, care quality and patient outcomes. For most, the best place to start is with the administrative, manual, burdensome tasks and processes bogging down already overwhelmed nurses.

Nurses want better processes for communicating, along with coordinating and scheduling staffing, which [require] hospitals and health systems to streamline and automate manual workflows.

Outdated, inefficient and manual workflows and communications processes consume too much of nurses' time and attention, and make it nearly impossible to achieve effective and efficient coordination of care across units and teams.

Believe it or not, many hospitals still rely on phone calls and paper lists to assign staff or coordinate patient discharges. Easing these burdens on nurses will allow them to spend more time on what they do best, which is caring for the patient at the bedside.

Focusing on health IT strategies that align patients, beds and staff to optimize productivity and flow is critically important for U.S. hospitals trying to navigate an influx of patient needs and a shortage of staff – which, in extreme circumstances, can lead to bed closures and worsened capacity shortages for hospitals. This is where better utilization of operations management, predictive data analytics and real-time insights come into play.

Proactive suggestions and real-time information are just a few ways that hospitals can gain greater value from their own data, enabling unit and staffing leaders to gain early visibility into the current and future state of the enterprise to support strategic, informed decision-making.

With AI-enabled operations and staffing technology solutions, unit leaders can see nurse staffing needs weeks in advance. Forecasting patient census, as one example, allows hospitals to attain more balanced workloads by leveraging data-driven predictions so that staffing assignments are made and updated based on actual demand and need.

This level of foresight is allowing unit leaders and nurses to identify the hospital units that are most likely to be impacted due to capacity and bandwidth challenges to allocate more support, along with which patients should be priority for discharge to streamline patient flow.

Not only does this use of proactive insights help to protect hospitals from reaching an overcapacity of patients, but it also empowers leaders to pinpoint exactly where and when nurses are most needed for more strategic staffing decisions, and where resources should be utilized for the greatest value.

Q. In your position as a chief nursing officer, what have you been hearing from the field when it comes to burnout and turnover?

A. This isn't the first time we've experienced nursing shortages. It's been cyclical in the '70s, '80s and early '90s. The difference is, we were always able to restock the supply with nursing school graduates.

But another trend we've seen over the decades is the nursing staff being a constant target for cost reductions. Almost every efficiency project or consultants' report looks around the hospital for redundancies and possible efficiencies before they eventually land on cutting nurses as an answer.

The problem is, decades of this approach have taken any available slack out of the line. As we've seen over the past couple of years with the just-in-time supply chain we've built for meat or packaged goods, any unplanned disruption of the chain can lead to outsized effects and empty shelves.

Decades of thinking about nurses as commodities – and not people with irreplaceable institutional knowledge – [have] led to empty shelves in hospitals and nursing schools.

Not only have licensed RNs been downsized over and over, but acute care settings have also decreased their ratios of professional to non-licensed staff, forcing nurses to practice with fewer resources in diverse healthcare settings.

As inpatient settings find a higher acuity level of patients receiving care from leaner workforces, many experts believe we're just at the start of a new wave of shortages that will be more critical than those of the past. Factor in increased competition for decreasing resources and we'll also see experienced nurses jumping from job to job, taking experience and inside knowledge with them.

Overwhelming workloads, over-scheduling and extended shifts, and the stress of providing care amid a pandemic, [have] pushed nurses to the brink. While many once envisioned a lifelong career in the field, the effects of the pandemic, compounded with years and years of systemic procedural problems, have forced many to leave the profession they once, or still love.

Overall, there are a handful of primary messages coming from the field about the current state of mass burnout, turnover, and the diminishing U.S. nurse workforce – all of which are centered on more support, both emotionally and operationally, better processes to make day-to-day workflows easier, and more insight into strategic staffing processes.

Q. What are some key actions hospital leaders and health IT leaders can take now to eliminate some of the key problem drivers and increase nurse satisfaction and retention?

A. As I noted, many of the manual, inefficient operational and staffing challenges that contribute to burnout and turnover can be alleviated with more strategic, intelligent use of technology. Most notably, AI-enabled operations management, staffing solutions and proactive analytics.

The core goal for hospital and health IT leaders right now should be to elevate and optimize nurses' abilities and day-to-day experience through the use of technology. Enterprise-wide visibility, predictive insights and better care coordination [have] been detrimental for hospitals navigating the pandemic demands, but furthermore, predictive staffing will have a significant impact on nurses' work environment and satisfaction long past the pandemic.

In addition to technology, fostering an environment in which nurses feel heard, supported and valued is hugely important. Leaders share in the responsibility of recognizing the signs and symptoms of burnout, which requires them to learn them first.

Additionally, nurses and staff must feel safe and comfortable in communicating feelings of burnout to leadership, which means it is up to leaders to foster an open, supportive environment and create opportunities to get this feedback.

For example, setting up educational sessions about burnout and ways to alleviate its impact is one way to spur better awareness and understanding around the topic. And by providing nurses with an avenue where they can share these feelings – whether a digital communication channel or recurring check-in meetings – leaders can ensure nurses feel supported and seen, while actively identifying root causes and opportunities for improvement.

Leaders can't ignore burnout any longer. With nurses halfway out the door, they must listen to nurse's needs, respond with direct action, and implement clear solutions to alleviate the drivers of burnout.

Leaders must make nurses feel supported, but they also have to show them that they actually are supported, and that comes from a combination of improved processes and management soft skills such as listening and empathy.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.