By now, even everyday Americans are aware of the scale of the national registered nursing (RN) shortage. A McKinsey study found that at least a third of all RNs are either retiring early, switching to another kind of work or thinking strongly about one of those options. The rampant burnout wreaked by the pandemic largely resulted from frontline staff giving heroic efforts and sacrifices for what most of them believed was not nearly enough pay or job satisfaction.
Herein I will outline a proposal, rooted in the microeconomics principles of supply and demand, that can guide our nation to a beneficial outcome: a way in which unequal access to care, combined with clinician burnout, can be remedied through the steady integration of a digitally enabled clinical workforce. For entrepreneurs, the design of solutions that mitigate the clinical challenge of maintaining or improving care quality can help solve the clear customer dilemma of an increasing volume of higher-acuity patients with a smaller direct workforce.
It seems likely that Covid-19 and its many variants and subvariants, as well as worries over safety and seeing too much death, were the proximate causes of the “Great Resignation” of RNs. This has led to a plethora of bad outcomes, from longer emergency room waiting times to a rise in adverse events such as hospital-acquired infections and patient falls. Not surprisingly, it has also led to reduced patient and staff satisfaction.
What most average Americans don’t know is that the nursing shortage was a burgeoning reality long before March 2020. This was due to a combination of the baby boom generation reaching retirement en masse, not enough replacements in the nursing college pipeline and changing attitudes among young people about the demands of the profession. (Seeing all those graphic details on TV—Covid patients on ventilators in ICUs and nurses without enough PPE—likely didn’t help the cause.)
The truth is that being a bedside nurse before Covid was no walk in the park. Their workdays have long been a study in distractions, with multiple tasks and competing requests from patients, providers and the health system. Electronic medical records, though an important step for safety and efficiency, have proven more burdensome than anticipated from a workflow perspective, taking nurses away from direct patient care.
What makes things worse now is that the supply of nurses is dwindling just when the need for higher-skilled nurses is growing. Patients are more acutely ill than before, as many did not seek needed care during the pandemic. Intensive care nursing is a job for highly trained, skilled and knowledgeable staff.
All of this points to the need for creative change: innovations that free up nurses to practice at the top of their license and make the most of existing nursing resources. Fortunately, existing telehealth technology and processes, if applied correctly, offer a less expensive and more effective way to lessen the nurse staffing crisis.
Virtual nurses can increase flexibility, reduce some of the friction points that delay treatment and incorporate better administrative support for frontline RNs, allowing them space to rediscover the reasons they became nurses in the first place. Indeed, organizations are building on single-point telehealth implementations and developing enterprise telehealth models. “Roadmapping” adds predictability to the implementation of telehealth-enabled care models that build on the foundational platform. This includes audio and video technology, engagement and clinical decision software and interoperability of electronic medical records (EMR) for ordering medication and documentation.
Telehealth is typically seen as a doctor sitting in his office, communicating with an established patient (and perhaps family members) about a condition. In some cases, this is correct; but more frequently, doctors are being used to fill gaps for rural and community hospitals that lack specialists in areas such as intensive care, stroke and behavioral health. One of the ways in which burned-out veteran RNs can stay connected (and employed) is by filling this role. Reputable telehealth companies hire dedicated, experienced nurses who take on many important tasks, allowing bedside nurses to focus on the art of nursing. Those tasks may include (but are certainly not limited to):
Collaborating with a hospital’s ER to reduce wait times for admissions and help drive down the rate of patients leaving the facility without being assessed.
Reviewing orders and making calls to facilitate access to lab and imaging results.
During a hospital stay, being a second signature for medications and blood administration; facilitating phone calls on behalf of the managing nurse to family, providers or ancillary departments; and performing nursing chart checks to see if all orders have been handled.
Discharge has become a day-long ordeal of missed orders and poor communication between overstretched doctors and nurses. Tele-nurses can obtain and/or review discharge orders, follow up on pharmacy fill of discharge medications, and teach patients about medications and when symptoms indicate they need to call the physician.
Perhaps the most important role for veteran telehealth nurses is as mentors to younger nurses. One of the outcomes of the Great Resignation is the professional, clinical and institutional memory being lost by these sudden departures. Virtual nurses use their experience to guide young nurses through their first real-world care experiences, such as insertion of lines and assessments of fall and suicide risk.
There isn’t a problem finding experienced RNs for virtual nurse jobs. The same McKinsey study found that 35% of RNs who were likely to leave their current roles indicated they wanted to stay employed in healthcare—just not in direct patient-care roles. Being able to work from home and set their own schedules is another draw.
For providers of care, these burned-out nurses can be an invaluable resource as healthcare enters a post-pandemic era of complexity, scarcity and change.