A New Nurse Model For Transformational Change | E. 87

The Healthcare Leadership Experience

American healthcare is at risk of collapse as one-fifth of nurses intend to leave the profession by 2027. Jennifer Thietz outlines her vision of a new model for nursing and healthcare to Jim Cagliostro.

Episode Introduction

Jennifer highlights the soaring post-pandemic levels of burnout and high turnover among nursing staff, why the four primary nursing models are no longer effective, and shares her vision of building on a one-to-five patient-nurse ratio. She also explains why rebuilding connections helps nurses and patients to thrive, why nurses need to unite and use their voice, and reminds us that all nurses are heroes.

Show Topics

• US healthcare is in a state of crisis

• Nurses are the bridge between healthcare providers and patients

• Healthcare requires a new model of nursing

• Building on a one-to-five nurse-patient ratio

• Healthcare comes down to human connection

• All nurses are heroes

04:12 US healthcare is in a state of crisis

Jennifer said that nurses represent 50% of the workforce but almost one-fifth intend to leave.

‘’….this is a news release in April this year, and it's from the National Council of State Boards of Nursing, and they gave some really scary facts. We know that over 100,000 nurses left during COVID. They're saying by 2027, 900,000, or almost one fifth of the 4.5 million nurses, intend to leave the workforce. So that's a really frightening stat. We know that 189,000 nurses under the age of 40 want to leave nursing by 2027, 50% of nurses report being emotionally drained and burnt out, and this is the worst burnout in nurses that we've ever seen. So we really are in a real crisis, and we are losing our nurses daily. And without nurses, considering that nurses are 50% of the workforce, and actually touch 90% of patients. So you can imagine, if we don't have nurses, we can't nurse. We can't work in healthcare as it currently is. And I believe there will be a collapse in healthcare if we don't make some changes now.’’

07:42 Nurses are the bridge between healthcare providers and patients.

Jennifer said 90% of hands-on care comes from nurses, who are essential to provide a safe and happy environment for patients.

‘’Well, nurses are fundamental to healthcare. As I've just said, 90% of the hands-on care comes from nurses. We're a huge, huge percentage of the caregivers in healthcare. And if we as nurses can provide care in a safe and happy environment, we can turn healthcare around. We're the bridge between the physicians, between the other healthcare providers, we are the bridge with patients. We are the ones who are there 24 hours a day, 365 days a year. We are the ones who are speaking with the patient, spending up to eight or 12 hours a day with individual patients, so we really are the front-runners. We understand what's going on, and we are the ones who are hurting. Everybody in healthcare is paying a price, but I believe that nurses are paying the biggest price at this stage. And the reason is that they don't... Many of them do not have sufficient help in the units.’’

11:21 Healthcare requires a new model of nursing

Jennifer said nurses are no longer able to provide care as they want to.

‘’Now, obviously, we are in unprecedented times in healthcare with this hemorrhaging of nurses, with the costs that are associated with care at the moment. And having been on the floors and seen how nurses work, I think the main issue with many of the nurses who I've been speaking with and who I've worked with, is that they don't have sufficient time to nurse the way they would like to. And the reason I think is related in some way to cost cuttings, where organizations are losing staff in order to stay afloat. And what's happening is nurses are now literally wearing two hats. They are doing their nursing specific tasks, which as the acuity of patients goes up, become more and more complex, more and more difficult, and then they're also asked to do care, for example, handing out food trays, or finding patients who are lost, and transport has got a patient and they're supposed to go to Dr. Smith's office, but he's now lost somewhere and they're making calls, they're doing ordering, they're doing billing, they're doing bathroom breaks, all of this work, which is obviously essential, because that's how a hospital turns around, and that's how nursing care is provided, but I think if we had staff, auxiliary staff, to help the nurses, just to take that load off them so they have the time to do their nursing specific roles, I think that for me would be the way to go.’’

12:46 Building on a one-to-five nurse-patient ratio

Jennifer explained how using the one-to-five nurse-patient ratio can transform patient care by combining the benefits of two models.

‘’And so I've looked at nursing, and I've used the benefits of two models. The one is the individual approach where obviously the nurse is involved with the care of the patient, and then a team approach where multiple people are involved, but I've shortened it or honed in on a ratio if possible of one to five, which is what CMS actually recommends. They don't mandate it, obviously, but the CMS is recommending a ratio, patient nurse ratio, one to five, and then involving in that team a nurse assistant that just works with that RN. So you would have one nurse, you would have one nurse assistant, you would have five patients, and then you have two sets of eyes on those patients all day. You have the auxiliary tasks, like handing out food trays, et cetera, taken care of, and the nurse then can go ahead and fully concentrate on their nursing roles. And I would add to this, Jim, which I think is extremely important, is a ward secretary, or a ward clerk we call them, whereby they are at the nurses' station, and they allow the charge nurse time to leave the nurses' station because they're going to be doing the directing of patients, they're answering the phones, maybe the ordering of meals, et cetera, and then charge nurse will then have the opportunity to be on the floor with the nurses where she's really needed, or he's really needed. So that's what I see as the hybrid individual team approach…. this one to one to five would be in units like telemetry, med-surg, oncology, the specialty units, obviously our ICUs, our step-downs, et cetera, have a totally different way of working.‘’

20:31 Healthcare comes down to human connection

Jennifer said the crisis in nursing is affected by the break in connection between patients and nurses, and between colleagues.

‘’….I think nursing and healthcare in general boils down to the connection we have with our patients and with each other, with our nurses. And our connection with patients, and I'm saying our, but I'm talking about specific nurses, there are other nurses who are working in wonderful work conditions who have the time. I spoke to a nurse last week who said, "Hey, I'm very happy. We have this incredible organization and I'm working in a great team. I have help." Absolutely. And this particular nurse has the nurse assistant with her. So there are many organizations who are doing it right. I don't want to give the wrong impression, but yes, I believe that the crisis in nursing now is happening due to the break in our connection with our patients and our nurses. With each other, colleagues. We need to have that human connection in order to thrive, in order to heal, in order to work to our best ability. And many of us are going into our workplaces every day, and we are given an assignment, and we look down and we see the tasks that we have, and we put our head down and we just plow through those tasks. And we don't have the time to necessarily sit with patients, with each other, to connect.’’

27:16 All nurses are heroes

Jennifer said in some ways nursing is more difficult now than during Covid and encouraged all nurses to use their voices and speak.

‘’… I think the most important thing that I'd like to share is my deep respect for nurses, and to really... I'm hoping to empower nurses who are sitting in jobs that are very, very, very challenging. I also worked during the COVID pandemic on the floor, and we as nurses were held up as heroes during COVID, and we were, and we are, and I think we remain those heroes. I think what nurses are doing now is maybe in some instances more difficult than during the COVID pandemic, because then we had the support of everybody. Now, each nurse that walks into a facility remains a hero because many of you are working very, very challenging conditions. And you are highly intelligent, highly skilled, highly motivated, your compassionate heart, you have a right to raise your voice and speak. And speak as much as you can and share with your leaders, if you have ideas on what can happen in your units to help your job, make your job easier, then go ahead and share that information. I think communication is vital. We need the connection. So keep connecting. Keep connecting with each other, pay it forward with each other, look after each other, look after your nursing managers, and your nursing leaders as well. And let's come together and change healthcare, because we are millions strong. We can do it. And we just need to get our voices out there.’’

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You’ll also hear:

From South Africa and a heart transplant first, to Mexico, via America. Jennifer’s 20 years of experience at the patient’s bedside. ‘’And I think for that reason, I can really speak to this topic today, because I've been there, I've worked with these nurses, I've been on the floor with patients, and I have a great understanding of what is happening in healthcare.’’

Why the nursing world as we know it is unsustainable: ‘’… I'm passionate about this situation as a long time nurse… And I'm hearing stories all the time about working conditions, which are extremely difficult.’’

Why the four primary nursing models are no longer effective for modern healthcare. ’’… these approaches are, as I say, World War II up to the 1980s. They're old. They are nursing approaches that have been around for a long time, and I don't think they speak to what is happening in healthcare at this point.’’

Offsetting the initial cost of a new model of healthcare against higher staff retention levels. ‘’In the long term, the cost savings would be huge. …. And I believe that then the patient satisfaction would go up, because they would have this interaction.’’

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