'Eliminate, automate, delegate': The 3 questions that help Health First reduce nurse burnout
Coauthored by Cheyana Fischer, Chief Nursing Officer, Health First
Nurse burnout is a critical issue for health systems across the country. Press Ganey’s “2018 Nursing Special Report: Optimizing the Nursing Workforce” revealed that the “combination of the aging population, the rising incidence of chronic disease, the increasing number of nurses approaching retirement age, and the capacity limitations of nursing schools has resulted in a nurse attrition rate that continues to outpace current and projected nurse supply.” And that was before the COVID-19 pandemic wreaked havoc over the nation and healthcare industry.
At Health First, a fully integrated delivery network in Central Florida, leaders are working to proactively solve problems related to nurse burnout and retention. They’re leaning in to understand and address the challenges their nurses face. Looking at data from their Press Ganey patient experience (PX) survey and NDNQI, Health First pinpointed opportunities for improvement and changes that would directly improve the employee experience (EX) for nurses.
Turning the tide against nurse burnout and turnover is critical, as the national picture for the nursing crisis remains sobering. According to the American Association of Critical-Care Nurses (AACN), two-thirds of nurses “feel their experiences during the pandemic have caused them to consider leaving nursing.” Press Ganey’s national Flight Risk Analytics assessment for 2021 shows that nearly a third of RNs are at risk of leaving their organization, and last year’s engagement ratings among RNs dropped at twice the rate of non-RNs in just 12 months.
To confront the pressing challenge of nurse burnout and turnover—and drive improvements in the employee experience, Health First is taking steps to streamline and improve the day-to-day responsibilities of front-line nurses.
Observing the problem: Nurse burnout and retention
Cheyana Fischer, Chief Nursing Officer for Health First and one of the authors of this article, realized that the current nurse staffing gap wasn’t going to be filled anytime soon. Health First needed to figure out how to take certain tasks—such as gathering supplies, checking vital signs, documenting information, etc.—off nurses’ plates so they could do the work they trained for—and do that work more efficiently.
Fischer, along with Health First’s Chief Clinical Officer, set out to analyze the challenges their front-line nurses faced to better understand what could be fixed. Health First ran a detailed time study, spending more than 125 hours one on one with nurses mapping out everything that was happening throughout their shifts. Three units were studied: an intensive care unit (ICU), a progressive care unit (PCU), and a trauma step-down PCU. The intent was to take key lessons from these units and apply them across med-surg or specialty units.
The team in charge of the study was made up of both clinical and nonclinical observers—including a Health First nurse. They were determined to find ways to operate with current staffing levels and improve the experience for nurses.
Assessing the findings: Nurses are inundated with extraneous tasks
Assessment was divided into the following areas:
- Bedside care
- Clinical conference
- Family conference
- Ancillary conference
- Time off the floor
- Telemetry monitoring
Health First took inventory of nurses’ current tasks and responsibilities, broken into their smallest parts, and how much time was dedicated to each. For example, the study drilled down on how much time nurses spent with documentation in Health First’s electronic medical records (EMR), pulling medication for patients, and procuring equipment and supplies.
Their findings were eye-opening—and powerful. They learned that front-line nurses spend 13% of their time hunting for things like blankets, pillows, and water or searching for supplies in another part of the facility, physically far removed from their unit. And more than 8% of their day is spent pulling medications. The team realized there had to be a way to reassign or mitigate those tasks so nurses could focus on more pressing issues—like treating patients, administering medications, and ensuring safe, high-quality care.
Taking action: Helping nurses work at top of licensure
Once finished with observing daily RN operations, leadership set out to help focus the nurse’s role into practicing at the top of their license. Fischer’s team developed three questions, asked in succession, about the tasks nurses were taking on that prevented them from getting to their real work.
- Can we eliminate it?
- If we can’t eliminate it, can we automate it?
- If we can’t automate it, to whom can we delegate the task?
Those three questions became the framework for redesigning nurses’ roles at Health First.
Health First is now piloting programs to address its workforce challenges and better serve nurses. For example, they began utilizing scribes to cover nursing documentation. Though each scribe was initially envisioned as working 1:1 with a nurse, the process evolved to have a scribe enter assessments for multiple nurses. And the nurses' responses have been overwhelmingly in favor of the program, in terms of saving time, accuracy, impact on work, and more. In the post-pilot survey, associates’ positive responses clocked in between 93% on the low end and 100% at the top.
Driving positive changes on the front lines—and then listening to employees’ reactions to those changes—continues to be an effective model for improving nurse resilience, minimizing burnout, and reducing turnover.
Press Ganey’s predictive analytics experts can analyze your organization’s unique data to identify risk factors and help you get ahead of burnout—and potential turnover. Schedule a quick, 15-minute Flight Risk Analytics assessment here.