It's National Nurses Week 2024, and it's time to celebrate the more than 5 million RNs nationwide who are so essential to care delivery. But overshadowing the celebration are many challenges impacting the nursing workforce. Chief among them: critical staffing challenges. 

Some federal and state legislators are seeking to mandate patient-caregiver ratios to help improve care and reduce nurse burnout. But many nurses and hospital groups oppose laws requiring minimum nurse staffing ratios, pointing to the risk of patients being diverted when there are not enough nurses available when they arrive at the hospital.

Beyond legally mandated remedies, healthcare leaders are leveraging information and technology – generative artificial intelligence, virtual nursing teams and algorithms that enhance insights into patient acuity – to help alleviate the strain on nursing staff. 

Healthcare organizations are "greatly interested" in innovations that can modernize nursing and solve the challenge, according to Tom Leary, senior vice president and head of government relations at HIMSS, the parent company of Healthcare IT News.

"With patient and staff safety as foundational values for engagement, the proper use of management systems technologies can help nurse leaders develop the right combination of staff to meet patient needs and nursing staffing requirements," he said.

Feds, states take up nurse staffing 

The past four years have been especially tough on nurses, of course. And even if the COVID-19 crisis has eased, the after-effects remain – straining the workforce. In 2022, one report found a staggering 90% of nurses thinking about leaving the profession. 

Quitting has not occurred on that scale, thankfully, but there has been significant attrition since the pandemic. And many challenges remain for nurses still at work.

Catherine Kennedy, RN, vice president of National Nurses United, told USA Today this week that the current state of nursing is affected by hospitals cutting costs at the expense of nurses' safety and nurses routinely fight administrations on staffing levels.

On the federal level, both the House and Senate have introduced bills to amend the Public Health Services Act last year. The Senate's Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act prescribes requirements on direct care RNs and others.

While California and Massachusetts have well-established hospital nurse-to-patient ratios, Oregon became the first to pass a hospital staffing plans law in September. 

Becky Hultberg, president of the Oregon Association Hospital and Health Systems told News KMTR after the announcement that the final version came out of long negotiations with all parties at the table. 

"It was pretty apparent that we needed to come to the table together to talk about how to solve our workforce shortages, and so that is what we did," she reportedly said.

With a statewide nurse staffing shortage, the Ohio Hospital Association is opposing the stalledHouse Bill 285, which would require hospitals to establish registered nurse staffing plans. 

Buckeye State hospitals say it would harm their ability to provide care, according to a Dayton Daily Newsreport this past week.

The American Hospital Association, meanwhile, calls state-mandated staffing levels ineffective at improving patient care and nurse experiences.

"Mandated nurse staffing ratios imply a 'one size fits all' approach to patient care," the AHA said in its mandated nurse staffing legislation toolkit. "Nurse leaders and nurses are best qualified to determine appropriate staffing for the needs of their patients."

Mixed support for mandated ratios

The Patient Safety Act in Pennsylvania, which passed the state's House of Representatives in June, has support from nurses. The bill is in the Senate's hands now.

"The commonsense protection of patients has been a journey of nearly two decades," said Wayne Reich, CEO The Pennsylvania Nurses Association 

Last year, Michigan legislators proposed actions bills that would create mandatory minimum hospital nurse-to-patient ratios, but Michigan Health and Hospital Association CEO Brian Peters called it "flat out wrong," saying it would significantly jeopardize patient access to care 

"Such a mandate would create an untenable situation for hospitals when a patient shows up and the facility is already at the mandated ratio: willingly ignore the law and risk penalties, fines and reputational damage, or follow the law," leading to patient diversions and limit access to care, he explained in a September report. 

In March, MHA released a new report focused on prioritizing the workforce because though Michigan hospitals employ more than 62,000 nurses, "the reality is that we are desperately trying to hire thousands more in every corner of the state," Peters said in a statement.

He said staffing decisions take into account the volume and acuity level of patients, the training level and experience of all the members of the care delivery team, technology and updated data. 

"There is a good reason why the Michigan Organization of Nurse Leaders is adamantly opposed to this legislation, and good reason why many nurse leaders I have spoken with in recent months have said they are personally offended by the premise behind it," he said.

Tech's role in easing nurses' workloads

Informed technology can help "improve clinical care delivery and enhance the overall work experience for practicing nurses," said Whende M. Carroll, clinical informatics advisor at HIMSS.

With the knowledge and skills to act as liaisons between clinical and technical stakeholders, informatics nurses are assessing and redesigning workflows to help decrease nurses' administrative tasks and ease their workloads.

"Nurse informaticists in healthcare organizations can impact staffing procedures for administrators and nurses by helping them leverage new technologies, such as using intelligent automation for enhanced scheduling tools and capturing documentation for seamless entry into health records for burden reduction and deploying tracking and trending systems for real-time data reporting and visualizations to assist leadership with more accurate and expedited staffing decisions."

GenAI could help address nursing shortage by easing patient documentation burdens, making the task faster, and surfacing needed information quickly in electronic health records, according to Jill Lashay, healthcare attorney, and Carly Barnes, associate, at Buchanan Ingersoll & Rooney.

They said that while nursing shortages will likely not abate this year, due to reduced enrollments in nursing schools and other factors, "health systems may consider developing virtual nursing teams."

Virtual nursing is designed "to address both the ongoing nursing shortage and enhance the patient experience" and provide an extra layer of safety monitoring, Barnes told Healthcare IT News in February. 

"Nurses can work from an on-site command center, or even work from home to handle patient admissions, discharge and transfers, review of medical history and assessment of current symptoms."

Salt Lake City-based Intermountain Healthcare, which has earned high marks for patient telehealth services, is piloting a virtual nursing that aids floor nurses in patient care. In a recent LinkedIn post, Becky Fox, chief clinical information officer, reported on modernizing nursing and said she heard first-hand "how excited nurses are to help innovate new technology, to share feedback of what works/doesn’t and creatively collaborate." 

She noted that one telehealth nurse at St. Joseph's Hospital in Denver told her about a powerful connection with a patient during their admission.

Many nurses have a deep district of AI. But others are much more encouraged about what it could mean for clinical practice. Stesha Selsky, DNP, and Meg Furukawa, RN-BC, nurse informaticists for the UCLA Health System, said last year that algorithms make nursing workloads more equitable.

Where measuring nursing workload acuity in the acute care setting is required in California, they helped to build a nursing workload acuity tool within the EHR, producing individual workload acuity scores using patient chart information.

Furukawa explained how informaticists involved bedside and other nurses to create the scoring tool and guide how it works. 

They say it has resulted in more equitable workloads for nurses because charge nurses can better assess and request additional support.

"The score is very transparent," Selsky said.

Nurses have overwhelmingly indicated in several surveys and studies before, during and after the pandemic that inefficient manual workflows and processes consume too much time and attention, often making it challenging to spend time with patients and coordinate care across units and teams. 

Their job satisfaction slid during the pandemic, and not surprisingly, 100,000 nurses left the profession with an additional 610,388 stating an "intent to leave" the workforce by 2027, according to research by the National Council of State Boards of Nursing released in 2023.

They've long said that improving technology in nursing to focus more time with each patient – improving acute care, outcomes and experiences – increases job satisfaction. 

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.