Nurses do heroic work. But too often that heroism meets unnecessary hurdles: hidebound thinking or ingrained inefficiencies that are frustrating even to the most dedicated care providers.

"The way I think about nurse innovation is really shifting the paradigm," Hiyam Nadel, director of the Center of Innovations in Care Delivery at Massachusetts General Hospital, during a HIMSS21 Digital session this past Thursday.

"The way it currently works is that equipment is given to us – processes, models of care – and we get very frustrated because they don't quite work right, or meet the patient's needs," she explained. "And we would like to shift that.

"We always say that the people who can invent the best are the people closest to the problem. Nurses need to be at the table. They need to be inventing, because they will have the most impactful solutions to health and health care."

"Nurses just have this incredible commitment to patient care," added Mary Lou Ackerman, vice president of innovation at Ontario-based SE Health. "Solving problems, finding solutions, fixing things, that's just what nurses do every day. It's just a part of making sure that the care is personalized and is able to be delivered.

"It's really important to formalize some structures around all of that activity that they're already doing, so that – at an organizational level or a national level or even a global level – these solutions and ideas can be shared," she added.

Even as they represent more than half of the healthcare workforce, and are indispensable to day-to-day care delivery, nurses are too often limited by process and technology challenges. Many were frustrated before the pandemic, but COVID-19 burnout is driving even more to exhaustion.

In the session, Ackerman and Nadel, along with moderator Rebecca Love, president of SONSIEL (the Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders), explored how to better ensure that nurses have the support they need and deserve – and how to ensure they're empowered to add their voices to the conversation, and that their good ideas for workflow and process improvements are surfaced, implemented and formalized where appropriate.

They focused on nursing innovation and entrepreneurship – highlighting the need for "disruptive thinking, innovation methodology, and systems and networks ... to support nurses to continuously improve patient care and outcomes."

Love noted some dispiriting stats about nurses and their daily workflows.

"The studies have shown: 27 workarounds per shift, 36 different places over the course of an hour, are innovating in a highly inefficient environment that's burning out our nurses more. We were always told, 'Take this new device, it's going to create less work for you.' But actually creates more work for the nurse."

And the pandemic has put the nursing workforce in an even more challenging position.

"We're seeing a lot of nurses leaving the bedside. We're seeing a lot of them are burned out. There's a lot of downward stressors. We're seeing in the United States a nearly one million-nurse shortage. Nurses are retiring, and it's expected an additional 500,000 will leave the nursing profession by the year 2022."

But initiatives such as those at Mass General and Saint Elizabeth, designed to harness the ingenuity and good ideas of the nurses in the trenches, could be key to helping stem that exodus – and ensuring that nurses are empowered to do their jobs in the best way possible.

"No innovation or solution should be delivered to a table without a nurse's voice and involvement in that solution," said Ackerman.

Nurses have great ideas, she said, and at SE Health there are processes in place to "capture those ideas and we can take a deeper dive into them, look at them, figure out which solutions fit, what we need to make them fit and create these, you know, these great solutions.

"The idea behind it is, when an idea comes forward, we want to have spent some time to figure out if this is desirable for the organization – if it's viable and if it's feasible," she said. "So in order to do that, we've got structures put in place that allow us to, you know, look at the idea, frame our intent around that.

"Then the next phase would be taking a deep dive and really understanding: Is there a business model, a new service model? Do we need tools and technologies? And then generating new concepts, and then finally testing and scaling."

It's not enough to say, "Oh, yeah, I think innovation is great. Just go ahead and do it," said Nadel. "Because that doesn't happen."

At Mass General, "we started to proactively elicit ideas and pain points from the nurses," she explained. "We didn't put any parameters around it. That did two things: It gave the leadership some insight to what the front line is facing. Also, by helping develop these ideas into real prototypes and beyond, and testing them, it also built the credibility that's needed to move forward."

This year, the MGH Healthcare Transformation Lab is launching the Ether Dome Challenge, designed to spur innovation and find remedies to the pain points identified by some 6,500 front line staffers, said Nadel.

"If you give them empowerment to have control over their lives – creativity and problem solving – it's fun, it's actually fun work," she said. "And then they actually see there are prototypes out on the units and other nurses testing it.

"They say, 'Another nurse did that?' It just accelerates, it brings excitement, it inspires people. So I really do think that we have to build that in."