3Q's for QI | Q&A with Stephanie Elston, MSN
Jan 7, 2025
One of the greatest challenges in acute care is the ability to hire and retain nurses. With high turnover and a limited candidate pool, how do you build a highly reliable organization with fewer nurses? This advanced care setting calls for Bachelor-level nurses, but those can be hard to come by, and contract labor is expensive and unsustainable in the long term. IHQSE graduate, Stephanie Elston, MSN, and her team have built a model that optimizes support to the front-line staff, helping to relieve the disproportionate reliance on RNs. We spoke with Elston about her team's approach to solving this pervasive challenge.
1. Tell us about your approach to this project?
Each of the unit managers identified their guiding coalition that included charge nurses, staff nurses, CNAs, and lead CNAs. These stakeholders were encouraged to voice frustrations, barriers, and “design-the-day” based on a perfect world and unlimited resources. We worked with our professional development team to create a curriculum designed around the soft-skills that were needed to make this model successful. This included change management principles, collaboration, and communication.
We were thoughtful about our approach to socialization and spent a considerable amount of time dedicated to this through individual rounds, staff meetings, emails, and small group sessions where we provided snacks, coffee, and tea we named “Tea Time.” We focused on socializing the model, spoke about the impact to the staff, patients, and the hospital. We encouraged them to ask questions and identify their concerns so that we could get ahead of these issues before launch.
Not only was it important to share this change within our team, but communication throughout the hospital was also integral to its success. After building the model with front-line staff, we socialized it throughout the hospital for several months before the launch date. This was done to create awareness, answer questions, alleviate concerns, and obtain buy-in throughout the facility.
2. Why is this work important?
The nursing shortage is expected to worsen as we anticipate a generation of nurses retiring from the profession. The Covid-19 pandemic exacerbated and expedited the shortage. The population is aging and the number of people that are needing care is increasing as is their acuity. As such, the traditional care models that rely heavily on RNs has to change to support our reality.
Retention of our nurses is paramount to providing high level care for our patients. Nurses are drawn to the profession for the patients, but the new generation of the nursing workforce is often less focused on organizational loyalty and more focused on work-life balance. In order to improve nursing satisfaction and increase retention, traditional care models need to be revamped to enable nurses to spend more time with the patients and participate in shared governance and professional development activities. In short, if we decentralize the care model’s overreliance on RNs, it will afford them the room to do the things that will bring joy back to the profession.
3. How do you think this will impact healthcare?
The supply of our nursing staff is continuing to dwindle as our demand is ever increasing. We must focus on the future if we want to stay ahead of the curve with our nursing workforce. In order to do this, nursing leaders need to be innovative and push the envelope. We need to color outside of the lines, leverage technology, and walk away from tradition in order to continue to care for the aging population. This is the beginning of our journey, but hopefully this transformation will encourage and inspire other new models of care to be implemented throughout the healthcare industry that will focus on supporting and retaining our bedside nurses.
Read the article published in Nursing Management.