IT IS BROADLY understood that nursing care is the central and essential service that is provided to patients within our health care delivery system. To attract, support, and retain a highly skilled and engaged nursing workforce, it is essential that specific investments are made and sustained to support nurses and nurse leaders within health systems. Given the issues that have been highlighted in the current nursing workforce crisis, it is vital that the voice of nurses be infused within governing boards and at executive leadership tables where decisions are made. There are several important investments that should be prioritized to ensure that nursing is restored and strengthened and that highly skilled nurses are readily available for the patient care demands within our health systems.
ENSURING AN ADEQUATE LEADERSHIP AND CLINICAL SUPPORT INFRASTRUCTURE
It is commonly understood that nurses make up the largest portion of the health care workforce and are required to provide round-the-clock services within the health system. However, leadership resources and support structures are often insufficient to adequately support the operational needs that are required for nursing practice. It is also common that nurses may have limited channels to provide health care leaders with their unique perspective and valuable advice. Key investments in nursing infrastructure need to include the following:
* Appropriate positioning of nursing demonstrated by an executive-level nurse leader with enterprise-wide accountability for nursing practice. This role provides direct and regular interactions with the governing board regarding nursing and patient care and engages in strategic discussions of the health system. This role also ensures that nursing has input into all decisions that impact nurses, their work environment, and care delivery.
* A common and integrated nursing governance structure to ensure nurses control their own practice and have the opportunity to lead and participate in work to improve the work environment and the quality of nursing care delivered to patients.
* A leadership support structure that includes management oversight of clinical care within all areas of practice 24 hours a day. This includes local shift oversight and department managers, as well as divisional leadership roles that support the goals and strategies of a cohesive nursing organization across the enterprise.
* A clinical practice support and education structure that provides robust onboarding, transition to practice, general skills and competency development, and leadership role development across the novice-to-expert spectrum. This function also includes the support of nurse-driven quality and patient safety initiatives.
* Specialty support resources in technology adoption (informatics) and supply chain processes (clinical value analysis) that ensures nursing input into decisions that have direct impact on nursing practice.
* Robust and fully integrated workforce management technology that supports staff and nurse leaders in the complex and dynamic process of nurse scheduling and staffing. Effective staffing systems require the ability to quantify and predict workload and ensure that adequate staffing resources are available for patient care. Staffing systems should be guided by staff-driven policies and practices that ensure optimal flexibility and support for work-life balance. Nurses also need to be meaningfully involved in budget planning and monitoring. Integration of finance, human resource, and workforce management technology can prevent duplicate work and ensure full transparency of resource needs.
Regardless of size or scope of hospitals or health systems, the investment in nursing's leadership and support infrastructure is key to ensure that nurses are supported in their practice and that patient care is delivered in a manner that ensures the best possible outcomes. These elements of support also allow nurses to develop and advance their professional nursing careers in a manner that supports retention and engagement. Health care organizations cannot excel without the full engagement and participation of their nursing staff.
Given the workforce challenges facing the health care industry, it is critical that the necessary investments be made to ensure a better future for nursing and patient care. The accelerating turnover and vacancy rates of the pandemic have resulted in insufficient staffing levels or patient care unsustainable financial results for our health systems. Most importantly, nurses are finding their current work environments to be unhealthy and demoralizing. Leaders need to consider these investments the cost of doing business for health care.
Finally, it is an urgent priority that health systems regain the trust and confidence of their nursing staff and take actions that demonstrate a sincere and authentic valuing of the contribution of nurses. Health care leaders need to ensure that nurses have a visible and meaningful presence within the governing board. Aside from the participation of the senior nurse executive, it is invaluable to have board members with a nursing background. Governing boards should be educated regarding the issues of their nursing workforce and monitor the performance of nurse-sensitive outcomes and nurse engagement metrics. The well-being and strength of nursing within an organization should be a critical performance metric for any health system leader today. Everyone now knows the true consequences that exist for our health care delivery system if nurses do not receive the support they so need and deserve.