Letting Go of Past Prized Practices: Making Meaningful Change in Healthcare

By Jacqueline Herd, MSN, DNP, RN, NEA-BC, FACHE
Vizient Principal

Throughout my 30-year nursing career, I have witnessed and experienced several nursing shortages. The impending retirement of the baby-boomer generation was already contributing to a projected nursing shortage in 2030. However, the COVID-19 pandemic further exacerbated the challenges faced by the healthcare workforce and brought about a dark and uncertain time that shook the world and highlighted the need for change in healthcare.

According to the most recent Vizient Nursing Workforce Intelligence Report, while nursing workforce indicators are starting to stabilize, turnover, overtime and burnout rates remain higher than pre-pandemic levels. Additional concerning statistics include:

• It is anticipated that 800,000 registered nurses will leave the workforce by 2027.
• By 2034, we will need an additional 124,000 physicians.
• In 2021, U.S. nursing schools turned away 91,938 qualified applicants due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. 
• A survey conducted in October 2022 by the American Association of Colleges of Nursing (AACN) identified 2,166 full-time faculty vacancies in nursing schools across the country, with an additional need for 128 faculty positions to accommodate student demand.
• About one third of the current nursing faculty workforce in baccalaureate and graduate programs are expected to retire by 2025.

Combining these statistics with an aging and increasingly sicker population, it becomes evident that we face a significant supply and demand problem in healthcare. To ensure timely access and quality care for our communities, it is crucial for healthcare organizations to redesign how they deliver care. What has worked in the past may no longer suffice in the future, but often organizations have difficulty in letting go of their past prize practices or beliefs.

For example, one concept that has gained attention in healthcare redesign is practicing to the top of license or certification — utilizing the full capabilities of healthcare professionals and breaking away from the traditional mindset that only nurses or physicians can perform certain tasks. However, despite recognizing the need for change, implementing this shift can be challenging for some organizations, as they are reticent to committing to change despite not having enough nurses and physicians to provide timely access and quality care to our communities.

So, why is it so difficult to let go of these past practices? One reason is the fear of the unknown. Change can be daunting, especially when we've become accustomed to certain practices or ways of doing things. We may fear that letting go of the familiar will lead to chaos or decreased quality of care. Additionally, there may be resistance from individuals who have a personal or professional attachment to the practice. They may feel that their expertise or identity is threatened by the proposed change.

However, to address the struggles in healthcare, we must be willing to challenge past practices and embrace meaningful change. Here are some strategies to help healthcare organizations and providers and staff navigate this process:

• Data-driven decision making: Use data and evidence to identify areas where past practices may be hindering progress. Collect and analyze data to understand the impact of current practices and identify opportunities for improvement. This can help build a case for change and provide a roadmap for implementation.
  
  For example, as a Chief Nursing Officer, I received complaints from surgery patients and their families about being required to arrive at the hospital at 6 a.m. for a surgery scheduled for the evening. After reviewing the data, we found a respected, long-time physician who had been practicing at the hospital for three decades had several block days with an overall utilization of less than 50%, with some rooms being as low as 37%. No one wanted to have the conversation with the physician regarding releasing his block and, more importantly, the impact it was having on our patients. We used data to revamp the block scheduling, which also included appropriately reallocating block times. The change was challenging, but in the end, it was a positive change for our patients and their families, and we were able to schedule surgeries timelier as well as grow volume.

• Engage stakeholders: Involve all relevant stakeholders in the change process. This includes healthcare professionals, administrators, patients and other key individuals or groups. Engage them in open and transparent discussions about the need for change and the potential benefits and address any concerns or resistance they may have.
  
  In 2009, organizations were being incentivized for quality care and safe outcomes, so there was a concerted effort to improve patient outcomes through evidence-based practice by preventing and decreasing hospital-acquired infections. One such example included decreasing the utilization of foley catheters. I recall several trauma physicians coming to my office to complain about the "no foley zone in the ED." They were not ready to let those foley catheters go, nor were they ready to implement and/or adhere to nurse-driven protocols for removal of foley catheters. However, through open and honest discussions with the physicians that highlighted the research and evidence for appropriate indications for foley catheters/removal of foley catheter, we were able to help convince several physicians of the needed change.

• Education and training: Provide education and training to healthcare professionals to help them understand the rationale behind the proposed change and how it aligns with best practices and evidence-based care. Address any misconceptions or fears they may have and provide support throughout the transition period. Also, be sure to celebrate the successes and positive outcomes as they can reinforce the benefits of change.
  
  I recall working with nurses who were unwilling to give up the nurse's stations for shift report despite an abundance of evidence that shows bedside shift reports improve communication and prevent safety events. At first, they refused to give up shift reports in the nursing station, giving varying reasons as to why they could not do bedside shift reports. But after continuous education, training and inspections, shift reports were moved to the bedside and we were able to collectively see the positive results.

• Leadership support: Strong leadership support is crucial in driving meaningful change. Leaders should actively champion the need for change, provide resources and support to implement new practices, and hold individuals accountable for embracing the change.
  
  As an example, engaging your leadership in the discussions about the importance of practicing top of licensure can help the entire organization assess the potential strengths of their staff to combat workforce shortages. Nurses and advanced practice providers can bridge the gap in access of care for patients. Licensed practical nurses, licensed vocational nurses, patient care techs, emergency medical techs, pharmacy techs and certified nursing attendants can bridge the shortage in nursing. Certified medical assistants and clerical support can decrease the administrative burdens in the ambulatory setting, and nurse anesthetists can provide extra anesthesia coverage.

As healthcare professionals, we must be willing to challenge past practices and embrace meaningful change. It requires a shift in mindset, a willingness to challenge the status quo and a commitment to improving support for your staff and providers that ensures successful patient outcomes and quality delivery of care.

Many health systems are shifting toward virtual nursing as part of innovative care models. Learn more about how virtual nursing can elevate patient, nurse and organization benefits in the Vaya Workforce Webinar "Unlocking the Value of Virtual Nursing," 11 a.m. PST, Monday, Dec. 4.