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Houston Methodist Explores Innovative Programs to Combat the Nurse Workload Burden

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Nurses comprise the largest healthcare workforce in the United States and are essential to providing high-quality, compassionate, patient-centered care. To meet the complex needs of our patients and families, nurses develop a specialized mix of broad scientific knowledge about health and wellness, practical competency in patient assessment and nursing interventions, and blend these artfully with advanced critical thinking and interpersonal skills. It is no surprise, then, that nurses positively affect patient outcomes and improve the safety and cost-effectiveness of care.

In recent years, the demand for nursing services has risen as patients get older and more medically complex, resulting in nurses across diverse practice settings having to shoulder higher workload demands. Coupled with a worsening shortage of nurses, healthcare organizations are challenged to develop a vision and strategic plan for effectively utilizing nursing resources to maintain care quality and safety while supporting a healthy work environment.

At Houston Methodist, the situation presents an opportunity to reimagine traditional models of care and focus on the immediate needs of nurse clinicians. Across our system, leadership teams have implemented several innovative programs to address the increased nurse workload burden, including expanded virtual nursing services in acute and critical care units, increased nursing education and practice support across the career continuum, and future-focused nursing research studies evaluating nurse-technology partnerships’ impact.

Leveraging the pandemic-driven expansion of digital technology in healthcare, a new virtual operations center at Houston Methodist Hospital directs telenursing services throughout the system. Our unique hybrid model of care integrates highly specialized teams of virtual nurses into clinical workflows to provide real-time support, enhanced patient monitoring, and workload relief to the bedside care team. The virtual intensive care unit (vICU) utilizes a remote team of experienced critical care nurses to offer supplemental, heightened, and continuous observation of critically ill patients using high-resolution cameras and two-way audiovisual equipment. Virtual ICU nurses harness their advanced knowledge and critical thinking skills to integrate real-time physiological monitoring data with predictive analytic tools to quickly identify patient deterioration and partner with clinical teams to initiate early interventions.

In acute care areas, clinical nurses can access virtual telenursing services to facilitate admission and discharge procedures for qualified patients. Using encrypted video conferencing software on a bedside smart tablet, the tele-nurse connects with the patient to virtually complete the admission or discharge process, providing in-depth teaching, anticipatory guidance, or care coordination, all while documenting the encounter in the electronic health record. This gives clinical nurses more time to focus on hands-on skills like physical assessment, all while patients receive dedicated, uninterrupted contact with an experienced virtual nurse who can answer questions and address any concerns.

In addition to investing in cutting-edge technology that extends the nurses, Houston Methodist also invests in developing our nursing care team by training and advancing them professionally. Established in 2004 and accredited since 2010, Houston Methodist’s Nurse Residency Program (NRP) is a year-long program for newly licensed registered nurses. The program helps nurse residents transition from student to professional. Since its inception, the program has graduated nearly four thousand nurses. In addition to giving nurse residents clinical knowledge and skills, the NRP teaches them to be leaders at the bedside. In fact, many of Houston Methodist’s current nurse leaders began their careers with the residency program. Ever evolving, the NRP continually evaluates the needs of the nurse residents and incorporates new speakers and topics to best prepare them for a dynamic healthcare environment.

Recognizing that nurses need educational and professional development support beyond residency and orientation, Houston Methodist has also expanded unit-based education to include an enhanced Professional Practice Leader (PPL) role. PPLs are highly educated, expert nurse clinicians responsible for providing clinical nurses with continuous mentorship, practice oversight, and individualized learning plans throughout their careers. For newer nurses, PPLs offer support during the transition to independent practice and serve as role models for nursing professional development. Experienced nurses benefit from having a unit-based resource for organizational policies and standards of care who can provide just-in-time education on evidence-based practice changes. And PPLs ensure that patients receive excellent care by continuously evaluating unit-level quality measures related to nursing practice working with clinical nurses and nurse leaders to advance their practice.

As nursing care models evolve, so too must roles within the healthcare team. Patient Care Assistants (PCAs), who are unlicensed personnel on the nursing care team that extend the capacity of nurses, are evolving. New technologies that continuously monitor patients and care environments are being leveraged. Introducing the wearable BioIntelliSense BioButton, which constantly measures vital signs and feeds them into the electronic health record, has enabled Houston Methodist leaders to reimagine the PCA role. As less time will be needed for collecting vital signs, PCAs are gaining new skills, such as phlebotomy and obtaining electrocardiograms. Other roles for PCAs, such as mobility technicians, are also being introduced to extend both nurses and physical therapists. These new responsibilities for PCAs will optimize the skill mix of our workforce and enable the nursing team to provide unparalleled care to our patients.

Building on these current nursing workload initiatives, Houston Methodist’s Nurse Scientists are leading innovative research studies focused on the future of nursing work. Supported by intra-and-extramural grant funds, these collaborative projects partner nurse scholars with Rice University experts in human factors research and robotics to study task-based nursing workload and the prospect of integrating robotic nursing assistants into clinical education and practice. These research programs seek to advance scientific knowledge on nursing workload and provide evidence-informed guidelines for safe and effective nurse resource allocation. Cultivating partnerships with multidisciplinary experts also ensures that future-focused technology development includes a nursing perspective, promoting intelligent, nurse-friendly design and facilitating successful implementation into the nursing workflow.

In a complex and dynamic healthcare environment, Houston Methodist is working to develop innovative solutions to the increasing workload burden of clinical nurses. By implementing novel approaches to digital technology integration and expanding educational programs, nurses at Houston Methodist have the resources and support they need to thrive as caregivers and advocates.

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