Opinion: Helping nurses bridge the care complexity gap

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While the ongoing national nursing shortage remains a major challenge for hospitals and healthcare systems, a related issue also requires leaders’ attention: the care complexity gap.

The industry is in the middle of a significant change in the nursing workforce as Baby Boomers retire and younger generations graduate and start their careers. A 2020 survey found that the median age of RNs was 52, and more than one-fifth of those surveyed intended to retire or leave nursing over the next five years. In a typical year, it’s estimated the country loses nearly 2 million hours of nursing experience on average to retirements, leaving gaps in everything from clinical expertise to institutional knowledge.

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At the same time, we are seeing a major shift in healthcare demand. By 2030, it’s estimated that 21% of the U.S. population will be older than 65. As individuals age, they have an increased likelihood of living with a chronic disease or multiple comorbid conditions (such as diabetes, heart disease, obesity or cancer) and experiencing limitations in functionality. We’re already seeing more patients dealing with multiple conditions or needing specialty treatment earlier in their care journey. Overall patient acuity has risen nearly 10% between 2019 and 2021, according to the American Hospital Association.

Looking at these two trends makes it clear we are facing a growing imbalance between the demand for complex care and the supply of experienced nurses needed to provide it.

Nurses now need to have a more robust understanding of pathophysiology and know how to implement a wider range of treatment options. That means it’s essential for healthcare systems to provide hands-on training for new nurses that goes far beyond the basics.

To do so, health system leaders should consider establishing residency-style programs. These are more in-depth experiences (typically lasting six to 12 months) and extend past basic onboarding to allow for specialty development, such as emergency services, intensive care and behavioral health.

Training also shouldn’t be one-size-fits-all. In the past few years, HCA Healthcare has rolled out an updated knowledge and competency assessment at the start of the nurse residency program. The results are used to create an individually tailored education plan to close any knowledge gaps for a particular nurse.

We continue to modify the program to meet nurses’ latest needs. Just this year, we incorporated a mentorship component that offers them additional support.

It’s also important to provide hands-on learning outside of the hospital. With rising patient acuity, we’re seeing fewer “easier patients” for new nurses to treat to build skills and confidence, so health systems need to expose them to experiences during training that are as close to real life as possible. Advanced simulation centers are a critical component in preparing nurses to handle rising care complexity.

At HCA Healthcare, we’ve built state-of-the-art Centers for Clinical Advancement across the country that model hospital floors, including patient rooms, supply and medication rooms and nurses’ stations. The facilities are equipped with high-fidelity manikins that provide realistic training functions, including providing physiological responses to a procedure, receiving IV insertions and even simulating childbirth. The centers allow us to reduce the gap between classroom and bedside and ensure continuity in all processes, from training to actual patient care.

While advanced simulation centers require significant investment, their role in advancing nurse competencies, confidence levels, staff retention and better patient outcomes is well worth it.

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As experienced nurses retire, it’s vital to ensure new hires and others early in their careers are still receiving ongoing guidance beyond skills training. We’ve introduced a new role to our care teams in the past few years: clinical support resource nurses. They’re dedicated to overseeing new nurses’ transition to practice and providing one-on-one coaching in skills development, stress management and time management. It’s a role that’s relatively new in the industry, but one that we’ve found critical to supporting our care teams.

The care complexity gap is only projected to grow over the next decade. Effective solutions will require resources and time to develop, deploy and scale, so leaders need to start now. The good news is that the benefits are clear: These initiatives will help develop an experienced, well-trained nursing workforce empowered and equipped to do their jobs for years to come, so we all can provide the best possible care for patients. 

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