In an evolving healthcare landscape, many hospitals and health systems have a diverse nursing staff of tenured employees, contractors, specialists, and more. While this can be a recipe for a dynamic and collaborative environment, it also has the potential to become precarious without proper management.
Disorganization and lack of communication ultimately trickle down to patients. In fact, a Joint Commission study found that 80% of serious medical errors result from miscommunication during nursing handoff.
With the continued staffing shortages in healthcare, organizational culture is ever more critical for maintaining morale among existing staff.
For one, nursing departments should strive to create balanced schedules and assignments that work for each employee and even out workloads as much as possible. Departmental leaders should be transparent about organizing so there is no perception of inequality. If everyone feels they are pulling the same weight, they will work together better.
However, in departments that rely heavily on contract and travel workers, there can be friction for similar reasons, including doubt about contractors’ workloads, level of commitment, and their skills and qualifications. This is where leaders must emphasize clarifying any misconceptions and the benefits they provide beyond crucial coverage for short staffing, such as adaptability, diverse perspectives, and specialized knowledge.
Shared governance is also becoming a standard practice in many healthcare organizations to empower nurses and foster collaboration. It is a working model where nurses can join councils, allowing them to be involved in decision-making for their departments and patients.
Clear Roles and Responsibilities
There shouldn’t be any ambiguity about assignments and responsibilities among everyone involved in patient care, from RNs to LPNs and UAPs. Along with their daily schedules, consider writing down each employee’s responsibilities in a shared document that everyone can access and reference. This ensures each employee knows exactly what their tasks are and that there is no gap in patient care coverage.
However, it’s also essential to leave room for spontaneous teamwork. For instance, a nurse has a free moment and responds to a patient not in their assigned block to help out another nurse with their hands full. While this isn’t a requirement or expectation, it should not be frowned upon.
Established Onboarding and Training Processes
Onboarding and training can be essential for setting the tone – what the standard operating procedures are, what the day-to-day job will look like, and the organization’s culture. If the goal is to have a cohesive team, these processes should be standardized for all types of staff, whether direct hire or contract worker.
In addition, all staff should have the same continuing education and growth opportunities, promoting a culture of equality and professional development and ensuring that every team member has the resources and support necessary to excel in their roles.
Transparent Communication Among Nursing Staff
In a hospital or clinical environment, losing track of so many moving parts is easy. Nursing teams need multiple modes of communication to ensure they are organized and on the same page.
This includes having proper tools to communicate, especially around patient care. Traditional chart notes and whiteboards in rooms are not going anywhere. Still, many organizations are also integrating newer technologies, such as HIPAA-compliant messaging platforms, for instant communication between staff members. This is especially helpful during emergencies to speed up response time to critical patients.
Good teamwork also means holding one another accountable, creating an environment where employees feel comfortable discussing their challenges and concerns, and collaboratively working to overcome them.
However, there should be an established feedback process for issues that need further addressing. For example, a staff member is consistently underperforming or making mistakes, affecting others – or worse, patients. Staff should know who to escalate these issues to, whether it is department leadership or HR, and how so that they can address and resolve the issue immediately.
Regular Team and Staff Meetings
Teams and departments should be meeting regularly to share important information and updates, as well as coordinate and plan, ensuring alignment of goals and objectives for the team and the organization. Meetings can also provide a forum for problem-solving, decision-making, and feedback, allowing employees to voice their opinions, share ideas, and actively participate in discussions. Additionally, meetings are an opportunity for recognizing and acknowledging individual and team accomplishments.
All these forms of engagement instill a sense of duty and shared ownership, which are fundamental components of a positive workplace culture and effective teamwork. Pair this with solid operational organization and communication to create an unstoppable nursing team that puts patient care at the forefront.
Clinicians need to have a better understanding of the potential impact of patients’ anxiety sensitivity, or “fear of fear,” according to an article published in American Journal of Critical Care (AJCC).
When a patient has anxiety sensitivity, they misinterpret nonthreatening symptoms as threatening, assessing the potential meaning across physical, social or cognitive domains. These “what if” thoughts may trigger a spiral effect, stimulating the nervous system and resulting in stronger sensations and further catastrophic misinterpretations.
It may lead to a patient avoiding activities they associate with anxiety-related sensations, such as physical activities or social situations. While in the hospital, they may resist interventions, such as repositioning or being weaned from sedatives. They may avoid physical or occupational therapy or struggle with efforts to help their recovery.
“Patients with anxiety sensitivity may falsely believe that their symptoms are the early signs of something bad, such as a heart attack, cognitive decline or social isolation,” she said. “It’s important for clinicians to be able to identify the difference between anxiety sensitivity and other medical conditions,” says Leanne Boehm, PhD, RN, ACNS-BC, FAAN, assistant professor at Vanderbilt University School of Nursing, Nashville, Tennessee, and investigator at the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University Medical Center.
For example, patients who have difficulty weaning from mechanical ventilation should first undergo a detailed workup to search for any underlying medical causes before anxiety sensitivity is considered as a primary cause.
ICU clinicians should be aware of patients’ possible anxiety sensitivity so they can use clear communication and implement pain management or relaxation techniques to mitigate distress and improve patient outcomes.
The Anxiety Sensitivity Index (ASI-3) is one tool clinicians can use to measure the extent of a patient’s physical, cognitive and social concerns about their anxiety. Providing basic psychoeducation to ICU patients on common symptoms may temper anxiety sensitivity, reassuring them their feelings are not unusual and putting their symptoms into context.
After discharge from the hospital, patients may continue to experience anxiety sensitivity and need increased assessment time, detailed explanations and extra demonstrations before participating in physical therapy or other activities.
Research specific to anxiety sensitivity in the critical care setting is limited, and future studies should incorporate assessment and management techniques across the critical care recovery continuum.
The American Association of Critical-Care Nurses (AACN) is bringing the lessons learned from its proven nurse leadership and innovation program and its Healthy Work Environment (HWE) initiative to help nurses at hospitals around the country improve the health of their workplaces.
AACN Clinical Scene Investigator (CSI) Academy is a unit-based program using implementation science to leverage direct care nurses’ expertise and build additional skills, preparing and supporting them as clinician leaders who effect positive changes that improve patient, nurse, and hospital outcomes.
Building on CSI Academy’s successful 11-year history and the documented benefits of sustaining an HWE, AACN has established a special version of its 12-month, team-oriented CSI program that will focus on the implementation of “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards).
The initial cohort is underway in Los Angeles, with nurses from Los Angeles General Medical Center and Cedars-Sinai Medical Center. Nurses from Ohio, Oregon, Delaware, Texas, and Washington hospitals will participate in other regional cohorts launching through spring 2024. The program will eventually encompass 80 teams with three to four nurses each.
The HWE standards are the cornerstone of AACN’s comprehensive HWE initiative, a long-term commitment to creating environments where nurses can provide the highest standards of safe, compassionate patient care while being fulfilled at work.
Findings from AACN’s most recent National Nurse Work Environments study indicate healthcare teams who have implemented the HWE standards or are in the process of doing so report better results than those who have not. Teams implementing HWE standards reported higher nurse well-being scores, improved staffing with an appropriate skill mix, and higher quality of patient care, among other outcomes.
“A healthy work environment is an essential element to nurse recruitment, satisfaction and retention, while also improving patient, nurse and hospital outcomes,” said AACN Chief Clinical Officer Vicki Good, DNP, RN, CENP, CPPS. “While the positive impact of HWEs has been demonstrated through decades of research, the nursing community still struggles to translate evidence into practice and gain sustained support for HWE implementation. We aim to change that.”
A grant from the AACN Innovation Fund is underwriting the program, with participating hospitals paying a fee of up to $1,500 per unit and providing paid time away from patient care for nurses to participate in the program and attend CSI Academy workshops and sessions.
CSI Academy encourages participating teams of nurses to immediately apply what they learn in a capstone project that improves outcomes in their units. Over the past 11 years, participants have reported achieving significant results, including:
Reduced length of stay, ventilator days, infection rates, delirium, pressure injuries and falls
An average median return on investment of 605% per team
Nationwide, more than 512 nurses at 105 hospitals in 15 states have completed the CSI Academy program since its launch in 2012. The program has touched over 1.2 million patients and over 7,200 nurses, with an estimated positive fiscal impact on hospitals of $111 million.
AACN offers access to its online collection of CSI Academy innovation projects― including project plans, clinical interventions, data collection tools, outcomes, and references ― as part of the program’s goal to inspire and empower as many progressive and critical care nurses as possible. With over 115,000 unique downloads of project materials, the CSI innovation project library has become a resource for hospitals, healthcare administrators, and clinical leaders seeking solutions that improve outcomes and reduce costs.
To learn more about bringing CSI Academy to your hospital or health system, visit the CSI Academy FAQ page.
In day-to-day 21st-century life, suffering surrounds us. Whether it’s a burned-out nurse colleague, the homeless person sleeping on the subway grate, a grieving mother standing over the body of her lifeless child, or the stranger crying in the supermarket produce aisle, there’s no shortage of moments in which we see the gravity of the lives of other human beings unfold before our eyes. So, what do we do in the face of it all?
Suffering Isn’t Optional
As nurses, we’re privy to so much:
The grieving mother
The patient with a new cancer diagnosis
The diabetic facing an amputation
The general suffering of morbidity and mortality
Our nurse training exposes us to pathophysiology, microbiology, and other sciences and opens a window into the intimate worlds of other people. Textbook learning is one thing — real life is another thing entirely.
Our patient-facing work is a microcosm of the macrocosm. For every patient with a new life-altering diagnosis sitting in our exam room, ED, or oncology unit, tens or hundreds of thousands of people will likely receive similar news on the same day.
A nurse on the other side of the world could be holding the hand of your patient’s doppelgänger, saying similarly comforting words while you express yours. It all points to the same thing: suffering isn’t optional. It’s universal.
The Spirit of Giving
As the holiday season begins, many people think about family and friends. There can also be a naturally heightened awareness of the suffering around us. Charitable organizations and non-profits send out their end-of-year pleas, understanding that this time of year can often open people’s hearts and their wallets.
Giving increases around the holidays, and while some might attribute this to the last chance to make deductible donations before the end of the tax year or a sense of overwhelming guilt as we spend thousands of dollars on frivolous gifts. In contrast, others go hungry, and most would likely agree that a sense of charity and generosity is generally in the air as the year draws to a close.
But no matter how many checks we write and gifts we give, nothing feels better than human touch, whether literal or figurative.
The Nurse’s Heart
The nurse’s heart is wondrous if not bruised, battered, damaged, and calloused by bullying and incivility, stress, burnout, moral injury, or compassion fatigue. That exact giving nature that led to the desire to serve others by becoming a nurse can also lead to other forms of service.
With over four million nurses in the United States and many more millions in the world beyond, nurses are often at the scene when they’re needed the most. Someone has a seizure in a restaurant, and a nurse sitting across the room snaps into action and knows what to do. An older woman tumbles at the mall and breaks her arm, and a nurse is there to tend to her. There’s a car accident on the freeway, and who pulls over to help? A nurse on her way home from work.
Speaking of work, nurses are the largest segment of the healthcare workforce. Thus, their presence is felt in almost everything that happens. Nurses show up, and our hearts and hands are always ready.
A Reservoir for Tears
Nurses’ hands are skilled: we start IVs, dress wounds, assist in surgery, insert catheters, mix and administer chemotherapy, and perform CPR. Our fingerprints are all over the delivery of patient care, and we also have a hand in non-clinical roles that serve equally important purposes, from writing code to balancing institutional budgets.
Yes, the gravity of human life unfolds all around us, and we nurses know what to do. We’re generally take-action kinds of people, and we reach out our hands to others in situations when the rest of humanity might shy away. Blood, guts, feces, urine, vomit, and afterbirth? We’re right there. Maggot-infested wounds and gangrenous battlefield stumps? Sign us up. The suffering of children, the elderly, and the disabled? We’re ready to pitch in. Our hands have seen it all, and we’re ready for more.
Nurses reach out their hands over and over. Our presence is ubiquitous and universal. We show up. We give. We give again. And we provide some more. No matter how deep the wound, acute the suffering, or how fresh the pain and grief are, a nurse’s hands are ready to be a reservoir for others’ tears.
We’re not heroes or superhumans, and we’re certainly not angels in scrubs. We’re human beings and fallible and flawed like all the rest. But we’re also not afraid to show up. And our hands are there when others’ hands may falter. That’s what makes us nurses, and always will.
Educational books can make excellent holiday gifts for nurses and nursing students. However, with so many titles to choose from, it can take time to determine where to start. Fortunately, Daily Nurse has compiled a list of eight great books written by nurses and healthcare professionals, making it easier to find the perfect gift.
This book is perfect for: Nurses, nursing students, and nurse educators who want to understand race and racism at structural, institutional, and individual levels.
This book is perfect for: Nurses and other healthcare providers that work with medical imaging testing modalities: radiographs, CTs, nuclear imaging, and ultrasound scans and images.
This book is perfect for: Nurses and nurse leaders who want to learn fundamental economic and financial management skills to be successful in daily practice and career advancement.
Smart hospitals are helping bring job satisfaction back to nursing, and care.ai, an artificial intelligence company redefining how care is delivered, is leading the way through gen AI and ambient intelligence powerful assistive technologies to empower clinicians to make healthcare safer, smarter, and more efficient by reducing administrative burdens, mitigating staffing shortages, and freeing up clinicians to spend more time with patients.
Chakri Toleti is the Founder and CEO of care.ai
care.ai’s founder and CEO, Chakri Toleti, a former filmmaker turned healthcare industry leader, was recently named to the Rock Health Top 50 in Digital Health list for his company’s Smart Care Facility Platform. He founded care.ai to bring the first AI-powered autonomous monitoring platform to healthcare to safeguard patients and improve outcomes. Daily Nurse spoke with Toleti about using the same technology as Tesla and other self-driving car companies to improve healthcare facility management and patient care to move toward his vision for predictive, smart care facilities.
What follows is our interview, edited for length and clarity.
You’re revolutionizing the healthcare industry with the same technology that Tesla and other self-driving car companies use to transform the automotive industry. Talk about how you reached this point in your career and your vision for predictive, smart care facilities.
I grew up around physicians. Though I’m not a provider, my mom, dad, and sister are physicians. Now, my daughter wants to become one. So, there are many healthcare people in the family, but I wanted to go a different route. I’m the black sheep of the family. In my previous companies, we were always looking at technology from other industries and trying to bring the learnings from different industries into healthcare. That’s what I’ve always wanted to do. In care.ai, we focused on bringing ambient technology to help the bedside teams be more efficient, just like a smart home. A smart patient room that gives you real-time visibility into operational clinical workflows.
How can it improve outcomes and efficiency in delivering that care within the hospital’s four walls? That’s our focus at care ai. Ambient technology, like self-driving cars, can be used in every other industry. For example, this cup of coffee that I’m drinking has AI in it. When manufacturing happens, cameras observe these cups. And if there’s a small tear, it pushes to the side. Technology is used in many forms; every vertical is usually in your smart home. You have a ring doorbell. Or a Nest thermostat. You can pick up your smartphone and control your garage door; it turns lights on and off. So, this technology improves our lives in multiple dimensions. You have Alexa devices and multiple voice-enabled capabilities as well. And with the advent of AI and bringing AI into regular use has transformed the acceptance and utilization of ambient technology dramatically. We’re doing that at care.ai, the single modality of capturing information. We are challenging the status quo.
So, a provider can walk into the room, do their job, and walk out without touching a keyboard or a mouse. The technology, which is transparent to the bedside team, should be able to document and understand what happened in the room and push it into the electronic medical record. And that’s what we’re trying to achieve. And now, when you bring virtualization capability into the room, your bedside team and other nursing teams can be anywhere, do the hourly rounds, admit discharges virtually, and interact with the patient more effectively in a focused way. With our experience during a Zoom call, a nurse can have the same experience with the patient to complete the admission mission. Some clinical and nonclinical tasks can be done remotely.
Talk about some of the hospitals that are currently using the Smart Care Facility Platform.
We work with some of the largest health systems, from HCA to Vanderbilt to Houston Methodist, for-profit, not-for-profit, and education institutions. We’re very strong in the acute and post-acute nursing spaces.
How is the Smart Care Facility Platform empowering Smart Care Teams?
We start with words, and nursing is one of the core modules and the core feature and workflow to centralize all the admissions discharges and help the bedside nurses. That’s the number one focus for many organizations we work with. In some institutions, when we deploy, it impacts employee satisfaction—reducing burnout. Turnover has dramatically come down, and people are applying to go into these units where we are deployed across the organization from one hospital to another, saying, ‘Hey, you know, we do have some additional support. So we’re not running from room to room to room as we used to do before.’
From employee and patient satisfaction, a significant fundamental paradigm shift of how changes to the care delivery process and redesigning the care delivery process is accelerating our growth.
Healthcare has a growing problem because there aren’t enough clinicians to deliver healthcare, and they spend more time with administrative tasks like filling out paperwork. Talk about how care.ai can help mitigate the staffing shortage, freeing clinicians to spend more time with patients.
There’s a significant burnout because you ask nurses to do more with less. That’s the fundamental challenge. More nurses are retiring and want to be still involved, but they don’t have the capabilities. Today, with platforms like these, retired senior nurses with experience can do the same work from home, doing the virtual nursing component and the administrative as they have been doing for decades. They have the experience to share, so when new nurses come on to the job and have to intubate a patient, they may not have the knowledge, so mentorship is a huge thing, or working remotely from home. In a five-day week, one day, they can work remotely, and the rest of the four on the bedside so they can change pace. So, there are multiple ways to empower the bedside teams that are changing how they look at the day-to-day work structure. Imagine if you’re giving them one hour back rather than them doing these documentation tasks. And the remote team takes all that there’s a significant value to the website team – amazing customer satisfaction.
Suppose you look at a simple workflow for discharge. If I do discharge instructions for a patient, I’m called ten different ways. So I tell them, ‘Hey, I’ll be back in five minutes and go and do something else come back.’ So you cannot spend that 20-30 minutes, focused, dedicated time with the patient to complete the discharge. And you’re doing five other things. That’s where a virtual nurse can be focused, dedicate 20 minutes one-on-one, and complete the discharge much more effectively. HCAHPS increased dramatically for patient satisfaction. Education is much more adherent. All of those impacts have a multi-dimensional effect.
Nursing leaders talk about how they see telemedicine and technology playing a critical role in bringing back retired nurses who can oversee nurses at the bedside. It’s a way of being part of the nursing team without being in the environment. Do you have any examples of how technology is enhancing patient care?
We have a great story from one of the bedside nurses. He injured himself at work. He couldn’t be on the floor standing for hours and hours. But he still wanted to be a part of the team. So he came back to work. And he’s now in the command center on-site. He’s part of the huddle every morning. And then he returns to his bunker, does all the admits, and discharges.
care.ai recently partnered with Google and is building Google Cloud’s generative AI and data analytics tools into your Smart Care Facility Platform. How is this partnership a game-changer for nursing, healthcare, and patient care?
AI is fundamentally going to redefine how care is delivered. If it has clinical context, imagine a virtual AI assistant helping you document the entire conversation and presenting it to you. And then you can say, ‘Yes, this is accurate, and then publish it to the medical record.’ So, those workflows will fundamentally change how you do your job daily, like using ChatGPT to write an article. It will write an article, but it’s not there yet. You still need a human in the loop. But it at least gets you 70-80 percent there.
Imagine when it comes to tools like Med-PaLM to make a generative AI large language model where you can ask a question to the model. It passed medical boards with 86% accuracy, which is top-performing. Medical students get those scores. So, the democratization of that knowledge is a fundamental change. As humans, we will have to get used to imagining a remote village in Africa having those tools that a Stanford professor who’s a neurosurgeon or a neurologist or a cardiologist has but now multiplied by 10,000 times those types of people training and in AI, that can give that kind of diagnosis and tools to people who didn’t have access to that before. Imagine someone sitting in Tallahassee, Florida, or getting access to a Stanford professor or someone in Nemours Children’s Hospital—some of the best minds in the world, and having access to that. Similarly, when you take the collective knowledge of thousands of nurses, imagine the best of them. Taking an understanding and teaching algorithms to document is a pretty passive task.
What’s next for care.ai?
We are focused on building technology that is transparent to the bedside so that they would never have to interact the same way they would have been interacting with technology. We build these complex electronic medical records and all these tools that are becoming barriers to the bedside teams to provide more human care. That empathetic care is why nursing exists. Bringing that job satisfaction back is what we’re focusing on, and building technology that gives that capability back to the bedside teams. AI will help us get there. As humans, we are prone to errors and mistakes. In the airline industry, 80%-90% of the flying is done by algorithms and computers. You still need humans in the loop. We’ll get to a point where, for safety, you can depend on some of these tools, and at care.ai, we are diligently working on improving patient safety to the maximum possible in a care setting. That’s our aim.
Do you have anything else to add?
We are building tools for nurses. We are building tools for the bedside teams who never stopped caring. They wake up, go to work, they come home, same thing. They never stopped caring, either at home or at work. And that’s the community that we’re working with. And it’s a privilege to be helping that community build tools that will truly transform how they work and live.
