Our nurses are in trouble: One-third of all nurses in the U.S. report an emotional exhaustion score of 27 or higher, considered to be “high burnout.” Long shifts, stressful work environments, and few reinforcements are unfortunately the norm. With an aging patient population and a projected nursing shortage through at least 2025, it’s a crisis that needs to be addressed.
While there are many factors that influence nurses’ job satisfaction, there’s one primary area that hospitals have only explored on a limited basis, even though it has tremendous potential: streamlining clinical workflows at the heart of care communications. About 60 percent of nurses reported working up to 10 hours of overtime each week due to wasted time trying to communicate with staff.
Connecting care teams with each other and with the information they need to do their jobs is key to beginning to reduce the burden on our busy nurses, and it all starts with clinical workflow.
What’s a Clinical Workflow?
Perhaps the best place to start is first defining what we mean by clinical workflow. Workflow is a term that gets used in a variety of ways, especially in healthcare. We like this definition from Vital Health Software:
Clinical workflow: A logical sequence of operations, which are carried out in order to obtain a pre-defined result within the delivery of clinical services
To dive a bit deeper, I think of workflows as the heart of clinical communications. Clinical workflows are truly the foundation of our work, and like the heart, are the essence of life and function as a system. You need every part of the heart to keep the blood flowing, or workflows running. Let’s explore five ways to optimize each part and ultimately streamline clinical workflows to make nurses’ lives easier:
The 5-Step Guide to Streamlining Nursing Workflows
1. Connect disparate systems
Hospitals continue to be plagued by silos, and if clinical workflows are like the human circulatory system, information needs to be like oxygen—constantly available. There are dozens of clinical systems that nurses interact with on a daily basis, including nurse call systems, patient monitoring devices, and the EHR system. At most hospitals today, these systems still don’t talk to each other, and if they do exchange information, it’s often on a limited basis that doesn’t provide significant real-time value. For example, patient vital signs from the monitoring devices may be recorded within the EHR, but there may not be a push of that information to the right nurse if the system detects something irregular.
A clinical communication platform can leverage the clinical surveillance capabilities of your EHR to automatically deliver best practice alerts with relevant clinical context. For instance, your EHR can use vital signs a nurse enters to calculate a Modified Early Warning Score (MEWS). If that MEWS exceeds the thresholds set by the organization, the system automatically sends an alert to the right caregivers on their mobile devices. The patient name, room, and MEWS score give the clinicians the full context they need to take action immediately.
2. Prioritize alerts
Nurses are never standing still—they log 4-5 miles during the average shift—because there is always a long list of things to do: patients to respond to, colleagues to collaborate with, data to enter and track. These tasks aren’t going away, but the trouble is knowing which is most important to tackle first. As a cardiology nurse, I would be with a patient and receive repeated nurse call requests from another patient. If they really needed me, that was all well and good, but oftentimes they simply wanted a glass of water or another pillow. If I had known that, I could have finished my current task then proceeded to fulfill their request, instead of bouncing back and forth like a boomerang.
For many nurses, alerts are just that: A beep or buzz on their smartphone or voice badge with little or no context. A clinical communication platform makes prioritization easy: Color-coded alerts, different audible tones, and patient information put all of the data needed to make an informed decision at a nurse’s fingertips. For nurse call alerts, you can even call back to the patient’s pillow speaker to better understand their request. Alert prioritization helps nurses go through their workflows in the most efficient way possible, reducing friction and frustration.
3. Drive alerts to the right role on the care team
Nurses really are the glue that holds care teams together, and as a result, they tend to take on more to ensure workflows run smoothly and their patients receive the best care. They’re known to change a patient monitoring device battery or run down to the cafeteria for a patient meal—tasks that aren’t really in their job description—to help the care team or go above and beyond for their patient.
This practice doesn’t empower nurses to practice at the top of their license, and it also creates waste in the workflow. A clinical communication platform can direct types of alerts to the role(s) on the care team best suited to handle that alert. For example, a loose lead or low battery alert can be automatically delivered to a biomed technician, and a patient discharge order can be sent to both the nurse and environmental services. With the correct routing rules, nonclinical tasks can be delegated and nurses can remain uninterrupted from doing what they do best: caring for patients.
4. Communicate and escalate—even if you don’t know their name
Care collaboration is the name of the game, but it’s easier said than done. Care teams are increasingly large and diverse. They may span departments and facilities, yet it’s critical for everyone on the care team to communicate as if they were in the same room. Spare your nurses from tracking down physicians, playing phone tag, and waiting for the operator by using a clinical communication platform that has an enterprise-wide, web-based directory at its core.
A single source of truth that is updated in real time enables all care team members, including nurses, to look up who they need to communicate with, even if they don’t know that person as an individual. For example, a nurse may know she needs to connect with the on-call hospitalist. She doesn’t know who that is on that particular day, but it doesn’t matter—the directory knows, and will connect her when she types in the role alone. This directory is also home to contact preferences, which are necessary for escalations. For example, a physician may be preferred to be texted on her smartphone, but if she doesn’t respond, to automatically escalate to her encrypted pager. Escalations can go beyond devices to roles as well—escalate to the next available caregiver, a charge nurse, or response team—to ensure patients are taken care of quickly.
5. Build visibility to workflow process to encourage innovation
The last step to simplifying nurses’ lives is the least technical, but arguably the most important: Put a spotlight on your workflows. Workflows are not meant to be intrinsic and invisible, and they must be frequently reviewed and discussed to foster innovation. Consider highlighting a specific clinical workflow, or even just parts of the workflow, each month and discuss with your team: What’s working? What’s not working?
There’s nothing “magic” about an efficient clinical workflow: It requires team-wide understanding, commitment to performance improvement, and creation of best practices. Invest in the time with your team to streamline and optimize your workflows, and you’ll reap the rewards for your staff and for patients.
Let’s Get Started
How are you streamlining clinical workflows at your organization? I’d love to hear what you’re doing and how I might be able to help. When in doubt, stick to this mantra that has served me well as a nurse leader: Don’t add a process, help to remove one!