Nurse Shortages Compromise Patient Care
As profit margins decrease, hospitals around the country are under constant pressure to find efficiencies wherever they can. One of the first places many hospitals look for cost containment is labor management. Labor costs, particularly wages, continue to increase, forcing hospitals to either consolidate labor (meaning fewer nurses per patient) or control costs elsewhere. This is not easy given margins are already so tight.
According to Moody’s, the nursing shortage will persist until 2025. Too few nurses for too many patients may be a dangerous trend. As our population grows and the elderly population booms, hospitals will be under more pressure than ever to find efficiencies in order to remain viable. The U.S. Census Bureau recently reported that the senior U.S. population is projected to outnumber the juvenile population for the first time in our country’s history. One in every five U.S. residents will be retirement age by 2030.
RNAction.org, an American Nurses Association (ANA) nonprofit, believes shorting healthcare facilities of adequate nursing staff is dangerous to patients of all ages, saying it is linked to “higher rates of patient falls, infections, medication errors and even death.” They believe the role of a nurse cannot be understated: adding Registered Nurses (RNs) has eliminated nearly one-fifth of hospital deaths and reduced the risk of adverse patient events. They go on to suggest that using fewer nurses in an attempt to cut costs does exactly the opposite as the intent. These adverse patient events result in longer hospital stays which incur additional hospital costs. They also reduce nurse satisfaction which often results in increased readmissions of improperly cared for patients.
Healthcare organizations must be proactive in optimizing efficiencies if they are to offset increased net operating expenses. But how?
Where Can Efficiencies Be Found?
The nursing shortage is not an easy or quick fix. In the meantime, hospitals must do what they can with what they have. Fortunately, finding efficiencies in their current workflows may hold some clues. By doing so, they give their existing nursing staff more time to spend with patients.
Simply by removing as many barriers to care as possible, hospitals instantly increase their nurses’ ability to become more efficient without sacrificing the level of care they are able to offer patients. These barriers come in many forms and depend on the healthcare environment. Something as simple as assigning nurses to patients in adjoining rooms can save time walking from one end of the hall to the other.
The Permanente Journal published an interesting study in 2008, evaluating how nurses in inpatient med-surg units spend their time in order to “identify drivers of inefficiency in nursing work processes and nursing unit designs.” Of the 767 nurses who participated, more than three-quarters of all reported time was devoted to nursing practice. But what constitutes “nursing practice?” The study broke it down into three subcategories to give us a better look.
- 35.3% (147.5 minutes) is devoted to documentation
- 20.6% (86 minutes) is required for care coordination
- 19.3% (81 minutes) is given to patient care activities
- 17.2% (or 72 minutes) accounts for medication administration
- 7.2% (31 minutes) of nursing practice time was considered to be used for patient assessment and reading of vital signs
The study concluded there were opportunities to improve efficiencies in the areas of documentation, medication administration, and care coordination. Further, “changes in technology, work processes, and unit organization and design may allow for substantial improvements in the use of nurses’ time and the safe delivery of care.”
It is interesting to note that actual nursing practice time falls to the bottom of this list of nurse activities. The primary reasons people go into the nursing field is because it is “an exciting, fast-paced profession” and “it gives you the opportunity to positively impact your patients and community,” one informal survey found. The truth is, nurses want to care for patients. What they don’t know when they’re in nursing school, perhaps, is that only a fraction of their day may actually be spent working at a patient’s bedside, caring for patients.
Can Medcarts Make a Difference?
When we look at how nurses work and what’s required of them, one of the first things we can see is that many of their tasks involve back-and-forth errands. They must gather medical supplies from various locations, complete patient charts and information at the nurses’ station, retrieve medications at pharmacy medication rooms, and of course, travel to and from patient rooms throughout the course of their day. Surely, there is room for improvement here.
Enter: medical carts. Medical carts have transformed the medical industry and may provide a small but significant benefit to hospitals and nurses looking to boost productivity. We’re not talking about a basic medical cart, here. Rather, hospitals need “smart” medical carts that not only transport medical supplies and medication but support modern technology, as well. They often provide space and power sources for laptops and desktops with access to the applications nurses use most, such as CPOE, eMAR, and EHR. Medical carts equipped with this type of functionality mean fewer trips to nurse stations and fewer errors as notes can be made in real-time at the patient’s bedside.
Healthcare facilities have the opportunity to give their nurses basically everything they need to care for patients and document their care in one place that can travel from patient room to patient room. Today’s mobile medcarts are built with the nurse, pharmacy and patient in mind and they come in a variety of configurations with multiple functions.
There are many types of medcarts that support an array of workflows in virtually any healthcare environment, including acute care hospitals, children’s hospitals, clinics, and blood centers. These carts are durable, tech-enabled and secure. Many come with MedKey software that does everything from managing user access and permissions to tracking activity. This technology not only affords much-needed efficiencies, but it helps the hospital control risk. With user access management and digital audit trails, the carts, and the nurses’ activities are all tracked. The data is available within a few clicks to make audits a breeze.
The Types of Medcarts
Not all medcarts are the same. They each need to function in different environments and provide specific functionalities. Thankfully, healthcare facilities have a wide range of options from which to choose. Many manufacturers offer the ability for their carts to be customized, enabling the facility to choose the size, the number of drawers, the dimensions of the workspace, technology enhancements, and multiple accessories. The configurations are virtually limitless.
While the medcarts may be called different things depending on the supplier, these are the most common carts that hospitals use to increase efficiencies, safety, security and nurse-to-patient care time:
Perhaps the most known type of medcart is the supply cart. These carts allow nurses to bring patient care supplies with them from room to room versus visiting a supply room or closet somewhere on the floor. Supply medcarts contain everything from wound care supplies to syringes and glucometers. To maximize efficiencies, the carts are preloaded in a centralized supply room with required supplies on a regular schedule, depending on the demand on those supplies.
Medication carts can be great efficiency boosters a hospital. The carts are secure, providing a dependable way for the pharmacy to get medications to patients in a timely, reliable way without worrying about medication theft.
Anesthesia medcarts carry tools that are required during procedures that involve anesthesia. Because these carts are used during surgical procedures, it is important that all of the tools are well organized and easy to access. This is particularly important when a patient must be taken out of the anesthetized state. Because the medcarts are mobile, they can easily be rolled from room to room, saving nurses and doctors valuable time they can use to spend with patients.
Crash carts contain life-saving supplies, technology, and tools, such as defibrillators, medications, and intubation equipment. Like the anesthesia carts, crash carts organize these items so they can be accessed quickly. Their mobility is key. Patients can crash anywhere in the hospital. Being able to quickly roll these medcarts to the patient is critical, particularly where seconds count. Having nurses running to supply rooms or searching for equipment can cost lives.
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Transfer carts can carry virtually anything from one part of the hospital to another. One of the most efficient uses of these medcarts is in the transferring of medications from the pharmacy to patient floors (to pharmacy medication rooms) or patient rooms. Because medications are on board, many carts come with a key locking mechanism to ensure no unauthorized person accesses the medications meant for patients.
Isolation carts are used to prevent infection from being transmitted from patient to patient from the contamination of supplies. These medcarts are designed specifically to reduce infection potential. As such, they have smooth, non-porous surfaces that can be easily cleaned with strong disinfectants. These carts store personal protective equipment that remains sterile in the cart, such as gloves, gowns, masks, and eye protection.
Of course, there are many other medcarts available to serve specific healthcare needs. These may include IV carts, catheter carts, suture carts, MRI carts, and specialty medcarts. As hospitals look to improve efficiencies and do more with fewer resources, all of these mobile medcarts can provide measurable benefits to both the healthcare facility and the patients in them.
Medcarts Enable Efficient Workflows
The key takeaway is that medcarts enable nurses to actually care for patients rather than spend their time locating what they need to care for those patients. When those supplies, equipment, technology, medication, and tools are neatly organized on specific mobile carts that can be rolled from patient bedside to patient bedside, the patient will likely have better outcomes and return to the hospital fewer times. Nurses are happier because they are doing more of what they entered the nursing field to do and less of the needless steps that burden their workflows.
The medcart has transformed patient care and enabled hospitals to provide better care faster and more reliably. It may not be the silver bullet that fixes all of the hospital’s challenges, but it does solve a significant portion of what eats up nurses’ time in caring properly for patients. At the same time, it reduces the hospital’s risk for errors and patient accidents because of those errors or nurses not being at the patient’s bedside. By making what they need to do their job easily accessible while still ensuring the items on the carts are secure, everyone wins.