Sammy Mosier of HCA Healthcare on the care complexity gap

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

The industry is in the midst of a significant transition in the nursing workforce as baby boomers retire and younger generations graduate and begin their careers. A 2020 survey found that the average age of RNs was 52, and more than a fifth of those surveyed intended to retire or quit nursing in the next five years. It is estimated that in a typical year the country loses an average of nearly 2 million hours of nursing experience to retirement, 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 the demand for health care. By 2030, it is projected that 21% of the US population will be over the age of 65. As individuals age, they are more likely to live with a chronic disease or multiple co-occurring conditions (such as diabetes, heart disease, obesity, or cancer). Experiencing limitations in functionality. We are already seeing that many patients struggle with a variety of conditions or require specialized treatment early in their care journey. Overall patient intensity is set to increase by about 10% between 2019 and 2021, according to the American Hospital Association.

Looking at these two trends, it is clear that we face 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 stronger understanding of the pathophysiology and know how to implement a wider range of treatment options. This means that health care systems need to provide practical training for new nurses that goes well beyond the basics.

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

Training should also not be the same for all. Over the past few years, HCA Healthcare has introduced an updated knowledge and competency assessment at the beginning of the Nurse Residency program. The results are used to create an education plan individually tailored for a particular nurse to close any knowledge gaps.

We continue to make modifications to the program to meet the latest needs of nurses. This year, we have included a mentorship component which provides them with additional support.

It is also important to provide practical education outside the hospital. With the increasing intensity of patients, we are seeing fewer “easy patients” for new nurses to treat to build skills and confidence, so health systems need to expose them to experiences that are as real as possible during training. Be close to life Advanced simulation centers are an important component in preparing nurses to handle increasing care complexity.

At HCA Healthcare, we have built state-of-the-art Centers for Clinical Advancement across the country that model hospital floors, including patient rooms, supply and medication rooms, and nurse stations. The facilities are equipped with high-fidelity manikins that provide realistic training tasks, including providing physiological feedback for a procedure, receiving an IV insertion, and even simulating childbirth. The centers allow us to bridge the gap between the classroom and the bedside and ensure continuity across 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 improved patient outcomes is well worth it.

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As experienced nurses retire, it is important to ensure that new employees and others still at the start of their careers are still receiving ongoing guidance beyond skills training. We have over the past few years introduced a new role to our care teams: the clinical support resource nurse. They are dedicated to overseeing change in practice for new nurses and providing one-on-one coaching in skill development, stress management, and time management. This is a role that is relatively new to the industry, but we have found it vital to support our care teams.

The care complexity gap is projected to widen over the next decade. Developing, deploying and scaling effective solutions will require resources and time, 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 that will be empowered and equipped to do their jobs for years to come, so that we can provide the best possible care to all patients. Can do

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