The new nursing crisis demands new solutions
February 28, 2022
The US nursing shortage is placing health systems under pressure. A few healthcare leaders are starting to think like sports team owners and remodel their teams to get more work done with less. They make scarce human resources more productive through automation technologies (process automation, artificial Intelligence, robotics) that can take over routine and support non-routine tasks. Leaders are also figuring out who among them is responsible for the change. The leadership challenges require a new mindset and an agile test-and-learn mentality to transform operating models.
Healthcare’s resourcing crisis is arguably most obvious to patients who go to hospital and need nursing care and experience the shortage. The reality is really starting to bite, and it’s a challenge healthcare must face. Early COVID-related retirement, burnout and mass resignation among nurses attracted by other industries (or home life) have added an acute challenge to chronic workforce aging. Research estimates that 660,000 baby-boomer generation registered nurses are working during the pandemic—the current backbone of the delivery system. Most of them are expected to retire by 2030.1 But if stress makes nurses retire sooner, a shallower pool of nursing skills could disrupt nurse availability throughout the United States. In fact, former healthcare workers often become patients, exacerbating the gap.
All the predictive demographics modeling around nursing resources indicates a growing gap driven by both dwindling supply and growing patient need.2 The slowing birth rates of the late twentieth century mean there won’t be enough nurses entering the labor market to keep up with demand. Aging societies with chronic diseases need more and more nursing care.
We used to talk about technology as a way of improving clinical outcomes but with an absolute shortage of human labor, technology’s role is increasingly about scaling precious human talent. The alternative—an inability to meet society’s healthcare needs—is unthinkable.
A hospital leader I spoke to recently compared healthcare leaders to sports team owners, and nurse managers to team coaches. When confronted with nurse staffing shortage, nurse managers would try to solve the problem using their current teams—saving time through greater efficiencies like a coach who optimizes tactical execution.
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Not only is the number of available nurses too small, but the number of patients and their needs is multiplying—there are effectively more ballgames to play.
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The team owner would rather look for the best players in the market and pay a transfer fee. In the nursing shortages of the last 20-30 years, US hospital leaders typically imported nurses from outside the US—and the problem dissipated. Now, changing immigration laws make that difficult. According to the census, net international migration into the U.S. last year was one-quarter what it was in 2016.3 Hospital leaders can´t rely on unforeseeable regulatory changes. Today’s challenges require different solutions. Not only is the number of available nurses too small, but the number of patients and their needs is multiplying—there are effectively more ballgames to play. The traditional hiring solution is also unsustainably expensive to solve with contractors. Even if owners paid the ever-increasing wages of “gig” nurses4, paying nurses more does not create new nurses and does not solve the shortage. Bottom line: This crisis requires the owner to step in and integrate automation technologies as part of a reinvented healthcare operating model.
Hospital leaders should look outside the dugout in the same way a sports team owner looks at new players. Coaches can work hard to get the best from existing players, but when new players are needed, it’s the owner who must buy them, and drive a new team strategy with the coach through the reallocation of tasks.
That’s why C-level involvement is required: without an executive champion, no organization will change operational fundamentals, and healthcare (for good historical reasons) is particularly set in its ways. Healthcare leaders often think the only way to improve labor capacity is to eliminate wastage. It’s great to eliminate inefficiency, but if you need 20-40% more capacity there just isn’t that much wastage in the system. What’s needed is a fundamental redesign and allocation of tasks to humans and machines. It’s time for owners to bring in entirely new resources that can perform manual and cognitive tasks. Owners will need to test-and-learn and fundamentally reinvent operating models.
What does the nursing workforce of the future look like? A 2019 Brookings study5 revealed that automation and artificial intelligence could automate up to 33% of healthcare work. But it’s not as simple as replacing a given person with a robot. While the workforce will include humans and technology, automation will take over only routine and simple non-routine manual and cognitive tasks. So while a robot might be able to take over tasks equivalent to two people’s work effort in terms of work volume, they cannot replace any single nurse (who typically handles numerous different cognitive and physical tasks in a workday6) entirely.
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Leaders would need to reengineer healthcare work so that every nurse passes on some tasks and fills up the remaining time with more complex tasks only human nurses can perform—non-routine manual and cognitive tasks, in particular. Instead of traditional calculations (the number of hires or agency staff required to fill vacant roles), the end state should be expressed in terms of the required tasks. These would probably be split into physical / cognitive and routine / non-routine tasks (see figure). Once split, the correct combination of human and automation technologies with the correct skill levels, and on the correct basis (permanent versus temporary) can be budgeted for—with automation technology focused mainly on routine tasks, and humans on non-routine.
Introducing automation into a provider organization requires cross C-Suite collaboration. Because automation involves aspects of both HR and IT functions, CIOs and CHROs will need to collaborate with the support of CEOs. The truth is the nursing shortage isn’t going away. It’s only getting worse and scaling up human labor capacity through technology to help meet greater demand isn’t a choice—it’s an imperative. It’s time for owners to buy those automated players, before they run out of flesh-and-blood team members completely.
1Buerhaus PI, Auerbach D, Staiger D. How should we prepare for the wave of retiring baby boomer nurses? Health Affairs Blog [blog on the Internet]. 2017 May 3 [cited 2021 Dec 6]. Available from: https://www.healthaffairs.org/do/10.1377/hblog20170503.059894/full
2Supply and Demand Projections of the Nursing Workforce: 2014-2030, https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nchwa-hrsa-nursing-report.pdf
3CBS, January 9, 2022, Slowing immigration worsens job shortages, https://www.nbcnews.com/politics/meet-the-press/slowing-immigration-worsens-job-shortages-n1287219 (Accessed February 14, 2022)
4Logan, K. November 19, 2021, Fortune, Nationwide nursing shortage is leading to big salary boosts, https://fortune.com/2021/11/19/nursing-shortage-salary-increases-average-pay/ (Accessed January 27, 2022)
5Muro, M, Maxim, R and Whiton, J, January 24, 2019, Brookings, Automation and Artificial Intelligence: How machines are affecting people and places, Automation and Artificial Intelligence: How machines are affecting people and places (brookings.edu) (accessed 01/02/2022)
6Gwynedd Mercy University, What Do Nurses Do?, https://www.gmercyu.edu/academics/learn/what-do-nurses-do (accessed February 14, 2022)