Long-Term, High-Impact Nursing Care Solutions Promote High-Value Care

It's no secret that nursing is in a state of crisis. From the onset of the COVID-19 pandemic to now, nurses nationwide have increasingly battled rising burnout and stress–all while caring for higher-acuity patients, with less support.

In April 2023, the National Council of State Boards of Nursing (NCSBN) found that 100,000 nurses left the workforce during the pandemic, and by 2027, almost 900,000 more nurses plan to join them. That’s nearly one-fifth of the 4.5 million registered nurses (RNs) working today. A recent workforce study published by JAMA Health Forum in February 2024 found that the number of RNs is increasing; however, RNs are leaving acute care for ambulatory, community health and other nonbedside roles. As nurses continue to move away from the bedside, not only are health systems facing a growing nursing care shortage, but new nurses are left without seasoned mentors to guide them. In the long-term, this lack of mentorship and support at the bedside may further challenge retention.

Unless major changes are made, health systems will continue to feel the squeeze of the ongoing nursing care shortage while patients are put at risk by a less experienced, smaller workforce. When we talk about achieving value-based care, nurses play an integral role in making high-quality, personalized care possible. To realize this value, we must prioritize supporting nurses in a safe work environment. To create change, health systems must go back to the basics by investing in long-term solutions that will ensure nurses are empowered and supported to deliver value-based care. 

A Team-Based Model Makes Integrated Care Possible

The primary nurse model is unsustainable in many situations due to a deficit of experienced RNs and an increase in less experienced ones. Nurses are struggling in this environment and are often unable to deliver high quality, safe care to their patients.

In a value-based care environment, an integrated approach to care is necessary to ensure that each member of a care team is engaged with their patients and helping to deliver value. To deliver the best possible care to patients, a care team must be highly collaborative–working together to deliver care based on their individual strengths and experience and tailored to a patient’s unique needs. A team-based approach to nurse staffing leverages the strength of experienced nurses overseeing and directing the care provided by less experienced nurses which in turn can improve care quality.

This care model allows experienced nurses to provide oversight to both registered nurses and support personnel making it possible to operate safely while caring for a greater number of patients. Novice nurses are supported and able to gain confidence and develop clinical judgement skills when receiving ongoing mentorship and guidance in a safe, supportive environment. In today’s environment where there’s a shortage of nurses at the bedside, a team-based model also offers a more agile approach to staffing.

Virtual Nursing Brings High-Touch Digital Care to the Bedside

During the pandemic, telehealth/virtual nursing grew in popularity because it allowed patients to interact with health care professionals. Virtual nursing has been used for patient encounters to triage a patient’s condition, provide patient education and follow up after discharge. Today, health care organizations are using virtual nursing to support novice nurses and take over many of the time-consuming tasks of nursing in general.

Virtual nurses can take on an array of clinical and administrative duties, helping to relieve the burden felt by bedside nurses. For example, a virtual nurse could assist with obtaining patient histories during admissions, sharing discharge instructions, providing patient education and supporting transition of care planning. Many organizations are using telehealth/virtual nursing to identify potential issues before they become catastrophic. Having real-time access to the electronic health care record (EHR) and being able to identify data trends that could identify a potential issue, the virtual nurse can contact the bedside nurse to alert them of a potential issue before it becomes life-threatening. Virtual nurses can provide resource support to novice nurses with a push of a button, allowing them to see the patient, check the EHR, talk to the patient and their nurse and provide expert knowledge and clinical decision making in a situation. The novice nurse basically has a mentor and coach supporting their clinical practice right in their pocket.

Nurses Should Feel Supported the Moment They Enter Practice

It’s important to remember that nurses aren’t leaving the bedside simply because they don’t want to “nurse” anymore. Most nurses are still passionate about their work and their patients. However, they want to practice nursing in a safe environment where they feel equipped to deliver quality care to patients. That’s why ensuring they feel adequately supported with a team behind them is so critical.

But making sure new nurses feel comfortable from the moment they step into a health care setting is also a key part of this puzzle. In recognition of this, many health care systems are investing heavily in newly licensed nurse onboarding programs and other training opportunities for their nurses. By investing in these programs, health systems demonstrate to nurses that they are valued while also training new nurses on key competencies. More and more health systems recognize that it’s not enough to simply graduate from nursing school and pass NCLEX; training needs to continue once nurses step into practice.

Nursing education and practice must work together to address the issue of new nurses’ preparedness for the reality of practice. Even though the total number of nurses is now increasing, we can’t be complacent. Health care organizations need to recognize nurses will leave the bedside for other roles if they aren’t supported and able to practice in a safe work environment that promotes the highest quality care.

About the Author

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, is a practicing nurse practitioner in critical care for Penn Medicine, Chester County Hospital and adjunct faculty in the graduate nursing programs for Drexel University and Neumann University. Anne has over 40 years of experience in nursing and 26 years of experience as a nurse practitioner. She currently serves as Chief Nurse of Health Learning, Research & Practice, Wolters Kluwer.