Nurses are stressed. A study of 50 000 U.S. registered nurses found that among nurses who left their job in 2018, 31.5% did so because of burnout. Before the pandemic, clinical nurses already worked in high-stress environments with heavy responsibilities.
But now, nurses are struggling under the weight of heightened pressure, deeper staffing shortages, more layers of PPE, and ever-changing protocols. It’s what might be diagnosed as “acute on chronic” workplace stress.
Even worse, some highly skilled and competent nurses can’t see a way forward. Although many feel a true calling to care for others, their career trajectory may not seem clear.
A lack of career progression or recognition of their work can be the final straw when combined with the daily pressures of knowing the slightest oversight can lead to a major medical error.
Amidst all this pressure, it’s no wonder that some US states are seeing record nursing shortages, nurses are reconsidering their career options. Of course, healthcare organisations are looking for solutions.
A large 2011 study of the nursing profession found that patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out—a troubling finding that signals problems with the quality of care.
And since nurses are the single largest group of healthcare professionals—in the U.S. alone more than 6 million nurses make up nearly 30% of hospital employment nationwide according to 2019 stats—a crisis among nurses means a crisis for the whole system.
But it’s going to take more than a few complimentary pizza dinners or some handouts on stress management to fix a problem this big. Systemic change requires ground-up solutions.
At Xapimed, we believe that an important piece of the puzzle is encouraging, documenting, and rewarding competency.
Here’s how nurturing competency can increase nursing career satisfaction—and put a dent in the nursing crisis.
Building confidence in new nurses
Making the transition from formal education to the workplace can be overwhelming for recent nursing grads. Despite their extensive training, they are often greeted by a steep learning curve as they step into the real world of nursing.
Even experienced nurses may feel overwhelmed when they transfer departments or arrive at a new facility. In specialized roles, such as intensive care or trauma, it can take years to feel truly confident in the entire range of skills required.
And it’s no wonder—medicine is a complex system of ever-changing best practices, technology, and teammates.
Obviously, it’s good for patients to be cared for by competent nurses. At the same time, however, it’s important that nurses have a healthy degree of confidence in their skills to give them staying power.
In fact, a 2017 study of Iranian nurses identified that “development and valuation of [individual capacities] would contribute to gaining nursing professional power.”
In order to build such confidence, there needs to be certainty—on both the part of the nurse and the facility—that the right foundation of training has been laid.
To do this requires rigorous skill assessment. After all, a nurse may be able to pass a written exam, but are they able to put those skills to the test during high-stakes life-and-death situations?
Enter Xapimed’s “Smart Orientations.” These digital orientations reduce the amount of time it takes to ramp up to full productivity by using adaptive assessment processes.
Better yet, they are all based on specific nursing roles and departments. For example, a labour and delivery nurse will need a vastly different set of skills compared to an OR nurse within the same hospital.
As we’ll see next, one of the keys to successful skill assessment is capturing them in the right context.
Assessing skills in the moment
Up until now, a lot of healthcare systems have relied on paper-based skill assessment systems.
A nursing skill is observed; it gets checked off a list. But this approach misses a key component to any assessment: context.
Assessing skills within the actual context where they have used calls for point-of-care skill assessment.
By exposing new nurses to a range of situations and giving them an opportunity to demonstrate their skills within the course of their work they can build—and document—new competencies.
In Xapimed, these kinds of assessments can be done peer-to-peer or supervisor-to-peer. “Skill Verification Requests” enable nurses to request verification of skills they’ve developed on the job.
Allowing verification from multiple assessors over time is important in deskless, 24/7 jobs such as nursing, since skills can be captured at 3 p.m. in a mock scenario or 3 a.m. in a real-life one.
By removing friction, Xapimed supports healthcare organisations as they capture skill levels at scale in real time. In a field with as much frustration already baked in as nursing, we believe it’s essential to remove it wherever possible.
One of the nagging issues with skill assessments in the past was that they were often tied to paperwork (which can go missing) or to desktop computers (which are cumbersome).
Xapimed, however, is cross-compatible across workstations on wheels (WOWs), mobile devices, Voalte phones, and can even be accessed through a bring-your-own-device (BYOD) approach.
There is no need to find the correct paper checklist, print it off, or file it afterwards—this digital solution eliminates the burden of paperwork.
How Xapimed Collected Mock Code Blue Data
Providing care to more than 500,000 patients each year, MedStar Health is the largest healthcare provider in the Washington, DC/Maryland region.
Together with Xapimed, they administered “Mock Code Blues” to improve resuscitation skills.
A medical resuscitation mannequin was placed in specific areas of the hospitals. As staff encountered the mannequin, they participated in the “Mock Code Blue.”
A Medical Educator used the Xapimed Group Observation App to record information about the participants, the resuscitation processes, and any problems encountered.
The biggest problem? A lack of understanding of the defibrillator’s user interface. This finding, along with several others, was used to refine skills training among 50,000 users across 10 hospitals.
Empowering Nursing Career progress
Many of the retention difficulties plaguing healthcare organisations may be linked to nurses feeling powerless, as though they are not active participants in their own careers.
According to recent research out Washington State University, “nurses who perceive themselves as empowered in the workplace have better patient outcomes and patient satisfaction scores.”
The antidote? Engaging nurses in their own career trajectory. In most healthcare organisations, career progress takes a top-down approach:
“Anyone with this set of skills, please step forward.” Xapimed however, encourages a bottom-up approach: “As a nurse, I can be responsible to develop this skill.”
One way to put nurses in charge of their own career development is having a comprehensive, accessible skill library available.
Individual nurses can select skills from the library to practice and demonstrate—and then have these new competencies documented.
There can either be a specific pathway laid out that sends assessment notifications prompting a nurse to have a certain skill evaluated, or the nurse may request an assessment on a specific skill.
Either way, Xapimed Digital Skills Checklists capture and verify skills digitally, offering nurses support as they develop and document new skills.
Offering nurses control of their skills and development journey offers them greater visibility and personal investment in their career progression.
Empowering nurses in this way can greatly improve engagement and job satisfaction. It often leads to rewards and recognition—and, most importantly, a path forward.
Floating success across departments
Among the army of nurses that make any hospital run is a subset called float nurses. These skilled nurses “float” from floor to floor as needed, covering unexpected staff shortages or shoring up patient care efforts in departments experiencing surges.
While some hospitals may choose junior nurses to float—since this is not always an enviable position—floating actually requires a vast set of skills.
For example, floating from the Surgical floor to the Emergency Department to the ICU might require knowledge of wound care, drowning protocols, ventilator management, and much more.
Obviously, a floating nurse with inadequate skills can create a latent hazard, creating the possibility that a lack of skill at a critical moment could negatively impact patient care.
Of note, it shouldn’t be left to nurses themselves to know if they should be deployed to a certain department—this must be managed by the organisation’s Resource Deployment department.
But, in order for Resource Deployment to manage staffing needs correctly, they must have float nurse qualifications at their fingertips. Enter up-to-date, digital skill assessments.
Soliciting and documenting feedback
Happy nurses? Unhappy nurses? How can healthcare organisations find out what is going on with one of their most valuable resources?
The answer is simple but difficult for many organisations to implement: ask.
As a direct result of the pandemic, nurses are receiving unprecedented press coverage. Although nurses are the single largest group of health care professionals, before the pandemic they were quoted only 2% of the time in US news media.
As COVID-19 crushed healthcare systems, however, reporters often enlisted nurses as sources. They frequently spoke about working conditions on the basis of anonymity for fear of reprisal—such as these four Canadian nurses.
There is surely a better way forward than leadership getting staff feedback via media outlets. Resolving dysfunctional communication between leadership and nursing staff requires a willingness to listen.
From first-day interviews to “stay interviews,” collecting and documenting nursing feedback is critical to retention.
Besides documenting core competencies, Xapimed can document nursing satisfaction.
For example, one client is going beyond monitoring competencies to capture job satisfaction by asking questions such as: “What do you like here?” and “What would be a reason you would leave?”
Xapimed also connects people with their direct supervisors to work through feedback and find solutions.
Easing the burden of compliance
Usingclunky, manual, paper-based systems means that whoever is assigned to monitor nursing competency—whether it’s the VP of Compliance, the VP of Data Quality, or someone else—may never have timely data to demonstrate compliance.
This presents a huge obstacle in being audit-ready. Paper-based and spreadsheet-based systems simply cannot deliver the timeliness and clarity of data required to satisfy regulatory requirements.
While competency is directly tied to job satisfaction for nurses, it is also a huge part of regulatory compliance for healthcare organisations.
Monitoring nursing competency can be a huge pain point for system administrators with millions spent each year in time, labour, and inaccuracies from administering paper-based learning management systems.
On the other hand, Xapimed integrates securely with existing systems and offers real-time dashboards; detailed, and time-stamped skills matrixes.
Digitisation of skills and competency frameworks offers efficiency, cost savings, and real-time data reporting so anyone can understand the skills and competency of the entire nursing workforce at any given moment.
Nursing may be a noble calling, but recent reports show that it can also be a pretty miserable profession.
Workplace culture issues, stressful working conditions, inadequate pay, difficult patients, and long working hours can drain nurses dry.
Overall, healthcare organisations are seeing high turnovers, skill shortages, and low job satisfaction.
The ripple effects of the COVID-19 pandemic may result in an unstable nurse workforce for years to come.
Given nurses’ far-ranging skill set and their importance in patient care, it is essential that organisations better meet their needs.
Xapimed ensures that nursing and clinical staff know how to complete tasks and procedures correctly with more rigorous training and assessment.
It effectively replaces antiquated, poorly performing paper systems. Overall, Xapimed supports a connected and empowered workforce—the kind of team that competent nurses want to join for the long term.