Reduced administrative burden: Nursing retention toolkit
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- Goal statement
- Initiative – Work re-design: Identify opportunities to free up nurses to focus on professional nursing practice
- Initiative – Digital preparedness: Prepare and support nurses through digital transformation opportunities that will result in a reduction of administrative burden
- Initiative – Documentation requirements: Streamline and reduce documentation by clarifying the purpose and importance of documentation that nurses are required to perform
Goal statement
Free up nurses to focus on the tasks and care that they are uniquely skilled to provide.
Initiative – Work re-design: Identify opportunities to free up nurses to focus on professional nursing practice.
Intended outcome
- Improved mental health, decreased workload or burden, and increased job satisfaction.
- Optimized scope of practice for nurses, allowing them to focus on nursing-specific tasks and patient care.
- Reduction of administrative burden on nurses by delegating non-nursing tasks to dedicated support staff.
- Increased patient satisfaction due to enhanced nursing-focused care delivery.
Description
This initiative aims to have the most appropriate health care provider and administrative support staff undertake the most appropriate work. This can be done by re-designing who is assigned certain tasks or duties, and alleviating nurses of administrative burdens and other duties outside the scope of nursing practice. There is wide recognition that nurses are often burdened with administrative tasks, as well as other duties outside the scope of a nurse, such as notifying patients of appointments, moving charts, cleaning exam rooms, and restocking supplies. Work re-design supports freeing up nurses to focus on what they are uniquely trained and skilled to provide. This initiative also applies to managers, who need to be supported to prioritize clinical leadership over non-nursing duties.
Two main areas for work re-design include:
- Non-clinical and administrative burdens: Identifying opportunities for non-clinical and administrative burdens to be streamlined. Burdens are often a result of how the structures and systems in an organization require a nurse to document in a way that is burdensome. Organizations can work to alleviate burdens by updating and clarifying the tasks/duties and structures of nurses and other supporting occupations, such as housekeeping and clerical roles, to better respond to the needs of both nurses and patients, and ensuring appropriate staffing of the supporting occupations. Technological solutions can also be introduced to support routine tasks (see "Digital Preparedness" for more.)
- Clinical work of another care provider: Across the health system, organizations try to have the most appropriate health care provider to deliver the most appropriate work for their scopes of practice. Unfortunately, due to system supply shortages and capacity constraints, this is challenging and, as a result, nurses often do work that could be done by another care provider. Health organizations should strive to identify the most appropriate work for each role across their interprofessional teams, including nurses, occupational therapists, physical therapists, recreational therapists, patient care aids (PCAs), and personal care workers (PCWs) across care settings (e.g., long-term care, acute care, community). Successfully doing so will create a team-based approach to care delivery and enable nurses as well as other providers to work to the top of their licence. Designing and providing dedicated training programs (e.g., simulation and practise with interprofessional teams) may be a required activity to realize the value of this activity.
Planning considerations:
- No "one-size fits all" solution: Nursing workplaces and units should be evaluated individually for work re-design, as administrative needs and responsibilities considered out of scope for nurses should be distributed in a way that yields optimal patient outcomes.
- Collect and assess data to drive work re-design: Organizations should collect and assess data that measures the extent to which nurses are engaged in non-nursing tasks, particularly non-clinical tasks in addition to measuring nurse-sensitive indicators. This evaluation can provide insights into how specific duties place undue stress on nurses, impacting both the quality of care and the well-being of the nursing staff. These findings could serve as a catalyst for garnering support and resources to re-design and optimize work as well as identify financial and workload impacts.
- Utilizing paid student positions: Students and new graduates can help contribute to administrative efficiency. It is essential, however, to design these paid positions or external roles to provide ample learning and development opportunities.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: Nurse Leaders will be responsible for overseeing work re-design; HR leadership will be responsible for modifying tasks and responsibilities in role descriptions for hiring or evaluation purposes.
- Accountable: Employers will be accountable for providing resources and supports.
- Consulted and Informed: Nurse leaders and point-of-care nurses should be consulted to identify task shifting opportunities and informed on decision-making throughout the planning and implementation process.
Reference resources and examples (See appendix for links)
- Sunnybrook Clinical Extern: This program invites nursing students to work part time and support interprofessional teams in the clinical environment.
- Alberta Health Services Undergrad Nursing Employee: Undergraduate nurses can provide patient care under supervision and take on tasks such as documenting assessments, decisions, observations and revisions, etc.
- Nova Scotia RN Prescribing: Registered Nurses with specialized education can prescribe medication in their area of expertise and conditions defined by their employer.
- RNAO Guidelines for Developing and Sustaining Interprofessional Health Care: These evidence-based guidelines for developing and sustaining an interprofessional health care environment can be leveraged by individual organizations.
- Horizon Health Insights on the Relationship between Quality Indicators and Administrative Burdens: Assessment of quality indicators across nursing units has shown that administrative burdens are often linked to low care quality scores.
Initiative – Digital preparedness: Prepare and support nurses through digital transformation opportunities that will result in a reduction of administrative burden.
Intended outcome
- Decreased administrative burden on nurses.
- Increased time for nurses to dedicate to nursing-specific tasks.
- Increased value of existing digital tools (e.g., digital charting is aligned with nursing workflows, redundant documentation tasks are reduced or eliminated).
- Digital tools are relevant to nursing environment, as nurses are involved as end-users throughout the entire spectrum of digitalization.
- Introduction of nursing informatics specialists where possible, to maximize benefits of digital transformation.
Description
This initiative focuses on supporting nurses through the adoption of technology that reduces administrative burden. By engaging nurses throughout the digital transformation process, this initiative aims to make technology work effectively for nursing professionals and enhance patient care outcomes.
Key activities are outlined below:
- Establish a nursing informatics role or team: Establish a dedicated nursing informatics role or team with expertise in both clinical practice and technology to guide the integration of technology solutions that address nursing workflows and needs.
- Technology needs assessment: Conduct a thorough assessment to identify the specific technology needs and challenges faced by nurses across different nursing workplaces and units.
- Identify, select, and procure digital tools: Collaboratively identify and select digital solutions that meet the needs of nurses in your organization (e.g., digital solution co-creation workshops). Ideally, procured tools are specifically designed for nurses. Nurses may receive new resources (e.g., phone, laptop, smart tablet) to access digital tools and support digital preparedness.
- Customize digital tools: Collaborate with nurses to customize digital tools to support professional practice of nurses.
Planning considerations include:
- Equitable access: Ensuring equitable access to technology across different regions and generations.
- Customization: To meet the diverse needs of various nursing workplaces, units, and specialties.
- Inclusion of nursing informatics expertise: With knowledge of digital and AI at all planning stages.
- Training and support: Strong nursing-specific informatics support and training programs to support adoption. Provide continuous training, especially when updated features or enhancements are introduced, and consider "Nurse Technology Champions," i.e., nurses or leaders within units who can serve as technology advocates and provide support to colleagues during the adoption process.
- Change management: Change management plans can support buy-in of nurses during the implementation process and help change mindsets and attitudes towards digital transformation.
- Standardization: Find opportunities for standardization so technology and systems work together.
- Co-creation: Co-creation of digital tools tailored to nurses' workflows, and demonstration of the impact tools will have on workflows and the way nurses do their work. Nurses should also be consulted on the type of digital documentation required when digital tools are created to ensure that documentation is relevant to patient outcomes. (See "Documentation Requirements" for more information.)
- Integration with quality improvement: Integration of quality improvement personnel and clear feedback mechanisms to understand the impact of tools on nurses.
- Public education campaigns: Public education campaigns or communications training for nurses may be needed to educate patients, families and caregivers on the use of digital tools and devices by nurse and other health care staff. This can help mitigate potential misinterpretation of health care professionals being distracted by digital tools and devices when they are using these devices to support and improve patient care.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: IT system team or administrators, decision-makers in digitalization, and nursing informatics officer or leaders to support digital transformation initiatives.
- Accountable: Employers and health systems.
- Consulted and informed: Clinical Managers and point-of-care nurses to provide insights based on clinical experience, IT experts.
Reference resources and examples (See appendix for links)
- Hamilton Health Sciences CNIO Role: HHS introduced its first CNIO in 2020 who is leading HIS transformation.
- Canadian Nursing Association (CNA) and Canadian Nursing Informatics Association (CNIA) CNIO Role Overview: CNA and CNIA have developed a sample CNIO Role Overview and Description, and provides a summary of the value of a CNIO in an organization.
- My SE Life App: This app was co-designed with direct care providers, managers, administrators, and billing leads to capture gaps and processes and opportunities in new workflows to create a digital application that truly supports nurses. The application provides real time access to secured client and visit information to support caseload management and continuity of care. Workflows supported include point-of-care documentation, reporting, accountability and communication.
- HIMSS CNIO Role Description: outlines qualifications, responsibilities, and reporting structure for a CNIO role.
Initiative – Documentation requirements: Streamline and reduce documentation by clarifying the purpose and importance of documentation that nurses are required to perform
Intended outcome
- Minimized delays with patient care activities.
- Nurses practicing at the top of their scope.
- Identification of redundancies and reduced or eliminated redundant documentation.
- Standardized and centralized documentation across care settings (e.g., between long-term care (LTC), acute care facilities, home care agencies) to ensure no information falls through the cracks.
Description
This initiative aims to address challenges related to documentation in nursing practice, with a focus on streamlining processes and reducing duplication and unnecessary paperwork. By clarifying the purpose of documentation (i.e., relevance to patient care and quality metrics), nurses can maximize their time for patient care and nursing activities. This initiative supports nurses in practising their full scope while effectively documenting essential assessment information.
Key activities include:
- Assessing current documentation practices: Assess current state of documentation practices to identify redundancies or unnecessary burden.
- Developing documentation guidelines: Develop clear and concise guidelines outlining the essential information nurses need to document for different types of interactions.
- Designing efficient documentation workflows: Create and refine documentation workflows to improve efficiency and integration with clinical nursing workflows.
Planning considerations include:
- Nurse involvement: Engage nurses at all levels (nurse experts, point-of-care nurses) to understand nurses' needs and perspectives and to identify essential documentation. Prioritize the voices of nurses as end-users and seek meaningful feedback. Promote critical thinking when assessing the value and relevance of documentation.
- Training sessions: Provide comprehensive training sessions to help nurses get familiar with the new documentation processes, tools, and guidelines.
- Nurse satisfaction: Collect feedback from nurses to gauge their satisfaction with the streamlined documentation processes and the perceived impact on their workload.
- Communication plan: Communicate the new documentation requirements clearly to all nursing staff, highlighting the benefits of streamlined documentation for both patient care and nursing practice.
- Quality metrics: Make connections between documentation requirements and specific quality metrics to ensure requirements are relevant to patient care.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.).
Stakeholder involvement and role of nurses
- Responsible: Nurse Leaders will be responsible for providing information to nursing staff on documentation changes and updates; HR leadership will be responsible for modifying task requirements and responsibilities in role descriptions for hiring and evaluation purposes.
- Accountable: Employers will be accountable for providing resources and supports.
- Consulted and Informed: Nurse leaders and point-of-care nurses should be consulted to identify how documentation can be streamlined and informed on decision-making throughout the planning and implementation process.
Reference resources and examples (See appendix for links)
- Ontario's "Axe the Fax": Replacing out-of-date fax machines with digital communication alternatives.
- Cortellucci Vaughan Hospital Digital Communication and Workflow: Enables the hospital's overhead communication system to integrate with smartphones using a mobile application. This allows staff to respond to emergency codes and access critical information on touch screens helping to direct them where they are needed most in times of crisis.
- Horizon Health's Forms Committee: A Forms Committee was formed to oversee the creation of new forms. They evaluate if existing hospital forms can serve the purpose, aiming to streamline processes, like consolidating multiple discharge instructions into one, with set implementation deadlines.
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