Changes associated with the COVID-19 pandemic include a rise in demand for nursing services with an increase in turnover. The impact on outpatient operations are underrecognized and significant. We review mechanisms to confront this shortage. Neuromuscular medicine practice is outpatient based and nursing resource intensive, including care coordination, infusion management and ongoing care needs. An outpatient nursing operation supporting a 13 cFTE clinic was impacted by retirement (April 2021), duty changes (May 2021), unexpected departures (June 2021, July 2021, August 2021), promotion (May 2021, July 2021), vacation (October 2021) and unexpected leave of absence (September 2021).
To stabilize operations, a plan with weekly interventions was implemented between 9/27/2021 and 1/10/2022. Stakeholders including practice providers, per-diem nurses, physician providers, resident physicians, outside partners, health IT, and healthcare assistants were engaged. Nursing positions at elevated pay scales were posted.
The department typically has 177 hours of nursing coverage per week including 40 in neuromuscular support. At its nadir, the department had 36. At minimum, 56 hours were available from stakeholders. At maximum, the plan included 196 hours per week to cover nursing tasks. The overage allows newly hired nurses time to be inefficient while training. Hiring was brisk. Total cost is expected to be neutral given that short term solves – while expensive, were offset by unused budgeted dollars due to unfilled positions.
During crises, outpatient nursing capabilities can be temporarily reassigned. Hiring replacement nurses quickly is required. As other providers are not efficient at executing nursing tasks, the temporary solves must overcompensate for losses. A weekly, detailed analysis of available resources is required to organize a response, engage stakeholders, salvage morale, avoid further losses and maintain acceptable levels of patient care. A “hire anyone” approach is not appropriate. A “hire at any salary” approach is not required.