Nursing pathways address causes of nurse shortage

Pathways include work force, learning, leadership

Many of the tactics suggested by the Joint Commission on Accreditation of Healthcare Organizations for addressing the nursing shortage already are in place at Kaiser Permanente, the health care giant based in California, says Marilyn P. Chow, RN, DNSc, FAAN, vice president of patient care services.

Kaiser Permanente launched a major effort a year and a half ago to address the critical nursing shortage threatening quality of care. A multifaceted, multiyear program called Nursing Pathways already is yielding results, Chow says.

The program involves these six pathways:

  • Work force: Improving outreach, development, and retention efforts.
  • Learning: Providing career development opportunities.
  • Leadership: Providing nurses with more authority and developing executive leadership.
  • Practice working environment: Improving nursing ratios and workloads.
  • Research: Improving the clinical pathways used by nurses.
  • Workplace safety and health: Decreasing injuries and other health risks in the workplace.

The pathways were designed to address individual problems that Kaiser Permanente nurses said were critical to deciding whether they would stay in the nursing profession or recommend it to others, Chow says.

The six pathways may be expanded to include other areas as Chow and other leaders at Kaiser Permanente continue to gather input from nurses. Chow recommends getting the support of hospital leaders, including senior executives, and then requesting input from nursing staff.

"We listened to the staff and agreed to staffing ratios that are richer than what is proposed by the state. We’re also developing a zero-tolerance policy for any sort of abuse of the nursing staff," she says.

Documentation burdens were a major issue for the staff nurses, so a Kaiser Permanente team has been working for more than a year to reduce the paperwork requirements. The multidisciplinary team includes nutritionists, therapists, and other staff members whose work overlaps with nursing so they can look for ways to consolidate forms and reduce the overall amount of paperwork.

Another effort that has been embraced by Kaiser Permanente nurses in the northern California region is the "no cancellation" policy for nurse staffing.

Under this policy, a lower than expected census will not result in the facility reducing the number of nurses working that shift, as it did before. Instead, Kaiser Permanente keeps the extra nurses on the clock and uses the opportunity to send them to continuing education classes and other professional development.

"That’s proven to be a very positive change for the nurses because it sends the message that we’re not focused only on maintaining the absolute bare minimum staffing levels," Chow says.

"We’re willing to invest that time in those nurses when the census allows us to."