In late 2019, data from the National Association for Home Care & Hospice showed a 20.2% increase in nursing demand, with a projected 500,000 nurses due to retire by 2022. The cost of replacing these nurses is massive: upwards of $100,000 for replacing each nurse. Nursing turnover was set to be a major challenge in 2020.
Then came COVID-19.
Now in the second half of 2020, with the pandemic raging in the United States, hospice providers are searching for ways to make the job more attractive to the best nurses. That includes reducing one of the top eliminators of nurses, particularly at the outset of their careers: burnout.
A major piece of the burnout solution is after-hours triage care, in which a team of hospice nurses takes phone calls for their fellow nurses who are with patients. These nurses triaging calls address as many caller needs as they can before handing the rest off to the nurses in the field.
The callers are typically family members caring for a loved one in hospice and in need of comfort and guidance outside of the normal business hours. These after-hours calls provide stress to nurses in the field, and an after-hours triage nurse-led team reduces that stress.
That is just one of three ways that this service prevents hospice nurse burnout. Here is a look at those three, including a look at how after-hours triage care boosts staff recruitment, too.
Addressing incoming, after-hours triage calls
Picture this: One of your nurses is in the home of a hospice patient when the family of another patient calls that nurse. If the nurse answers the call, she risks making the family whose house she is in feel as if they do not have her complete attention. If she ignores the call, she knows there is someone out there who is not receiving the help they need.
There is a business imperative at play too: Not only does a hospice’s ability to field after-hours calls improve its CAHPS score, but patients who don’t reach the hospice they are calling might move on quickly to another provider, resulting in lost revenue, says Daniel Reese, CEO of IntellaTriage.
“With our years of data, we can address between 60 and 80 percent of all after-hours calls,” Reese says. “And that leaves field nurses a significant amount of time to handle in-home work while dealing with a much smaller volume of after-hours calls.”
Reese says that the vast majority of after-hours hospice calls are family caregivers of a hospice patient, looking for one of three services:
— Tools for their caregiving process, such as durable medical equipment or morphine
— Guidance on symptom management
— Personal, emotional support
“Most of those issues, they are looking for a soothing voice and general nurse guidance,” Reese says. An after-hours triage service keeps a field nurse’s work manageable by keeping those other after-hours calls away from field nurses and instead with the registered nurses answering those calls.
“The nurses in the after-hours triage service can be that voice in the night,” says Suzi Meschbach, executive vice president at IntellaTriage. “They can be that comforting nurse.”
Reducing nurse stress
Keeping the bulk of after-hours calls away from nurses in the field is a huge piece of the anti-burnout puzzle. Nurses who are supported by a nurse-first after-hours triage service know that when they are talking to a family in a home, and their phone rings, they are only receiving the most important calls.
“Nurses want to provide good, quality care,” Reese says. “That is their nature. And when they don’t feel that they can provide the best care, they worry about the job they are doing, and they worry about the patient and their families. “
Backed by an after-hours triage service, a nurse’s focus in the home is not constantly disrupted by a ringing phone. The stress of those phone calls is two-fold. First, the nurses feel as if they are going to let one or both patients down. Second, without an after-hours team, those phone calls are a reminder that they are working with less support than they would otherwise have during daytime business hours.
“Nurses dread after-hours work because they feel isolated from the rest of the team,” Meschbach says. “During the day, the case managers have the support of the intake department and other providers on call. There is a whole infrastructure during the day that isn’t established after hours. So we provide a sense of teamwork. They know that we have their back.”
Reducing the rotation of after-hours nurses
Once a hospice is using a nurse-first after-hours triage service, it can reduce nurse burnout by changing the way it staffs its overnight cases.
Many hospices staff overnight shifts based on expected call volume, Reese says. A hospice might budget one nurse per 10 expected calls, with an anticipated 40 calls. But IntellaTriage works to address 75%, or 30, of those calls.
“Now you just stretched a once-every-three-nights rotation into once-every-nine-nights rotation,” Reese says. “It’s a numbers game. Over time, (clients) see that ‘40 calls’ actually means ‘10 actionable calls.’ And that’s where they can start staffing their nurses properly.”
Those numbers make the after-hours rotation much less demanding, which is information a hospice can use as it recruits new nurses. One of IntellaTriage’s clients in the Raleigh, North Carolina area has been able to compete successfully for nurses despite sharing a region with major health systems.
“They’ve been able to recruit much better because they have us as a service,” Reese says.
To learn more about how IntellaTriage can help your hospice reduce nurse burnout, visit IntellaTriage.com.