Our team of Healthcare Industrial Engineers created this newsletter to share the industry’s best practices with leaders who can apply operational efficiencies in their daily work.
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Nurse vacancies and contract labor rates have soared in the post-pandemic environment. As a result, many hospitals are currently evaluating alternative care delivery models to support the staffing ratios needed to provide quality patient care and retain staff.
This newsletter reviews four alternative care delivery model options, ideas to attract applicants, and considerations for successfully implementing a change to your current care delivery model.
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Four Alternative Care Delivery Models
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The RN extender model utilizes LVNs or LPNs, depending on your state, on Med/Surg nursing units to expand patient capacity. The LVN/LPN and RN work together as a team to care for 50-60% more patients than the RN alone. For example, if your current Med/Surg unit staffs a ratio of 1 RN for every 5 patients, your extender team might care for between 7 and 8 patients, depending on acuity.
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The replacement model is similar to the extender model above, except the RN + LVN/LPNs operate less like a team, and in more of an oversight format with the RN focusing on RN specific duties. In this model, the LVN/LPNs have their own patient load, but the RNs cover RN scope of practice duties, such as assessments, with the patients. The RNs have a patient assignment of their own in this model while also overseeing RN duties for assigned LVN/LPNs.
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3
LVN/LPNs IN PLACE OF TECHS/PCAs
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Some Med/Surg and Intermediate Care Units have found success in slightly expanding RN ratios when employing high-functioning LVN/LPNs in place of techs. Depending on the unit’s size, this model typically retains one tech 24/7 to focus on patient bathing, stocking, and other specific support duties while all other techs are replaced with LVN/LPNs to provide expanded support for RNs.
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The team model is the most popular of the alternative care delivery models because of its efficiency, as it maximizes scope of practice for team members. It is especially effective for units with census levels that correspond to the patient ratios per team (aka staffing grid “sweet spots”). In this model, a team of one RN, one LVN/LPN, & one Tech/PCA are assigned the same patients. As an example, in a Med/Surg unit, the team would be assigned between 10 and 12 patients. The RN leads the team and coordinates care between the team members.
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Top Tip: Don’t assume one size fits all at your hospital! Be sure to examine each unit separately against potential models to find the right fit.
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Successful Implementation
& Change Management
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It is important to thoughtfully establish, and carefully track success measures prior to implementing any change to your current care delivery model.
Be sure to highlight risks and benefits to the team prior to going live with any care model change. Ensure all team members understand the “why” and check in to measure engagement in the new care model before and after the pilot.
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Top Tip: Internal marketing and communication resources can help with this piece of the transition, if you are lucky enough to have these at your organization!
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It is critical to collect and review feedback throughout the pilot and make adjustments to support success prior to the transition from pilot to full implementation.
Finally, design a staggered implementation that realistically accounts for the anticipated hiring and onboarding timeline. Transitioning to LVN/LPN new hires cannot be achieved immediately. It will take time to recruit and orient to the unit. Develop a reasonable plan for this timeline and set appropriate expectations with staff and administration.
Alternative care delivery models are without question, easier said than done. However, a thoughtful and committed approach often yields results with more reasonable staff workloads, leading to improved retention and staff engagement, as well as reduced premium spend.
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Top Tip: Finding the right staffing model for nursing units can be a challenging process because to identify the best solution, we must consider patient type, acuity variability, current staff skill mix, the potential to recruit and fill various position types for the unit type, and more. Time studies should often be used to ensure workload is distributed as designed. It is important to remember, it is very appropriate for different units within the same hospital to employ different care delivery models because the considerations often vary by unit.
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Attracting Applicants
We would be remiss in not mentioning the LVN/LPN applicant market when all alternative care models noted include this role! RN shortages have increased demand for LVN/LPNs and other non-RN caregivers, driving a competitive hiring market for even a creative staffing complement. Carefully consider incentives to attract LVN/LPNs in the short-term and support long-term retention. Below are some ideas for recruiting and training LVN/LPNs and helping transition your LVN/LPNs to RNs over time.
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