Innovation Units: The New Standard in Nursing?

Mercy's CNE says it will be.

There are three w’s that are major pain points for CNOs: workforce, work environments, and workflows, says Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy in Missouri. And Mercy has a solution.

Mercy’s new nursing innovation unit has the potential to become the new standard practice in nursing as it employs new ideas, concepts, and technologies to improve the frontline nursing experience and quality of patient care. The unit seeks to streamline electronic medical record (EMR) charting, decrease workload, and standardize a patient’s care for the entire clinical team, all while improving retention rates and employee well-being.  

We sat down with Betty Jo to discuss the impact of the new unit on Mercy’s nursing workforce, and what other health systems could learn.  

This transcript has been edited for clarity.

What's the vision behind the new nursing innovation unit?

Rocchio: One of the things that we're pretty passionate about at Mercy is our nurses' experience or joy in practice. This year, we've had an extreme focus on three things: workforce, work environment, and workflows. As we took a look at that, we realized some of the friction that was occurring at the front lines and increasing workload for our nurses. So, we wanted to take a frontline approach and try to solve that with them.

How long did it take to plan and build the new unit?

Rocchio: It took more planning than some of the actual building because we did it with our frontline coworkers and it wasn't just nurses, it was our techs, some of our LPNs, RNs, and then ancillary personnel that are in our units, because that workload is driven by all those intersection points. So, having the frontline staff walk us through a day in their life and then start to look at it from a nursing informatics perspective was key to this work. It took about nine months to actually start to look at what that might look like and what places we needed to touch in their daily workflows.

Where's the funding coming from for the new unit?

Rocchio: The funding is coming from a lot of different places, but one of them is reducing that workload at the front lines [to increase] our retention rate. I don't mind sharing with you that during COVID our turnover rate was right around 28%, and that was right in line with the national average. If you think about it, that's a lot of people leaving your organization and then retraining them.

We're at about 14% today, so we basically cut that in half by focusing on getting enough workforce and then reducing that friction in their day.

When you consider nurse turnover… in the United States today [is] about $50,000 per nurse, when you cut that in half, you're saving a good bit of money. So, the funding is coming from Mercy, but it's coming from the savings and our turnover rate.

What kind of new technologies are inside the unit that the nurses can utilize?

Rocchio: I want to highlight that technology is important, but technology sometimes can be a big disruptor to workflow too. There is some technology that we will talk about, but the innovation is really streamlining the work in our electronic medical record, and some of the technology we're using to do that … is in Epic called Rover and its real-time charting.

Today, we use mobile phones just like we do in regular life. They're secure in our hospital system for our private patient information, but they're using that in the moment to chart. They're scanning all their supplies with it, they're charting with it, they're able to do their assessments and then talk the assessment, and have it go back into the electronic health records.

So, we're saving a couple of hours a day by putting that into the workflow; that's one of the big technologies that we've lifted. It was a heavy lift because we had to standardize that EMR documentation and then we had to make it mobile. We're still going through it, it's not completely perfected, but on this unit, we're working through what that perfection looks like before we launch it across all 45 hospitals.

What are some of the ways that you're seeing technology interrupt workflow?

Rocchio: For example, if we would have launched that Rover functionality to be able to chart in the moment, but we didn't clean up how nurses were actually charting in our EMR, that would have been nearly impossible to be able to do that, and so working on that was key.

The other thing that's key is taking our plan of care that's housed in our EMR and putting it up on an electronic board in the room. So, the patient, the family, the physician, and anybody who enters the room understands what the plan of care is for the day.

That's become important for goal-directed therapy for our patients and that interdisciplinary approach to allow all of our clinical coworkers to understand what's needed for that patient for the day. When it's buried in that electronic medical record, it's hard to know what's going on, but launching it onto these electronic boards is going to be the key to the future.

What kind of nurses are working inside the unit?

Rocchio: We've started on our med-surg units for a couple of reasons. Med-surg nursing has the highest workload, maybe not acuity of patients, but the workload's high there because of the number of patients that they take care of and the different health needs of all those patients. We thought starting on those units would yield us the greatest results.

How are the nurses chosen to work inside the unit?

Rocchio: We did choose certain nurses to develop the concepts … with us, and we chose those people that were constructively dissatisfied. So, you know, the squeaky wheel gets most of the attention. We love those people in this process because they're able to speak up, they're able to tell us what's bothering them, and we're able to solve problems with them in real time.

What's been the nurses’ reaction to the new unit?

Rocchio: It's interesting, it's the first time in my career—and I've been doing this for 30 years—that we are actually changing nursing practice. We are using evidence-based practice out there in the literature to decide what to include and not include, and we're doing it with our frontline.

I've never seen such a dramatic change or plan change with the way that nurses are practicing today. They are so excited because they're contributing.

The plan is to launch the program over 45 hospitals?

Rocchio: We will eventually launch it. Right now, we're still perfecting that innovation unit the way we want it, and we imagine three phases.

The first phase is launching, the second phase will be optimization, then the third will be fine-tuning the workload for the nurse and the tech.

Have there been any unexpected challenges or outcomes?

Rocchio: Yes, believe it or not, getting technology to play nice in the clinical environment with that ease of use is a heavy lift, which is why it can be such a big disruptor, because if it's not put in and worked into workflow, we end up working around the technology.

Making sure that the technology we pick is delivering to the satisfaction of the front lines is key, and it is as simple as vital signs being taken by a machine and automatically having them documented in our electronic medical records, so nobody has to touch it.

So how do you think this program will evolve over time?

Rocchio: I think it's going to be the standard in nursing, and I say that because we're struggling, and we've been struggling in med-surg nursing more than any other type of nursing. I think we're going to have to connect it into our staffing and scheduling with a workload tool.

If we are doing something at the front lines, we should have a way to measure it, and I think we're going to start asking these nurses more about how they feel about the patients, and start scheduling them by a workload number to group those patients rather than ratios. That is going to launch in that third phase that we talked about, the workload assessment tool that automatically makes assignments for nurses based on workload of the patients. That helps our charge nurses, and it helps our nurses with how they feel when they go home.

The workload measurement is not just objective, but it's also subjective, how the nurse felt at the end of their shift. I think that's a really important point, how nurses feel going home. We want to send our nurses home still feeling good with plenty of energy to be able to take care of their family, friends, [and] personal lives, rather than leaving so exhausted from work.

What can other health systems learn from this new unit?

Rocchio: Just to be careful about starting small and trying to get as close to perfect as you can before you start to launch it wide, and about the change management that's going to be needed. When you're changing nursing practice at this level, and doing it right in front of patients and physicians and other caregivers, you have to be certain that you've got it pretty correct before you start launching it across the system. So that's why we started in one unit with many ideas coming in from across the ministry.