The recent Covid-19 pandemic left hospitals nationwide with a deficit in their workforce, due to staff burnout, retirement, and an uptick in the travel nurse industry. UMBWMC was no exception. As staff worked short-handed, they expressed feeling overwhelmed, making it difficult to adequately perform daily duties. The timeframe of the pandemic also showed an increase in patient acuity and Hospital Acquired Pressure Injuries (HAPIs). Acute Care units within UMBWMC operated at a 20-30% RN vacancy rate with recruitment at a minimum as the organization continued to fight monetary incentives offered by travel agencies that simply could not be matched.
The integration of Licensed Practical Nurses (LPNs) into the acute care setting was generated from the idea of adding trained, licensed individuals at the bedside. Goals identified at the start of the program were to optimize the care provided to the patient as well as increase staff satisfaction among RNs as they were allotted the time and resources to practice to the highest extent of their license.
In September 2021, the Intermediate Care Unit (IMC) of UMBWMC was selected as the pilot inpatient unit for the integration of Licensed Practical Nurses (LPNs) into the acute care setting of the University of Maryland Medical System (UMMS). Training for the LPN staff included general nursing skills, dysrhythmia, medication and assessment days, regulatory requirements at the state and national levels, Advanced Cardiac Life Support (ACLS) with an LPN focus, shadow training days with physical and occupational therapy, NDNQI Skin Training, and Skin Round attendance once weekly. Clinical orientation time ranged from six to eight weeks depending on the LPNs skill set at the time of hire. Clinical development was supported with biweekly meetings between the LPN orientee, preceptor, professional development coordinator, and the nurse manager.
The fiscal year 2021 saw a HAPI occurrence of 10 cases, with all being reportable. Fiscal year 2022 had 17 HAPIs with 12 being reportable and thus far fiscal year 2023 has seen 10 HAPIs of which 3 have been reportable. In addition to the decrease in reportable HAPIs, the acute care units have reported an average RN vacancy rate of 14% as of April 2023.
Over the past three years, the healthcare environment has seen a dramatic decrease in nursing professionals as the COVID-19 pandemic has accelerated retirements, burnout, and travel agencies provide monetary incentives. The LPN pilot implementation at UMBWMC was interpreted at the University of Maryland Medical System-wide level as a viable solution to the staffing crisis and within three months of the pilot start date, LPN positions were being created for each hospital within the 13-Hospital system. If done successfully, it is anticipated that the system will see an increase in collaboration within the nursing practice, increased RN satisfaction, and increased patient satisfaction. The long-term prediction shows hope for a positive impact on future LPN and RN graduate recruitment as existing unlicensed staff return to school to become LPNs and LPNs continue in their professional development to become RNs.
Audience Take away Notes:
- Learners will understand the importance of thinking outside of the box when it comes to incorporating different levels of licensed practitioners at the bedside
- Learners will identify the successes and opportunities of implementing LPNs at the bedside
- Learners will be able to discuss ways to expand upon the reintegration of LPNs into an acute care setting
- Learners will be able to take the lessons learned from the presenting organization and apply it to theirs with the hope that they will also be able to support better patient outcomes and improve nursing retention
- Learners will also understand the importance of supporting the professional development of LPNs with the hope that they will continue in their education to become RNs, NPs or other obtain other higher level degrees