Can a Little Tech Ease the Burden on Nurses?

Groups like the Canadian Federation of Nurses Unions have been saying it for years: nursing shortages are a ticking time bomb. 

The pandemic may have finally lit the fuse. 

A 2019 analysis suggested that Canada will be short 117,600 nurses by 2030. Two years later, health-care job vacancies in this country hit 100,300 — up 57 per cent from 2019. Canadian hospitals had the highest vacancy rate of any sector. 

The reasons for the nurse exodus, particularly in hospitals, were spelled out in a Royal Society of Canada-funded study in 2022. It echoed many previous reports: nurses are burnt out, dissatisfied and don’t feel they are getting proper support. 

Combine all of this with already stretched hospital resources, an aging population and growing patient-care complexity, and hospitals are now looking far and wide for any solution that will help ensure Canadians get the care they need. 

One area getting more attention is called “nursing workforce management”. It basically looks at how nurses in a hospital can be more efficiently deployed without sacrificing patient care.

In some cases, technology can lend a big hand with nursing workforce management, says Vedat Verter, professor of management analytics at Smith School of Business. “This doesn’t completely solve nursing workforce shortages, but rather than having to throw a whole bunch of money at the problem, it could level the playing field for nurses and make it a bit easier for them,” he says. 

Exhibit A comes from a recent study co-authored by Verter; Beste Kucukyazici, an associate professor of management analytics at Smith; and Pooya Hoseinpour, an assistant professor at Amirkabir University of Technology in Tehran. 

Using real-time location system (RTLS) data from a large tertiary hospital, the researchers tried to develop algorithms that hospital managers could use to optimize nurse-patient assignment decisions and make the work of nurses more efficient. Verter says it’s one example of a growing interest in how technology can ease the health-care crunch in hospitals. 

Follow the nurse 

Verter, Kucukyazici and Hoseinpour’s study, called “Nurse Workload Balancing Using Real-Time Location Data”, is currently being reviewed for publication in Operations Research, a top-tier academic journal. It looks at the daily decisions of nurse managers. 

As Verter explains, “Every morning, these managers have one big question: How do they assign the existing and incoming patients to the nurses on the floor?” Obviously one of the worst things they can do is to overload a nurse with too many patients. 

It’s also inefficient to give individual nurses too many patients that need a lot of attention or to make them walk long distances in hospitals to get from patient to patient. “So helping these managers make good decisions about evenly distributing that workload is what this study was all about,” Verter says. 

To begin, the researchers partnered with the surgical department at Montreal’s Jewish General Hospital. Using an RLTS installed throughout the department, they were able to track the movements of every patient, nurse and physician 24 hours a day for about 10 months. This allowed them to see when nurses were at patient bedsides, how long nurses provided direct care to each patient, and how much time nurses spent walking from patient to patient.

After months of crunching the data, the researchers developed algorithms that could be used to significantly increase nurse workload equity. With these algorithms in hand, the results showed that the mean variation in total direct care was reduced by 47 per cent. In other words, the average difference between the direct care load on the busiest nurse and the least busy nurse went down by 47 per cent. Also, the variations in the walking distance for nurses and the number of assigned patients per nurse were shortened by 65 per cent and 30 per cent, respectively.

When used with an RTLS and patient data, these algorithms could be plugged into the decision support software used by a nurse manager, says Verter. “And it would say, OK, give these patients to nurse A, these to nurse B, et cetera. It would predict that on a rolling basis every day or every shift given what’s been happening with the patients.” 

Buying into AI? 

As promising as this study is, it’s just one of an increasing number looking at how technology might help ease the health-care crisis in hospitals, says Verter. He and Kucukyazici recently led the launch of a Healthcare Analytics Initiative at Smith. 

Hospitals seem to be particularly interested in the potential of artificial intelligence technology right now, he adds. 

“I know of one large hospital in Kingston [Ontario], for example, where they are looking at how they can use generative artificial intelligence technologies to do some of the more mundane work. Perhaps it could draft reports so that the physicians spend less time with paperwork every day and devote more of their time to direct care.” 

Whether hospitals will end up using AI to its fullest extent depends on the funds available to explore it. “You cannot do this type of thing without strong IT departments, and to have a strong IT department, you have to have the budget,” Verter says. “And we already know hospitals are stretched thin.” 

The expanded use of technology in hospitals will also depend on how it’s perceived by the people it affects, adds Verter. If nurses, physicians and other hospital workers believe technological solutions will replace their jobs rather than complement their skills, those solutions are doomed. 

Verter, Kucukyazici and Hoseinpour dealt with these concerns first-hand during their study at Jewish General Hospital. Worried about the RTLS, some nurses wondered if the study would be used to cut jobs. 

“I had to learn quite a bit about change management, and we had to have quite a few meetings with the nurses to reassure them,” Verter says. “But it was a good lesson in that, yes, technology can be quite efficient and useful, but there’s the human component. And to the extent you ignore that, there’s no way you’re going to launch your technology successfully.” 

Still, Verter is cautiously optimistic that technology will make a big impact on the challenges that hospitals face. 

“There are lots of these potential pockets of excellence,” he says. “But change is uncomfortable, so there’s a lot more work to do to go from those pockets to across the entire system. But I’m hopeful. I think big changes can happen.”