Vanderbilt University Medical Center has received a $3.9 million grant from the Tennessee Department of Health to evaluate innovative models of nursing care that include screening and responding to social drivers of health to better meet the needs of all VUMC patients.
The state’s Healthcare Resiliency Program — Practice Transformation and Extension Grant is intended to “encourage innovations in the delivery of health and health care services that foster improved health outcomes,” according to grant criteria. “This could include innovative or alternative care delivery models, enhanced care coordination, investments in technology, innovation, or partnerships which have the potential to change and improve how services are delivered, particularly with respect to minority, rural and other traditionally underserved groups.”
Vanderbilt’s approved grant project brings together a 27-member multidisciplinary team including researchers, VUMC clinical staff and faculty from Vanderbilt University School of Nursing to solve two main issues — how to mitigate nursing staff shortages to ensure optimal care quality and patient safety in the hospital, and how to improve care for underserved groups following hospital discharge. Both issues have been exacerbated by the COVID-19 pandemic.
“We have this incredible opportunity with this large multidisciplinary team of researchers, clinical care experts and clinical care teams to work together to do something that will help our staff and be of direct benefit to our patients,” said project lead Sandra Simmons, PhD, professor of Medicine. “We are implementing this project in real time, where there is this very tangible direct relationship between what we’re trying to accomplish as part of the project and decisions we are making in clinical practice. And that is really exciting to be a part of.”
Nursing staff, both at VUMC and nationwide, came under increased strain during the pandemic, as more experienced nurses retired and turnover increased. As a result, a greater proportion of the workforce is comprised of novice nurses. The project team is looking at alternative care models to better support novice nurses to ensure patient safety and increase nurse job satisfaction and retention.
Simmons said the project will expand existing research funded by the Agency for Healthcare Research and Quality using simulation modeling of optimal hospital staffing to determine which alternative staffing models are most beneficial to both staff and patients. She said the modeling is itself innovative, using time-and-motion data to determine how much time various tasks take in different hospital units with diverse patient care needs, providing reliable and objective data. The resulting data could determine how to apportion nursing care differently and optimally, and how to strategically bolster licensed nursing care with care partners in certain units to free up time for nurses to focus on RN-specific tasks.
The research pairs the expertise of VUMC nurses with VUSN nurse faculty.
“Vanderbilt University School of Nursing has been working with the VUMC Nursing Models of Care team to model and test new ways to augment the ability of nursing care teams to provide care for hospitalized patients who have complex care needs,” said Ruth Kleinpell, PhD, ACNP-BC, Independence Foundation Professor of Nursing Education and associate dean for Clinical Scholarship at VUSN. “We are excited about this opportunity to contribute to advancing the transformation of nursing care with this state grant to better meet the health care needs of the residents of Tennessee.”
The project team is also working to improve the coordination of care services for underserved patients, including those who present with social drivers of health challenges such as financial strain due to medication costs, transportation needs to get to their medical appointments, housing instability, food insecurity and poor health literacy, all of which are shown to adversely affect health outcomes. Addressing overall staffing shortages within the hospital will also help to improve care for underserved patients, because such shortages affect VUMC’s ability to provide wide-scale screening and referrals to address social drivers of health.
Addressing the needs of underserved populations is twofold — to build screening for social drivers of health into routine clinical practice and, when such needs are identified for Vanderbilt patients, to connect them with community resources after hospital discharge to further support optimal health outcomes.
The project seeks to build on two existing strategies to improve routine screening for underserved populations. One, the Vanderbilt Discharge Care Clinic, provides follow-up care and coordination of community-based services after hospital discharge, with a goal of reducing hospital readmissions. The other, the Emergency Discharge Clinic, provides similar care after discharge from the Emergency Department.
While VUMC currently assesses health literacy and interpersonal safety, the project team will work with the clinical care teams and the Office of Health Equity to identify screening tools most acceptable to patients and community partnerships that can meet patients’ needs, particularly those in rural and/or medically underserved counties.
“This project is an excellent example of a multidisciplinary partnership that includes Vanderbilt clinical nurse teams and nurse researchers, all with the common goal of improving nurse satisfaction and better outcomes for our patients,” said Executive Chief Nursing Officer Marilyn Dubree, MSN, RN, NE-BC. “It truly does take a village, and I am excited to see what this talented group of colleagues will accomplish in the coming years.”
