Reviving the Nursing Workforce By Applying Starling’s Law

I was recently with a group of nurse managers, and we were discussing how to foster resilience.  It reminded me of an earlier parallel I made between my clinical critical care nurse leadership practice with Starling's Law. As a leader I was constantly faced with pressures of how much work I could do, how far I could stretch and what I could produce, all while trying to balance people and systems for everyone's greatest benefit, much like the clinical principles of Starling's Law.

Simply stated, the law says the strength of the heart's output is directly proportional to how much the heart chambers fill and stretch. But there is an optimal point of stretching — if the chambers stretch too far, damage is done, and the heart cannot function optimally. The heart works to compensate, but over time will begin to fail — commonly known as heart failure. Thankfully, there are many innovative ways that medicine helps patients heal and reverse the harmful effects of the overstretch.

When considering the nursing workforce, Starling's Law also can be applied. Good faith efforts have been made to advance our practice and find the maximum stretch (the best and right work from the optimal number of professional nurses) for the maximum output (exceptional patient and organizational outcomes). However, we have reached a tipping point, and, like Starling's Law, much depends on volume, pace, stretch and resistance to output. According to the most recent Vizient Nursing Workforce Intelligence Report, many underlying structural challenges remain in the post-pandemic world of healthcare. The great news is that we can address those structural challenges for the betterment of nursing and healthcare.

So how do we treat the professional equivalent of chronic heart failure and revitalize the nursing workforce?

Just as clinicians take a multi-pronged and evidence-based approach to optimizing care for patients with heart failure, so should healthcare organizations create a comprehensive care plan for an overstretched and ailing nursing workforce.

• Integrate supportive care: While providers should use contract labor resources wisely, we must also shift the mindset to providing the four rights: right people, right care, right time and right place. Contract labor can provide a strategic advantage to bolster retention and promote a culture of flexibility.
• Optimize stretch: In a recent Vizient blog, Jacqueline Herd discussed abandoning past prized practices to gain efficiencies in nursing work and achieve top-of-license care. A continuous learning approach also illuminates tasks and processes that may no longer provide professional or patient value.
• Address volume: Operational inefficiencies increase length of stay, reduce margins and create work burden for nurses when patients cannot move through the continuum of care. Decreasing length of stay can free up nurses to care for patients that truly need in-patient care.
• Adopt a systems approach: Just as physiologic systems are interdependent, so are the systems of healthcare organizations. Nurses play a vital role in addressing system problems. Nursing process — assessment, diagnosis, planning, intervention and evaluation — is deeply rooted in process improvement and strongly positions nurses at all levels of the organization to influence positive change.
• Mitigate the contributors of burnout: While many workforce indicators have leveled off, measures of burnout remain on the rise. Understanding the contributors of burnout — moral distress and injury, compassion fatigue, secondary trauma and physical fatigue — can help in the creation of strategies to alleviate these burdens and improve resilience and engagement. Vizient's SCORE culture and engagement survey is one way that healthcare organizations can gain deeper insights about their workforce to drive clinical, operational and cultural change.

Nursing is the heart of healthcare. It's time to work together to revive the nursing workforce in new and collaborative ways — for the benefit of our communities, organizations and the nurses. Working together to optimize systems will ensure nursing's trusted place in delivering high-quality, patient-centered care — without missing a beat.