Re-Imagining the Role of the Clinic RN: Alternative Staffing Models for the Post-COVID World

Purpose: The purpose of this evidence-based project was to address poor satisfaction, increased turnover, and muddied role clarity as related to the overall staffing model and standard work for ambulatory care RNs in a pediatric primary care clinic.

Description: The post-COVID-19 pandemic environment has resulted in great shifts in the nursing workforce and job market. Additionally, the pandemic enlightened employers to the value of hybrid employee work and remote work. Over the past 2.5 years, a busy pediatric primary care clinic experienced frequent nurse turnover, inefficient clinic workflows, and poor utilization of clinic RNs. This prompted an evidence-based project to identify the gaps in clinical practice, engage stakeholders to think creatively, and implement an alternative staffing model that incorporated remote telephone triage work with in-clinic direct patient care. The project leader conducted a pre-implementation survey which revealed a desire for more dedicated administrative time, increased patient interaction, and greater structure to their workday. This prompted the development of a hybrid staffing model which incorporated a team of nurses performing remote work (triage calls, medication refills, electronic prior authorizations) and a team of nurses performing in clinic work (nurse visits, patient education, clinic procedures, and paper prior authorizations). Nursing teams alternated every two weeks to ensure visibility with clinic staff and adequate cross-training. A post-implementation survey was conducted revealing increased staff satisfaction and improved perception of productivity. Additionally, key metrics such as open encounters at end of day and MyChart messages at end of day suggested improved productivity.

Evaluation/outcome: The results of this quality improvement project yielded significant decreases in turnover, increased productivity, and greater employee satisfaction.