This is an easier way to draw blood, says this CNO.

HealthLeaders spoke to Anna Kiger, system chief nurse officer at Sutter Health, about how introducing technology for needless blood draws would improve the patient experience.

Nurse leaders must determine what staffing model works best for both patients and nurses, says this CNO.

The nursing shortage continues to be one of the biggest concerns for CNOs across the country, and many are brainstorming creative staffing models to recruit and retain more nurses.

When implementing new staffing models, there are several factors to consider. CNOs must prioritize what works best for patients while also meeting the needs of their nurses.

According to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children's Healthcare, there are several innovative staffing models that CNOs could implement at their health systems.

Innovative staffing models

Staffing models have recently been expanding to include more specialized roles and nurses of different designations, Tilton explained. Leveraging advanced practice nurses can help enhance care delivery while filling gaps in the workforce.

"Contingency labor and role specialization to ensure operational efficiency and adaptability in meeting patient care demands are being leveraged as well," Tilton said.

There are four examples of new staffing models that Tilton emphasized, the first being team-based care, which promotes collaboration between nurses, nurse practitioners, physicians, physician assistants, pharmacists, social workers, and other healthcare professionals. This model empowers nurses to be more autonomous, Tilton explained, and to participate in decision-making by contributing their expertise.

"Team-based care enhances coordination, communication, and efficiency in healthcare delivery," Tilton said, "leading to improved patient outcomes and satisfaction."

The second model is flexible staffing, which, can help health systems adapt to fluctuations in patient volume and acuity as well as staffing shortages, according to Tilton.

"These strategies may include the use of float pools, cross-training programs, per diem staffing, and contingency staff," Tilton said. "Implementation of innovative scheduling practices such as self-scheduling, shift bidding, and predictive analytics-based staffing algorithms are being considered to optimize staffing levels and match resources with patient needs."

Care continuity models are also necessary to promote patient safety, reduce medical errors, and enhance the patient experience, Tilton emphasized.

"Care continuity models aim to maintain consistent nurse-patient relationships across care transitions and settings," Tilton said. "These models may involve assigning care coordinators or a primary nurse to patients throughout their healthcare journey."

The last innovative staffing model is telehealth nursing. Virtual care has revolutionized nursing and other aspects of healthcare in general, by providing new opportunities for nurses to work remotely and flexibly, while still providing patients with quality care. According to Tilton, nurses in telehealth roles can provide direct patient care, health education, counseling, and support through virtual consultations, remote patient monitoring, and tele-triage.

"Telehealth nursing enables greater access to care, especially for underserved populations," Tilton said. "It improves care coordination and enhances patient convenience and satisfaction."

Choosing for patients

The second piece of the puzzle is choosing which staffing model works best for patients. According to Tilton, there are several factors regarding patient needs, nursing practice, organizational resources, and external details that CNOs must consider when making the right decision.

First, CNOs need to assess the demographics, acuity levels, and care needs of their patient population, Tilton recommended, while working with their teams to make sure their workforce is experienced and competent to address those needs.

"This assessment helps CNOs determine the appropriate nurse-to-patient ratios, skill mix, and expertise needed to deliver safe and effective care," Tilton said.

Next, CNOs must remain in compliance with regulatory requirements, accreditation standards, professional staffing, and patient care guidelines, according to Tilton.

"They need to stay informed about state regulations, nurse licensure laws, staffing ratios mandated by regulatory agencies," Tilton said, "and recommendations from professional organizations such as the American Nurses Association and the National Council of State Boards of Nursing."

Then, CNOs should assess their health system's financial resources, budget constraints, and reimbursement mechanisms to decide a staffing model's feasibility.

"Analyze staffing costs, productive metrics, revenue generation opportunities, and return on investment associated with each model," Tilton said.

Finally, Tilton recommended that CNOs engage with key stakeholders during the decision-making process, including the nursing staff, interdisciplinary team members, healthcare executives, patients, families, and community partners.

"Through soliciting feedback, gathering input, and fostering collaboration, [CNOs] can ensure buy-in and support for the chosen staffing model," Tilton said.

Throughout this entire process, communication is key. Tilton emphasized the need for CNOs to promote transparency, communication, and shared decision-making to make successful changes to the organization.

"By considering these factors holistically and collaboratively," Tilton said, "CNOs can determine the staffing model that best meets the needs of their patients, optimizes nursing practice, and supports organizational goals and priorities."

Repetitive needlesticks are impacting patient care, according to this survey. 

Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective.

A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.

These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have. 

Here's what you need to know about the reality of repetitive needlesticks. 

Click here to read the accompanying article. 

Repetitive needlesticks might no longer be necessary with new technology, say these nurse leaders.

Several new care delivery models are taking over the nursing industry and streamlining daily nursing practices, now including needlestick procedures.

Repetitive needlesticks can be a challenge in hospitals, from both a nurse and patient perspective. A recent survey conducted by the Harris Poll revealed that out of the participants with a recent hospital stay, 59% of patients needed multiple needlestick attempts for IV insertion, and 71% for blood draws, with 11% needing 10 or more sticks to obtain a single blood sample.

Impact on patients

These numbers are representative of a major issue. According to the survey, more than half of Americans report some fear of needles, and a top reason is fear of multiple insertions. The survey also reported that 77% of patients are not aware that they should expect no more than two needlestick attempts from one clinician, no matter what condition they have.

However, IV and blood draw procedures are a necessary part of the hospital stay, and according to Anna Kiger, system chief nurse officer at Sutter Health, they make the patient experience less positive.

"It is one of the most frequent tasks that a nurse or phlebotomist does," Kiger said, "so if you come for healthcare, it's a high probability we're going to stick you at least once, if not more."

There are several factors that can also make needlestick procedures more difficult, Kiger explained.

"Whether it's in the emergency department or later on in the acute care setting, we do need to obtain blood samples from them for a variety of reasons," Kiger said, "and unfortunately, due to the acuity of their diagnosis and their age, obtaining a clean single needlestick to get the blood can be very difficult."

According to Michele Acito, executive vice president and chief nursing officer at Holy Name Medical Center, repetitive needlesticks impact patients in both the short and long term. Not only do needlesticks increase anxiety and pain among patients, but incorrect vascular access practices in general can impact health literacy and lead to potential rehospitalizations or disease progression.

"When patients are more anxious, they're less likely to understand the procedures that are being explained to them," Acito said. "Short term, they're not hearing about their care, about their needs, about their diagnosis, and long term, they're not hearing about the things they need to do upon discharge."

Needlestick alternatives

Luckily, alternatives to repetitive needlesticks are on the horizon.

According to Kiger, there is now a device that can provide needleless blood draws.

"This particular technology, which allows a nurse to obtain a direct blood draw through an IV catheter, does eliminate the need for a needlestick," Kiger said, "and that particular device can be used in the ED or in the inpatient setting."

This new technology is called the PIVO™ device, currently owned by BD, which essentially enables a small tube to enter the blood vessel through the IV to avoid an additional needlestick when blood draws are necessary.

"It's an IV with a tail essentially coming out of it," Acito said. "The patient should expect one stick when they come into the hospital and they have the IV inserted, unless they need a special test like blood cultures, then this PIVO™ device would be used."

In patients Kiger has observed, the experience with the device is painless and the blood samples taken with it are of the same quality as those obtained through a needle aspiration.

"If you can remove the needle and obtain a quality blood sample and get to the test result that is required for a physician to make a decision, then I'm all in favor of doing that," Kiger said, "because it's one less penetration of the skin, which is our protection from infections, and the patient gets an entirely different experience, a painless experience for most, obtaining blood."

Acito said they oftentimes employ licensed practical nurses (LPNs) to do the blood draws with the device, which can greatly benefit them as well as the patient.

"This allows [the LPNs] to work at the top of their license, while reinforcing education that has already been provided to the patient, interacting with the patient, providing other needs while they're in the room," Acito said.

In addition to the PIVO™ device, Acito emphasized the importance of good IV care to help decrease repetitive needlesticks.

"Once you put in the IV, if you maintain it well and you choose the site properly, you can use devices that help you find the vein so that there's a decrease in the number of sticks," Acito said. "How many blood draws you get is really determined by your diagnosis and the number of tests that need to be run to find [it] or to see if the treatment is working."

There have already been positive outcomes from using this device as well, according to Acito.

"The positive outcome is that you don't waste more resources trying to find a vein, [and] trying to stick the patient," Acito said. "When you walk in, no longer do you have to check this arm and check that arm and find that vein. You already have access."

The bottom line is that it's better for the patient, Acito explained, because it decreases exposure to excessive bleeding, bruising, or infection.

"They know when they come in and they get that PIVO™ device because of education from the nurse that this is going to be the site where [they] get [their] medications [and] IV fluids, and it's also where we're going to draw [their] blood from," Acito said.

Training and education

Both nurses and patients need to be educated about needlesticks and vascular access procedures and their alternatives.

CNOs must ensure that nurses receive the proper training on how to make patients feel more comfortable during a needlestick experience.

"I think it's really important for the nurse to always recall for themselves what it would be like or even a personal experience with having had an IV," Acito said. "Completely engage the patient, distract them, [and] make sure that the patient is fully educated on what to expect."

Kiger said the most important thing leaders can do is educate other nursing and hospital leaders about the new technology alternatives that do allow for successful needleless blood draws, like the PIVO™ device.

"First of all, basic education, getting more literature out, getting more published research out, getting the experiences of those who actually use a device like this in clinical practice, and then also getting the patient's perspective out there," Kiger said. "Then I think it becomes a matter of showing that over time, this is actually an easier way to draw blood."