Revamp, Refresh, Retain: A Collaborative RN-LVN Care Model

REVAMP, REFRESH, RETAIN A Collaborative RN-LVN Care Model

By Adam Ramirez, LVN, WCN-C, IV-C and Mary Lee Potter, PhD, MBA, RN, CWOCN

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

EVEN BEFORE THE COVID-19 PANDEMIC, nursing shortages were a topic of discussion among healthcare leaders. The pandemic hastened the exit of many Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) from the nursing profession, creating an epic shortage in an already stressed workforce.

According to the 2022 National Nursing Workforce Survey, during this time an estimated 200,000 experienced RNs and LVNs left the profession. (Smiley et al., 2023) As reported by the American Association of Colleges of Nursing, nursing schools cannot meet the growing demands and in 2021 turned away almost 92,000 qualified students partially due to the lack of faculty and available clinical sites (Rosseter, 2022). As a result, hospital leaders have been considering all their options in order to continue to provide safe quality patient care in this dynamic environment.

More than a decade ago, LVNs were phased out of many of the acute-care environments including a hospital in South Central Texas. Prior to transitioning to an RN-only model, LVNs were utilized widely throughout the organization including the intensive care units (ICUs). In light of the current staffing challenges, nursing leaders began exploring different staffing models, and LVNs were identified as an untapped resource. After considering the matter carefully, a previously used RN-LVN nursing model was revamped and transformed into an innovative Collaborative Care Model.

With the re-introduction of LVNs into the acute-care setting, nursing leadership created a platform to support the LVN to work to the full scope of their licensure guided by the Texas Board of Nursing (BON) rules. By re-vamping their role in the hospital, the LVNs work in collaboration with their RN partners to care for and manage a group of patients. The facility, which is a part of a larger for-profit health system, utilizes an RN-LVN partnership model, supporting the LVN to work at a higher level of responsibility and proficiency as allowed through the NPA. The RN-LVN partnership model reinforces a positive practice environment leading to higher nurse engagement.

To help support LVN’s transition back into the acute-care hospital setting, the hospital established an LVN Council which meets monthly. In addition, the facility developed a LVNfocused Clinical Support Resource Nurse (CSRN), which is a new role developed by the organization that is responsible for mentoring the new nurse transitioning into their first nursing position. The CSRN-LVN provides clinical support and professional guidance that extends past the orientation timeframe. Together, these resources have augmented the LVNs educational onboarding.

According to the Texas BON, in 2019 only 17% of LVNs worked in an acute-care setting. With this in mind, prior to the return of the LVNs into the hospital, policies, competencies, and onboarding tactics had to be refreshed to include the LVN scope of practice. While LVNs were educationally prepared to be competent in several nursing skills, the lack of hospital experience in many of the candidates created a steep learning curve for the LVN during the onboarding process , including both tenured LVNs and LVNs new to the profession.

Adding to the challenge, many (if not most) of the RNs and other healthcare providers had not worked in a RN-LVN model during their career, and in some cases, had misperceptions about LVNs that had to be addressed. Lessons learned with the initial onboarding cohorts included the identification of knowledge gaps with all levels of clinicians, confusion with interpretation of RN and LVN scope of practice, and LVN specific transitional needs from school to practice.

Using these lessons, LVN Onboarding Strategies were refined over a two-year period. Specifically, education provided to LVNs and RNs centered around scope of practice and best practices to support caring for patients collaboratively. A number of resources were also created such as a BON reference sheet, tips for success, and LVN Orientation Guide, made easily accessible to everyone. As the RNs and LVNs become more competent working within the new model, an atmosphere of mutual respect developed, creating strong team bonds.

Since the launch of the RN-LVN Collaborative Care Model in Fall 2021, improvements were seen in vacancy rates, nurse engagement scores, turnover rates, and the LVN and RN nurse engagement scores improved steadily over the past 18 months.

Across the country, retaining nurses of all types is a top priority for hospital leaders. Taking an active approach to recruiting LVNs had a significant impact on efforts to rebuild core staff following COVID. Since the launch of the RN-LVN Collaborative Care Model in Fall 2021, improvements were seen in vacancy rates, nurse engagement scores, turnover rates, and the LVN and RN nurse engagement scores improved steadily over the past 18 months. From 2022 to 2023, year-over-year annual externalized turnover improved almost 35% for RNs and 24% for LVNs. While the numbers tell part of the story, the connection among the staff is what really shines. As a hospital, a cornerstone of the culture is inclusivity, celebrating the strengths of the individual and the connected effort of many. Embracing the RN-LVN Collaborative Care Model has been a huge win for the campus, and ultimately for the communities served. Revamping previous staffing approaches and refreshing practices to include both the RN and LVN may help organizations with the challenges faced with nurse retention, while also promoting a culture that values the diverse contributions of a talented workforce. i

Acknowledgement for Editorial Support: Noah Zanville, PhD, RN

REFERENCES

Rosseter, R. (2022, October 1). Fact Sheet: Nursing Shortage. Https://www.Aacnnursing. org/. Retrieved December 15, 2023, from https://www.aacnnursing.org/Portals/0/ PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf

Smiley, R., Allgeyer, R., Shobo, Y., Lyons, K., Letourneau, R., Zhong, E., . . . Alexander, M. (2023). The 2022 National Nursing Workforce Survey. Journal of Nursing Regulation, 14 (1), S1-S90.

https://www.bon.texas.gov/

https://www.aacnnursing.org/news-data/fact-sheets