I started my nursing career on a medical-surgical unit of a busy city hospital. Like most new nursing graduates, I was put on the night shift and frequently assigned more than the recommended number of patients. That meant while the city slept, I sprinted from patient room to patient room for 12 hours. One of the most frustrating aspects of my job was dealing with the lack of supplies when and where I needed them. For a hard-pressed nurse, that meant taking extra steps to track down supply inventory and losing time caring for patients.
Lack of supplies in the middle of a shift
Any nurse who has worked on a hectic unit knows the feeling of having a complex wound dressing to change, only to find your unit’s supply room does not have what you need. The temptation is to improvise, and sometimes that is acceptable. For example, folding up regular gauze when out of drain sponges when changing dressings for a tracheostomy or new gastrointestinal tube.
But other times there is no substitute. In those cases, I was faced with a choice of either waiting for the supply room to be restocked or going to another unit to find the supplies I needed. Restocking the supply room happened once per shift, so waiting meant trying to time multiple patients’ needs around one event. On the other hand, leaving the unit required finding another already overburdened nurse to watch my patients while I went supply hunting. These were not great options.
My experience is not unusual. One study found nurses spend close to 40 minutes per shift on activities considered to be ‘waste’ – primarily looking for items they needed like supplies (Hendrich, A. et al, 2008). Those wasteful activities accounted for nearly 20% of the nurse’s time spent off their unit. Another study of hospital supply chains found nurses spend 14% of their time working around operational failures when needed equipment and supplies are not available (Tucker, A.L. et al, 2014).
Besides the time lost providing actual patient care, lacking supplies causes another inefficient behavior: hoarding. To avoid ever getting stuck without needed supplies, nurses commonly hoard them at the patient’s bedside. In fact, one experienced nurse told me early in my career to keep an eye on any complex cases coming onto the unit, and put a pile of supplies next to the bed early. That way I would never be without in the middle of a procedure.
Impact of poor supply management
In addition to preventing other nurses from accessing the supplies, hoarding is an expensive way to ensure the right items are available. A study on operating room inventory found the cost of ‘just in case’ supplies surgeons requested ranged from $92 to $637 (Ahmadi, E. et al, 2018). For hospital systems trying to recover from the financial impact of the pandemic, controlling inventory is a critical component. This becomes more difficult to control when staff do not trust they will have needed supplies, so they keep extra inventory out of circulation.
The pandemic exacerbated this lack of trust as the shortage of masks, gowns, and other personal protective equipment led to healthcare worker infections. A Washington Post-Ipsos poll performed in May 2020 found two-thirds of front-line healthcare workers noted shortages of personal protective equipment (Bernstein, L., Safarpour, A. 2020). As of September 2020, 570,000 healthcare workers were infected with COVID-19, and 2,500 died from the virus in the Americas, according to the Pan American Health Organization.
There is now renewed focus on the mental health of healthcare workers, especially nurses, and managing inventory plays a significant role. A recent study of 372 Registered Nurses in Indiana discovered a new type of trauma called ‘Insufficient Resource Trauma’ – the psychological impact from lacking knowledge, personnel, or tangible supplies. Nurses in the survey described feeling like they could not carry out their professional responsibilities when they did not have needed supplies, which was associated with feelings of anxiety and fear . Insufficient resources also led to nurses losing trust in their healthcare organization (Foli, K.J. et al, 2020).
What is needed to improve inventory management
Similar to forecasting staffing needs, healthcare organizations should forecast supply needs. Having some visibility into short-term demand is a way to get ahead of supply shortages. However, that also requires having solid information about inventory available.
A Harvard Business Review article written early in the pandemic highlighted several supply chain best practices that are not yet commonly used in healthcare (Bohmer, R. et al, 2020) . For example, understanding inventory in real time and sharing that inventory information with other healthcare organizations would have allowed hospitals with critical shortages to pool their resources. Unfortunately, few hospitals were prepared to do this at the time, and the lack of information led to unintentional hoarding of supplies across systems and regions.
The key to future preparation is information – having inventory data available in real time would allow organizations to predict demand, usage rates, and stock levels.
Conclusion
When we look at what health systems must do differently in the future, the saying ‘do not let a good emergency go to waste’ has never been more applicable. To adequately support and win back the trust of nurses, healthcare organizations must look at their inventory management approach. Not having the right supplies where and when needed is a real inconvenience in normal times. During a pandemic, this becomes catastrophic. This is an opportunity for healthcare leaders to learn from this experience and improve the working environment for nurses.
Lisa Brooks, RN, MSN, MBA
Informatics Nurse, Health Writer
Lisa Brooks is a Registered Nurse with masters’ degrees in Nursing Informatics and Business Administration. She spent 6 years of her career in bedside clinical care before moving into health technology. Over the last decade, Lisa has done everything from teach computer system classes for nurses, to lead large technology projects at healthcare companies. She is a thought leader, writer, and the voice behind Writing the Future of Health – a site that brings nursing and technology together.
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