Setting the Record Straight: A Make-Believe Model Stokes Unfounded Fears of Team-Based Care

A recent article in Medical Care Journal paints a bleak picture of the future of healthcare, claiming hospitals intend to replace Registered Nurses (RNs) with lower-paid and less qualified staff, which the authors assert would lead to poorer quality care and skyrocketing costs. The article even suggests that hospitals want a return to a bygone era of healthcare.

Let’s be clear -- the care model imagined by the authors is disconnected from the reality on the ground. Nursing and hospital leaders are working every day with their teams to build modern, multi-disciplinary models focused on maximizing the quality and safety of care. Rather than assessing these actual changes in the field, the authors use highly dubious assumptions about the work happening in hospitals to deliver the innovations that modern healthcare requires, and patients want. Let’s set the record straight on just a few of the key misconceptions perpetuated in the article.

First, the analysis effectively assumes that hospitals’ care model of the future would be comprised of only nurses at various levels of licensure and that a lower percentage of nurses would be registered nurses (RNs). That is simply not the modern model of team-based care that hospitals have today or are building for the future. Instead, hospitals are building teams with diverse professionals, including virtual RNs, advanced practice professionals, physician assistants, respiratory and physical therapists, and pharmacists. These approaches, as demonstrated in a white paper from the American Organization for Nursing Leadership (AONL), can help free bedside RNs to practice at the top of their license and focus on complex care, leading to higher satisfaction and reduced burnout. In other words, these collaborative approaches enhance care, not diminish it.

The article also suggests that the proportion of nurse staffing comprised of RNs is the key determinant of performance on quality and cost. Yet this assumption is undermined by the authors’ heavy reliance on some of their own previously published research in favor of RN staffing ratios, and underplays other factors that would influence these outcomes, such as the expertise and experience of the clinicians delivering care, patient acuity, and the organization’s overall care model, to name a few. The authors do not make any serious attempt to analyze these other factors.

Lastly, the article’s presumption that the only care design hospitals are undertaking is reducing expenses is belied by real-world data. Hospitals and health systems spent $839 billion on labor costs in 2023, comprising 60% of their costs. In fact, hospitals’ labor costs increased by $42.5 billion between 2021 and 2023, demonstrating their commitment to recruiting and retaining a well-trained workforce. Wages and benefits to the hospital workforce have also grown by over 45% since 2014, far outpacing the rate of inflation, and underscoring hospitals’ commitment to investing in their teams. Hospitals have had to sustain these investments in the face of inadequate reimbursement by government payers and steep increases in drug and other supply costs.

The future of healthcare requires a forward-thinking approach that leverages technology, empowers nurses, and fosters collaboration across disciplines. This requires a nuanced understanding of the evolving landscape, not a rigid focus on outdated staffing models. Let's learn from the past while building a healthcare system that prioritizes both patient well-being and a sustainable future for our healthcare workforce.

Robyn Begley is the chief nursing officer of the American Hospital Association and chief executive officer of the American Organization for Nursing Leadership. She has more than 40 years of experience as a frontline caregiver and nursing leader.