Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.

Nurses everywhere are going on strike.

Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.

Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.

Underlying causes 

According to Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, there are several reasons that nurses have been going on strike, starting with the staffing crisis and its impact on overall nurse wellbeing. Workplace violence, unmanageable workloads, exhaustion, and the feeling of not being heard are also contributing factors.

“There is a generalized dissatisfaction of the current state [of the industry] from nurses,” Boston-Leary says, “and I think that the phenomenon that’s happening right now is nurses are really saying ‘no more.’”

Due to staffing shortages and heavy workloads, nurses are not able to spend as much time with their patients as they want to, and according to Boston-Leary, they often leave work feeling like they did not provide the best possible care.

“We have unintentionally set up a system that pulls nurses away from what matters most to them,” Boston-Leary says, “which is spending time with their patients.”

COVID-19 exacerbated the issue. It forced nurses and other healthcare professionals to be introspective, and to reassess what their priorities were in terms of job structure and how work should balance with their personal lives.

“I think COVID is an accelerator and illuminator,” Boston-Leary says, “and it just adds fuel to everything that we [already] knew.”

Boston-Leary believes that nurses are using unions as a last resort to find their voices in health systems, and that they are voting to make sure that things are changed for the better, for themselves and for new nurses. If they do not see the issues being addressed, nurses might feel a need to turn toward the more compulsory, structured approach.

Boston-Leary also states that in all her experience leading and working in unionized hospitals, the unionized environment does not impact the dedication that nurses have to their profession.

“Nurses have a right to voice their concerns,” Boston-Leary says, “and [they] find a number of different ways to do that through shared governance, through leadership, and in some cases through unions.”

Are strikes avoidable? 

Last year, Temple Health was close to a nursing strike, and the issue up for negotiation was staffing. According to Dr. Chaudron Carter, Executive Vice President and Chief Nurse Executive at Temple Health, they were able to avert the strike by sitting down with the nurses and adjusting staffing based on acuity and many other criteria.

“We essentially averted a strike by really just getting together and agreeing to some changes in our staffing guidelines,” Carter says.

Temple implemented a new set of staffing guidelines that do not include ratios, and they developed a process where the guidelines are looked at on a monthly basis, and any necessary adjustments are made. Leadership focuses on a different unit each month, and they provide the union with updates about new staff and other information. The meetings last for eight hours, four are dedicated to discussing topics on a shared agenda, and the other four are spent assessing the staffing guidelines and making changes if needed.

To Carter, it is crucial that the nursing staff show up for these discussions, and that they continue to deliver on quality of care, as part of the effort to foster shared governance.  

“Leadership can make decisions,” Carter says, “however, if it is not the right decision to drive the change that we want, it won’t work.”

Communication and action

With the principles of shared governance in mind, the responsibility falls on CNOs and other nurse leaders to be able to strike a balance between the unions and health systems in a way that is beneficial for everyone.

According to Boston-Leary, the nurses will know that the CNO is listening when their questions and concerns are answered and addressed.  

“I’ve learned the hard way that it’s not enough to have an open door,” Boston-Leary says. “You have to walk the walk and talk the talk and really show people that you’re listening.”

CNOs can find out what their nurses are going through by asking them directly. Boston-Leary recommends setting up a shadow board in the department so that nurses can give feedback in a structured way. It is also vital that leaders give feedback to nurses about actions being taken to make progress and to keep them updated on that progress.

“We have to get to a point of resolving a lot of these issues and managing these pain points, because it’s at the point of being unbearable for nurses,” Boston-Leary says, “which is why we’re seeing all the [union] activity that we’re seeing.”

Additionally, CNOs can maintain relationships with their nurses without always involving the unions. Boston-Leary states that nurses are a part of a CNO’s team regardless of union presence, and it’s important to still have conversations with them.

“You should have relationships with the people that are under your leadership because those relationships are important,” Boston-Leary says, “and the unions don’t necessarily have to come between [those] relationships.”

For Carter, communication is also key. She recommends stepping onto the hospital floor and spending time listening and talking to staff to better understand the pain points that might arise in union discussions. That way, CNOs can get ahead of the curve and develop strategies before negotiations that will help move the problem-solving process along.

“If you could develop a strategy before you get to go into negotiations around what those topics may be, and the organization develops a strategy on how to combat those issues,” Carter says, “I think you’ll position the organization better as it relates to going into negotiations and averting a strike.”

Trust is another important ingredient. Carter believes that open dialogue and transparency can help create a trusting relationship between the two parties, so that even when there are disagreements on approach, there are still shared goals.

“We don’t always see eye to eye,” Carter says, “[but] we’re here for the same reason, we’re here for safe patient care, [and] to make sure that the staff is taken care of as well.”

Have a contingency plan 

For CNOs working in union environments, preparation is essential.

Carter highly recommends that any organization embarking on contract negotiations should have a contingency operations plan in place. The plan should detail how to continue operations at the hospital if the nurses go on strike.

Carter suggests that this could involve pulling from other departments within the health system, such as housekeeping or radiology, or hiring an agency to bring in a contingency workforce. CNOs should determine where and how to downsize and distribute staff so that they can still provide the same quality patient care.

“The plan is huge because nursing touches all aspects of an organization,” Carter says, “and so you have to think of the most minute things to the larger scale items.”

At the end of the day, unions are an inevitable part of dealing with the workforce.

In her time leading in a unionized environment, Boston-Leary took the approach of enlisting the support of the unions and keeping them informed in order to help tackle nursing issues. She found it important for nurses to see their leaders working together for their benefit, rather than an adversarial relationship where no progress is made.

“I learned that I cannot treat unions as if they were the bad guys, because that was a non-starter,” Boston-Leary says. “If they’re here, they’re here, and you have to work with them and partner with them.”

This CNO has advice for the huge challenges facing nurse leaders as we enter the new year.

As we dive into the new year, CNOs must be prepared to deal with the new and ongoing challenges facing the nursing industry.

Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, has laid out what she thinks are the five biggest issues that CNOs will face in 2024.

For more information, check out the full article here. 

According to this CNO, here’s what nursing leaders are facing in the new year.

2024 is gearing up to be another hectic year for healthcare. With the never-ending stream of new AI technologies on the rise, and the upcoming presidential election, there are sure to be some curveballs thrown at the entire industry, including nursing.

While the impacts of these changes cannot always be predicted, there are many trends that can be.

To get a glimpse at what to expect in nursing this year, we sat down with Lisa Dolan, CNO at Ardent Health Services, to discuss what she thinks are the top five biggest challenges facing CNOs, and the impacts of new technologies and virtual nursing.

This transcript has been edited for clarity.

 

What do you predict will be the top 5 biggest challenges in nursing in 2024?

Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.

Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.

I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.

Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.

And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].

What can CNOs do to help mitigate those challenges?

Well, probably one of the biggest things is just to create efforts that reenergize their communities and their markets around nursing and healthcare careers in general. I think COVID-19 initially painted healthcare workers in a positive light, and on the heels of COVID-19 we had a lot of people think, “Gosh, I really don't know that I'd want to do that for a living.” So, really trying to help reenergize the public about healthcare careers and how fulfilling they can be is a key piece and a key role for the CNOs going forward in their communities.

Additionally, I think really creative partnerships with academic settings to help produce more healthcare workers. We've got healthcare settings that need support and staff, but then the academic settings also need help and are short staffed. If we can be creative in our partnership efforts with those academic settings to help augment their staffing and clinical instructors, and allow them to take additional students, [that] would all be very helpful as well.

What do you foresee being the next technological trend in nursing next year? How can that technology aid CNOs and their teams?

There's several that I wanted to make sure that I mentioned. I think virtual care and virtual care platforms are key for our future. Virtual care in nursing can assist with data collection. We can help admit patients, discharge patients, do patient education, family education. There are many things that a virtual nurse can assist a bedside nurse to complete and do, and actually feel like they have more time to spend with the patient. So that's a key piece.

Additionally, I think virtual provider support, and what I mean by that is bringing specialist to the bedside, and that might be a specialist in nursing, to offer support to maybe a newer nurse, or it could be a certain specialist physician to see a patient. Where those resources might be scarce, it can help bring that provider or that specialist to the bedside much quicker. So that whole virtual platform is going to be a huge benefit to nursing and bedside care in general.

One of the other pieces that's pretty significant are wearable technologies to monitor vital signs and monitor the patient's status. So that is just going to open [everything] up. One, it allows more continuous monitoring of vital signs. It frees [up] the staff so they don't actually have to do the task of taking vital signs, but can spend time with their patients doing other things.

Then we have just that continuous and reliable monitoring that can then feed into systems, which takes me to AI and the future of taking that information and that data and helping to support the clinician to make decisions. [AI] can even add alerts and pick up things quicker to aid the team at the bedside.

So, lots of technologies. There’s also the whole notion of smart rooms, and creating smart room technology that allows you to monitor patient movement within the patient room. You can look for things like patients who are at risk of falling that might be sitting out of bed, or is a patient turning as often as they should, and then driving alerts to the team to help with an intervention if needed.

One really exciting piece is the smart room that can hear and listen, so the opportunity might be there for transcription, or [doing] documentation just by talking through the room and having that assist with my documentation. Or, if I'm in a potential safety situation, then I could say keywords or call for assistance and be able to get help if I needed it in the room.

What do you think the impact of remote patient monitoring and virtual nursing will be?

I think what we're going to see is significant impact to certain outcomes. I would anticipate that virtual care is going to be able to help us manage our length of stay for patients. It'll eliminate some delays, possibly, in a specialist coming to the bedside. I think we'll be able to pick up on patient deterioration much quicker if we've got continuous vital sign monitoring.

I think that the assistance it provides will help retain nurses, because it's going to free their time from doing tasks, [and] maybe they can use that time to spend with patient at the bedside, with emotional support, actually caring and [doing] compassionate activities with a patient, which is going to be very fulfilling for the nurse. That's typically why nurses go into this career. It frees them up from doing being so task focused and allows them to really take care of activities that are much more fulfilling and provide the patient with support.

How can CNOs help their staff avoid burnout and maintain a healthy work-life balance?

Gosh, there's a lot that can be done. I think one of the initial things is just to be open and talk about burnout and recognize that it's a real situation. We can do things like having well-being check ins, [or] debriefings after a serious patient event, [and] we can do things creatively to help our staff adjust with key life events. You know, maybe offer support programs that are geared toward new moms or people who are taking care of aging parents.

I think the thing that we forget so often is just to recognize people and celebrate wins. If we have great outcomes, let's celebrate every opportunity we have, and then make sure that we harvest especially patient feedback to recognize our nurses anytime we can.

Are there any other trends you’re seeing that you think will continue into the new year?

I think we're going to see continued emphasis on quality and safety measures. That whole focus of pay for performance and meeting all of those key metrics is going to continue to be really important.

I think we're going to see a transition. I know that at Ardent, we will see a transition from a focus on patient experience in the hospital to almost a consumer experience across the care continuum. So, what is the experience for our patients when they interact with the system? That might be making appointments, it may be their experience when they access their information through their epic chart. Those are all key things.

I think the other piece that we'll see a lot of is different pilots on care delivery models. Because we know we don't have enough nurses to support historic approaches, we'll see people do different team approaches to care. The ability for people to work as a collaborative group and come together and care for a patient, I think it's going to be key into the future over the next year.

Click here to read the accompanying article. 

Technology can be a huge disruptor if implemented incorrectly. 

On this week’s episode of HLM Shorts, we hear from Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, about the technological challenges that her team faced while building Mercy’s new nursing innovation unit. Tune in to hear her insights.

Transcript (edited for clarity):

Have there been any unexpected challenges or outcomes regarding Mercy’s new nursing innovation unit?

Rocchio: Getting technology to play nice in the clinical environment with that ease of use is a heavy lift, which is why it can be such a big disruptor. If it's not put in and worked into workflow, we end up working around the technology.

So, making sure that the technology we pick is delivering to the satisfaction of the front lines is key. It's as simple as vital signs being taken by a machine and automatically having them documented in our electronic medical records, so nobody has to touch it.

That was a heavy lift with a lot of interfaces and things that you wouldn't think in the background, so our Mercy technology team has really been working overtime to lean in and help us.

Click here to view the full interview.