Nurses in different generations have different needs that CNOs must fairly accomodate.
On this week’s episode of HL Shorts, we hear from Cassie Lewis, Chief Nursing Officer for the Richmond market at Bon Secours Mercy Health, about how CNOs can ensure that offerings are equitable between generations of nurses. Tune in to hear her insights.
Nurses everywhere are feeling the effects of burnout, and so are nurse leaders.
Burnout is being cited across the industry as one of the top workforce challenges. A report from AMN Healthcare found that 72% of nurse leaders experience some level of burnout.
So, what can CNO’s do about it?
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke at length about how CNOs can reduce burnout among their workforces.
Identifying the problem
Croland compared burnout to “death by paper cuts.”
“Everybody has bad days,” Croland said, “but it’s when it’s happening all the time and we’re not able to recover from it that I think that analogy comes to mind.”
The first step in addressing burnout is to identify when nurses are experiencing more than just a bad day. If nurses are returning to work the next day and are back to normal, that is likely just exhaustion, whereas burnout presents a more consistent personality shift.
“[It’s] the person who’s no longer engaged, the person who doesn’t participate, or their personality has changed,” Giordano-Mulligan said, “even with collaboration with their peers, they just don’t seem to be the same.”
When a nurse begins to feel this way, it’s important for CNOs and other nurse leaders to intervene and help that individual. Giordano-Mulligan emphasized that outside stressors are a large contributing factor as well. World events and family obligations can bring additional stress into the workplace.
“We have programs that come in to help reduce all of these stresses for employees,” Giordano-Mulligan said. “We have to help these individuals to feel comfortable coming to us so that we can help them with employee support services.”
Along with programs, having a personal connection with each member of a nurse unit is also critical for identifying burnout. Croland explained how that connection and relationship is necessary to be able to notice a change happening.
“Recognizing when there are subtle differences, whether they’re angry or more withdrawn,” Croland said, “those are going to be indicators that something’s going on.”
According to Croland, making sure employees are utilizing resources available to them is also key to preventing burnout. Nurses should have sick or wellbeing days, and CNOs must make sure that they are using them. If nurses are financially struggling, leaders should sit down with them and connect them to employee assistance programs or a financial counselor, or another resource offered by the health system or hospital.
“Sometimes the burnout isn’t necessarily caused by something that’s happening at work, but it’s being exacerbated by something in their home life,” Croland said. “We have the opportunity to connect them through to resources that could help them.”
Strategic solutions
One of the best ways to address and prevent burnout is having personal relationships with staff, and according to Croland, being intentional and having thoughtful conversations with them. At OSF St. Francis, they do monthly mission partner rounding.
“So very intentional, purposeful rounding that the leaders are doing with their frontline staff asking them [questions],” Croland said, “what’s going well, what frustrated [them] in the last couple shifts [they] worked…what problems have you experienced, [and] how can I help?”
Croland recommended making the effort to understand the nuances and pain points that nurses have, and to work to address each of those things, since burnout is often caused by the build up of those little stressors.
Additionally, Croland suggested putting more focus on having micro debriefings at the bedside, to help nurses deal with the frequent whiplash of handling one tough patient situation and then moving on to the next.
“We don’t often times give ourselves as the clinicians the opportunity to process what happened, [or] the opportunity to talk things through,” Croland said. “[It’s important] if you’re a newer nurse, [to take] the time to get the assurances that you did a good job and that you did what you were supposed to, to have that support.”
Giordano-Mulligan agreed, citing her focus on creating healthy work environments and authentic leadership in her career. CNOs need to build relationships with their staff so that when something is going on, the nurse is comfortable confiding in the CNO, and they know they have a safe place to go.
“Getting to know your staff and [having that] relationship building is extremely important,” Giordano-Mulligan said, “and to know when a team member is not who they normally are.”
At Huntington Hospital Northwell Health, Giordano-Mulligan said the hospital has a process called Team Lavendar to help nurses deal with patient losses.
“There’s a team that comes in and helps support the staff and [the other] people involved in that loss,” Giordano-Mulligan said, “to give them the time to decompress, [or] to go off to the tranquility space, and to have the time to come back…[and] go on the next assignment.”
The program also allows nurses to be relieved, so that they can come back to their next shift with the right frame of mind.
“Part of being able to care for others is to care for self,” Giordano-Mulligan said, “because if you’re not in that space to be in a good frame of health or mind, you can’t begin to care for others appropriately.”
Compensation and benefits packages need to evolve with the workforce.
Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process.
Here are five tips for compensation and benefits that CNOs need to know, according to Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital.
People will not stay in a culture where they feel unsafe, says this CNO.
On this week’s episode of HL Shorts, we hear from Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, about what nurses value in workplace culture, and how culture can be treated as a benefit. Tune in to hear her insights.
Nurses are considering more than just compensation, says this CNO.
Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process.
CNOs should take a look at their health system’s offerings to make sure they are attractive to new nurses and that they are staying competitive in the industry.
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, spoke about innovative perks to attract and keep nurses, and how workplace culture and safety play a role as benefits alongside compensation.
Diversifying offerings
First and foremost, health systems need to stay market competitive with both compensation and benefits packages. According to Steaban, that is the minimum a health system can do, along with making sure that employees are fully aware of all of the offered benefits.
“Today’s workforce is so much different than it has been historically,” Steaban said. “So diversifying what’s available for your employees is really important.”
It is crucial that CNOs understand the different needs and desires of their staff. Steaban explained that many nurses who are entering the workforce for the first time do not need healthcare coverage because they are still covered by their parents.
“So how do you create programs that are a little bit diverse for them so that they can still achieve some benefit?” Steaban said.
Flexibility is also a huge need in today’s workforce, and Steaban suggested creating some positions in a health system with associated compensation that offer various degrees of flexibility. This could include an internal travel resource pool where nurses can have more options, or even for working in different hospitals within the health system. The key is to diversify the work and match compensation to it.
There are some newer benefits that health systems should consider offering, including wellness benefits, loan forgiveness, tuition assistance, and compensation for certification or advancement programs.
“All of those things help people change their compensation level and benefits in multiple ways [during] employment,” Steaban said, “versus just straight compensation.”
Culture as a benefit
Workplace culture plays a large role in nurse retention and overall satisfaction. A strong workplace culture will make nurses feel less alone and more like a part of a team, enabling them to ask questions without being judged.
“Every day I run into nurses, and I ask [them] what keeps them here,” Steaban said, “and nine times out of ten they say [their] team.”
Steaban emphasized that people will not stay in a work environment where they do not feel safe or where they cannot practice safely. Because of that, the relationships nurses have with physicians and other technicians are also extremely important.
Nurses also need to have a voice and feel heard and responded to. CNOs should provide opportunities to influence their health system, and they should help nurses be successful, advance their careers, and have the experiences that want to have at work.
“There should be forums and places where nurses can really impact the direction of the organization and the standards of care,” Steaban said, “[so they can] really put their fingerprints on their own work life.”
According to Steaban, CNOs should remember that health systems are businesses with the goal of helping patients, and that change must happen, or the business will fail. Nurses should be included in that change, and change management is a vital part of that.
“At the front line of the care continuum are those nurses,” Steaban said, “if they understand why, and they can put their fingerprints on the process a bit, they’ll appreciate that.”
Presenting culture
CNOs need to show the culture of their health system to potential candidates so they can see the benefits of working there. According to Steaban, this starts with demonstrating on first contact with a new nurse that the health system is not only interested in the work being done, but about the candidate as a person. Candidates should also be connected with the team they would be working with, so they can get an idea of what the culture is in that unit.
“Words are cheap,” Steaban said. “The actual experience of the culture is what will either glue them to you or not.”
Nurse leaders should manage the culture across their organizations and make sure that everyone is walking the walk, not just talking the talk, Steaban explained.
“Make sure that your culture is not just on a sheet of paper, or words of a mission or vision,” Steaban said, “but it’s actually the truth of what people experience when they start working.”
Flexibility
As more nurses are looking for flexibility as a benefit, health systems should evaluate where they can put programs into place to accommodate their nurses’ needs. At Vanderbilt University Hospital, Steaban says they are working on a way for nurses to contribute and describe what flexibility they need, since it is different for everyone.
For nurses going back to school, weekend programs can be beneficial, so that nurses can attend classes Monday through Friday and then work on the weekends. Likewise, for nurses with young children, mid shift assignments are helpful if they need to drop off and pick up their kids from school at the correct time while still being able to work.
Steaban says they also have a robust PRN program, where nurses are able to choose the days they want to work and they can fill in where the organization has needs and have ultimate flexibility over their schedules.
“Self-scheduling is still something we do debate all the time, [and] whether it sometimes can create a lot of stress for nurses,” Steaban said. “You actually get to pick your shifts and you can [give] yourself some time off by putting your shifts [in] early in the schedule or late in the schedule.”
There are also travel program options or short-term programs where a nurse can decide if they want to work frequently for a short period of time and then take extended periods off, so they can craft their life like they want.
“That’s really hard to do on a unit,” Steaban said, “but you can do it as an organization, [and] say we’re going to use those nurses to fill in where we have some gaps, but they’ll work a 13-week contract or 6-week contract.”
However, CNOs should still be weighing the nurses’ flexibility with the quality of patient care, according to Steaban. Nurses need to be spending enough time with their patients to develop relationships with them and fulfill care obligations.
“What’s hard for me is our ultimate responsibility is to our patients,” Steaban said. “If your nurse is changing every two or four hours, I worry about our clinical obligation to patients.”
Career advancement
Nurses are also looking for career advancement opportunities as a benefit. At Vanderbilt, Steaban said they have a career advancement program for staff nurses, with peer mentors who can help walk them through the program.
Steaban also recommends offering certification courses as a way to help nurses specialize in their practice. Continuing education credits are also important for nurses to make sure they meet the criteria for certifications and so that they can uphold standards of care.
“Offering certification courses, offering to pay for [them], [and] paying for the completion of that certification testing [are] all really important,” Steaban said, “and then aligning compensation with those accomplishments.”
Geisinger's CNE discusses their health system's goals for virtual nursing.
CNOs everywhere are talking about virtual nursing, and many predict that virtual nursing will help fill the gaps from the nursing shortage.
Janet Tomcavage, executive vice president and chief nurse executive at Geisinger, outlined what Geisinger wants to accomplish with their virtual nursing model. Tomcavage is a part of the HealthLeaders Virtual Nursing Mastermind panel, a months-long, exclusive series where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing these new technologies.
Here are Geisinger's four goals for their virtual nursing program.
The HealthLeaders Mastermind series is an exclusive, months-long series of calls and an in-person event featuring hand-selected healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Geisinger's CNE discusses their health system's goals for virtual nursing.
CNOs everywhere are talking about virtual nursing. Health systems across the country are utilizing their nurses and technology departments to create new programs that have the potential to revolutionize the industry.
Virtual nursing provides new opportunities for nurses to have more flexibility, and for hospitals to use their staff more efficiently. A single nurse can now observe more patients at once, and watch for signs of patient discomfort or distress. Tenured nurses can stay employed longer, without having to worry about working long shifts, and they can support new nurses virtually.
Additionally, many CNOs predict that virtual nursing will help fill the gaps from the nursing shortage, and many health systems have already seen positive results from their programs.
Janet Tomcavage, executive vice president and chief nurse executive at Geisinger, outlined what Geisinger wants to accomplish with their virtual nursing model.
Tomcavage is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.
Geisinger's goals
Geisinger is one of many health systems to embark on the virtual nursing journey, and according to Tomcavage, they are most excited to be fully leveraging technology for the first time as a way to support care. There are several goals that Geisinger has already begun to accomplish with their virtual nursing program.
The first has to do with the nursing shortage, which Tomcavage said everyone is aware of. While there are many things that need to be done to solve the workforce issue, virtual nursing is a key component that can help make a big impact.
"We think of it in terms of really opening up the workforce by creating… a new role for nurses to consider, especially later in their career," Tomcavage said, "those who maybe have left, now have options to come back."
The next area of focus at Geisinger is on care quality. According to Tomcavage, the acuity of patients in the hospital is much higher than it has been in the past, due to both the COVID-19 pandemic and other factors. That along with lower tenure of the nursing staff has created several challenges.
"I think the virtual model can really help us enhance quality and things like fall prevention, hospital acquired pressure injuries…mentoring new graduate nurses…[and] patient education" Tomcavage said.
Another key goal is employee engagement, and how virtual nursing can help their nurses directly. Tomcavage explained how the response to the virtual nursing program has been overwhelmingly positive.
"Once [the nurses] really got a handle on what virtual nursing could do, they've been extremely positive about it," Tomcavage said.
The final area that Geisinger is focusing on is patient engagement and experience. According to Tomcavage, there was some apprehension about what the patient response to the virtual nurses would be, but patients have been enthusiastic.
"The virtual model gives patients that one-on-one time with nurses that's uninterrupted," Tomcavage said, "and you can get through an assessment and not miss anything."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
As healthcare costs rise, CNOs must brainstorm ways to lower them.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task. To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Here's what you need to know about cost containment, according to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist.
CNOs must strategize to keep tenured nurses in the workforce longer.
On this week’s episode of HL Shorts, we hear from Gail Vozzella, Senior Vice President and Chief Nurse Executive at Houston Methodist, about how CNOs can bridge the gap between tenured nurses leaving and new nurses entering the workforce. Tune in to hear her insights.
With rising costs in healthcare, CNOs need to brainstorm how to keep expenses down.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task.
According to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, the nursing shortage drives up labor costs and turnover costs in nursing. Labor costs have gone down marginally with the consolidation of travel nursing, but many organizations are still requiring the use of agency nurses, which drives up costs.
“Every time we spend time training a nurse, it costs money,” Vozzella said, “[but once a nurse] feels that it’s not a good work environment… [they turn] around within those first three years and leave that organization or unit, [and] it is a significant cost.”
To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Redesigning care
One cost containment strategy that CNOs should consider is using technological solutions to change the day-to-day workflows of nurses so that they have more time to care for patients.
At Houston Methodist, Vozzella said they meet with the deans of the surrounding nursing schools, and the number one reason why nurses go to nursing school is still to help people. Nurses want to be at the bedside, not typing into an electronic medical record, hunting supplies, or finding equipment.
“The nurse’s time is precious, and a good thing that’s come out of having a shortage is the focus on nurses doing things that only a nurse can do,” Vozzella said, “or what technology can pick up other tasks that are non-value added.”
Vozzella also recommends using ancillary support staff, such as phlebotomists, to do lab draws instead of the nurse. At Houston Methodist, Vozzella said they also partner with Rice University to help develop robotics that can screen trays to make sure the right tools are present before a tray goes into an operating room, so that the responsibility of checking the trays no longer falls on the nurse.
“[When] nurses have such a high value…and some ancillary support, we can redesign the work of that nurse in order to give that support,” Vozzella said, “so that it offloads that work and [nurses] are able to focus on caring for the patient.”
CNOs should be careful about the designation of work as well, and make sure that they support staff with communication efforts to make sure nurses understand the why of what they are doing.
“We tend to be a little controlling sometimes, or there’s factors like a very tenured ancillary person and a new graduation nurse,” Vozzella said. “It’s sometimes a challenge for that nurse to tell somebody else what to do.”
Care coordination
Additionally, efficient patient care management can help keep costs down by creating a better work environment. There are care milestones that patients must meet before they can go home, and those milestones are met with the help of care management, leadership, physicians, nurses, and advanced nurse practitioners.
According to Vozzella, improved care coordination is beneficial to both the patient and the nurse, as it improves the work environment and provides the patient with some insight into why certain processes are happening.
“It certainly helps patients with a shorter length of stay feeling like they’re a part of their care journey,” Vozzella said, “but it’s definitely helpful for the nurse too, because they feel [like a] part of something bigger than themselves and part of a team.”
Preventative care
Preventative care can also keep costs down. When primary care physicians can help patients manage diabetes or hypertension successfully, they are less likely to have an inpatient admission, Vozzella explained. Technology can help with this, so that patients can have more support at home without having to go into a doctor’s office or to the hospital.
Patient education is important to preventative care, because patients need to know about how different health factors affect their overall health, and nurses are a huge part of that.
“It is an exciting time for nurses to be part of that,” Vozzella said, “because it does offer nurses [the opportunity] to do more preventative care, but also to potentially do that virtually.”
CNOs should look at why patients are coming to the hospital in the first place and strategize ways to create support for them at home as well as in the hospital. Vozzella recommends having a case manager or social worker who can check in with patients and make sure they have transportation, food, and psychological support so that they attend their appointments and prioritize their health needs.
Leveraging technology
Over the past 15 years, according to Vozzella, health systems have moved toward rebuilding facilities to have better environments with natural light and private rooms, but it has just increased the amount of walking nurses have to do daily to see their patients.
“When [nurses] are in a room, they’re typically the only person,” Vozzella said, “and it’s so very isolating for, in particular, nurses that are newer in their career.”
However, bedside nurses are no longer alone with the addition of virtual nursing. Through virtual care, nurses can log in and come on the television screen in a patient room and act as a second set of eyes for the bedside nurse.
“I think virtual [nurses] can be a huge support, but it has to be implemented in partnership with bedside nurses,” Vozzella said. “We have to really work hard to understand where nurses tend to need support and make sure that’s our highest priority.”
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