How HCA Healthcare Is Empowering Clinical Nurse Coordinators Through Innovation

CNOs should bring in new resources using feedback from frontline nurses, says this CNE.

Bedside nurses are the backbone of the healthcare industry, and it's the CNO's job to advocate for their needs and uplift their voices.

This means giving nurse leaders on the frontline the resources they need to be efficient and effective.

At HCA Healthcare, there is a position on the nursing units called the clinical nurse coordinator (CNC), which is similar to a charge nurse. According to Sammie Mosier, senior vice president and chief nurse executive at HCA, the CNCs are critical leaders since they are the ones closest to the bedside leading their teams.

"HCA is a very large company," Mosier said, "so to continue to gather the voice of our leaders, we leverage our structure to do that."

The health system has pulled together leaders from each of its divisions to serve on shared governance councils, one of which is the CNC Council, Mosier explained. During one of those council sessions, the CNCs shared that what they needed was a way to get more information at the bedside in real time to aid in decision making.

Enter the CNC resource tool.

Logistics

After the CNCs made this request, Mosier said the health system's ITG partners, an internal team at HCA, and the nursing infrastructure team were pulled in to start brainstorming what a potential piece of technology could look like. The tool's metrics needed to be operationally focused on the unit level, but also provide a way for the CNCs to judge the healthiness of their units and individual nurses.

"The goal in mind was for our charge nurses to proactively use the tool and then based on the results, they could go assist a nurse if they were falling behind, or to ensure that everyone had lunch," Mosier said. "That's very important to our teams for wellbeing."

As implemented, the tool allows CNCs to pull up an app on their phones and look at their unit's performance. They can see how many patients are coming in, how many patients are being discharged, the team's schedule, and the flags that signify if a nurse needs help or if there are any missing tasks or breaks.

More metrics include medications that have been completed, orders that need to be completed by the nurse under a physician's guidance, and the frequency of vital sign checks. The tool will also flag if patients are having challenges with vital signs.

"We have scaled across the enterprise in med surge [and] we're working on our behavior health population," Mosier said. "Whatever those clinical components are, our teams are working to identify the highest importance so that they can operationalize that."

Impact on the future

According to Mosier, the CNC resource tool has helped the most when it comes to new graduate nurses. New nurses have to get used to how things work in the health system, such as how to prioritize their tasks and find their schedules, and the new tool has helped CNCs proactively assist those nurses.

"That has really helped us with engagement and retention," Mosier said.

Clinical support nurses at HCA are also using the tool to round on new graduate nurses to make sure everything is going well.

"They leverage the tool because they see the value and it helps them determine where they should prioritize their day," Mosier said. "When we're able to use that real time data to inform decision making, it really does help with efficiencies and with ensuring that we’re prioritizing things in the right way."

In the future, Mosier explained that they plan to keep expanding where the tool is used, starting with behavioral health and women's health. Patient care techs also have expressed interest in using the tool.

"[We've been] looking at that care team and expanding it beyond just the nurses' workload," Mosier said, "because that's where the magic happens, in leveraging the full team to care for the patient."

For CNOs who want to try implementing a similar strategy, Mosier recommends prioritizing what the nurses say they need and allowing them the space to brainstorm what works best for them at the front line.

"We've started small, but we've got a great tool now, but being able to prioritize what [the nurses] are after, that's meaningful and that's value add," Mosier said. "I never want to bring a product forward that doesn't include their insight and their voice."