A new survey finds that poor or ineffective technology is costing the healthcare industry $8 billion a year. Here are the eight biggest culprits.
Healthcare organizations are losing $8 billion a year to ineffective and outdated IT, and few have the money to improve that technology.
That’s the key takeaway from a new survey of more than 900 healthcare professionals by Black Book Research. The study, the third in Black Book’s “What’s Hot and What’s Not in Healthcare IT Investments” series, finds that bad IT investments have jumped significantly since 2017, when those costs were estimated at $1.7 billion, and budget limitations are keeping healthcare leaders from correcting those problems.
"Three-quarters of IT leaders surveyed indicated that they have no plans to allocate funds for replacing these flawed systems in 2025, reflecting a broader trend of financial constraints across the sector," Black Book President Doug Brown said in a press release.
"CIOs are understandably cautious about replacing underperforming systems when the ROI is uncertain, given the track record of many healthcare IT vendors failing to meet expectations. Without clear evidence that a new investment will deliver tangible financial or operational improvements, justifying the expense becomes challenging."
According to the survey, tech limitations are tied to one of more of five key reasons: poor user experience (almost have of those surveyed cited this), lack of interoperability (24%), cost (20%), lack of flexibility (6%) and alert fatigue (2%).
The findings will disappoint healthcare leaders who are counting on their IT platforms—especially their EHRs—to support innovations like AI and virtual care. An ineffective tech platform not only cuts into the ROI of a new program, but adds to the stress and frustration that haunt nearly every health system and hospital and cause burnout and workforce shortages.
Black Book’s study lists eight IT adventures that have plagued healthcare leaders the most:
Overly complex or unintuitive EHRs. Either a scapegoat or a savior for healthcare organizations collecting and managing their data, EHRs haven’t yet fulfilled their promise. According to Black Book, more than three-quarters of those surveyed are still having issues, often with navigation or workflow design, leading to “click fatigue.” In addition, at a time when many smaller health systems and hospitals are being acquired by larger, more stable networks, 91% of small medical practices in the survey say the haven’t been able to transition smoothly to the larger system’s EHR.
Bad telehealth. Virtual care saw a surge in popularity during the pandemic, but in many cases those platforms were adopted quickly and without due diligence. As a result, more than 80% of survey respondents said those telehealth tools are not synching with their EHRs, creating dreaded data silos and duplicate information, and impeding workflows.
Clunky RCM systems. Healthcare organizations have for years tried to automate their revenue cycle management operations to improve efficiency, capture lost reimbursements and reduce manual administrative tasks. Unfortunately, the technology has met expectations. Some 70% of executives surveyed said their RCM tech is either outdated or unable to integrate new tools like AI, leading to longer claims processing times and higher denial rates. Also, just more than 60% said poor claims scrubbing and denial management capabilities are resulting in lost revenue.
Uncooperative HIEs. Health information exchanges offer the potential to connect health systems and enable data sharing. But 28% of medical practices said their EHRs aren’t synching well with the HIE, and 23% cite a lack of data standardization and integration.
Poorly integrated CDS tools. Providers often rely on clinical decision support tech to improve their decision-making and boost clinical outcomes. But according to the survey, 80% say their CDS tools don’t integrate with the EHR, and first-generation tools often generate excessive or unnecessary alerts, leading to “alarm fatigue.”
Lack of patient engagement support. Patient engagement technology, including portals and messaging platforms, are designed to improve the patient-provider relationship. But 77% of hospital executives surveyed said their portals aren’t meeting the needs of their patients, resulting in ineffective communication and engagement. And 88% of those surveyed said smaller, niche products don’t have the integration or mobile-friendly capabilities they need.
Hyped-up AI. AI might be able to address many of healthcare’s biggest pain points, but the technology isn’t there yet. A whopping 96% of executives surveyed said they are facing challenges with ROI, and 92% said they can’t yet rely on the accuracy of the tools and find actionable results. Some 85%, meanwhile, said the tools they’re using to automate diagnostics or treatment planning aren’t yet capable of handling complex or real-world clinical environments.
Interoperability issues. Finally, 31% of the executives surveyed said they’re not happy with their data interoperability vendors, the chief complaints being slow updates and poor API support. This despite federal efforts to create a nationwide interoperability grid, through TEFCA. Many are struggling to adopt (FHIR) Fast Healthcare Interoperability Resources standards, and 8% say they’re stuck with technology that isn’t, well, interoperable.
The W-2 on-demand staffing model is a win-win for health systems, nurses, and patients, according to this CNO.
A lot has changed in nursing in the past few years, specifically in staffing.
Healthcare has become more virtual, and flexible scheduling models have replaced more traditional ones, and it's up to CNOs to consider innovative staffing solutions to address these challenges.
"COVID taught us that a lot of things can be done remotely," Garnica said. "We have a lot of telehealth, we have a lot of things out there outside of just acute care in the hospital, and that's attractive to a lot of nurses."
Garnica also explained how the competitiveness of the market has increased since the pandemic, which does not help with the nursing shortage.
"Everybody needs nurses, and we're not only competing with hospitals," Garnica said, "we're competing with all of those other venues as well."
Nurses are now looking for flexible schedule options beyond just full and part time, and they are looking for strong benefits.
"That's a challenge for hospitals who traditionally had believed that your core staffing should be about 85%," Garnica said, "[with] very little contingent staffing."
Due to these changes, SSM Health is trying something different.
The W-2 on-demand model
During the pandemic, Garnica explained that SSM Health had to quickly shift to other staffing models out of necessity. The health system began using external or third-party staffing agencies, with contracted nurses who were often coming from faraway places across the country.
"They're doing their contract, [then] they're exiting, and […] although it's a short-term solution, you have a staff and a nurse at the bedside," Garnica said. "It creates some long-term challenges not only with cost, but just around longevity, loyalty, [and] sustainability for outcomes."
Enter the on-demand model.
"An on-demand model gives us the ability to adjust our staffing needs very quickly, use nurses when we need them, flex them, [and] maybe offer [them] to other areas when we don't need them," Garnica said. "It also created a lot of loyalty and longevity with local nurses."
Garnica said the health system now gets local nurses from St. Louis through their partnership with ShiftMed, and since they all work in the area and in other local markets, the nurses can build relationships with one another.
"They're helping to sort of recruit and sustain one another," Garnica said. "So, you're getting this wonderful on demand support that understands the market, they're there to support your ministry, [and] they have relationships with your own staff."
Beginning the process
Ultimately, this new model led SSM Health to convert more than 100 on-demand nurses into full-time staff, and according to Garnica, the first step in making this change was helping the nurses to understand why it was happening.
"Helping our staff understand why we were making that shift and then engaging them in the process was probably one of our biggest successes," Garnica said, "because again, they are our best recruiters."
Garnica said that leadership had many discussions with core staff, and that they provided tools to help welcome and onboard the on-demand nurses. The goal was to have the core staff build relationships and express why SSM Health St. Mary's is a good place to work, Garnica said, and to make the on-demand nurses consider what it would be like to be a permanent employee.
"We offered some unique PRN options and things that we thought would be a nice complement for those folks," Garnica said, "and I think our conversion of those nurses to onboard to our own staff, really I would credit our nursing staff. They really were our best recruiters."
Garnica attributes the decisions of many on-demand nurses to stay on full time to the core staff who made it happen, and also to the idea that the on-demand nurses get to trial the environment beforehand.
"I think there's a lot to be said for when you're being recruited from a peer," Garnica said. "It's not scary to make a leap when you get to try it out."
The on-demand model also addresses the idea of nursing being the same in every health system.
"When you have folks that get to come be a part of your culture, be a part of your hospital, and be a part of the things that you're doing in an ongoing basis […]," Garnica said, "I think it makes it a lot easier because that jump isn't scary."
Outcomes
According to Garnica, the core staff reaction to this strategy has been positive.
"They are really proud of themselves, we update them on folks that they were able to help get moved over," Garnica said. "I think there's a lot of pride and excitement in that."
The nurses also appreciate the relationships that they get to build with more local nurses, and they feel as if they are part of a staffing solution, rather than feeling like a victim of staffing challenges.
"When you're short staffed, it's really easy to fall into a victim mentality [that] feels hopeless sometimes," Garnica said, "and I think this enables them to feel like they were part of the solution."
From a financial standpoint, there are also several benefits, according to Garnica.
"I think looking at areas of turnover and retention, obviously that's a really high-cost business when you're bringing folks in and you're turning them over," Garnica said. "Anytime we can reduce that turnover rate, we're obviously going to save money."
This model also cuts down on onboarding costs, Garnica explained.
"When you have an on-demand partner whose nurse is onboarding, they've probably already been working at our hospital for months, maybe a year," Garnica said, "so that onboarding is much quicker because they're already pretty acclimated."
The health system has also saved money on external agency contracts, and in general by stabilizing their workforce.
"We've had significant improvements in HAIs, patient experience, and those areas, because we don't have such an unstable workforce anymore," Garnica said. "We treat these folks as our own, they are part of our staff, we embed them in our culture."
Garnica said there have also been overall improvements in productivity and morale among the staff.
"When you stabilize the workforce, when nurses come to work, knowing that we're doing everything we can to get support into the building for them and they've built those relationships," Garnica said, "they know that the on-demand nurses are their partners, [and] there's a lot of positive energy around that."
For CNOs who might want to consider using this strategy, Garnica recommends being open minded, and to shift mindsets to understand that the market has changed. CNOs should focus on building those relationships and partnerships, and engaging staff in decision making to help bring about change.
"You have to learn to live with staffing [looking] different than it used to," Garnica said. "There are creative options out there […]. Once you get it going, you can see a lot of really positive outcomes."
Virtual care programs for veterans are seeing mixed results. That could help healthcare organizations better understand what works and what doesn’t.
Recent efforts to improve healthcare access for veterans offers insight into which virtual care strategies are working and which ones aren’t.
The success (or lack of) of programs launched by the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) could help health systems and hospitals better understand the direct-to-consumer telehealth market.
For instance, the VA recently announced that its tele-emergency care (tele-EC) platform will now be available to veterans across the country, after the success of pilot programs in selected regions. The program, part of VA Health Connect, enables veterans to connect with care providers on-demand through a smartphone and associated app.
“Veterans can now be evaluated for possible emergencies from the comfort of their home,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “Sometimes, you’re not sure whether what you’re experiencing is a minor emergency or not — and tele-emergency care can help you resolve those questions. Veterans can get immediate, virtual triage with a VA medical provider who has direct access to their medical records. This avoids having to potentially drive to the nearest emergency department and wait to be evaluated, if appropriate.”
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in a recent interview.. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
So why is the tele-ICU program working but ATLAS is struggling? The issue may be similar to why so-called disruptors like Walmart, Walgreens and CVS Health are struggling to find a healthcare niche with retail clinics.
Tele-ICU is working because it gives veterans access to needed healthcare services from wherever they are, including and especially their homes. ATLAS, meanwhile, still requires veterans to travel to a specific site for healthcare.
That strategy works well for veterans in remote locations where broadband availability and even phone service is weak, and that does address a key barrier to care. According to the GAO report, those 10 ATLAS sites where veterans did access care were successful in helping those veterans and eliminating the need for long drives to the nearest VA center and long waits.
The VHA has responded to the GAO report by saying it will transition from a pilot to a grant program, adding financial sustainability to the equation, but the GAO is also asking the agency to develop benchmarks to measure the success of the ATLAS program on an ongoing basis, much like it does for other telehealth programs. Those benchmarks could help the VHA understand why veterans aren’t going to certain ATLAS sites and enable the agency to create sustainable virtual care programs that will attract veterans.
The examples set by the VA and VHA could also help healthcare leaders to understand how and where consumers want to access care. Consumers, like veterans, prefer on-demand virtual platforms for urgent care needs, while the success of retail clinics and stand-alone services is more nuanced, driven by factors that aren’t yet fully understood.
It’s clear that virtual care can address access challenges—the VA has conducted more than 9 million telehealth visits in each of the past two years—but simply putting together a virtual care platform doesn’t guarantee success. Providers need to understand how, when, where and why patients want to access care and create programs that address the needs and eliminate the barriers.
The expectations of nursing have changed drastically in recent years, and CNOs need to pivot their strategies to sustain their workforce.
HealthLeaders spoke to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, about how CNOs can keep up with changing workforce expectations and support their nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
TGH and CEO John Couris successfully navigated Hurricane Helene using lessons learned from Hurricane Ian.
Editor’s note: On October 10, Tampa General Hospital was hit by Hurricane Milton. The system remained open as emergency response teams were activated to support communities impacted by the storm. “Preparing for Hurricane Milton was an incredible effort by the entire team and a true test of our resources, but it ensured we could continue to provide exceptional care for our patients in a high-quality, safe and uninterrupted environment before, during and after the storm,” John Couris, president and CEO of Tampa General Hospital said on its website. “Tampa General is open to support communities impacted and particularly our first responders. Working together, we will come back from Milton stronger than ever.”
When it comes to preparing for hurricanes and other natural disasters, hospitals must be ready to protect patients, staff, and facilities.
Tampa General Hospital (TGH) successfully navigated Hurricane Ian in 2022, avoiding damage despite being in the storm's path. Unfortunately, history repeated itself this year.
On September 26, Hurricane Helene made landfall in Perry, Florida, and caused flash flooding in the western part of the state, but luckily, the hospital's vulnerable Level 1 trauma center remained dry and unscathed.
“We are pleased to share that our Tampa General Hospital health system stood strong against the storm. In the wake of the hurricane, we remain focused on providing world-class care to our patients and supporting emergency response efforts across our community,” the health system’s website says.
How did they do it? Well, CEO John Couris was prepared.
Here’s how to prepare your facility for an emergency storm, based on TGH’s experiences with Hurrican Ian:
1. Start Early: Preparation Begins Well Before the Storm
TGH started preparing for Hurricane Ian a week before it made landfall. This included stockpiling critical supplies like food, water, and medical resources.
According to Couris, “[We] began bringing in our emergency supplies, med-surge supplies, and emergency water about a week out. We also set up our AquaFence, which can push back about 15 feet of storm surge.”
Actionable Steps:
Review emergency supply stockpiles well ahead of time.
Secure critical infrastructure, such as flood barriers or AquaFences.
Test backup systems like emergency generators to ensure functionality.
Three days before Ian, TGH activated its emergency command center, part of a larger 8,000-square-foot facility that uses AI and predictive analytics. “We have a dedicated emergency management team that takes over, with leadership staying on-site to make real-time decisions,” Couris explained.
Actionable Steps:
Establish a centralized command center to coordinate response efforts.
Ensure your leadership team stays on-site during the storm for fast decision-making.
Create a two-tier staffing model (Team A for the storm, Team B for post-storm relief).
3. Practice Disaster Drills Year-Round
A key to TGH’s success was regular disaster training. Couris emphasized, “All critical elements worked because we practice this stuff all year long. We conduct mass casualty drills and review standard procedures constantly.”
Actionable Steps:
Conduct regular disaster preparedness drills, including mass casualty simulations.
Train staff on emergency protocols and refine procedures through tabletop exercises.
Make emergency readiness part of routine operations.
4. Plan for Water Shortages
A major lesson learned from Ian was the critical importance of water. At the time, several hospitals had to evacuate due to a lack of water pressure, even though their facilities withstood the storm.
Couris pointed out that during Ian, “Water was the primary reason why patients had to be transferred. We are developing plans to ensure TGH has its own emergency water supply.”
Actionable Steps:
Evaluate your facility’s water usage and plan for emergency water storage.
Consider tanker trucks or alternative water sources in the event of supply interruptions.
Develop contingency plans to maintain fire suppression and sanitation systems if municipal water is compromised.
5. Make Sleeping Arrangements for Staff a Priority
TGH had 2,000 staff members caring for nearly 900 patients during Hurricane Ian. Couris noted that while their emergency plan worked, sleeping arrangements for staff always pose a challenge. “Hospitals aren’t designed to house thousands of staff for days, so we’re always learning how to do that better.”
Actionable Steps:
Designate sleeping areas and provide adequate bedding for on-site staff.
Anticipate long stays and ensure facilities are equipped with basic amenities like showers and meals.
Continually refine staff accommodation plans based on feedback from previous events.
6. Collaborate with Other Hospitals for Patient Transfers
After the Ian, TGH played a crucial role in assisting hospitals to the south, transferring over 50 patients from affected areas. Couris explained, “We had five helicopters and ambulances running patients from Fort Myers up to Tampa.”
Actionable Steps:
Establish relationships with nearby hospitals for mutual aid agreements.
Plan for patient transfers, including air and ground transportation logistics.
Ensure your hospital is prepared to accept patients from neighboring facilities in case of evacuations.
7. Constantly Review and Improve Your Disaster Plan
Couris’s final piece of advice is to make disaster preparedness an ongoing effort. “My advice to people is practice, practice, practice. Review your processes and systems consistently. The only way to stay ready is to make this part of your routine operations.”
Actionable Steps:
Regularly review and update emergency plans based on new insights and lessons learned.
Involve all levels of staff in disaster preparedness to build a culture of readiness.
Keep refining your plans to ensure your hospital is ready for the next storm.
By following these strategies, hospitals can better prepare for the impact of natural disasters, ensuring the safety of patients, staff, and facilities.
Healthcare leaders are moving quickly to keep AI growth under control, but are they handling the governance question effectively?
As healthcare organizations move swiftly to embrace AI, leadership is struggling to understand how to make sure governance isn’t pushed aside.
But what does governance really mean in a hospital or health system? And who gets to decide how and where AI is used?
At the recent HIMSS AI in Healthcare Forum in Boston, issues of compliance and liability were front and center for health system executives looking to chart a clear and effective AI strategy. Sunil Dadlani, chief information and digital officer for the Atlantic Health System, said AI regulation must be handled carefully, so that it doesn’t curb innovation.
The challenge lies in deciding where innovation has to take a step back so that compliance and liability can be addressed.
As Albert Marinez, chief analytics officer at the Cleveland Clinic, said, AI introduces “the art of the possible” to healthcare. “We know that there are problems that we can solve with generative AI that we could never solve before,” he said at the HIMSS event.
“Healthcare should be proactive in the establishment and enforcement of AI governance and guidelines,” Jim Barr, MD, Atlantic Health’s vice president of physician value-based programs and CMO of ACOs, said in an e-mail to HealthLeaders. “Governmental oversight will occur, but those in healthcare should display our ability to fully understand the issues and regulate ourselves.”
“Your reason to use AI tools can’t be just the need to say we’re on the cutting edge,” he added. “With ACOs the challenge is designing and managing successful implementation while continually measuring impact and ROI. You need to take into consideration the existing pain points for clinicians, practices and patients, their willingness to change, deploy a transparent QA/validation process to build trust, and a clear customer value proposition.”
Developing a Governance Strategy
So where does governance fit into a health system’s strategy?
Ravi Parikh, MD, MPP, an assistant professor of medicine and health policy at the University of Pennsylvania, assistant professor of medical ethics and health policy at the Perelman School of Medicine and director of the Human-Algorithm Collaboration Lab, says federal efforts to establish a governance framework have resulted in vague guidelines that are a good starting point, but not enough.
“They're sort of general guidelines on monitoring for bias and monitoring for performance drift,” he says. “But how that gets operationalized is actually really variable.”
The first step for many healthcare organizations is the creation of a governance committee, charged with managing how the health system negotiates vendor contracts as well as how AI is developed, tested, used and—most importantly—monitored.
At the HIMSS summit, Shahidul Mannan, chief data, analytics and AI officer at Orlando Health, said many health systems are using AI in small programs across the enterprise, but leadership will have to create an engine to pull everything together on the same track. The trick is deciding who sits in the engine.
Parikh says current committees are “very ad-hoc,” with a mixture of executives from areas such as clinical care, IT, legal, and finance. Few are including the patient voice, which could be a critical oversight as Ai products flood the consumer marketplace and patients ask for AI capabilities to plan and manage their healthcare.
Patrick Thomas, director of digital innovation in pediatric surgery at the University of Nebraska Medical Center, wondered at the HIMSS event whether healthcare leadership is even ready to govern AI for its patients. Patients and providers are doing their own research, he noted, forcing decision-makers to try to keep up.
Understanding the Value of Data
Beyond the makeup of a governance committee, a key function of that committee is to understand data and data analytics, especially when outsourcing AI technology.
In dealing with vendors, health systems need to understand what datasets are used and how that data can affect outcomes. For instance, a company that relies on data from a decidedly white population might not help a hospital or health system whose patient population is ethnically diverse.
And when errors, such as hallucinations, occur, it may be hard to get a vendor to correct them.
“it’s actually really difficult to respond to these hallucinations by modifying the algorithm,” Parikh says. “You might be able to fine-tune and sort of say ‘Hey, we want to avoid this type of output’ and there's certain reward-based mechanisms to do that, but usually that's not in the health system’s control. Usually it's a developer who's having to respond to feedback that they're getting from the health system and then doing some things behind the hood that we don't honestly know about.”
A governance committee also has to be perpetual, and that will cost time and money that smaller organizations don’t have. Many standards now being considered are for basic AI functions, rather than generative or predictive AI, which hasn’t matured enough to be used in healthcare. But those tools will come along soon, and the rules for governing them will have to evolve.
Parikh isn’t convinced that health systems or the federal government will be able to draft standards for an ever-evolving AI landscape. Instead, he expects organizations like the Coalition for Health AI (CHAI), the Trustworthy & Responsible AI Network (TRAIN), or the Digital Medicine Society (DiME) to create standards and adjust them as the technology evolves.
He also says the federal government could, in time, require healthcare organizations to become accredited to use different types of AI, possibly as part of a quality improvement program or even payment policy.
“We [could] have these accreditation systems that signal to developers which institutions are robust for both validating and deploying [AI] technology and which of those might not be certified for large language model generation … but might be more certified for other types of predictive AI solutions,” he says. “I suspect that people are going to realize that some health systems just have more capacity for governance and more data availability to be deploying these tools. And that's a good thing for patients because we don't want to be rolling these things out for patients where errors might be promulgated.”
Cassie Lewis, chief nursing officer at Bon Secours Mercy Health Richmond market, chats with nursing editor G Hatfield about how nurses and nurse leaders can help patients engage with their healthcare, in and out of the hospital.
Changing expectations have led to a trend of new nurses leaving their jobs.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
Here are some of the reasons why new graduate nurses are leaving their jobs.
More than 45 hospitals and another 50 clinics in the Lone Star State will share data and best practices through an HIE platform, giving them important tools to improve care and participate in a new quality payment program.
A network of more than 45 rural hospitals and another 50 clinics in Texas is partnering with a health information exchange to improve data exchange and interoperability, giving the hospitals a better foundation for sustainability.
The Texas Organization of Rural & Community Hospitals (TORCH) is joining forces with C3HIE, a non-profit community HIE in the TORCH clinically integrated network (CIN), which was launched in 2021 to pursue value-based care opportunities. TORCH, which consists of 27 hospitals and 51 clinics, will add more than 20 new hospitals to the CIN through the C3HIE partnership.
The collaboration gives rural hospitals and clinics, many of which are struggling to stay open, an important platform for interoperability. Through the CIN, these organizations can exchange healthcare data through their EHRs, exchanging analytics tools and best practices to improve care management and coordination.
“We know rural hospitals are better together,” John Henderson, president and CEO of Round Rock-based TORCH, said in an e-mail to HealthLeaders. “Our partnership with C3HIE overcomes geographic isolation and connects our hospitals and clinics to help our rural communities.”
“When our rural providers are better connected across the state, they’ll know earlier about treatment outside their county,” he said. “They’ll be able to get [patients] into the clinic quicker for follow up. They’ll also get access to risk assessment tools using community health information to ensure the higher risk patients get the care plans they need [and] improve the ‘right care at the right time’ concept.”
The network also has value-based contracts in place with Aetna, Amerigroup and United Healthcare.
“Rural hospitals that can demonstrate achievement by region will benefit financially from ATLIS,” Henderson said, noting that hospitals could save at least $150,000 per year, which would go back into improving infrastructure and data capture.
The key to recruiting and retaining new generations of nurses is strong mentorship, onboarding, and support programs, according to these nurse leaders.
While healthcare changes, so do the expectations of the workforce.
Newer generations of nurses are expecting more technology, flexibility, and reassurance from management, and without that setting, many new graduate nurses are choosing to leave their health systems or leave nursing entirely.
CNOs need to pivot their strategies to meet these new expectations, while balancing the needs of their organization.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, and Gloria Carter, vice president and chief nursing officer at St. Mary Medical Center and HealthLeaders Exchange member, there are several strategies that CNOs can use to improve the recruitment and retention of new graduate nurses and tenured nurses.
Mentorship and support
CNOs must ensure that the work environment is supportive of both new and tenured nurses, with plenty of opportunities for career advancement and mentorship.
Carter explained that the first step is to support the nurse leaders who will be managing new graduate nurses and facilitating their introduction into the organization.
"Mentoring includes ongoing communication, engaging with their staff and having that presence as a leader to establish and maintain a rapport with the new graduates is critical to their success," Carter said, "so that you have awareness what is contributing to them staying in the organization or leaving] …and hopefully you can help support them through the latter to avoid them exiting the organization."
Heuston recommended implementing preceptors and training to support new nurses, while also focusing on making sure that the tenured nurses doing the training are recognized.
"You've got to focus on the retention of your senior staff," Heuston said. "The very first thing I did was talk to senior nurses to see what was difficult for them, and they felt really unrecognized for the work of training new nurses."
Heuston said the solution was building the training into the clinical ladder, in a program called CAPE, which stands for clinical advancement for professional excellence. Within the program, nurses can move up a level and get extra compensation added to their base salary for preceptoring and mentoring. The nurses also receive training on how to function in a training role.
"I felt like really acknowledging the senior staff who are putting that time and energy into training, and training, and training new people and new nurses," Heuston said, "and really being attuned to the newer nurse."
At St. Mary Medical Center, they have students who use the hospitals as part of their clinical rotation, which provides a first impression of the organization and work environment.
"This provides an opportunity for all nurses to mentor future nurses to gain the confidence and skills necessary to develop their clinical expertise," Carter said. "We have to take time to ask and answer questions to ensure we are creating a great learning experience for potential employees."
According to Carter, leaders also have a role in creating a first impression by being visible and approachable for students who are seeking guidance.
"Being visible is extended outside of the hospital with our academic partnerships and community events," Carter said. "Our facility also precepts graduate and doctoral students to ensure we provide opportunities for all future healthcare careers.
At WVU Medicine, Heuston said they piloted an Aspiring Nurse program, in partnership with academic institutions throughout West Virginia and the surrounding states. The goal of the program is to take into consideration the social determinants of health and to give nurses the support they need to continue their education.
"We selected really good partners and developed a contractual agreement with them, where we gave five thousand dollars a semester with absolutely no strings to how they spend it," Heuston said. "What we needed in exchange [was] we developed a role where we had mentoring for them on a monthly basis to the organization."
The CNOs at WVU Medicine will interview each candidate to develop relationships with them early on. Once the students are in the program and go through a signing ceremony, they become integrated into the health system's culture, Heuston explained, and leadership follows up with them on a monthly basis and students can receive support tailored to their needs.
"We rolled it out to our health system, and we have nearly 250 nurses in that program that we know is a guaranteed pipeline," Heuston said, "and there are nurses now going to school that would not have normally gone."
Onboarding
Another key strategy for CNOs is placing nurses within the right departments and making sure that the onboarding process is smooth and efficient.
At St. Mary Medical Center, Carter said the nurses join the workforce in one of the following ways, experienced nurses, new graduate nurses or transition to new specialty. Carter explained the transition program option affords nurses the opportunity to train in a different specialty.
The most common pathways for transition nurses are telemetry to the intensive care unit or telemetry to the emergency department.
"Transitional nurses are highly motivated to make this change," Carter said. "It's the same onboarding process that is provided to the new grads, with less precepting time based upon their previous clinical experience."
"Similar to our nurse residency program, the transition program includes class time and clinical experience in the patient care area," Carter continued. "Training is supported by a preceptor, residency coordinator, department staff and leaders. There are learning modules and additional class time to support their learning."
Carter said the outcomes of this program have been positive, and that the transitional tracks support nurse retention by allowing the nurses to train in new specialties and transfer to another department within the facility.
"It's more important that they stay within the hospital as a whole," Carter said. "It's fine if they want to move from department to department, but as long as they stay at the organization that's the greatest benefit to the facility and the community."
At WVU Medicine, Heuston recommends switching focus to making nurses excited about joining the med-surg units.
"Med-surg nursing is really where we need the nurses, where we need to recruit to, and make the better work environment," Heuston said. "We’re really focusing this graduation class on in-depth clinical experiences in med-surge environments that are welcoming and excited to have them."
Heuston said it's the CNO's job to then give nurses a great clinical ladder to climb so that they want to stay in the field.
"The new generation [wants] to continue to develop and see themselves advance in their career and not have to wait 20 years," Heuston said. "[Not] every nurse [has] to go to CRNA school or nurse practitioner school to advance their career, because all of us need good med-surg bedside nurses that are going to take care of us when we're sick."
This is part two of a two-part series. Read part one here.
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