UMMS' new CNE aims to lead the health system on a journey to become a high reliability organization.
Peggy Norton-Rosko brings more than three decades of nursing experience and leadership. Most recently, Norton-Rosko served as the Regional Chief Nursing Officer for Trinity Health's Illinois and Indiana regions, where she oversaw nursing practices across a network that included an academic medical center, two community hospitals and a large ambulatory care network. She also served as an affiliate faculty member with the Loyola University Chicago Marcella Niehoff School of Nursing.
Following a nationwide search, Norton-Rosko has been named Chief Nurse Executive for the University of Maryland Medical System (UMMS), an academic-focused system which employs more than 9,300 nurses, effective May 20th.
For our latest installment of the Exec, we sat down with Norton-Rosko to discuss how she began her journey into nursing, her thoughts on the future of virtual nursing, and meeting the needs of a multigenerational workforce.
Lisa Stephenson, chief nursing informatics officer at Houston Methodist, chats with nursing editor G Hatfield about technology in nursing and how CNOs and CNIOs can use smart technology and AI to improve nurse retention and patient outcomes.
The average tenure of employees on the VPs team is 10 years.
Succession planning was revealed to be a common issue among revenue cycle executives during the recent HealthLeaders’ Revenue Cycle Exchange. The leaders agreed on its importance, yet many stated their organizations didn’t have the time to allocate towards it.
However, at Moffitt Cancer Center in Tampa, Florida, Lynn Ansley, Healthleaders Exchange member and vice president of revenue cycle management, has made succession planning an integral part of the employee experience for her team and has seen great outcomes because of it.
Where to Start
Simply creating an organizational chart is a step in the right direction.
“When you look up an [organization’s leadership] chart, no matter where you’re sitting in that org chart, you want to know there’s a path for you to go,” Ansley told HealthLeaders. “Whether it’s up or even laterally across the organization.”
Succession planning then begins with an informational interview, where the employee is able to learn more about the role or department they’re interested in, qualifications, and discuss what they need to do to meet those qualifications.
During this stage, in particular, Ansley looks for potential leaders and will give them stretch assignments, which is a task where they have the chance to display their skills and capabilities as a leader.
They’ll be included in the organizational wide programs Moffitt’s development team puts together where they learn more about the organization and how different roles intersect with each other. Employees will also meet with their leader each quarter for professional development meetings to check their progress.
“When you look down in any area of my front, middle, and back-end shared services, there’s a pipeline of who’s up next for that leadership role,” Ansley said.
Different ladders within the organization require a particular HFMA certification, which, upon receiving the certification, makes them qualified to advance in the organization and increases their marketability should they ever decide to pursue other opportunities at a different organization.
Pictured: Lynn Ansley attends the 2024 Revenue Cycle Exchange.
Looking Forward
In addition to training opportunities, employees are encouraged to think about how and where they want to grow in the organization, especially now that the practice is growing.
“What I encourage our team members to do a lot is not just focus on the next six months, but look out a little bit further,” Ansley said.
“If the role that you think you want isn’t available today, we’re going to be multiplying the number of opportunities in the short term and into the next 10 years.”
The average tenure of members on Ansley’s team and leaders she reports to is 10 years. Because of this, she stated, the organization has a wealth of internal knowledge on their operations and processes, which contributes to a greater culture of continuous learning and improvement.
“We have a lot of, I call it ‘musical chairs’ in rev cycle, because it means that our team members are growing throughout all of the areas,” Ansley said.
“I’m not sure that there’s any more valuable of a team member that has sat in multiple seats on the bus and got to see the view from all of those different angles to see how the cycle really impacts one another.”
TheHealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
The nurse leaders at AONL looked to the future to solve the current workforce issues.
The 2024 AONL Conference wrapped up last week in New Orleans after three days of brainstorming, collaboration, and leadership discussion. There were many common themes throughout the sessions and the keynotes, but as expected, workforce development was front and center. Turnover rates are high among frontline nurses and in leadership positions, and even though predictions are positive, the current nursing shortage is going strong.
The nurse leaders in attendance offered many creative and innovative solutions for the different prongs of the workforce crisis. Here are the top five subjects they focused on.
Ben Wobker, founder and CEO of Lake Washington Physical Therapy, joins HealthLeaders strategy editor Jay Asser for a discussion on what the industry can learn from the recent Change Healthcare attack, as well as his experience with implementing electronic payment strategies.
On this week’s episode of HL Shorts, we hear from Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, about how CNOs can identify which nurses are experiencing burnout. Tune in to hear her insights.
The nurse leaders at AONL looked to the future to solve the current workforce issues.
The 2024 AONL Conference wrapped up last week in New Orleans after three days of brainstorming, collaboration, leadership discussion, and heavy rain.
There were many common themes throughout the sessions and the keynotes, but as expected, workforce development was front and center. Turnover rates are high among frontline nurses and in leadership positions, and even though predictions are positive, the current nursing shortage is going strong.
The nurse leaders in attendance offered many creative and innovative solutions for the different prongs of the workforce crisis. Here are the top five subjects they focused on.
5. Workplace violence prevention
Workplace violence incidents are rising, and even though many physical safety measures have and are still being taken by health systems, there seems to be little to no improvement.
This is due to the wrong approach, according to Mary Beth Kingston, chief nursing officer at Advocate Health. In a conference session, Kingston suggested that taking a more patient-centered approach to workplace violence is the missing piece of the puzzle.
Kingston recommended getting to the bottom of why incidents occur, by meeting patients where they are at, and trying to understand what might be going on in their life to cause certain behaviors. De-escalation training should be meaningful and involve some kind of "customer service" training to help nurses speak to patients, families, and visitors in stressful situations.
4. Addressing burnout
Burnout was a part of almost every conversation at AONL this year. Burnout is one of the biggest reasons for turnover rates for both frontline nurses and nurse leaders. Nurses are expected to do too many extraneous tasks that take away from the time they have to spend with patients, and many of the CNOs and nurse leaders at AONL emphasized the need to remove those tasks from daily workflows.
In another conference session, Linda Alderson, chief nurse executive at Tacoma General and Allenmore Hospitals, and Jennifer Graham, chief nurse executive at MultiCare Health System, spoke about how they are leveraging technology to lessen the workload for nurses.
Graham spoke about how they use a robot called Moxi, who currently works as a delivery robot in the hospital. Moxi is responsible for running supplies and smaller lab specimens to and from locations to assist the nurses on the floor. So far, Graham said the results have been successful in diverting the task of supply delivery away from nurses.
3. Career development
Creating career development opportunities for nurses who want to become leaders in their space was also a hot button topic. In the same session, Kingston gave advice about personal career accelerators that nurses should take into consideration.
Kingston recommended that nurses who want to become leaders engage in professional organizations, and partaking in the opportunities offered by those groups. They should also become comfortable with the idea of taking calculated career risks, and recognize that they have skills that are transferable.
2. Mentorship
Along the same lines, there was a general consensus at the conference that the gap between new graduate nurses and tenured nurses is concerning, to say the least. The idea of mentorship programs is not a new one, but it is becoming more necessary in the current state of the industry.
Erin Kirk, director of patient care services at Norton Children's, discussed in a session how the health system has a mentorship program where nurses can become part of a learning cohort through a nomination process.
In the hybrid learning program, they learn skills such as interprofessional communication and how to problem solve using critical thinking. According to Kirk, 59% of participants have gone on to expand their roles or involvement with the health system since completing the program, which Kirk deems a success.
1. Virtual nursing
To no one's surprise, virtual nursing was the number one trend at AONL in 2024. Not only was the topic the subject of many of the sessions, but it was the main theme in the exhibit hall as well. It is crystal clear that the future of the nursing industry is virtual, and that nurse leaders need to be ready for the implications on workflows and patient care.
Along with Moxi, Graham and Alderson shared their findings from the new nursing care model they are currently testing. The care model involves a unit made up of an RN, an LPN, a virtual nurse, a robot, and a CNA. The model separates the duties of the virtual nurse and the RN and LPN, and outlines the places where they cross over each other.
According to Graham and Alderson, the virtual nurse is in charge of admissions, discharges, dual nurse signoffs, and mentoring and clinical support. The bedside RN and LPN are responsible for physical assessment, patient safety, medication administration, procedures, and other hands-on care. Things like patient rounding, patient education, care plan updates, pain reassessment, interdisciplinary rounding, and connecting with patients and families are all integrated duties that both parties are responsible for.
Graham and Alderson have seen success with this model, and while it still has a long way to go, this is a good example of how CNOs and other nurse leaders can incorporate virtual nursing into their hospitals.
Here's how one health system lowered their turnover rates, according to their CNO.
Editors note: Cheryl Reinking, DNP, RN, is the chief nursing officer at El Camino Health and has been with El Camino Health for 35 years. She has served in numerous positions in her career including clinical nurse, case manager, clinical manager, nursing director and vice chief of clinical operations before becoming the enterprise Chief Nursing Officer in 2013.
During the past four years, high rates of burnout, heavier workloads and decreased support at work, among other issues, have contributed to a historic, nationwide shortage of health care workers across the country, especially among nursing professionals. Many of these nurses are leaving their current positions or the practice altogether, and health systems are searching for ways to better retain their nursing staff, while also bridging the gap in patient care affected by this shortage.
As a new generation enters the workforce, Gen Z nurses are not only facing these shortages, but also navigating a health care landscape that is evolving more than ever before. In the midst of these changes, El Camino Health, a four-time Magnet-certified health system, is building upon the longstanding success we’ve accomplished with our nursing workforce, by implementing new structures and processes that put our nursing staff first. And, we’ve found that these new strategies are already showing heightened retention rates among Gen Z nurses at our organization.
El Camino Health’s low turnover rate of eight percent for all nurses is far lower than the national rate of 22.5 percent, due to the retention efforts of these streamlined structures and processes, which include improved workflow and more flexible scheduling. These are tactics that we have found appeal to nurses across the board. We’ve also honed in on professional development opportunities, especially for newly graduated nurses, while examining what differentiates Gen Z nurses from their colleagues in the profession.
Growth and advancement opportunities
What sets Gen Z apart from other generations is their desire to forge a clear path forward in realizing their career goals, with dedicated milestones to help them achieve those goals. Professional development opportunities are stepping stones along that path to help nurses create career advancement plans and stay motivated along the way.
Among the career advancement opportunities that we have found to be extremely important to retention is our prestigious one-year nurse residency program. This fully ANCC accredited with distinction training program gives newly graduated nurses the opportunity to further their career goals in various specialties like labor and delivery, emergency and oncology. This program enjoys a 92% retention rate. By combining clinical hours, classes, evidence-based projects and dedicated training support, our nurses can efficiently boost their career trajectory, something we’ve found is important to Gen Z nurses and their desire to learn and grow in the practice.
In addition, the resident program perfectly positions these nurses to enter one of the transitions of specialty programs allowing nurses to change specialties through a rigorous program designed to provide the knowledge and skills necessary to care for different patient populations such as critical care, cardiac catheterization, and neonatal intensive care.
Creating space for nurses to be heard and listened to in the workplace
Nurses, but especially Gen Z nurses, are more likely to stay within a health system if they feel they are being heard, respected and have the ability to make a difference for patients through their own ideas. It’s important to provide space for nurses to give valuable input and insight on organizational policies and patient care, in order to improve and build upon existing structures to better serve patients. We have a mature professional governance and shared decision-making structure. Nursing partnership councils exist on all units which are led by direct care nurses. These councils allow nurses to solve problems for patients as well as to create a nursing practice environment that is optimal.
A big reason for our 92 percent retention rate can also be attributed to the mentoring relationships we’ve facilitated between new and seasoned nurses. In these partnerships, nurses with varying levels of experience work together to identify methods of improving current processes and outcomes for patients. We’ve found that these professional development strategies help elevate the voices of our nurses and encourage their autonomy in the practice to continue bringing new ideas forward.
Making work-life balance a priority
As a whole, health care workers are facing a mental health crisis, with nearly half of all health care workers reporting burnout in 2022, and 41 percent saying they were likely to look for a new job. As a health system, prioritizing work-life balance for our employees, especially our nurses, is critical to helping them avoid burnout and other mental health issues that can arise in such a demanding profession.
Solutions we have implemented that have a positive effect on our nursing workforce, and also limit burnout, include creative and more flexible scheduling options, avoiding scheduling double shifts and the Save Our Staff (SOS) program. For example, the SOS program allows nurses struggling with situations like patient loss to contact a peer who can listen and provide psychological support in the moment. These measures not only help us prioritize work-life balance for our nursing staff, but also help us mitigate the burnout so many health care workers are currently experiencing.
Ultimately, offering growth and advancement opportunities, making work-life balance a priority and creating space for nurses to be heard and listened to in the workplace are some of the most important ways organizations can work to retain Gen Z nurses amidst the ongoing nationwide nursing shortage. And as health care systems usher in a new generation of nurses, designing strategies that are specifically tailored to their success can not only boost the profession as a whole, but improve the lives and outcomes of the patients we serve.
Editor's note: Care to share your view? HealthLeaders accepts original thought leadership articles from healthcare industry leaders in active executive roles at payer and provider organizations. These may include case studies, research, and guest editorials. We neither accept payment nor offer compensation for contributed content. Send questions and submissions to content director Amanda Norris at anorris@healthleadersmedia.com.
Patients are able to access their health information and make payments with ease through the system's patient portal.
From allowing patients to communicate with their providers, to viewing test results and making payments at their convenience, patient portals make up a significant portion of the patient experience.
Over the last decade, Ochsner Health began efforts to expand the system’s digital front door strategy. The system had been sharing billing statements and other information with patients through MyOchsner, its patient portal, but the onset of the COVID-19 pandemic in 2019 expediated these efforts as social distancing impacted patients’ access to care.
According to Eduardo Benitez, director of physician payments at Ochsner, the pandemic forced them to revisit healthcare and the way they coordinate with patients.
“There’s so much patients can utilize, from scheduling visits, to interfacing and coordinating with their healthcare team,” Benitez told HealthLeaders, referring to the capabilities of MyOchsner. “Being able to request their prescription refills, pay their bill, and even being able to do a telehealth visit.
Patients also appreciate having their medical information readily available to them, said Pam Barker, patient accounts supervisor at Ochsner. She added that a team manages the portal which is integrated with the system’s electronic health records platform, and there are smaller teams that oversee specific areas.
Benitez estimates the system’s portal utilization to be between 35-45%, with different factors coming into play, like the patient’s location and the department they want to interact with.
“With patient accounts and customer service, we can get upward of 6,000 easy requests per month just through the digital platform,” he explained. “The usage of it for [prescription refills] or maybe scheduling visits is probably a higher utilization.”
Looking at patient location, utilization varies regionally with some patient populations. According to Barker, New Orleans has the largest utilization for MyOchsner, while patients in areas like Lafayette prefer the system’s new pay by phone option. Since its implementation in January, the system has captured several thousand calls, Benitez said.
The growth of the system’s digital presence has increased the importance of protecting patient information.
“There’s quite a few back-stream methods in place, whether it be in [our EHR platform], within the portal, or even within our site to monitor for any suspicious activity,” Benitez said.
For example, in the event that a patient loses their portal password, they must verify their identity before they’re able to reset it. Similar identity verification efforts are used for employees.
“Any employee that is accessing a patient’s account has to add a notation to it on what [they] were in the account for,” Barker said.
As AONL 2024 continues, nurse leaders are brainstorming how to integrate technology into their workflows.
After day one at AONL 2024, it's clear that nurse leaders and executives have a few common goals in mind to tackle workforce concerns.
Virtual nursing
It's no secret that the largest issue facing nursing today is staffing. CNOs are working hard to lower turnover rates by improving recruitment and retention efforts, and many of them are incorporating virtual nursing as a way to do that.
At AONL 2024, Linda Alderson, chief nurse executive at Tacoma General and Allenmore Hospitals, and Jennifer Graham, chief nurse executive at MultiCare Health System, spoke about how they are incorporating virtual nursing and robotics into their care models. Alderson and Graham estimated that once fully integrated, the new care model, which involves a bedside RN, a LPN, a CNA, a virtual nurse, and a robot, with save the health system $2.2 million per unit per year.
Leadership development
Another way nurse leaders are confronting the staffing shortage and other workforce issues is through leadership development. As more nurses retire from the industry, CNOs need to create mentorship programs for newer graduate nurses so that they can become acclimatized to the workforce and also so they can become the next generation of leaders.
At Norton Children's, Erin Kirk, director of patient care services, spoke at AONL 2024 about the health system's implementation of a mentorship program that empowers nurses through adult learning. The opt-in program is set up as a hybrid mentorship program that uses an external technology platform and in-person sessions to educate nurses who are nominated to participate, as either mentors or mentees.
So far, the program has seen great successes, according to Kirk, in encouraging nurses to continue with their career and leadership development, with 59% of participants having expanded their roles or involvement with the health system since engaging with the program.
More workforce trends
Many leaders were also focused on shared governance, workplace violence prevention, social determinants of health, and the public perception of nursing. There is also growing concern about the number of graduating nurses who are entering the workforce, which ties into the staffing shortage as well.
However, there is hope.
Nurse and healthcare economist Dr. Peter Buerhaus spoke about the latest research on the staffing shortage, which predicts that the nursing industry will grow by 1.2 million RNs through 2035 if entry into the workforce continues at recent levels.
CNOs everywhere will have to wait and see if that happens, in spite of the many challenges that will appear along the way. In the meantime, AONL 2024 continues, so stay tuned for more coverage.
Pictured: Lynn Ansley attends the 2024 Revenue Cycle Exchange.
