For CNOs who want to improve nurse retention, it's important to identify the biggest hurdles.
On this episode of HL Shorts, we hear from Abby Rudy, VP of Nursing, Adult Critical Care at Penn State Milton S. Hershey Medical Center, about the biggest barriers to nurse retention in 2025. Tune in to hear her insights.
This health system's virtual nursing program has matured into a scalable and sustainable care model since last year.
Virtual nursing is quickly becoming a staple of care delivery in nursing workflows. Creative program expansion is what will keep the ball rolling for health systems who want to continue exploring the technology's potential.
Derek Godino, senior director of nursing at Geisinger, recently gave HealthLeaders an update on the health system's virtual nursing progress over the past year.
Godino is part of the HealthLeaders Virtual Nursing Mastermind program, which brings together several health systems to discuss the ins and outs of their virtual nursing programs and what their goals are for now and the future.
New year, new goals
In 2024, Geisinger had several goals for virtual nursing: to open up the workforce by creating a new role to consider, to improve care quality, and to boost nurse and patient engagement and experience. According to Godino, the program has matured into a scalable and sustainable care model.
"We've optimized workflows and refined our onboarding and training protocols," Godino said.
Additionally, Geisinger has put emphasis on integrating virtual nursing into many different aspects of nursing workflows.
"We've also strengthened our interdisciplinary partnerships and improved the integration of virtual nurses into daily clinical routines," Godino said, "enhancing team cohesion and patient experience."
Going forward, the health system plans to expand virtual nursing services into transitional care and chronic disease management in the post-acute and ambulatory spaces, Godino explained. New technologies are also on the horizon for the program.
"From a technology perspective, we are exploring AI-powered decision support tools, biometric monitoring integration, and more advanced virtual rounding capabilities to improve efficiency and patient engagement," Godino said.
The current strategy
Godino explained that the biggest challenge so far has been ensuring consistent technology infrastructure across sites due to infrastructure requirements and limitations. As of right now, Geisinger is working with two to three primary vendors for technology platforms, hardware, and support services.
"This number has slightly decreased as we've consolidated, to streamline integration and support," Godino said. "We anticipate this may change as we evaluate new partnerships for expansion into outpatient settings or adopt more sophisticated analytics and AI tools."
The health system's staffing strategy has moved towards blending experienced nurses who want flexible or alternative roles with nurses who have specialized skillsets that are ideal for remote care, Godino explained.
"We've aligned our recruitment and retention strategies with these profiles and have invested in remote work support and engagement programs to maintain a strong sense of team identity," Godino said.
To measure the program's results, Geisinger is looking at clinical outcomes, such as falls, readmissions, and escalation events, and operational outcomes, such as staff satisfaction and time savings. Godino said they are also looking at financial metrics, like cost avoidance and length of stay.
"Early data has shown positive trends, particularly in nurse workload reduction and improved patient communication, with ongoing efforts to quantify broader ROI," Godino said.
Onward and upward
Moving forward, Geisinger is looking beyond just virtual nursing. According to Godino, the program will serve as a critical connector between inpatient discharge and outpatient follow-up, specifically for care coordination, chronic condition management, and the Geisinger at Home program.
"By embedding virtual nurses into these models, we can provide continuous, proactive support and reinforce care plan adherence, reducing unnecessary readmissions and improving patient satisfaction," Godino said.
The biggest surprise so far, for Godino, has been how quickly both nurses and patients have adapted to the virtual nursing program.
"The acceptance and appreciation from patients, especially around responsiveness and continuity of care, have exceeded expectations," Godino said.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights intoexcelling 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.
Atrium Health’s Levine Children's Hospital has launched the first Hospital at Home program in the country that focuses on children and their families.
Few would argue that the hospital is no place for a child. But can the Hospital at Home strategy work for children who would otherwise be stuck in a hospital bed?
Levine Children’s Hospital, part of the Atrium Health network, is putting that theory to the test. The 247-bed hospital in Charlotte, North Carolina, launched the nation’s first program to deliver acute-care services to children at home earlier this year.
Stefanie Reed, medical director of the Pediatric Hospital at Home Program, says the program is modeled after Atrium’s Health’s Hospital at Home program, one of hundreds across the country following the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) model. That model establishes protocols for home treatment of patients who would otherwise be admitted to a hospital, with a mixture of daily in-person and telehealth visits and remote patient monitoring.
But where those programs focus on adult patients, Levine is targeting a very different population.
“We do things a little bit differently,” Reed says, pointing out that whereas adult-level care focuses on the patient, pediatric care often envelops the whole family. The program aims to bring “wrap-around care” to the patient and family, bringing in a much larger mix of care providers, including pediatric hospitalists, certified nurses and pharmacists as well as specially trained paramedics, child life case management and discharge managers and other specialists.
That’s a different dynamic, she says, focusing on team-based care rather than individual visits or services.
Stephanie Reed, medical director of the Pediatric Hospital at Home Program at Atrium's Health's Levine's Children's Hospital. Photo courtesy Levine Children's Hospital.
“It’s important for us to make sure that we really support families and team members throughout the hospitalization by being really, really available to them in ways that probably you don't need to be on the adult side,” Reed says.
A unique program with unique protocols
In many ways, providing home-based care for pediatric patients is more complex. Aside from the use of specialists, Reed says they’re tracking more metrics. Alongside the basic data on care quality, readmission rates, hospital flow and patient safety, they’re taking a closer look at patient experience with care teams and technology. Among the questions being asked: Is this an easier and better way of doing things than in the hospital?
They’ve also built in some “extra checks and balances,” Reed says. Clinicians are asked to visit more than once a day with families. And a clinician--doctor, nurse or paramedic--is online or at the home every time a medication is administered or the child is interacting with technology.
“Even in these early days there are some really positive things,” she says. “We are definitely seeing a lower readmission rate and revisit to the ED rate. We are certainly seeing our patient satisfaction rates off the charts. I've yet to have a family that that said, ‘You know this was no fun.’ Every single family has said, ‘Thank goodness we could do this.’”
Since the program was launched in February, Reed says 40-50 kids have received care at home, and those numbers are growing.
An effective Hospital at Home program, of course, begins in the hospital. Pediatric patients and their network of caregivers need to be screened well in advance of moving care into the home. Reed says the program runs on an “inclusion/exclusion basis,” meaning anyone from infancy up to age 17 can be eligible. That said, the range is currently limited to the Charlotte area, and children in intensive care or with complex care needs aren’t eligible at this point in time.
Reed says they’ve treated everyone from newborns with jaundice to teens dealing with flu or dehydration—and, most importantly, their families.
“We always start with family-centered care,” she points out. “Families should feel engaged and [be able to] participate in the care of the child from the moment that they come into our care.”
“I joke all the time,” she adds. “I've met more aunties and grandmas and pets because I'm in the house and I can really talk to them about the support that this mom needs.”
Assessing the home environment
They also take a close look at the home, assessing social determinants of health (SDOH) like food, transportation and family dynamics. Social workers and case managers play a role in this evaluation.
“We really want to elevate that environment,” she adds. “We know if we can do a good job, whether they're with us in a brick and mortar [setting] or they're discharging from hospital at home, if we've set that groundwork, then you have a healthier child and the likelihood of them needing to come back to an emergency room drops dramatically.”
Even then, when all the boxes are checked, things crop up, and the care team sometimes has to react on the fly. Reed says one family assured them that they had transportation, but when a paramedic visited the home he found that the car battery was dead. So he stayed around to recharge the battery and make sure the care was working.
The program is entirely voluntary, Reed says. And there are times when the hospital is a better place for care than the home.
“If a family is not ready, if the home environment is not ready, if they need our support in a different way, that's OK,” she says. “We will be there and we can reapproach it [later if necessary].”
Reed says the program can be an important bridge from the hospital to the home for both children and their families.
“It’s hard to leave the hospital and go home, even when you’re ready to go home,” she says. “Having someone there, holding your hand, so to speak, making sure you really, truly have what you need, someone that you can call anytime of the day or night is a value in a support system in itself.”
Solving for staffing, burnout, and workplace violence issues will require thinking differently about solutions, says this CEO.
HealthLeaders spoke to Phil Dickison, CEO of the National Council of State Boards of Nursing (NCSBN), about the 2024 National Nursing Workforce Study and what CNOs should take from it. Tune in to hear his insights.
A new project in Illinois aims to connect at risk mothers-to-be with a remote patient monitoring platform that includes a Fitbit, a phone, and an AI assistant named Nurse Avery.
Google and digital health company Drive Health are launching a remote patient monitoring project in rural Illinois to connect expectant mothers with an AI bot to guide them through their pregnancy.
In a partnership with state officials, selected women in Cook County will receive Google Pixel phones, Fitbit devices and access to the Google Cloud to connect with Nurse Avery, an agentic AI health assistant developed by Drive Health. The Healthy Baby program is expected to engage more than 56,000 women over the next few years.
"The Healthy Baby pilot represents a critical step in maternal healthcare, showing how AI can help deliver personalized, proactive health support directly to underserved mothers," Chris Hein, field chief technology officer for Google's Public Sector division, said in a press release. "Using the AI agent, Nurse Avery, and delivering it through Google Pixel phones and Fitbit devices, the program provides real-time support – managing appointments, monitoring vitals, and offering health guidance directly, aiming to make essential resources more readily available."
The program isn't entirely unique. Health systems and state health departments have been trying to use telehealth and digital health for years to connect with at-risk mothers-to-be and monitor them up to and through childbirth. They're driven by maternal mortality rates that place the U.S. well down the list, among developing nations.
In Illinois, that problem is acute. Roughly one-third of all counties in the state struggle with access to maternal care providers, and more than 90% of hospitals lack adequate mental health resources. Among Medicaid populations nationally, 40% of pregnant women have an undiagnosed or untreated mental health concern.
The Health Baby project takes a multi-pronged approach to connecting with at-risk women. The Fitbit device will be used to track participants' activity as well as monitoring heart and sleep data. That information will be collected on Drive Health's platform on participants' Google Pixel phone, from which they can access personalized health recommendations – and Nurse Avery.
This is where digital health outreach meets AI, offering participants are more personal, interactive platform. According to Drive Health executives, Nurse Avery bridges "the gap between providers and patients," answering questions, prompting care plan adherence and providing information on a variety of health concerns, including nutritional support and folic acid intake coordination, vaccination updates, genetic risk assessment, mental health and stress management, and chronic disease management.
As with any RPM program, the key to success will lie in patient engagement. Will expectant mothers be comfortable with using the devices and interacting with an AI assistant? And will the state see improvements in maternal health outcomes as a result? According to officials, they'll be looking for reduced mortality rates, improved birth weight and more full-term pregnancies, as well as reduced costs tied to better access to timely care.
As CNOs deal with nursing shortages, it's critical to understand why they are happening.
The National Council of State Boards of Nursing (NCSBN) recently published the latest 2024 National Nursing Workforce Study which surveyed 800,000 nurses about the state of the nursing workforce.
According to the study, there are five main reasons that nurses are leaving, according to the data. According to Phil Dickison, CEO of NCSBN, solving these issues will take thinking differently.
"Every one of those numbers is a voice, it is not simply a number on a page," Dickison said in regard to the survey participants. "My argument is that [as leaders] we need to be better about…listening to these voices of the nurses before we invoke solutions."
Prioritizing nurse wellbeing has an impact on the entire workforce, not just nurses, says this nurse thought leader.
On this episode of HL Shorts, we hear from Diane Sieg, Registered Nurse, Author, Coach, and Creator of the Well-Being Coaching Initiative, about how health systems benefit from prioritizing nurse wellbeing. Tune in to hear her insights.
There are five major reasons why nurses are departing from the workforce, according to this new study.
As CNOs deal with nursing shortages, it's critical to understand why they are happening.
The National Council of State Boards of Nursing (NCSBN) recently published the latest 2024 National Nursing Workforce Study which surveyed 800,000 nurses about the state of the nursing workforce. According to the study, 40% of participants indicated their intention to leave the workforce in the next five years. The study also reported that 138,000 nurses have left the workforce since 2022.
So why is this happening? Let's take a look.
Why nurses are leaving
There are five main reasons that nurses are leaving, according to the data: stress and burnout, workload, understaffing, inadequate salary, and workplace violence. According to Phil Dickison, CEO of NCSBN, solving these issues will take thinking differently.
"Every one of those numbers is a voice, it is not simply a number on a page," Dickison said in regard to the survey participants. "My argument is that [as leaders] we need to be better about…listening to these voices of the nurses before we invoke solutions."
Dickison stated that more data is necessary to determine which nurses are having certain experiences and which ones are having others. For instance, the stress that an ICU nurse faces might be completely different than what a NICU or med surg nurse might experience.
"We need to find this out because we're doing correlations now, but maybe there's better correlations that stress is higher in those areas," Dickison said. "Intuitively…we might believe that, but is it true? And if it is true, then what are the causes of stress in that area?"
Positive outlooks for the industry
Despite what the study suggests about nurses leaving, there are also some positive trends that can be drawn from the data. According to Dickison, one of the positive results has to do with the number of nurses currently in the workforce. The data show that 88% of RNs and 71% of LPN/VNs are actively involved in nursing, which is a sign that employment levels have rebounded since the height of the pandemic.
"We've started to see a rebound in the size or the number of individuals in the workforce," Dickison said. "We started to see that grow in the right direction."
The study also shows that the median age of the nurse workforce went up as experienced nurses begin to return to the workforce. Additionally, 73% of participants hold a baccalaureate degree or higher, which is the highest educational level for nurses that NCSBN has ever documented. The number of Hispanic and Latino nurses has doubled to 7.2% since 2015, and nurses are experiencing a 10-16% increase in median pre-tax income.
A call to action
Dickinson cautions that though these numbers are good, the question remains about whether the workforce is sustainable. While the survey does show moderation for some of these issues, it's critical that the focus remains on solving them.
"I have this fear that because we're showing moderated stress and burnout data that it will somehow become a backburner issue," Dickison said. "Let's not let that happen, because the fact that we moderated it is a good thing, but it is not solved."
Dickison believes CNOs need to continue prioritizing stress, burnout, salary, and workplace violence even though they might be moderated for the time being.
"We need to prioritize that as a moment in time now to go forward and not just talk about solutions, but seek and implement solutions," Dickinson said.
Dickinson also emphasized that these are multifaceted problems, and CNOs alone will not be able to solve these problems.
"What I would argue [for] at this point is somewhat of a call to action within NCSBN and [to] all of our partners, our clinical partners, our practice partners, our education partners, and our policy partners," Dickison said, "because I think this is not a single solution set."
Houston Methodist is now using virtual nursing across eight acute care campuses, and handling some 500 admits and discharges per day. Many of those nurses are even working from home.
While virtual nursing programs typically begin with one or a few specific functions and outcomes, scaling those programs means creating a comprehensive platform that can handle many services.
Houston Methodist, which launched its virtual nursing program in 2022, is now using the platform to facilitate more than 500 admits and discharges a day across eight acute care campuses, says Steve Klahn, the health system's clinical director for virtual medicine. And at its newest location, Houston Methodist Cypress, that experience is much more immersive.
"The team is piloting care delivery in a more comprehensive fashion with remote virtual nurses," Klahn, a participant in the HealthLeaders Virtual Nursing Mastermind program for the second year, said in a recent e-mail exchange. "This pilot includes rotating bedside nurses through a local virtual operations center and supporting bedside nurses' care for their patients by increased remote documentation assistance, multi-disciplinary rounds participation and virtual consenting."
Steve Klahn, clinical director for virtual medicine at Houston Methodist. Photo courtesy Houston Methodist.
As noted in a 2024 story on the program, Houston Methodist is in it for the long run. That means understanding where the platform can evolve and where executives need to take a step back and evaluate their priorities.
"Maintaining flexibility to all the great ideas [that] come in, while being able to remain standardized in the approach so as to not have to re-educate and change workflows too frequently," is crucial to the program's growth, Klahn says. "We also aim to ensure programmatic efficiency with minimization of wait times, while maintaining 24x7 services with safe and fiscally responsible staffing solutions."
One glimpse of the future might be seen in their staffing strategy. Several participants in the Mastermind program have indicated they're looking at enabling nurses to work from home—a key incentive to retaining current nurses and attracting new ones. At Houston Methodist, which now has 50 RN FTEs dedicated to the program, Klahn says the idea is being pushed along out of necessity. Some 70% of the health system's virtual nurses now work from home, and the gaol is to get that number up to 90%.
"We are currently shifting more of our teams to remote work, as space in our virtual operations center is at a premium," he says. "Our strategy remains for direct hire exceptional staff nurses (no-outsourcing to contracted teams), as well as supporting nurses in times of short-term light-duty assignments."
Klahn says the program is gradually integrating new services as well, including dual medication signoffs, remote witnessing of controlled substance wasting, and VTE prevention rounding.
He says the program's success is due to how well it has been received by both patients and nurses.
"We continue to appreciate high levels of satisfaction with patients, bedside nursing teams, physicians/providers and hospital administrators," he says. "The team does an amazing job of ensuring focused high-quality completion of the clinical support they do on a daily basis."
"The biggest surprise to me is how fast the program grew with the strategy our organization acted upon," Klahn adds. "It was amazing to see how quickly the bedside teams embraced this new approach to patient care, and we were able to quickly deliver on the requests for services to each of our hospitals. The future is very bright for VN programs and we look forward to much more growth in the space."
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling 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.
CNOs must provide career pathways and robust wellbeing support systems to improve nurse retention, say these nurse leaders.
In the latest edition of HealthLeaders' The Winning Edge webinar series, a panel of nurse leaders discussed innovative retention strategies that CNOs can use to foster career growth, prioritize wellbeing, and create a more sustainable work environment.
The discussion included three key takeaways: how to support nurses at every career stage, the importance of providing professional development opportunities, and why it's critical to center nurse wellbeing in retention strategies.
