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.
Attendees at this week’s HealthLeaders CFO Exchange are addressing how they confront mounting financial and operational pressures, from labor shortages to unions to recruitment.
CFOs gathered this week at the HealthLeaders CFO Exchange to discuss the pressures shaping the financial landscape of health systems. With margins still squeezed post-pandemic, the tone was less about recovery and more about resilience and planning, particularly around the workforce.
Workforce Headwinds Take Center Stage
As expected, workforce issues are still at the top of the agenda. Nurses and frontline staff are commanding higher wages, while those who rely on costly agency staffing are facing their own financial burdens. Many CFOs expressed the need to develop their workforce in-house, through expanding education platforms.
While turnover is down since COVID, it’s still high. But some CFOs are seeing a silver lining: Some employees are completing short-term or contract work with the health system, then deciding to stay on.
Radiology and Anesthesiology Costs
Some CFOs expressed concern with the rising costs of radiologists and anesthesiologists, including CRNAs, all of whom are commanding higher salaries. The hope here is that AI can be used to bring down those costs, particularly in handling administrative tasks that take up a lot of time.
Nursing
CFOs also have a lot to say about nursing costs. Two top concerns are nurse safety and nurse staffing ratios. Nurse staffing ratios, in particular, are often the first thing incoming nurses ask about when being hired. Nurses want to know that they won’t be overloaded from the get-go, and burnout is certainly still a huge pain point for the industry.
Unions
Exchange members spoke about the process of unionizing non-union hospitals and the challenges with keeping non-union wages up to par. Tough market productivity metrics are also difficult to keep up with, some members said. There’s also a feeling of general unproductivity here because of regulated ratios for unions.
Other members found more periodic experiences with unions that typically manifest on the nursing side. It’s clear the nurses know their value and aren’t afraid to speak up. Exchange members said it’s important to be able to sit down and have thorough talks with the nursing staff. Members also pondered how they can set themselves apart culturally from unions.
RecruitingThe Community
Many exchange members spoke about the importance of showing their support for the communities they serve by partnering and providing opportunities for local medical students.
Many have started partnering with local universities and tech schools, especially for recruiting for ultrasound tech positions. CFOs agreed the main idea here is to “put your money where your mouth is” and ensure the health system is supporting schools and the incoming workforce. Consistent outreach and offering shadowing opportunities are two components in this strategy.
One of the biggest challenges CFOs have found with recruiting is getting the staff that wants to work the second and third shifts, staff who are willing to work nights or in a Level one emergency department. The timing of shifts is more where the challenges are rather than the roles themselves.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders CFO Exchange event, email us at exchange@healthleadersmedia.com.
The Cleveland Clinic is the latest to partner with a developer of ambulatory surgery centers to take minimally invasive procedures out of the hospital.
Health systems are taking a step toward the hospital of the future by outsourcing minor surgeries.
The latest to do so is the Cleveland Clinic, which announced a partnership this week with Tennessee-based Regent Surgical to build a number of ambulatory surgery centers across the country. These centers are designed to handle minimally invasive procedures, which require little to no hospital stays and shorter recovery times, much of which can be handled at home or in clinics.
As hospitals struggle with workforce shortages and look to reduce costs and their patient census, leadership is looking for alternatives to expensive and resource-intense hospital care, with the idea of saving the hospital for those who need acute care services and will spend several days there.
As a result, the ambulatory surgery market is growing. Fortune Business Insights reports the market size was valued at almost $44 billion in 2022 and projected to grow to more than $75 billion by 2030. There are currently more than 6,000 such centers in the U.S.
Arizona-based Banner Health joined forces with Select Medical in 2018, and now has a network of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy Centers. Mark Garvin, the health system’s SVP of Partnership & Venture Development, says the partnership is part of Banner’s strategy to grow beyond its extensive hospital footprint and provide value-based care where it’s most convenient.
“These are people that wake up every single day and this is what they worry about,” he said in a recent HealthLeaders interview. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin says health systems and hospitals have the advantage over disruptors because of the name brand and the expertise in providing healthcare services.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Cleveland Clinic, which is internationally known for outsourcing second opinions through The Clinic by Cleveland Clinic, a partnership with telehealth provider Amwell, is banking on new efficiencies with the Regent Medical deal.
“Ambulatory surgery centers provide an important setting for health systems to expand access to surgeries, and to be more efficient in the delivery of services,” Cleveland Clinic CEO and President Tom Mihaljevic, MD, said in a press release. “Regent's capabilities in managing and operating ambulatory surgery centers will enable us to focus on continuing to provide the highest quality care for our patients and will enhance our ability to grow and offer that care to more patients.”
CNOs must be ready to support nurses from the beginning to the end of their careers, and throughout life changes, according to these nurse leaders.
Nurses are multifaceted individuals with needs that must be met both at work and at home. CNOs must take the time to understand each nurse's individual needs and goals. The goal should be to create a space where nurses are not afraid to approach leaders with their needs.
CNOs must provide career pathways and robust wellbeing support systems to improve nurse retention, say these nurse leaders.
Retention is struggle for all leaders in healthcare, including CNOs.
Predictions about the nursing workforce are somewhat grim, with many studies suggesting that nurses plan on leaving the workforce in the near future. That coupled with existing shortages and continuing issues with nurse turnover, does not bode well for the industry.
So, while health systems might have different approaches, there are several creative retention strategies that CNOs should take into consideration.
The panel discussion included three key points about retention strategy.
Support at every career stage
Nurses are multifaceted individuals with needs that must be met both at work and at home. CNOs must take the time to understand each nurse's individual needs and goals. For new-to-practice nurses, many of whom are Gen Z, the panelists recommended that nurse leaders meet with them within the first 30 to 90 days of their employment to discuss their career path. Then, come up with a road map for how they can accomplish those goals.
The goal should be to create a space where nurses are not afraid to approach leaders with their needs. Gen Z nurses in particular appreciate emotional connections with the people they work with, according to the panelists, and they enjoy recognition.
For more tenured nurses, the goal is to create opportunities for them to share their knowledge with the next generation of nurses. This might involve having them enter virtual nursing or telehealth positions. For nurses who have family members to care for at home, the panelists emphasized the importance of flexibility. Leaders must be able to empathize and help their nurses navigate through life changes while they continue to work.
Professional development opportunities
Nursing is a dynamic career with many pathways to success, and CNOs are responsible for equipping nurses with the skills they need to grow and mold their careers. Professional development is not only critical to nurse retention, but it is also the key to succession planning and fostering the next generation of nurse leaders.
According to the panelists, CNOs should focus on building leadership pipelines that help bolster the nurse's career path. Nurses should be able to cross train, participate in leadership development, and obtain certifications for other skillsets.
One key benefit that CNOs should consider is tuition assistance. The panelists explained that for many nurses, the cost of certification or continuing education is the one barrier standing in their way. If health systems are able to cover the initial costs up front, that can help lift financial burdens off of nurses who are ready to advance their careers.
Centering wellbeing
CNOs and other nurse leaders must also prioritize nurse wellbeing to maintain the sustainability of the workforce. This is done by creating a work environment that is as safe, efficient, and barrier-free as possible.
First and foremost, health systems must provide mental health support systems for nurses, through EAP programs and other resources. The panelists recommended mental health counseling and stress first aid, which equips nurse leaders with evidence-based stress response practices for when incidents occur. CNOs can also advocate for physical spaces in the health system where nurses can go to find a moment of relaxation in their day.
More specific strategies can include initiatives to improve individual wellbeing. For instance, promoting sleep schedule recommendations for nurses who work a mixture of days and nights. CNOs should get in touch with their workforce to see what their wellness needs are, and then make sure to provide the kinds of support they need.
AI can help clinicians manage complex conditions and relationships, says the CMIO of Stanford Medicine Children's Health
Pediatric healthcare is a complex undertaking. The doctor-patient experience is far more complicated, involving not just patients of various ages but parents, grandparents, siblings, other caregivers, maybe even a pet or two, real or imaginary. The old standard ‘How are you doing today?’ usually doesn’t do the job in this environment.
“So much of pediatric care is about connection, and about preventative medicine, and about ensuring that you understand the complex interactions between the child, the parent and the provider, and so, so much of that kind of subtle nuance about what is the child doing during the evaluation,” she says. “So much of what we’re assessing is the child’s behaviors [and] the child’s interaction with other people in the room, the child’s body motions. And if you're sitting at a computer and typing the whole time, you're missing all of that very rich data.”
Children’s hospitals have a rich history of embracing innovation, often because the tried-and-true ways of care management for adults don’t necessarily work for kids. Clinicians often have to take new ideas and technology designed for adults and modify them for their own patients.
That’s also true of AI, which, Pageler says, needs to evaluated differently.
Natalie Pageler, MD, CMIO of Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Take ambient scribes, which are designed to capture the doctor-patient encounter for the medical record.
“We did a rigorous evaluation of how that affected the interaction for children and families, because most of it was developed in the context of a single provider and a single patient,” Pageler says. “Of course, in pediatrics, it's often the patient, a couple parents, a couple kids running around the room screaming. We really wanted to do that evaluation to understand [whether] it could have the same impact for children and families.”
The potential value of these tools for pediatric clinicians is clear. In that busy exam room, a doctor or nurse needs to be attentive to the children as well as the parents, picking up on subtle clues and interactions that could play an important role in diagnosing and treating underlying health concerns.
“We need to make sure they are addressing the true needs of the patient and the family,” Pageler notes.
Just as important, she says, is the connection between the clinician, the patient and the patient’s family, a key dynamic in any healthcare experience but critical to those working with children. Pageler says AI is helping to take the technological barriers out of the exam room and making children and their parents feel more comfortable.
“We’ve had several patients walk out of the room and say, ‘Wow, my provider looked at me the whole time and we got to really talk about this complex challenge I'm having with my child's behavioral issue,’” she says.
Pageler says some doctors have even decided to use AI instead of having a scribe in the room or listening to the conversation from another location. In some cases, she says, Ai is less intrusive to parents and children who want to talk about personal issues and don’t want another person listening to that conversation.
Aside from ambient listening opportunities, Pageler says AI can be a valuable support tool for doctors who are treating patients as young as infants and as old as teens. Different ages often call for different treatments, and the technology can help clinicians gather the information they need to guide their conversations with children, adolescents, parents and other caregivers.
“The relationships are so complex,” she notes. Clinicians have to be “extremely thoughtful” in how they share information with different patients and family members.
Pageler expects clinician decision support to be the next wave of AI innovation, helping clinicians find and use the right data to improve care management and coordination. That’s especially true as healthcare organizations set their sights on health and wellness and prevention opportunities.
As she sums up the value of AI in the pediatric care space, Pageler says the technology enables doctors and nurses to interact with patients, their families and others without the intrusive presence of computers and scribes.
“AI should make care more human, not less,” she says. It will “allow for more humanity” in care management.
Vanessa Ryan, senior vice president of operations at TruBridge Analytics, talked with HealthLeadres about the ways oversights in data analytics cause health systems to miss out in the revenue cycle...
These nurse leaders are coming together to share leadership strategies in celebration of nurses everywhere.
The nursing industry has grown and changed in many ways, especially in the past five years.
Heavy workloads, burnout, and workplace violence challenges persist, and nurses are departing from the industry, leaving staffing gaps and shortages behind. Despite these challenges, innovation in nursing has taken off, with AI and virtual nursing at the forefront of many CNOs' strategies.
This week is National Nurses Week, meant to celebrate the essential contributions that nurses make in communities worldwide. HealthLeaders is participating in the celebration with a week full of events, beginning with the next webinar in our The Winning Edge series.
Retention is the new recruitment
In the face of staffing shortages, retention is just as important as recruitment for CNOs. To truly build a resilient workforce, nurse leaders must focus on retaining nurses at every stage of their careers, from new graduate nurses contemplating life at the bedside to seasoned professionals nearing retirement and everyone in between.
The Winning Edge for Keeping Nurses Happy will explore innovative retention strategies that CNOs can use to foster career growth, prioritize wellbeing, and create a more sustainable work environment.
G Hatfield, Event Moderator and HealthLeaders CNO Editor
This isn’t just another webinar—it’s your chance to learn from the best in the business and walk away with strategies you can implement immediately. Join us as we face the problems, share solutions, and help you reboot your retention strategy.
Supporting nurse wellbeing is another key consideration for CNOs who want to build a sustainable workforce. Cheryl Reinking, CNO at El Camino Health, recently spoke to HealthLeaders about nurse turnover rates and how they are impacted by burnout and workplace violence.
For CNOs who want to improve retention, Reinking believes the culture of recognition at the frontline is key. Workplace violence prevention is another critical piece of the strategy. Reinking also said they brought in a nurse retention specialist in 2024 to help build professional career development plans for nurses.
For Nurses Week, Reinking will join Alicia Potolsky, associate CNO at El Camino Health, on a panel moderated by Joel Ray, chief clinical advisor at Laudio, where they will discuss how El Camino Health successfully addressed key workforce challenges and improved wellbeing for its nursing staff.
Virtual nursing, AI, and other technological advancements have taken the nursing world by storm with the promise of reducing burdens for nurses at the bedside. Virtual nursing has proven valuable in shortening admission and discharge times, and it provides support at the bedside for patient observation and education.
For Nurses Week, the following leaders in nursing and technology are coming together to discuss the natural progression of virtual patient observation, from focused observation to broader clinical applications, and to demonstrate how virtual nursing creates new clinical pathways for delivering expert care while addressing staffing challenges and maximizing the impact of existing nursing resources.
Nurse turnover rates have been high since the COVID-19 pandemic, and it's important for CNOs to reflect on what they can learn from that time.
HealthLeaders spoke to Cheryl Reinking, chief nursing officer at El Camino Health, about how the health system reduced its nurse turnover rate to 5%. Tune in to hear her insights.
A bill introduced in both the Senate and House would Improve Medicare reimbursement for rural providers using RPM technology.
While adoption rates are growing for remote patient monitoring (RPM), rural and remote providers are holding back, due in large part to low Medicare reimbursement. A new bill before Congress aims to change that.
The Rural Patient Monitoring Access Act, introduced this week by U.S. Senators Marsha Blackburn (R-Tennessee) and Mark Warner (D-Virginia) in the Senate and by U.S. Reps. David Kustoff (R-Tennessee), Mark Pocan (D-Wisconsin), Troy Balderson (R-Ohio) and Don Davis (D-North Carolina) in the House, would set a geographic payment floor for RPM reimbursement, enabling rural providers to recoup expenses from Medicare at the same rate as their urban and suburban counterparts.
Supporters say the bill would also ensure that providers are capable of responding to health concerns detected by RPM and that the RPM technology can promptly transmit biometric data at the EHR. It would also give the Centers for Medical & Medicaid Services (CMS) a pathway for reporting data to the Health and Human Services Department (HHS) to evaluate costs savings generated by RPM.
The proposed legislation has a number of supporters, including Marshfield Clinic, Lifepoint Health, SSM Health, Ascension, the University of Virginia Center for Telehealth, the American Telemedicine Association (ATA), the National Rusal Health Association, HIMSS, and the Alliance for Connected Care.
According to a summary of the bill, RPM reimbursement via Medicare is lowest in areas where the prevalence of heart disease, hypertension and diabetes are above average and where access to care providers is problematic.
“Patients in rural and underserved communities deserve the same opportunity to manage their health as those in more resourced areas,” Christ Frost, Lifepoint Health’s CMO and Chief Quality Officer, said in a press release. At Lifepoint, we’ve seen firsthand how high-quality remote patient monitoring can help bridge long-standing access gaps and drive meaningful clinical improvement, especially for chronic conditions like hypertension and diabetes.
The bill comes just two weeks after the Peterson Center on Healthcare released a study that called for improvements to RPM reimbursement, including coverage that aligns with specific services that have shown the most value, improved access to high-impact RPM services and improved data collection from RPM devices.
The study also found that hypertension, diabetes and heart failure are the most common conditions being monitored through RPM.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
