The future of care hinges on a healthy nursing team that's in it for the long haul.
Editor’s Note: This is part 1 of a two-part story. Read Part 2 here.
2024 will be restorative, if CNOs have their say.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
“The current times have required a new level of operational rigor [and] a keen focus on the people providing the care and service,” says Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, executive vice president and Connelly Foundation chief nurse executive officer at Jefferson Health, which has 17 hospitals throughout New Jersey and Pennsylvania.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
And while buoying wellbeing for beleaguered teams may sometimes seem at odds with imperatives like driving quality care and efficiency, it's the right strategy, says Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN, chief nursing officer at Press Ganey, which provides experience survey solutions and consulting services to healthcare organizations, including nursing leaders and teams.
“What our data clearly shows is that if you are not taking an employee-first approach right now, you will never be able to meet the … patient promises that organizations are making to their communities,” he says.
Focus on the rewards
Workforce shortages and turnover “are not going away any time soon,” says Deana Sievert, DNP, MSN, RN, chief nursing officer at The Ohio State University Wexner Medical Center, where more than 5,000 nursing team members work across the system’s seven hospitals.
But that doesn’t mean CNOs can’t start turning the tide.
“Our retention has really bounced back and improved in 2023,” says Meredith Foxx, MSN, MBA, APRN, NEA-BC, PCNS-BC, PPCNP-BC, CPON, executive chief nursing officer for Cleveland Clinic, where she leads 35,000 nurses across the system’s more than 20 hospitals in Ohio and Florida.
Foxx attributes a lot of Cleveland Clinic’s turnover turnaround to its robust total rewards.
“We have a professional ladder,” she says. “We have tuition assistance. We have loan repayment. We have a tremendous amount of resources in our wellbeing space.”
Her team has also enhanced communication around these benefits, many of which are longstanding, so nurses know the possibilities from the beginning.
“When I get to say a few opening comments [at orientation] to all the nurses starting, I tell them every time, ‘You can spend your entire career here and work in different locations, different specialties, have different opportunities.’ ”
Radiate shared purpose
When it comes to building a strong, committed team, compensation must be competitive, Doucette says. But that's not enough.
In Press Ganey's latest research on workforce loyalty, one’s relationship to work—liking it, finding it meaningful, feeling it makes a difference—was the top reason healthcare employees said they would stay with an organization for three years, even if offered a job elsewhere.
Other drivers include strong managerial and team relationships, as well as the organization's care quality; ethics; and follow-through on diversity, equity, and inclusion commitments for patients and employees.
It's “interesting given the national political climate around these types of conversations,” Doucette says. “But it is definitely at the top of mind for healthcare employees, and especially clinicians across all job categories.”
Resilience is a key to satisfaction across domains, he says.
“People talk about resilience all the time, but many leaders don't fully understand what it is,” he says.
To build it, CNOs should focus on the two major aspects that are measurable:
- Activation: “How connected to the work we are, how we feel about the work, as well as our connection to the organization's mission, vision, and values,” Doucette explains.
- Decompression: “How we get away from the work and recharge our batteries,” he adds. It's a big issue right now at all levels of the organization and especially for clinicians.
“How do we take what was already a fragile professional practice environment prior to the pandemic—and of course, these cracks turned into canyons during the pandemic—and how do we repair and rebuild an engaged and highly resilient workforce?” Doucette asks.
Listening can help.
“We've got to stay connected, especially to folks on the sharp edge of care,” he says.
Healthcare organizations that boast the highest employee engagement scores in Press Ganey's database have robust continuous listening strategies, meaning they check in with their teams in a variety of ways throughout the year (e.g., through surveys, stay interviews, and coffee chats with CNOs and other executives), he explains.
And all that listening should lead to talking.
FitzPatrick and Sievert find the people in their purview—from nursing teams and leaders to the C-suite—expect more transparency and communication on the macro conditions affecting healthcare.
“We have seen these national trends really take on a life of their own through social media and other media outlets,” Sievert says. “Part of my role as a CNO is to keep our team aware of the changes, the implications, and the risks [and] benefits.”
Doucette agrees. To keep everyone focused on the big picture, even amid the “everyday fires” that are bound to flare, he says, CNOs need a “well thought-through strategy that is well-communicated to all levels of that organization and creating that alignment and accountability.”
Design the future of care
Creating a professional practice environment that reinforces purpose and loyalty—what Doucette calls “the new PPE”—is a must to fortify nursing ranks.
Projected shortages in key clinical roles over the next decade are “forcing needed innovation in the care delivery models,” FitzPatrick says. “We will have to move fast and agile and the new models will have to demonstrate a more financially sustainable model with the same or better quality outcomes.”
It's quite an undertaking, especially in acute care.
“The biggest challenges that I believe we are facing are around making this 24/7/365 environment appealing to the younger generations,” Sievert says.
In the past, new graduates coveted bedside positions. Today, they're calling for balance and more predictability.
“That simply isn't the hospital setting where holidays and weekends are required, night shifts are necessary, and often many positions require on call beyond the normal work week,” Sievert explains. The challenge is to “create flexibility for the staff but ensure adequate, safe staffing for the patients,” all while keeping costs low.
One solution that all the nurse executives highlighted to HealthLeaders: Virtual experiences on the floor and behind the scenes. FitzPatrick now uses virtual nursing to offload administrative tasks so bedside nurses can focus on top-of-license practice, while Sievert says that ambient listening can cut down on clinical documentation.
Another common refrain: Be brave, bold, and agile.
“Get comfortable with taking some risk,” Sievert says. “In this market and time we are in, the first one out of the gate will be ahead.”
That means ditching perfectionism.
“Don't be afraid … if it doesn't work out exactly as you planned it the first time,” Foxx says. “We spend a lot of time discussing the what-ifs.” As long as patients aren’t put in harm’s way, “just go for it and fix things along the way.”
Foxx adopted this mindset when launching a virtual patient companion program earlier this year. The initiative allows unlicensed nursing assistants to monitor patients from afar—specifically, from existing onsite bunkers to preempt additional real estate costs—so bedside caregivers can focus on providing hands-on service.
“I'm giving you permission to be agile,” she says of her teams’ approach to implementation. And they’re being just that, with work underway to roll the program out to all system hospitals to reduce overall sitter hours and expenses. “We've had a lot of success with that this year. And so we definitely want to scale and push it out further.”
Delaney Rebernik is a contributing writer for HealthLeaders.
“The current times have required a new level of operational rigor [and] a keen focus on the people providing the care and service.”
— Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, executive vice president and Connelly Foundation chief nursing officer, Jefferson Health
From economic downturn to staffing upheaval, nursing executives are up against some dogged forces heading into 2024.
To set the stage for success, CNOs must build up their teams both in number and resilience, nursing chiefs and experts say.
How? Make compensation compelling, share purpose and power, redesign care for the future, and play a very long game when it comes to recruiting.