Top nurse execs gathering this week for HealthLeaders Media's inaugural CNO Exchange will engage with their peers over rapidly changing care models and new roles for nurses and chief nursing officers.
If you want to convince a busy nurse leader to step out of the office and away from the hospital for a couple of days, you'd better have a really good reason.
I can't think of a better one than an invitation to the inaugural HealthLeaders Media CNO Exchange at the Omni Barton Creek resort in Austin, TX.
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This week, more than two dozen top nurse leaders from around the country will gather to exchange ideas about the most urgent issues that nurse leaders—and the nursing profession as a whole—are facing. I expect lots of spirited and thoughtful discussion among this select group of leaders and I can't wait to join them. Here's a preview of some of the topics we'll be covering:
People: Recruiting and Retaining Top-Performing Staff
Recruiting and retaining nurses is an ever present challenge for nurse leaders. The profession has seen its share of nursing shortages, though a recent study estimates the next shortage may not be as severe as once thought.
Still, attracting and keeping the nurses with the right skill mix is no walk in the park.
"One of the things we grapple with here is how to fill our openings," says Kathy Bonser, RN, MS, vice president and chief nursing officer at SSM Health DePaul Hospital in St. Louis. "We've been pretty successful recruiting the graduate nurses because some of our competitors in the market made the choice to only hire BSNs. We've stayed committed [to also hiring ADNs] because of relationships we have with many of our community colleges that surround our hospitals." In 2015, Bonser hired 50 new graduate nurses in January and 54 more in June.
Kathy Bonser, RN, MS |
Mary Shehan, RN, DNP, NE-BC, CNO at Weiss Memorial Hospital in Chicago has also had a good supply pool of RNs. "I have not had a lack of applicants," she says. "I would say for every new grad position I had, I had at least 10 applicants."
Keeping those new nurses in the organization, however, is a separate challenge, especially in a market like Chicago where hospitals are just a few miles apart from each other.
"There's quite a bit of a problem with nurses going from one organization to the next, and I see the biggest problem with this is the new grads," she says. "They are constantly moving and mobile. I spend a considerable amount of time bringing new grads on through internship programs and residency programs, only to have them leave and go to the next hospital."
Bonser has seen the same thing among her younger staff. "I'm a baby boomer; I admit it. I've been here for 34 years," she says. "That what my parents did, that's what people my age did. The millennials they want to move and they want to shake it up."
Practice: The Changing Scope of Nursing Roles
More than ever, the healthcare industry is placing greater emphasis on outcomes, quality metrics, patient satisfaction, and the care continuum. Nurses have a huge opportunity to influence changes in these areas. As a result, nursing roles and practice settings will also change.
"Our greatest opportunity is to really work at the fullest level of our capability, to work to the highest level of your degree," Shehan says. "We have so much opportunity to have nurses helping us as hospitalists or even out in the clinic setting."
Mary Shehan, RN, DNP, NE-BC |
Shehan sees huge potential in using APNs to help delivery care.
"Here at Weiss, I do have a number of NP hospitalists," she says. "They're helping make tremendous strides in reduction of length of stay and making sure that I am using protocol driven order sets."
Bedside nurses are also influencing nursing practice by providing more input into policies, process flow, and patient care interventions says Bonser.
"I've got to have the people at the bedside making decisions about how the work is done," she says. "I haven't been at the bedside for many years, so I can't be that person."
Bonser says bedside caregivers are the best people to drive nursing practice and standards because they are the ones who are in the thick of things when it comes to delivering patient care. "One of the things we've done to help bridge that gap is we have our shared governance structure," she says.
Each of the SSM DePaul nursing units has a nursing practice council and there is a campus-based practice council. Both are comprised of bedside nurses. In addition, SSM has a St. Louis-region nursing practice council and recently created a system-wide practice council to connect bedside nurses across the four states with SSM facilities.
"[This is to ensure] decisions about practice and what nurses are doing out there every day are made by the right people," Bonser says.
Profession:The Evolution of the CNO
Nurse leaders have to concern themselves with far more than just nursing nowadays.
"I've been a CNO now just a little over 15 years," Shehan says. "I need to be aware of all aspects of healthcare and not just taking care of the division of nursing." Achieving financial and quality outcomes, readmission rates, and other system-wide initiatives all hinge on nursing and the CNO, she says.
"You have to be totally in line with all of the different things that we're faced with," she says. "It's my role to try to let the bedside nurses know that what they do really impacts [things]—whether it be the bottom line or the quality outcomes that were expected."
Nurses Can't Afford to Ignore Healthcare Costs
Nurse leaders must take into account things that would have once been considered outside their realm, such as medical codes and length of stay.
"We're just seeing sicker and sicker patients and the workload is hard," she says. "[When you add in] this patient codes out to being a length of stay of three or four days, and you have ask, 'So what are we doing to get these patients to the appropriate level of care in the most economical time frame?' That to me is a real challenge."
Nurse leaders need to be concerned with process and workflow barriers that could be impeding patient care as well, she says. Plus, they must consider whether an acute care setting is the right place for the patient to receive care.
"It's really about getting them the appropriate care on time," she says, "What are the delays in getting them that care? Can that care be provided in a different setting? Is it time to move them to the nursing home or home with home care? Or are they truly so sick that they're an outlier to that length of stay estimate and they should be still in the facility?"
With all this responsibility, the CNO has definitely earned a seat in the C-suite, she says. "It's truly a partner at the executive table. The CEO, CFO, COO and the CNO and CMO—those five roles are just so important."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.