A growth mindset, emotional intelligence, and innovation create a workplace where nurses want to stay.
A hospital or health system's nurse recruiting strategy may be successful, but retaining them requires the skills and management of effective nurse leaders, says Sara Groff, MSN, CMSRN, RN-BC, MedStar Health's senior nursing director for Oncology and Surgical Services.
These three competencies can help nurse leaders create the kind of workplace environment that successfully encourages nurses to stay where they are, Groff says.
1. A growth mindset
Nurse leaders must focus on progressive career development for their nurses, Groff says.
"An operations leader used to get that role and stay in that role for quite some time, whether it be at a unit level or senior level, and that's not the nursing workforce or the workforce in general anymore," Groff says.
Instead, nurse leaders must recognize their rising stars and help them climb the career ladder of their choosing, Groff says.
"We need to be able to have rising stars ready to come up the steps, so to speak, and nurse leaders must understand that you don't want to hire to keep someone in that particular role, but you want to hire to grow them," she says. "Having this growth mindset across the entire nursing profession is important not just when they start as a nurse, but as an evolution of the profession.
2. Emotional intelligence
Today's workforce is different than generations prior because most new nurses have never held a job before, Groff says, which requires greater emotional intelligence (EI)—an ability to identify and manage one's own emotions and understand the emotions of others—on the part of nurse leaders.
"EI is so crucial because the workforce is coming into this profession not having as many professional or work experiences prior. And it's not good or bad; it just is," she says.
"I use myself as an example: When I became a nurse, it was common that most of my peers would have worked, whether it be in their high school or their college years, to help sustain being able to go to school. Based on their upbringing, they were going to have a job," she says. "Now, there's more of an effort to ensure that kids can reach their capabilities as kids for a longer period of time, so we started to notice here that this is people's first job, not just their first nursing job."
Consequently, nurse leaders must have the capability to usher new graduates not only into nursing, but into the professional world.
"Our leaders now have to have that patience, but also have the EI to help the nurse arrive into nursing, which is already a pretty tough profession, but also help people arrive into adulthood, so to speak," Groff says. "Health systems are looking for the ability to be agile—the ability to have emotional intelligence to grow and support the nursing workforce."
3. Innovation
Nurses generally are innovative problem solvers because of their training, but effective nurse leaders elevate innovation to drive change, Groff says.
"Before the pandemic, we used to be able to innovate because we might have a couple of things that needed worked on, but now you can't have an excuse to not innovate," she says.
"We need creative leaders—people who are willing to take chances but who still keep patient flow and patient care plans at the center," Groff says. "We need nurse leaders who can think through an operational problem and solve it, while also considering how it impacts the bigger picture."
Teaching leadership skills
All three competencies can be learned with the right support from healthcare organizations, Groff says.
"They need to not just encourage the leadership options, but actually support nurses to do that," she says.
MedStar Health, for example, has developed a curriculum/learning series for nurse leader development called Nurse Leader Academy at MedStar Washington Hospital Center. The curriculum is based on the American Organization for Nursing Leadership (AONL) Nurse Manager Competencies.
"It started a few years ago when we recognized the need for better onboarding of nurse leaders and then ongoing opportunities for development in leadership skills and knowledge," she says.
The curriculum continues to evolve as new leaders enter roles.
"We want to be contemporary and applicable to the needs of our leaders," Groff says. "This year, we have a new role that will further support and tailor leader development. We have a director for Nurse Leader Development, and they will work closely with our senior leadership and frontline leaders to consult, guide, and develop learning and career mapping for our team."
HealthLeaders' most popular stories for nurse executives for Q3 2023 range from big data and staffing ratios to robotic nurses.
Though a handful of state legislatures have enacted or are considering mandating nurse-to-patient staffing ratios, staffing should stay in the hands of nurses, Robin Begley, CEO of the American Organization for Nursing Leadership (AONL), told HealthLeaders in a story that ranked No. 1 in readership for the year's third quarter.
Besides staffing, nurse executives also were most interested in stories about technology, LGBTQIA+ care, recruiting and retaining, big data, and rural healthcare. Here are HealthLeaders' top seven nursing stories by ranking:
Legislators working to mandate nurse-to-patient staffing ratios may have good intentions, but the process of a nurse-patient ratio is antiquated and out of alignment with healthcare delivery today, says Begley, DNP, RN, NEA-BC, FAAN.
"In particular, it does not consider advanced capabilities in supportive technology, or what we're seeing across the country right now, which are interprofessional team-based care models," she says.
Additionally, staffing is complex and best understood by experienced and expert care teams—not policymakers, she says.
"The way of determining the staffing ratio is a very static method. It's a tool that is at a single point in time," Begley explains. "At the beginning of a 12-hour shift, for example, the activity, the patients, their conditions, and the staffing of a floor can look very different than what's required throughout that 12-hour period. That nurse-patient ratio fails to acknowledge that care needs can change on a dime in a hospital."
An unintended consequence of mandated ratios is less access to care for patients, Begley says.
"If a hospital or health system has to close several units because they don't have the prescribed number of nurses to care for patients who would have been in those beds, patients are unable to make it past the emergency department, or they may be transferred to other facilities that that are not close to their home," she says. "So, those are serious concerns that need to be evaluated before something as dramatic as a mandatory nurse-patient ratio is implemented."
As hospitals and health systems continue to seek solutions to workforce staffing—particularly nursing—many are veering away from traditional methods and embracing new ways of attracting and retaining employees.
Nurse hiring and retention now entails upskilling, collaboration, and nontraditional support.
For example:
Geisinger, a Pennsylvania healthcare system, is filling critical nursing roles through its Nursing Scholars Program, which awards $40,000 in financial support to each employee pursuing a nursing career, providing that nurse commits to working five years as a Geisinger inpatient nurse. The program is open to any employee who is not already an RN, physician, or advance practice provider, and begins on day one of their employment.
Allegheny Health Network, based in Pittsburgh, launched Work Your Way, a mobile internal staffing model that provides flexibility for nurses to choose how and when they want to work. Mobile nurses work rotational, six-week shifts in emergency medicine, telemetry, critical care, and perioperative care at eight of AHN's 14 hospitals. Those traveling more than 50 miles to work receive premium pay and mileage reimbursement; those traveling more than 75 miles also receive lodging reimbursement. Options to work weekends and night shifts are included.
Northwell Health offers eligible employees as much as $5,000 in financial assistance to purchase a home on Long Island.
The AI wave comes at a crucial time in nursing because it can effectively train nursing students, improve patient care management, and adjust nurse workloads, which ultimately helps to reduce stress and burnout—and that's just the tip of the iceberg for the emerging technology.
"One of the things we need to think about is if nurses are asked to do things that technology could do more efficiently or more effectively," he says. "There's no need for nurses to be doing that kind of work when a machine can do it much more quickly, more efficiently, and in a less-stressful manner."
Indeed, nursing needs to be a partner with technology and consider it like any other tool, he says.
"If you think about years gone by when we were using mercury thermometers to take people's temperature, we didn't think anything about it; it enabled us to get an accurate value in terms of whether someone might have an infection," Benton says.
"Nowadays, we've got different technology that does that in real time, and we think nothing about it," he says. "AI needs to be a partner with us in terms of delivering safe, effective, and efficient healthcare into the future."
The concept of AI-powered robots in nursing isn't far-fetched anymore—Baptist Health in Jacksonville, Florida, is using Moxi, a robot, to help with tasks that might otherwise take up time away from patients—but issues remain whether they are capable of providing quality nursing care, a new study says.
Researchers from three Japanese universities examined whether AI and robots have the ability to perform nursing tasks as well as humans.
Nurses' human touch establishes meaningful connections with their patients. That's why nurses have ranked first for 21 years as the most-trusted profession in America.
The researchers examined whether current advancements in robotics and AI can implement these human qualities by replicating the ethical concepts attributed to human nurses, including advocacy, accountability, cooperation, and caring.
While AI can inform patients about medical errors and present treatment options, "the researchers questioned its ability to truly understand and empathize with patients' values and to effectively navigate human relationships as mediators," according to Tokyo University of Science.
Robots may not fully replace human nurses anytime soon, but it is a possibility, the researchers note. If that time comes, "their deployment requires careful weighing of the ethical implications and impact on nursing practice."
When students of Brenda Cassidy, DNP, RN, CPNP-PC, at the University of Pittsburgh School of Nursing expressed uncertainty about how to respectfully ask patients about sexual orientation and gender identity, a consult with her colleagues found their students felt the same hesitancy.
Cassidy and those colleagues—Betty Braxter and Andrea Fischl—set about to develop a unique interactive learning module and resource toolbox to provide best practices in LGBTQIA+ healthcare to those students—and all healthcare providers.
The unprecedented resources are available to any healthcare provider who wants to approach patients in a welcoming and inclusive manner, Cassidy says.
Despite the American Association of Colleges of Nursing's initiative to improve academic nursing programs' ability to prepare working nurses for a diverse patient population, including LGBTQIA+ individuals, fewer than 20% of nursing students get such preparation, and one-third are ill-at-ease when attempting to provide care for LGBTQIA+ patients, according to the association.
Most providers aren't deliberately prejudiced, but instead harbor unconscious bias, says Cassidy, a pediatric nurse practitioner whose specialty is adolescent healthcare, particularly sexual reproductive health.
Consequences of unconscious bias can be devastating for LGBTQIA+ patients, Cassidy says.
"Unfortunately, it results in discrimination and stigma toward this population who's already vulnerable," Cassidy says. "Negative experiences that they have had creates hesitancy on their part to delay seeking care, which then delays diagnosis and treatment, and that results in negative consequences."
"Inclusivity is about making people feel comfortable to say who they are, being who they are," Cassidy says, "and we really have made wonderful, great strides, but our work is not done."
With more than 100 million Americans lacking access to primary care, employing more nurse practitioners (NP) and allowing them to practice at the top of their license is critical to making healthcare more accessible in rural areas, NP leaders say.
NPs could ease "care deserts" created by physician shortages and rural hospital closings. Nearly 80% of rural U.S. counties are medical deserts, according to the National Rural Health Association.
NPs' holistic, wellness-centered approach to primary healthcare—health promotion, prevention, and chronic disease management—is particularly beneficial to rural patients who must travel long distances when illness requires acute care.
"One really valuable thing they bring to rural health is the approach to healthcare, which differs a bit from the medical model," says Michele Reisinger, DNP, APRN, FNPC, a working NP and assistant professor of doctoral nursing at Washburn University in Topeka, Kansas. "Nurse practitioners are trained to look comprehensively at the individual."
"Nurse practitioners in rural areas wear many hats," she says. "They may be seeing primary care patients; they may be tasked with extended care rounds in nursing home facilities, which requires extensive geriatric management; or they may be in a setting that requires knowledge of trauma. So, we try to prepare them in a way that is global in that manner."
That's why Simpson and Vicki Stover Hertzberg, PhD, FASA, a professor and director of Emory's Center for Data Science, helped create an online, self-paced data science certificate program—to help nurses use Big Data to solve problems in healthcare settings.
Big Data is a relatively new concept for nursing—it's been around two, perhaps three years, Simpson says—but its capabilities are unlimited in developing patterns of patient care.
"To compare six patients and 10 patients and 30 patients and 400 patients is not a good indicator of evidence. You need large trillion data sets," Simpson says.
Getting comfortable with Big Data can only help nurses in their clinical practice.
"Every specialty in nursing has a component of informatics, and the weakness of those disciplines is the lack of informatics in their discipline," Simpson says. "For nursing to be successful in the future, we have to embrace it. We have to understand it and know how to use it."
Nurses’ understanding of patients and recognizing gaps in care provides a unique perspective to the use of technology and other innovative processes to offer appropriate care for each patient.
Combining that perspective with innovative engineers and their expertise in the latest technology will create ideas and inventions to improve patients’ lives, according to the university. Research, education, community engagement, and technology transfer are the four focal areas of the new center.
"Engineers are trained to solve problems and create solutions. They have the technical knowledge, skills, and abilities to actualize new technologies," says Leila Daneshmandi, PhD, assistant professor in residence in Innovation and Entrepreneurship and director of the entrepreneurship Hub (eHub) in the School of Engineering.
"By partnering with nurses and healthcare professionals, who have deep contextual knowledge of on-site problems and needs, we can ensure that our innovations are user-centric and designed for unmet healthcare needs," says Daneshmandi, who is co-directing the center with Tiffany Kelley, PhD, MBA, RN-BC, visiting professor and director of the School of Nursing’s Healthcare Innovation Online Graduate Certificate Program.
"The Nursing and Engineering Innovation Center is a natural progression of ongoing collaborations that have been ongoing for the last several years," Kelley says. "We are excited to see how it will enhance our research and educational programs, help meet the demand for our graduates in the workforce and provide better care for patients. It is amazing what we can do with a little seed funding, enthusiasm, and determination."
Two phases
The first phase of the new center, expected to take two to three years, includes creation of joint educational programs for students and seed grants for collaborative research among faculty.
Phase two is creation of a shared state-of-the-art research and teaching facility that would further integrate established undergraduate- and graduate-level programs in the schools of nursing and engineering, as well as allow prototypes to be field-tested. This phase will require major university, state, federal, or donor investment.
"The School of Engineering has strong connections in healthcare, especially through our Biomedical Engineering Department operated with UConn Health," says Kazem Kazerounian, the school’s dean. "With this new Innovation Center, however, we’re investing in patient-focused care at the hands of the talented nurse workforce."
Hackensack Meridian Health is training nurses systemwide to effectively evaluate young suicidal patients.
With New Jersey pediatric emergency room psychiatry consults dramatically increasing in 2022 over the previous year, Hackensack Meridian Health (HMH) has launched Adolescent Clinician Training for Suicide Prevention for Nurses (ACTS) for its nurses.
The initiative calls for training non-behavioral-health nurses to better assess, evaluate, and treat or refer young suicidal patients who come into the health system, with the initial phase serving as a baseline for the expanded training of thousands of HMH nurses by 2025.
The program is in response to troubling research:
Pediatric emergency room psychiatry consults increased between 20% and 49% from 2021 to 2022.
Adolescents accounted for a larger share of suicides across 14 states in 2020 than they did over the previous five years.
Suicide is the second leading cause of death for youth, according to the U.S. Centers for Disease Control and Prevention (CDC).
30% of high school girls had seriously considered suicide while 13% of them attempted it, says the CDC.
45% of LGBTQ+ teen-agers had seriously considered suicide while 20% of them attempted it, says the CDC.
New Jersey is among five states that saw an increase in suicide deaths among adolescents during the pandemic, according to JAMA Pediatrics.
"The need for skills and knowledge in identifying and delivering a wider range of behavioral health disease identification and treatment strategies has never been greater," said Don Parker, president of Behavioral Healthcare Transformation at HMH.
"We are continuing to invest in our nursing staff throughout the network and are committed to making sure they have every tool available to help the growing ranks of behavioral health patients," Parker added.
With a $100,000 grant from the Morgan Stanley Alliance for Children's Mental Health, and a partnership with The Society for the Prevention of Teen Suicide (SPTS), the initiative will train nurses across the HMH network by 2025.
"Hackensack Meridian Health is committed to addressing the growing behavioral health crisis, especially when it comes to our young people," said Robert C. Garrett, the health system’s CEO. "By expanding access to care, better coordinating treatment, and continuing to invest in our frontline teams, we will help more people find the path to recovery."
While many medical professionals say they feel ill-equipped to treat adolescents at risk for suicide, this project to train frontline nurses is life-saving, says Dawn Doherty, SPTS executive director.
"Our partnership with Hackensack Meridian Health is a crucial step in equipping non-behavioral health nurses with specialized suicide prevention training," Doherty said. "Together, we’re strengthening our commitment to youth mental health and saving lives."
4 nurse executives who have transformed nursing at their respective organizations share their key tips.
Virtual nursing, the return of licensed practical nurses to acute care, and adding advanced practice nurses are among care models nurse executives are implementing as they seek to adapt to the current state of today’s healthcare environment.
HealthLeaders talked with four nurse executives who are transforming nursing care at their respective organizations and asked each one, "What are key tips you would suggest in implementing practice redesign?"
Their replies have been lightly edited for brevity and clarity.
The primary focus for any leader planning a practice redesign is to have strong communication. You have to build in that feedback loop and make sure you've had that communication with the staff that are going to be involved with the change to get their buy-in. A leader needs to figure out what staff think is going to work and what's not going to work.
The other part is to empower them to make change. As you trial these things, it's important to hear from staff what's working well, what's not working well, and what they would like to see tweaked. Then, have planned stages where that feedback can be implemented, versus pushing it out from the top down. That has not been successful. I've been a victim of that before, where we recognize that something sounds like a great idea, but once we roll it out, it failed, so empowering the team to own the process and the change has been what’s really worked for us.
As an aside, it’s important to recognize that anytime you're talking about a practice redesign, there's not a lot of literature out there that says, "This is a tried-and-true model. Everyone should do it because it works every time," because every situation, every organization, every community's going to be different, with different resources, constraints, and barriers. It’s important to keep that in the forefront of your mind whenever you're talking about any of these redesigns because a lot of them are unproven and you don't know if they're going to work for your organization until you try them.
That’s why it’s important to get the feedback of staff and key stakeholders—to make sure you are looking at all the variables that are specific to your unit, your area, your community.
Newly retired chief nursing officer and vice president for patient care services Brigham and Women's Faulker Hospital
It’s never wrong to think about all the stakeholders and in this example, the immediate problem was the emergency department. If we had put just the emergency department together with that, it would have been a one-focused orientation to that group who are making choices for another person's areas, so you need to ask, "Who are the key stakeholders that need to be at the table to start to talk about this?"
At that table, it’s important to build an open mindset and a strong ability to listen to each other's issues, brainstorm things that may be completely outrageous, and listen without judgment. Then you systematically go through and vet those choices.
Another key tip is it’s important to realize testing and piloting a redesign and being willing to iterate as you learn more. And even once you've tested it and implemented it, to be willing to go back to the table and continue to improve on what you've done or what you perhaps did not anticipate was going to come forward.
Executive vice president and chief nurse executive Indiana University Health
Balancing that structure and autonomy and not waiting for the perfect model that's going to work for everyone. Care is so complex across different patient populations, and different acuity levels that we have to lead more through guiding principles and really involve the front line and the voice of the patients and families in redesign.
It's been key to equip the frontline managers with the change management tools because there is a fear of, "What if this doesn't work?" or "What are we going to have to ask the staff to do?" It’s a shift to say that we want the staff to come up with the ideas and help with the redesign.
Leverage your professional governance structures and the Magnet principles—team empowerment, continual improvement mindset, focus on quality, safety, affordability, and equity. The biggest step is to let go of the past and challenge the status quo. Ask the "why," and then help communicate the "why" with team members.
I have found that these initial pilots really work with the willing. There are many who want this change. They live with this every day, and they're frustrated, and they want to provide care in different ways. Our frontline team members see the deficiencies, so who better to be involved in the changes?
Letting go of that traditional paternalistic command-and-control models of leadership and getting into that shared leadership/professional governance mindset is the key to the future with this. The best ideas come from our front line on how we're going to change care or do things more efficiently.
Associate vice president for advanced practice Private Diagnostic Clinic at Duke University Health System
First of all, look at where the need is. Then look at the resources that you may already have that are well-trained, that are well-ensconced within your organization, that understand how you practice. And then figure out if you can change anything about the way that they're working right now, in order to get them to the top of their scope.
Ask them, "What are you doing that you think could be done by someone else to the top of their scope?" This is a question that's being asked all over the country right now about advanced practice, but it’s also true for physicians, nurses, and medical assistants, as the nursing shortage is real.
We need to be creative about how we deploy people, and how we put them together in teams. Some of our teams use EMTs while others use athletic trainers alongside physical therapists. We’ve found that utilizing pharmacy technicians to help with some of the paperwork required by pharmaceutical companies and insurance companies can be incredibly beneficial.
Once you've figured out who you have, and how you can use them to achieve your goal, then anticipate where the barriers are going to lie, and have a ready answer for every naysayer who comes toward you with a complaint or reason why it can't work—because it's working all over the country and it's working beautifully.
Nurses with associate degrees can now complete their BSN at UM-Flint's School of Nursing while taking courses on community college campuses and remotely.
Obtaining a nursing degree just got more convenient and affordable in Michigan, where the University of Michigan-Flint has partnered with three community colleges to provide a Bachelor of Science in nursing.
Such alliances are the trend as healthcare educators and leaders search for creative ways to bolster the number of nursing students, and thus, the nursing pipeline. Indeed, the Bureau of Labor Statistics projected that by 2029, demand for RNs would increase 7%, illustrating an employment change of 221,900 nurses.
The community colleges will offer cohesive opportunities for nurses with associate degrees to complete their BSN at UM-Flint's School of Nursing while taking courses on community college campuses as well as remotely.
"We are excited about this new partnership with the University of Michigan-Flint," said Steve Robinson, president of Lansing Community College. "This opportunity will make the transition for our students seamless as they continue their studies and complete their academic goals in nursing at LCC."
"As we launch the new initiative, the nursing programs at LCC and UM-Flint will be building on an existing 17-year partnership, predicated on our commitment to our collaborative relationship," said McCurren.
"We are motivated by our shared vision to leverage the assets of both of our programs of nursing to ensure ADN/BSN graduates are ready to transform healthcare and promote a culture of health for all," she said.
Cedars-Sinai Serenity Lounges allow nurses to return to the floor better equipped to manage stress.
Cedars-Sinai Medical Center Serenity Lounges—break rooms equipped with massage chairs, aromatherapy oils, artwork, and other soothing amenities to provide a respite from nurses’ demanding work—are proving to be effective in nurse well-being, staff engagement, and retention rates.
Since the first Serenity Lounge opened during the COVID-19 pandemic, 13 more have opened throughout the medical center, says Melanie Barone, RN, MSN, associate nursing director and co-creator of the Serenity Lounge initiative.
Nurses who used a massage chair in a quiet room for as little as 10 minutes experienced mental and emotional relief, allowing them to return to patient care better equipped to handle the stress, according to a study by Barone and Cedars-Sinai nurse Florida Pagador, RN, MSN, published in the American Journal of Nursing.
"Specifically, we found that using the massage chair for 10 to 20 minutes is the most effective," Barone tells HealthLeaders. "Being in the chair at least 10 minutes shows the most reduction, so you don't need to be in it for 40 minutes. If they use it more than 20 minutes, it didn’t have an impact, which I thought was really interesting."
Nurse retention rates also improved because of the Serenity Lounges, Barone notes.
"Specifically on my unit, prior to implementation of the lounges, our turnover rate was about 4%. After the lounges, we went about six months achieving our goal, which was less than a 2% turnover rate, and we actually went 0% for five months," she says.
Retention rates have seesawed, but not because of stress and burnout, Barone says. "I have lost some staff, but it’s usually because of life circumstances, such as moving back home to take care of family or things along those lines," she says.
Staff engagement scores also have continued to rise since implementing the lounge, she says.
"It was pretty good before—in the 70s—and now we're at 86 for staff engagement and it comes down to the culture here: 'You are supported. Your mind, body, and soul are cared for by our team. We are making it a priority for our staff.'"
A place to recharge
The first Serenity Lounge opened when Pagador expressed a need for relaxation from her demanding duties during breaks.
"I needed a place to relax and recharge, so I pitched the idea and we got to work," she says.
Pagador and Barone found an underused locker area, gave it a makeover, and established the first lounge. As the pandemic continued, more Cedars-Sinai nursing teams created their own Serenity Lounges, which have gathered attention and inquiries from nursing professionals throughout the United States.
Success in well-being, retention, and engagement is due not only to the Serenity Lounges, Barone says, but to the larger care culture at Cedars-Sinai.
"The lounges are important to the staff but also to the leadership team," she says. "It's our way of putting our money where our mouth is and it’s telling our nurses, 'We talked about wanting your wellness and we're holding true to what we have been saying and we want you to use this.'"
The program not only helps solve retention challenges, but also retains the expertise of experienced nurses to avoid knowledge gaps that can occur when nurses retire and new nurses join the care team.
Novant's nurse emeritus program began to take shape during COVID-19 as Novant nurse executives were configuring care teams to have enough critical thinking skills and knowledge, says Akers.
The program officially debuted in January 2022 and has about 15 participants.
"As we are bringing many new grads into our building, we wanted people to be available that had experience, that could work side by side, be there for questions, help with critical thinking, and utilize new equipment," Akers says. "They were not to be a preceptor, because the new grad has a preceptor, but this is in addition to that—to be part of that care team."
"These nurses have the experience, knowledge, and critical thinking skills to work side by side with new nurses," Akers says. "They also bring the ability to help nurses work through problem solving."
Most of the teaching moments are small, confidence-building lessons, she says.
"I ran into one of our emeritus nurses recently who was working with a nurse who was probably a year into her career but had not had the opportunity to start many IVs. She had asked this nurse emeritus to go in and start the IV for her, but instead of doing so, the nurse emeritus went to the bedside and walked her through the process," she says. "This [newer] nurse did a fabulous job, felt more confident, and got the experience. That nurse emeritus helped her to get to that point."
"The other thing I love is seeing the education that the emeritus nurses are providing to the team members on the floor," Akers says. "They find new creative ways to educate and bring real-life situations that could occur with the specific population that they're working with."
Such guidance furthers the program's goal of helping less-experienced nurses successfully grow into, and find satisfaction from, their job.
"The nurse emeritus program works for retention," Akers says.
The program is primarily evaluated through performance reviews and direct team member feedback. And while Novant has observed a decrease in turnover across all of the units that participate in the emeritus nurse program, the program is just one portion of the health system's retention efforts, so it's unable to assign a specific cost savings or retention rate to the presence of emeritus nurses, according to the hospital.
A solid background
All of the emeritus nurses were bedside RNs at one time, Akers says, and bring at least a required decade of nursing experience to their roles as coaches and mentors.
"Some of them have been nurse leaders," she says. "We've got a real variety of where they retired from, or where they were transitioning their career into an emeritus nurse role, so we have all types."
"All of the [emeritus nurses] are working in the specialty that they worked in for the majority of their career," Akers says, "so if they've got a strong cardiac background, they're working on our cardiac floors or if they have a strong neuro background, they're working with our neuro teams."
Emeritus nurses are typically scheduled in four-hour shifts on their chosen workdays, but they can work longer or shorter hours if they prefer, Akers says. Their compensation is based on years of experience.
Novant recruits by posting the emeritus positions to online employment sites, but most of the participants have been recruited by word of mouth, Akers says.
"This is a way for them to remain part of the care team, and to have an impact on the care we're delivering and an impact on the community they're living in," Akers says, "so it’' just as fulfilling for the nurse emeritus as it is for the team itself."
'Go-to person'
Neurosurgery nurse Elizabeth Emshwiller, who retired from Novant after about 37 years of nursing, enjoyed two years of a relaxed retirement before she felt compelled to join the emeritus program about a year ago to coach and give less-experienced nurses a guiding hand.
"I coach, inspire, and mentor, and whatever needs to be done to educate the staff," she explains. "I am not at the bedside giving medicines; I do not have a patient assignment; I am not the primary care nurse for any patient; I do not fill in when there's a call-in. I am here for the coaching, inspiring, and mentoring."
Nurses who encounter a situation where they need assistance, or simple affirmation that they're providing the correct treatment, can quickly summon Emshwiller by facility phone.
"I'm a troubleshooter, a problem solver, and the go-to person on the floor," she says.
Having that "go-to person" can make all the difference for an inexperienced nurse, Emshwiller says.
"I remember when I was in their position, just graduating from school, and how I felt I wish there was someone to bolster me up," she says. "It definitely gives them confidence, and I'm hoping because of that, we won't lose as many nurses because there is somebody who can support and help them."
The new center joins more than 40 other state nursing workforce coalitions working to increase the nursing labor pool.
Kansas healthcare has a new ally in efforts to address shortages of nurses and nursing faculty: the Kansas Nursing Workforce Center.
The center, housed at the University of Kansas (KU) School of Nursing, joins more than 40 other state nurse workforce entities engaged in increasing the nursing labor pool to resolve the critical nursing shortage.
"Statistics show how critical the situation is," said Sally L. Maliski, PhD, FAAN, dean of KU School of Nursing. "The Kansas Department of Labor’s 2022 Occupational Outlook report shows that by 2026, we will need more than 28,000 nursing assistants, 18,000 registered nurses, and 6,000 home health aides. Rural Kansas hospitals are facing nursing shortages that could mean hospital closures."
"As we saw the growing crisis of nurse and nurse educator shortages, we knew something had to be done to address this in a unified and collaborative manner. Also, Kansas was one of only 10 states that did not have a nursing workforce center to help address this critical issue for Kansans," she said.
Like other state nursing workforce centers, Kansas will collaborate with employers, schools, professional associations, government agencies, and other stakeholders to strengthen the state’s nursing workforce by examining and analyzing the supply, demand, educational pathways, and demographics of nurses, while also researching methods to develop and sustain the existing nursing workforce.
State nursing workforce centers also educate organizations and policymakers about issues and policies affecting nurses by collecting and analyzing data, publishing reports and relevant information, and recommending changes necessary to resolve the nursing shortage.
The Kansas center’s focus areas are:
Support how nurses lead in all work settings
Health and well-being of nurses individually and as part of the care team
Approaches used to build, sustain, and retain the nursing workforce
Best practices for optimal patient care experiences
Optimal ways to deliver improved or new care to patients
The center is currently forming its advisory board and developing nursing data dashboards.
Amy Garcia, DNP, RN, FAAN, associate clinical professor at KU School of Nursing, will be the newest center’s director.
"The Kansas Nursing Workforce Center will do things that matter," Garcia said. "We will help people find their pathway to becoming a nurse. We will develop programs to help nurses find joy in their work. We will study the supply of, and demand for, nurses and provide reports to help communities find and keep the nurses they need. And we will convene schools, employers, associations, and government to find better ideas to strengthen nursing and resolve the ongoing shortage of nurses."
While KU School of Nursing has provided initial financial and operational support, the center will seek additional funding, including research and program grants, to operate.
"People trust nurses to be there when they are sick, injured, or simply trying to be healthy," Garcia said. "Nurses care for us at the beginning and the end of life. Every Kansan should have access to high-quality nursing care, and nurses should have access to the education and support they need to excel in their jobs."
For example, virtual reality’s simulation systems provide nursing students with tailored, real-world situations to let them safely develop their skills in caring for patients; in management, tech is used for staffing and scheduling; and clinically, AI is used in venipuncture, where it scans the patient’s arm and identifies the best vein for an IV more than 90% of the time, Benton says.
These three stories from HealthLeaders illustrate how nurses at hospitals and health systems around the country are embracing the advancements that technology and AI can provide:
The challenge to effectively train nurses without enough preceptors led Singing River Health System to turn to technology to get the job done.
Singing River Health, a community-based, nonprofit healthcare provider for the Mississippi Gulf Coast, piloted the customized Elemeno Health workforce empowerment app at its Pascagoula hospital a little more than a year ago for nurse training and orientation and recently deployed it in numerous departments throughout its entire health system, says Susan Russell, MSN, RN CCRN-CSC, the health system’s chief nursing officer.
The platform provides nurses with a resource hub they can consult for bedside care by delivering hospital best practices in readily digestible resource formats such as interactive guides, how-to video clips, concise updates, and intuitive checklists.
"With high turnover rates, it's been an enormous challenge to get people in and get them trained because we have less people with experience to help train new nurses," Russell says. "With the app, we’re able to replicate the best preceptor you ever had and have them available as many times or anytime you need it," she says.
"Say I am that less-experienced nurse on night shift and I'm not familiar with gastric tubes. I learned virtually in school but maybe I just haven't seen it. Theoretically, you would have a preceptor," she says. "That's what we're able to get with this [technology]. Where we used to lean on human resources is now available in electronic format."
HCA Healthcare nurses are using ever-developing technology that has enhanced communication, decreased administrative burden, and provides skill development—all with the goal of improving patient care, says Sammie Mosier, DHA, MBA, BSN, NE-BC, CMSRN, senior vice president and chief nurse executive.
"One we have implemented very wide scale is our iMobile platform where smartphones are deployed to caregivers, or nurses and beyond, to improve communications. It has secure text messaging, so they can send that without worry," Mosier says.
"Obviously, they can make phone calls, but then the platform also has the ability to provide some updates from our EHR so they get those alerts directly to their phone. Any critical labs for the patient or other necessary information are right there at their fingertips," she says. "Our nurses love that technology, and it has enhanced communication among the care team."
HCA has continued to invest in that platform to improve workload for other areas, Mosier says.
"One example that we did last year was wound care imaging, so that after a nurse takes the photo, it's a seamless integration with our EHR. Prior to that, nurses had to take a photo, print it off, and scan it in, which took about 20 minutes per image," she says. "It removes time for administrative tasks so the nurse can focus on patients."
What began as an innovative way to monitor and care for COVID-19 patients at the height of the pandemic is evolving into a growing virtual nursing program at Atrium Health.
The North Carolina-based health system, now part of Advocate Health, launched its virtual nursing program in March 2021 when, like other health systems, nurses struggled to meet staffing demands.
Nurses loved it, patients loved it, and the health system noticed positive outcomes: decreased medication errors, decreased falls, increased patient satisfaction, and more, says Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL, vice president of nursing operations, professional development and practice.
"The virtual nurse allows for early recognition of any changes in patient status, so attempting to get up would certainly be among those things we’re watching for," she says. "It has also provided us an earlier notification of when the rapid response team needs to engage, and in instances where the patient has coded."
Atrium Health has seen a 56% reduction in the number of call bell responses, and patient experience scores have risen dramatically, Mook says.
"It’s also useful in helping avoid mistakes. If you have a novice nurse on the floor, having an experienced nurse ‘in the room’ with them via video can be a huge comfort and ensure that all elements of care are provided appropriately," she says. "It truly has proven to be an additional layer of support to enhance patient care and outcomes."
