The John A. Hartford Foundation, a nonprofit, nonpartisan philanthropy focused on improving care for older adults, awarded the grant to LeadingAge “because of the breadth of its membership across the full continuum of nonprofit providers of aging services, as well as its efforts in building coalitions of stakeholders with diverse perspectives and forging policy approaches with broad appeal,” according to a press release.
"Nursing homes face a web of complex challenges, but the NASEM report provides clear, solution-driven recommendations for making progress," said Terry Fulmer, PhD, RN, FAAN, the foundation’s president. "The time is now to unite and take action that will deliver measurable and meaningful improvements in the care of older adults."
LeadingAge, which represents more than 5,000 nonprofit aging services providers, plans to convene a coalition of organizations representing nursing home residents and family caregivers; providers, including leaders and frontline staff; as well as advocacy groups, researchers, foundations, policymakers, and others to achieve the NASEM report recommendations.
Those recommendations include:
Ensure a well-prepared, empowered, and appropriately compensated workforce
Deliver comprehensive, person-centered, equitable care that ensures residents’ health, quality of life, and safety
Design a more effective and responsive system of quality assurance
"The NASEM report is a wake-up call for our country—and long overdue," said Katie Smith Sloan, president and CEO, LeadingAge. "As the only organization representing providers across the care continuum, LeadingAge brings a unique perspective and depth of experience from our work in advocacy, education, and research to this project."
"It is time for action, and we’re excited to take the lead on this ambitious effort to implement the NASEM recommendations," Sloan said, "to ensure older adults and their families can access safe, high-quality care."
Since joining HCA Healthcare in 2020, Galen has quickly expanded access to nursing education.
Galen College of Nursing is opening a new campus in Asheville, North Carolina, as it continues its efforts to educate a growing number of future nurses amid a national shortage, HCA Healthcare has announced.
The Asheville campus, expected to open in late September, will be the eighth new campus Galen College of Nursing has opened since joining HCA Healthcare in January 2020.
At the time, Galen offered nursing programs across five campus locations, as well as an online campus, and had a total enrollment of about 7,100, according to a press release. When the Asheville campus opens, Galen College of Nursing will have 13 campus locations and the nursing school’s total enrollment is expected to reach 10,000 this year.
“As part of HCA Healthcare, our potential to impact the lives of so many across the country has never been greater—not only by creating more opportunity for so many more called to nursing to achieve their dreams, but through the care those future nurses will provide to the people in our communities,” said Mark Vogt, chief executive officer for Galen College of Nursing.
“Together, we are expanding access to quality nursing education, enhancing our programming and creating more career advancement opportunities for nurses,” Vogt said. “Galen graduates are having a profound impact on patient care across the country, and we are focused on continuing to nurture a pipeline of potential nurses critical to healthcare in our communities.”
The partnership with Galen enhances HCA’s ability to care for patients and support nurses while helping to address the national nursing shortage, said Sam Hazen, HCA Healthcare’s chief executive officer.
HCA Healthcare, with more than 93,000 registered nurses holding positions from bedside caregivers to leadership roles, brought Galen under its umbrella, combining two leading nursing organizations to increase access to nursing education and to provide nursing career development opportunities for HCA Healthcare colleagues.
Nearly 2,000 HCA Healthcare colleagues are enrolled at Galen to help advance their careers. HCA Healthcare has loan repayment and tuition assistance programs for eligible colleagues.
Additionally, opportunities for collaboration between clinical practitioners and faculty are expected to help enhance teaching by connecting evidence-based practice to the delivery of nursing education.
To that end, Galen and Sarah Cannon, the Cancer Institute of HCA Healthcare, recently collaborated to develop an oncology care elective that will be available next month and teaches recent advances and emerging trends in oncology nursing care.
The other campuses Galen College of Nursing has opened since joining HCA Healthcare are in Pembroke Pines, Gainesville, and Sarasota, Florida; Nashville, Tennessee; Myrtle Beach, South Carolina; Richmond, Virginia; and Austin, Texas.
Other campuses are in Cincinnati, Ohio; Hazard and Louisville, Kentucky; San Antonio, Texas; and St. Petersburg, Florida.
As critical staffing shortages threaten patients' access to care, healthcare leaders share ways they are recruiting and retaining their employees.
Editor's note: This article appears in the May/June 2022 edition of HealthLeaders magazine.
COVID-19's brutal toll on healthcare's frontline workers, with burnout and mental health challenges at an all-time high, could create even more significant workforce shortages, jeopardizing patients' access to care.
By 2026, healthcare will experience a shortage of up to 3.2 million workers, says an analysis of EMSI data.
The United States is expected to face a shortage of nearly 124,000 physicians by 2033 and must hire at least 200,000 nurses per year to meet increased demand, which the AHA says is partially due to an aging patient population.
That's not going to be easy. A recent U.S. Bureau of Labor Statistics report found that, after experiencing large increases in jobs in January (+18,000) and February (+64,000), the healthcare sector gained only 8,000 jobs in March.
The challenge to stem workforce shortages is undoubtedly an uphill climb, but hospitals and health systems are up for it. HealthLeaders spoke with healthcare leaders about three ways they are working to stop workforce shortages and how they've been successful.
1. Pipeline propels students toward healthcare careers
Children's Hospital Colorado created a hospital workforce pipeline more than 20 years ago to better reflect the community it serves.
Through the Medical Career Collaborative (MC²), which launches high school students toward healthcare careers through hands-on experiences and more, Children's Colorado has filled at least 80 roles since the initiative began. The pipeline continues to help with workforce challenges, says Stacey Whiteside, the hospital's director of experience and engagement who leads MC².
"We have close to 20 graduates who have gone on and gotten their medical degrees, but this past August, we had our first MC² grad return to Children's Colorado and get hired as a pediatric emergency physician in an attending role in our emergency department," Whiteside says.
"Her story is indicative of the long-term plan this program has in place," Whiteside says. "She grew up literally around the corner, went to a high school that is about two miles from Children's Colorado on the Anschutz campus, and now she's back serving in this community. It's pretty phenomenal."
Children's Colorado launched MC² in 1999 to help develop a workforce that would more accurately represent its community.
"There was research coming out at that time that said the more diverse your workforce, the more effective you are, and Children's picked up on that earlier than other organizations," Whiteside says.
"We also started the program to partner with a local school [as] a diversity program to connect with students interested in healthcare," she says, "so the program had multiple goals."
Just three or four years into the program, Children's Colorado expanded its scope.
"There was so much interest and students were saying, 'I could work in a hospital and see what it means to have a healthcare career,' and the schools and other community groups were knocking on the door saying, 'We want in on this program,' so we changed the model and expanded it to serve students from other [non-local] schools," Whiteside says.
Now, the two-year program admits around 80 high school juniors annually out of about 350 applicants from partner schools. With the same number of seniors in their second year, MC2 educates roughly 160 students at a time. They learn either at Children's Colorado or its sister site, Denver Health, which adopted MC² in 2015.
"We have way more applicants to the program than we can possibly serve, which is both a hard thing and a neat thing to see," she says.
At least 96% complete the program and "somewhere north of 70%" pursue a career in healthcare, which may include clinical care, public health, psychology, mental health counseling, or other medical or social work, Whiteside says.
How MC² works
MC² is designed to offer several different experiences that expose students not only to health careers, but also to varied professional environments, Whiteside says.
The first year of the program includes field trips, workshops, training, and a paid internship at Children's Colorado or Denver Health.
"They're doing entry-level tasks as an intern, and they're learning things like, what is the difference between what a nurse does or a radiology technician or a lab technician? What does the CNA do and how is that different from administrative roles?" Whiteside says. "They're seeing that for themselves and getting a real picture of the different roles and what they mean."
The second half of the program focuses on coaching.
"They've had the hands-on experience … and senior year we shift to help the students decide what's next," she says. "We want to make sure they have the knowledge and tools to take this next step, so we support the students in writing for scholarships and we do coaching around college and career."
Adding to the workforce
While some MC² graduates attend college in other states, most stay local and begin their post-secondary education in the Denver area, Whiteside says.
"They would like to work while they're in school, which we love, so we are now piloting some different ways of keeping those students connected to our hospitals and moving quickly as they graduate from high school into entry-level roles where they can work and continue their education path at the same time," she says.
CNA courses and roles that don't require technical training—such as a lab assistant—are ways Children's Colorado employs MC² grads attending college.
MC² stays connected to its graduates, both near and far, with alumni programs and events for which they are invited back each year.
"Some of our alumni have never left the fold," she says. "And then we have some who leave and come back because this is their home community, and they want to return to Children's. We have both of those extremes and then everything in between."
One MC² graduate who went on to become a CNA, and then an RN, recently was offered a job as a nurse practitioner at Children's.
"She talked about how her whole career has been at Children's and she doesn't ever want to leave, and with turnover and retention issues, having that kind of buy-in is music to anybody's ears," Whiteside says.
"When somebody starts with us that young, there's a unique kind of loyalty. When you think about growing up with an organization and feeling like the organization invested in you when you were 16 years old, then that creates something kind of special," she says.
It's a testament to Children's Colorado's forward thinking, she says.
"For 20 years, Children's Colorado has been investing in this program and supporting students and it's no small feat. ... It's a lot of work, a lot of energy, and a tremendous amount of logistics," Whiteside says.
"But the return on the investment is starting to be pretty wonderful as we see nurses and now doctors, physician's assistants, lab scientists, radiology, and social workers starting to fill in our workforce, which was the original mission of the program," she says. "We're delivering on that now."
2. AI helps to more accurately schedule nurses
When nurse staffing needs for Sanford Health were estimated the traditional way—by humans—they were accurate about 60% of the time. But an artificial intelligence (AI)–driven tool currently being rolled out at the hospital system's four major medical centers has an accuracy rate of almost 90%, says Erica DeBoer, RN, Sanford Health's chief nursing officer.
Created by Sanford Health, the new AI predictive analytics tool, called LAMP (Leveraging Analytics to Mobilize our workforce and Prepare), is so named as "a bit of a hats off to Florence Nightingale as one of our original innovators," says DeBoer.
Traditionally, nurse scheduling was based on patient statistics from a year prior. LAMP, however, analyzes workplace activity to produce a schedule up to 18 months in advance.
Previous scheduling systems, with their spreadsheets, were "archaic," giving managers old statistics and requiring too much time and effort, DeBoer says.
"We had an opportunity to use predictive analytics to try to anticipate what our census is going to be and then based on that census, on a med-surg unit, or an OB unit, an adult ICU, or a pediatric ICU, we could start understanding what our staffing needs were going to be and look ahead at least four weeks and then anticipate even longer than that, as we think about workforce shortages of the future," she says.
Sanford Health sourced various data to develop the AI tool. Key indicators included a breakdown of the average patient census—admission, transfer, and discharge information—at key times during the inpatient nursing shift, which was gathered from EMRs.
"Tons of data points went into this to anticipate what the staffing needs might be," DeBoer says.
The algorithm also takes steps beyond predicting to prescribe the best possible solution, increasing the quality of long-term planning, according to DeBoer.
The AI tool was built to be agile and change along with Sanford Health's needs. As patient volume changes, staffing patterns can be tweaked in the tool to quickly adjust for the variations, she says.
"It's taken a long time for us to get here, but it will help us give our managers and leaders some time back and also not make staffing so reactive," she says. "It helps us to anticipate what those needs are."
Sanford Health began piloting the AI tool two years ago at its Fargo, North Dakota, location, and it's scheduled to go live in June at its other medical centers in Sioux Falls, South Dakota; Bismarck, North Dakota; and Bemidji, Minnesota, for nurses and unlicensed staff.
The health system, which employs about 10,000 nurses, anticipates implementing the tool at its other hospitals and clinics as well, she says.
"Productivity is based on a staffing mix, and that doesn't include just our clinical staff; it includes some of the support teams as well, so we have some opportunities to continue to expand and make sure we're covered with support services, too," DeBoer says.
LAMP will be able to provide much more than accurate staffing for Sanford Health, DeBoer says.
"When you think about our integration with the electronic medical record and our ability to anticipate what our patients' needs are, I think the sky is the limit," she says. "When you think about what it could mean to understand and predict the flow of patients from an outpatient and an inpatient stay, it could help us revolutionize and anticipate what our patients and community needs are."
Increasing workforce satisfaction
Another advantage of the new technology is an expected increase in workplace satisfaction for nurses and nurse managers, DeBoer says, which will result in increased employee retention, better performance, and higher patient satisfaction.
"Specifically, it will help our managers be more present with our employees and with our patients. It takes some of that workload away because it automates it and there's not that worry that they have to be calling [nurses into work] and reacting to a specific patient need," she says.
"There'll always be a piece of that, knowing the acute-care dynamic, but what we hope is that from a manager and leader perspective, we'll give them upwards of 10 to 14 hours back in a week, which means they can not only take care of themselves, but they can help take care of our employees."
Bedside nurses will appreciate that the LAMP tool will help Sanford Health hire the right number of nurses to each unit, ensuring they get uninterrupted days off.
"Our employees then can anticipate what their schedule is going to look like and hopefully we can minimize some of those call-outs [caused by] reacting to additional staffing needs," DeBoer says.
Tools for good nursing have advanced since Florence Nightingale's day, but the idea—effective patient care—remains the same.
"We're trying to leverage technology as much as possible to automate workflows that probably don't add value, or that can take some of the load off that frontline nursing team," she says, "and get them back to the passionate work that they do every day with our patients."
3. A strong succession plan increases retention and lowers costs
When an Indiana University (IU) Health chief nursing executive moved into a chief operating officer role, her position was seamlessly filled by the chief nursing officer from the health system's largest hospital because of IU Health's solid succession plan.
"There was development and intentionality about having him on her [succession] plan," says Christina Chapman, IU Health's vice president and chief learning officer. "We were able to execute that and have a ready-now successor when she moved on."
Succession planning is identifying and developing potential candidates to move into leadership roles when they become vacant, she says. "It's the talent review process that comes before the succession plan," Chapman says. "It's important so that you can develop your own internal pipeline of talent."
That begins with an annual look at IU Health's talent pool.
"[During] our talent review process … we ask all of our team members to update their talent profile, which tells us more about their career aspirations—long term and short term, what their career dreams are, what their openness to relocation would be, and just a little bit more about them," Chapman says. "And then that talent profile information is available for their leader, [who] completes a talent assessment."
That assessment looks at the strengths and opportunities of the employee, what their next best role in the organization might be, and the effect of their transition on the team and the organization, she says.
Names of employees are placed in a nine-box grid, a widely used matrix tool designed for talent management and succession planning, that displays, categorizes, and compares employees' work performance and potential.
Senior leaders convene to discuss potential of the talent by asking such questions as:
• For those people considered high potential, what are we doing to develop them?
• Do we have differentiated development plans?
• Have we invested in development?
• Have we communicated to those employees that we think they have a strong career pathway ahead of them?
• For those individuals that don't have a strong successor path, how can we help them be successful?
They'll also review top jobs across the health system—chief executive, medical, financial, and nursing officers—and ensure that key talent pools are consistent across the regions, she says.
"We look at who is in that succession pool for those roles so that we get visibility to the talent not just in one hospital, but knowing where our talent sits everywhere," Chapman says. "And then outside of that, we then work on and partner on development."
IU Health has succession plans ready for more than just key leadership roles, Chapman says.
"We identify the positions where business operations would significantly be impacted if we didn't have a high performer in that role," she says. "Those roles may be a little bit deeper in the organization, [but] if we don't have strong performance in the role, it would either hinder us or not help differentiate us in the market."
The health system always reaches down into director levels, sometimes to the manager level, and occasionally to non-leadership talent pools, Chapman says.
"They may not go through the full talent review process, but we have leaders identify who they think might be emerging leaders, and those will be high potential individual contributors," she says. "We get them nominated for an emerging leader program, so in a sense, that's a succession activity for them. We're investing in them, giving them the opportunity to lean in a little bit more, and a lot of our managers come from that emerging leader pool."
Lower costs, higher retention
Retention, lower hiring cost, and organizational stability are among the greatest benefits of succession planning, she says.
"People want to know that they have a path forward," says Chapman. "As much as people want to grow and develop, it helps with retention in today's world. That's important to keep our talent."
Hiring someone from outside the health system is usually twice the cost of the position's annual salary, so it's more affordable to hire from within, which also adds to employee engagement and, ultimately, organizational stability, she says.
IU Health's internal promotion rate guides how well the succession plan is working, Chapman says.
"If we're going external more than we're coming internal, then we're not executing our succession plan successfully," she says.
"Where we're at is about two-thirds internal promotion and one-third external hires, which is a healthy mix from an industry data perspective to say that you bring in some fresh talent, but two-thirds of the time you're promoting internally," she says. "That's where we've been with some of our director-and-above succession planning, so we're proud of that."
"We also look at diversity percentages to make sure that we are promoting people up into roles and that our succession plans are allowing us to mirror our patient populations and the diversity in the communities that we serve," she says.
A successful succession plan requires work and intentionality, Chapman says.
"You can't just put a name in a box and say, 'This person could be a successor,' " she says. "It has to be something actively worked on."
The funding round was led by Goldman Sachs as part of its One Million Black Women initiative.
CareAcademy, a care-enablement platform that provides state-approved training for home care and home health agencies, has received a $20 million investment to accelerate product development and data measurement capabilities.
The round was led by Goldman Sachs Asset Management, as part of Goldman Sachs’ One Million Black Women initiative, a $10 billion commitment to narrow opportunity gaps and impact the lives of Black women over the next decade, according to a CareAcademy press release.
The new funding also will be used further “the company’s mission to unlock the unmet potential in home and community-based services,” according to CareAcademy.
The Boston-based CareAcademy, which has been named to the Inc. 2021 Best in Business list in the education category, was founded to empower and upskill caregivers across the long-term care continuum to deliver advanced, high-quality care that measurably improves patient outcomes.
CareAcademy has set a goal of certifying 1 million direct care workers by 2023 to help mitigate the projected care shortage.
With more than 1.5 million hours of web-based training delivered to nearly 300,000 learners, CareAcademy provides caregivers with access to state-approved education and training to address chronic disease.
“This is a momentous time for CareAcademy. This strategic investment positions CareAcademy to meet its ambitious goal of empowering 1 million caregivers by 2023. Caregivers across the entire long-term care continuum will access CareAcademy to meet not only their state and federal required training but also the needs of the patients and loved ones they support,” said Helen Adeosun, CareAcademy’s founder and CEO.
“Having the support of Goldman Sachs enables us to further accelerate our growth, expanding our reach into enterprise and home health opportunities, and increasing our product and data measurement capabilities to equip caregivers of all types to reach their full potential,” Adeosun continued. “The next stage of our growth is furthering the win-win-win: providing caregivers in all settings the supports they need, enabling employers to recruit and retain a quality workforce, and enabling communities to access quality care.”
The rebranding initiative's third and final phase is scheduled for early September in 17 states.
The ongoing rebrand of the home health division of Kindred at Home (KAH) to CenterWell Home Health has added 14 states in Phase 2 of the initiative.
That brings to 21 the number of states where KAH home health services have transitioned—or started transitioning—to CenterWell Home Health, according to a press release from Humana.
The brand transition represents a major step in the full integration of Kindred at Home’s home health operations into Humana, which announced last August that it had completed the acquisition of KAH to reinforce its commitment to home-based clinical solutions.
“During the pandemic, the amount of care delivered in the home surged, further validating to patients and providers alike that home is an effective site for the care of many conditions,” said Andy Agwunobi, M.D., MBA, president of Humana’s home business. “As a result, we expect increased levels of adoption of care in the home to continue.”
Humana introduced the CenterWell Home Health brand, along with the first phase of transitioning the home health division of Kindred at Home, on March 1.
Home health operations in the following states are included in Phase 2: Colorado, Georgia, Illinois, Iowa, Louisiana, Maine, Maryland, Michigan, Minnesota, New York, Pennsylvania, Texas, Virginia, and Wisconsin.
Phase 1 included Arizona, Idaho, Nevada, New Mexico, North Carolina, Oregon, and Washington.
The rebranding initiative’s third and final phase is scheduled for early September in 17 states. When rebranding is complete, CenterWell Home Health will support patients from more than 350 locations across 38 states.
Care continuity will be maintained throughout the brand transition, said Susan Benoit, president of CenterWell Home Health.
“In fact, both patients and providers should notice little change in their experience, with the same care provided by their same trusted caregivers,” Benoit said.
The newly branded locations will display new interior and exterior signage reflecting the CenterWell Home Health brand and employees will receive new branded uniforms, apparel, and other materials.
The program—the first in the state— will begin enrolling students this fall.
Texas State University (TSU) will be offering a new master’s degree in Long-Term Care Administration—the first such a degree in the state.
The new degree, with instruction to be delivered fully online, was authorized by the Texas State University System Board of Regents to address pressing demand in the state's economy created by the rapidly aging "baby boomer" population, said a TSU press release.
The program will build on state and national boards' minimum requirements to become a nursing home administrator. Graduate level preparation is not a current requirement in most states, though "employers view applicants holding a master's degree in high regard," according to TSU.
TSU's new program, offered through the College of Health Professions and Graduate College, will cover environmental design and management, personnel management, elder abuse and mistreatment, and internship hours. Students will be able to complete the degree requirements with either full- or part-time enrollment.
By 2030, the elderly population will be double what it is in 2022, with 61 million people 66-84 years of age living in the United States, along with another 9 million aged 85 years and older, resulting in a significant need for long-term care for these aging populations, including nursing homes.
Texas is expecting an exponential rise in the number of nursing home residents, from about 101,000 in 2010 to more than 309,000 by 2040, according to TSU.
The program will begin enrolling students in the fall of 2022, pending final approval by the Texas Higher Education Coordinating Board.
The success rate exceeds state and national averages at a time of unprecedented nursing workforce need.
Graduating students in the nursing program at The University of New Mexico-Taos achieved a 100% pass rate on the National Council Licensure Exam (NCLEX) for the fifth year in a row, surpassing both the national 82% average pass rate and 83% New Mexico state average pass rate.
The NCLEX is a nationwide standardized examination that nursing school graduates must pass to become either an RN or licensed practical nurse (LPN) and enter the workforce.
This marks a major achievement as nursing programs around the country have been seeing declining pass rates over the past two years during the COVID-19 pandemic.
“Every day, our outstanding nurse educators, exellent instruction, and high-quality, diverse clinical experiences help empower our hardworking students to perform at the highest level," says Dawn Kittner, MSN, RN, CNE, director of nursing. “With America facing a historic nursing shortage on top of the impacts of the COVID-19 pandemic, it is more important than ever for UNM-Taos to invest in the next generation of nursing talent.”
UNM-Taos serves a rural and largely Hispanic community, and many of its nursing students go on to serve the local community following graduation as practice-ready nurses.
After implementing a concept-based curriculum in 2016 and offering a low nursing student-to-faculty ratio, UNM-Taos increased its program retention rate to 70%—higher than the state average.
Outside of the classroom, students gain clinical experience in local hospitals and healthcare systems, school districts, family clinics, the Department of Health, and behavioral health centers.
Such success at UNM-Taos is notable particularly because the United States’ nursing shortage is partly attributed to a nurse education crisis.
With declining enrollment rates, a serious shortage that has left 7% of nurse faculty positions vacant, limited program capacity that forced nursing schools to turn away nearly 92,000 qualified applicants from baccalaureate and graduate nursing programs last year, and high attrition among nursing students and new graduates, numerous challenges are preventing students from staying and graduating nursing school.
UNM-Taos was able to overcome these challenges with innovative technological education support tools, a dedicated and skilled faculty, and a concept-based curriculum, according to the university.
Creating a successful dyad model requires staying 'in sync,' finding balance, and great listening, says the CNO-CMO partnership.
If nurse leaders in the LifePoint Health system need guidance, they don’t automatically go to Michelle Watson, senior vice president and chief nursing officer (CNO); they also can get the information they need from Christopher Rehm, MD, senior vice president and chief medical officer (CMO).
That’s because Watson and Rehm together oversee all clinical, quality, and patient safety initiatives through a singular clinical lens—a dyad leadership model.
LifePoint, a Brentwood, Tennessee-based private healthcare network operating 63 community hospital campuses, 30 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care in 30 states, adopted the dyad leadership model in early 2020, right before the COVID-10 pandemic ramped up.
Watson and Rehm spoke with HealthLeaders about how the dyad works, its challenges, and its benefits.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Can you explain how LifePoint came to adopt this model?
Christopher Rehm, MD, CMO: We have preached in our quality program that healthcare is a team-based sport, and we need everybody to be engaged and everybody to be involved. Our direct supervisor is Victor Giovanetti, the executive vice president for hospital operations, and Victor’s vision—and Michelle and I are totally aligned with this—was if the CNO and CMO of the company worked in a dyad, that would be an example for the rest of the organization—nurses, physicians, and then extrapolate on across the line, whether it's techs, aides, physical therapy, occupational therapy, etc., [showing] that the entire team is a team and not a hierarchy, where the physician writes the orders the nurses execute the orders. That’s not what leads to success and high-quality and safe care.
Victor came to the two of us and said, “You’re the CNO and CMO, and I want you to work in a dyad,” and it's for a number of reasons, but I think at its core, it was to reinforce that everybody has a seat at the table and everybody's voice matters. It’s the hierarchy that frequently shuts down conversation, that keeps people from speaking up, that can be intimidating to new team members, and the dyad is representation of how we break down those barriers.
Michelle Watson, CNO: It’s common for any hospital or any healthcare system that there’s the work of the nursing staff and the nursing leaders and then there's the work of the physicians and the medical staff. The dyad model has brought those two together and with Christopher and I, it is the vision of one clinical voice whether it's the nurse or the physician, that has been a part of what that dyad model is meant to represent. It’s one clinical voice driving quality and safety across the organization.
HL: How has the concept of the dyad trickled down within the organization?
Rehm: Prior to Michelle and I being in the dyad, at the HSE [health, safety, and environment] level there would be calls where we would pull together the CMOs on a monthly call, and Michelle would pull together nursing leadership on a monthly call. When we came together in our dyad leadership model, we then brought the CMOs and the CNO council together in a single monthly cadence because we're working on the same issues and if there is an issue that's specific to nursing, that impacts the entirety of the hospitals, so the CMOs need to be at the table, engaging in dialogue, etc., and if the CMOs are working through some challenge, that’s important to nursing as well because they are practicing together in the facility.
That reinforcement, the dyad, and that monthly call has brought our facility CMOs and facility CNOs closer together. At our facilities that have a CNO and a CMO, we've asked them to work in a dyad as well—not an org structure like ours, but to functionally work in a dyad. And they are saying that is trickling down all the way to the front line where it's just a better dialogue and culture between the practicing physicians and the nurses.
HL: Please explain exactly how the dyad works there at LifePoint.
Watson: For two years, during the pandemic, if you were to look at our calendars, 80% of our calendars were exactly the same. We were in every meeting, every call, together from early in the morning to late at night. That forced us quickly to become aligned in how we think and how we strategize. It also modeled to the field that nurse-physician alignment in making those decisions collectively.
Even though we've moved past the pandemic and we're getting back to normal operations, we still have that very same approach. We’re not so focused on COVID, but if you look at our calendars now, about 60-75% of the time, we're on the same calls. We are intentional and stay connected … so that if Christopher is primarily taking the lead on, say a technology platform discussion, and he has to be out, I can step in and represent the dyad in Christopher's absence. If I’m taking the lead for something that's more clinical or operations, by keeping Christopher informed he can quickly step in for me if I need to be out. That’s the beauty of the dyad, but there has to be a lot of intentionality around staying connected.
Rehm: We tried to overtly reinforce that first year by purposely picking what we were going to report out at meetings [Rehm would report on nursing matters; Watson would report on physician matters] so that it would drive home that we really are in a dyad. That was key to drive how we continue to work today. We make sure we’re bringing our different perspectives to those areas that historically were in the other’s role.
HL: What are some of the challenges of a dyad model that you've encountered in this last year?
Watson: One of the biggest challenges would be for the two of us to always stay in sync. We’re pulled in so many different directions and we're not on the same calls together, so being intentional to stay in sync and then finding the balance in that and making sure that you have an equal voice between the CNO and CMO, because sometimes it can get heavily weighted one way or the other.
Rehm: That first year as we were figuring out the dyad, we didn't want the business to be challenged by others asking, “Do I need to call Michelle?” or “Do I need to call Christopher?” or “Do I need to call them both?” We wanted to make it easy for everybody else by not forcing them to think about it. We want them to think about us as the dyad, and it doesn’t matter which one of us you invite.
HL: You’ve touched on some benefits of this model. What are some others?
Rehm: No single person has all the answers, and no single person is necessarily going to be able to analyze every challenge, every opportunity, from every angle. Michelle and I do not have exactly the same view of every everything we should do, but with the right kind of understanding of how we work together, to every decision we bring a multitude of perspectives. Her background is different than my background and in an open dialogue, we explore every challenge more broadly and more deeply than if either one of us was doing it individually. We bring experiences, we bring an open mind, we're great listeners, and we end up with better decisions because of that.
Watson: One of the great benefits is between the two of us, we bring such a broad view of quality clinical operation. As a CNO, I would only bring my view from hospital operations nursing leadership quality. Christopher brings a different view from his background as a physician, so it’s bringing the two together and being open to listen—to each other, to your teams, and to what the organization needs. That broader view has really helped us a lot.
HL: Is this dyad model workable for any and all health systems?
Watson: It is workable in any healthcare system, but it can have its own challenges. The important piece is having a CNO and a CMO who have a shared vision and a shared mental model of team-based care because that's really what it's about: driving high-quality performance at the bedside through a team-based model. It is doable, but there has to be a lot of intentionality between the CNO and CMO.
Rehm: There are potentially CNOs and CMOs who would struggle working in this model. You have to have the right characteristics as the CNO, CMO to function a dyad and not have it be something that doesn't work well, but that I don't think that's a system challenge. You have to have the right people in the roles to function in a dyad.
The number of 12-hour shifts filled by nurses new to the organization within the last year rose by 55.5%.
In March 2021, the median years at an organization for nurses working 12-hour shifts was 3.6; by March 2022 the median years was 2.78, signifying a 19.5% drop, according to a new study by Epic Research.
The study sought to determine nursing staff turnover in healthcare organizations by evaluating data from more than 26 million 12-hour nursing shifts for 539,765 RNs across 189 U.S. healthcare organizations.
One of the study's measures of turnover is the median length of time nurses have been at their current organization, of which the findings indicated the 19.5% change.
Other key findings include:
While this decrease in median nurse tenure is seen across the United States, it is most prominent in the West.
The number of 12-hour shifts filled by nurses new to the organization within the last year also rose by 55.5%.
Shifts covered by nurses new to the organization in the last 30 days increased in all regions.
The median tenure in the West fell by 32.2%, compared to 17.7% in the Northeast; 16.4% in the Midwest; and 11.3% in the South, according to the study.
Another of the study's measure of nurse turnover is how many shifts are covered by new nurses—defined as a nurse who started at an organization in the last 30 days.
The percentage of shifts covered by new nurses increased across all regions, with the largest increases in the South (3.4%), followed by the Midwest (2.9%), the West (2.6%), and Northeast (2.6%), the study says.
The study also reviewed the distribution of shifts based on how many years the nurse had been at the organization. The greatest number of shifts—hundreds of thousands—were filled by nurses with less than one year of tenure, a number that rose by 55.5% from March 2021 to March 2022, according to the study’s data.
The change was consistent across all regions, but most pronounced in the West and South.
These findings show that nurses are leaving the profession or changing organizations more frequently, according to Epic Research, which highlights a crucial need for organizations to invest in retention and onboarding programs for nurses.
WisCaregiver Careers, a public-private partnership, is designed to address the shortage of CNAs in Wisconsin nursing homes by providing free training, free certification testing, and $500 sign-on or retention bonuses. The idea is to encourage new workers to enter the field of caregiving by lowering the costs of becoming a CNA and by making training more readily accessible.
“Across Wisconsin, a strong healthcare and long-term care provider workforce is essential to the health of our entire state,” said Gov. Tony Evers. “With an aging population, Wisconsin has been facing a healthcare workforce shortage for years—a challenge the COVID-19 pandemic only further underscored—and this funding will support a real solution to the state’s healthcare staffing needs that will benefit our entire state well beyond this pandemic.”
WisCaregiver Careers, originally launched in 2018, has engaged more than 300 of Wisconsin’s 385 nursing homes in expanding the healthcare workforce. With a previous $400,000 grant, the program is on track to exceed its goal of training 500 new CNAs for employment before the end of June, according to a press release.
“Supporting and strengthening Wisconsin’s long-term care workforce is a critical part of addressing the healthcare workforce shortage statewide,” said DHS Secretary-designee Karen Timberlake. “With this investment, we will expand a program that is working and build our efforts to grow a workforce ready to support Wisconsin’s health needs today and in the future.”
The $6 million investment, funded through the U.S. Centers for Disease Control and Prevention (CDC) Nursing Home & Long-term Care Facility Strike Team program, will expand the current program including recruiting qualified employers. To date, more than 180 employers have registered with the program.
Funds will support employee recruitment and success through retention bonuses, employer reimbursement and success bonuses, and mentorships.