As providers compete for the same limited supply of personnel, they must be creative, industry expert says.
With the demand for bedside nurses greater than the supply, long-term care facilities must search out viable and effective ways to attract and keep nurses to provide the care their residents need, according to industry expert Reginald Hislop III.
Hislop, a healthcare executive, consultant, author, and widely recognized thought leader in healthcare, specialized healthcare, post-acute care, and health policy, spoke with HealthLeaders about how long-term care staffing can be brought back to safe levels.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Overall, what is the general state of nurse staffing and long-term care facilities right now?
Reg Hislop III: If I were to use a scale of 1 to 10, with one being as bad as possible and 10 being great, we were at about a 6 prior to COVID so they were probably 5 or 4 and maybe in some cases 3. When we think about staffing, we talk about them in terms of nationalized trends, but the reality is, each market area or region is experiencing things differently—positively or negatively—to the national trends. The national trend is poor, but if you go into certain environments at certain locations—rural, for example, or inner city—it's far worse than the national trend.
So, we've got a long way to go and part of that is fighting an uphill battle in terms of the reputational issues that are in the industry, but also fighting certain trends that have been plagues to the overall healthcare industry, especially with regard to bedside clinical staffing, and that is, folks are burned out and they've retired.
The average age of registered nurses and LPNs was not very young prior to COVID, so you can imagine the number of folks who have just simply said, "I don't need to continue to do this anymore," or "I can continue to do this, but I'm going to do it differently. I'm going to step back, reduce my hours, work only premium shifts, maybe join a staffing agency that allows me to staff within the same environment that I was in, but do that at a much higher wage rate." So, we've got a whole number of moving pieces going on right now.
HL: So, how are they filling staffing gaps?
Hislop: Some just aren't, and that's frank reality. Some of our client base that operates in rural areas literally cannot find staff for particular shifts, so they are running bare minimum and, in some cases, have had to focus on reducing organic census or reducing occupancy levels to meet where staffing levels are realized or can be realized.
The primary reliance that providers are using today is one of three arrows in the quiver, none of which are all that great. One is simply wages. Pay more. Do whatever is necessary. Offer as many financial incentives as possible, whether it's sign-on bonuses, enhanced base pay, incentives for picking up shifts, higher shift differentials for tough-to-fill shifts and using any kind of financial lever they can to fill shifts. The other is to rely on outside agencies. That is precarious in some markets because some of the agencies don't have enough staff and can't attract additional staff to fill additional shifts.
The in-between is having folks work overtime, adding additional shifts, using incentives to create environments where folks can be flexible around picking up—instead of full shifts—partial shifts, doing things with two- or three-person teams to creatively address some of the key openings on certain shifts, but not filling the entire eight, 10, or 12 hours. But these are all duct-tape kinds of solutions; they're not permanent.
HL: As they're working to bring staffing to safe levels, what should they be doing to recruit nurses?
Hislop: The unfortunate thing is that it's going to be difficult to do a lot on a short-term basis. We've got a supply-and-demand problem. The demand for bedside nursing is greater than the supply of folk available. Some markets are better other markets are not, so as long as that imbalance exists … providers are battling for the same limited supply of personnel.
What providers can do is be creative. It sounds rudimentary but keep all your own staff and try to increase the amount of time that they're willing to work. See if you can take your part-timers to two-thirds time or the two-thirds time folks to full time and do that in a way that you can get maximum coverage and productivity out of your existing workforce.
The next thing you need to do is look at how you deliver different elements that are part of the staffing equation. Pay is only one element. The other elements include workplace satisfaction, support, giving folks the opportunity to team schedule, self-schedule, finding creative ways to address some of the core elements that are dragging folks away from bedside nursing and saying, "Is there a way that we can improve this? Are there ways that that we can improve the work-life balance, the quality of life internal to the organization?"
Partner with various agencies to see if there are ways to work with some of the nursing programs and schools in your market to offer opportunities for folks to complete their education and work for the provider … while addressing some of the costs of tuition, if that's feasible. Look at a variety of creative benefit options, which may be as easy as getting meals at work or partnering with daycare centers. A lot of our nursing staff are female and they have kids that need childcare options. The real issue is, in the short run, being sensitive to pay, but also to quality of life.
HL: How about retention? What should they be doing to hold on to their current nurses?
Hislop: Retention is the No. 1 element, so providers need to appreciate their staff in ways that show them, beyond just dollars, the significance of the work that they are doing. There's a lot of recognition that needs to be provided to the folks that are doing the work. That includes a number of different things.
One is identification of work that they're doing and rewarding them and recognizing them for that. It doesn't have to be huge—handing out movie tickets or gift cards. Doing appreciation events is a big thing. Talking directly to the staff and having open lines of communication, and making sure that floor-level and building-level management is being open and communicative in how they are dealing with the work-life challenges that staff may be having right now in dealing with burnout.
Make sure that you're being smart about how you're using staff and that you're sensitive to some of the issues that are out there and that you're not overburdening them. Step away from certain bad things like mandating overtime. Some will push back and say, "But if we don't do that, we won't get staff," and the answer is, yes you will.
But the word mandate is different. If you say, "We're not going to mandate … overtime. [But we] will ask, and we'll work with you to help you pick up shifts." That sets the tone of mutual respect.
The reasons I hear from nurses about why they don't work at certain places anymore, or they don't feel as if they should remain in bedside nursing are threefold. One is they're being overworked. Two is, they're not being treated with respect. Three, they are essentially being put in a position where they feel as if they don't have a whole lot of say around the compromise that might be going on with regard to patient care quality. That last one is a big one.
We need to have open dialogue and communication about what's safe and how we can help them and move some non-nursing tasks so we all can concentrate on patient safety.
The winning pilot programs are predicted to 'transform the education, regulation, and practice of nursing,' the foundation executive director says.
The American Nurses Foundation is granting $14 million over three years to 10 nurse-led pilot programs that are sparking new ideas, as part of the foundation's Reimagining Nursing Initiative.
The pilot programs are being developed and led by nurses at various universities, nonprofit hospitals, and startup companies that serve diverse communities across the country and will help determine how they can be scaled and broadly implemented, according to the foundation.
"The Reimagining Nursing Initiative provides the solid investments nurses need to transform the education, regulation, and practice of nursing,” says Kate Judge, the foundation's executive director.
"Nurses are a natural catalytic force for accelerating the evolution of our health system because they have an unmatched perspective on prevention, wellness, and delivery of healthcare services,” Judge said.
Of the 10 pilots receiving grants:
One focuses on decreasing first-year nursing turnover by exposing nursing students to clinical rotations in perioperative nursing practice.
One is using robots equipped with artificial intelligence that can predict and deliver what nurses need based on a patient’s electronic health records.
Another makes it possible for patients to receive home-based, nurse-led primary care for people living with dementia.
One uses an off-the-shelf technology to deploy nurses to assist people returning home after being discharged from the hospital, allowing patients to request and pay for nurse care directly and on-demand.
"We received nearly 350 nurse-led projects to consider for this initiative, and we have selected those that have the potential to be most transformational. We look forward to enjoying the healthcare that nurses are creating," Judge said.
The COVID-19 pandemic reinforced the critical role nurses play and solidified how healthcare must change to meet evolving needs, said Greg A. Adams, chair CEO of Kaiser Permanente, one of the foundation's financial supporters.
"There is no better time to reimagine the nursing profession to help lead this transformation," Adams said. "This initiative supports innovative ideas and solutions from the perspective of nurses that will make a difference in patient’s lives and improve access, care, and health outcomes for all."
Neglect and mismanagement by the Roman Catholic Diocese of Albany caused 1,100+ former employees to lose retirement benefits, attorney general alleges.
The New York attorney general today filed a lawsuit to help more than 1,100 former employees of St. Clare's Hospital in Schenectady, New York, recover lost retirement benefits because of alleged "negligent and intentional actions" by the Roman Catholic Diocese of Albany.
Attorney General Letitia James alleges that the Diocese shirked its fiduciary and legal responsibilities to the former hospital's nurses, lab technicians, social workers, EMTs, orderlies, housekeepers, and other essential workers when it failed to preserve and protect the hospital's pension that was entrusted to its care.
Of those 1,100+ who lost their retirement benefits, 650 retirees lost all their pension rights and nearly 450 retirees received a single payment equal to 70% of their pension's value.
James seeks to hold the Diocese liable for the misconduct and recover the pensions.
"These former hospital workers nobly served their community and cared for the sick, elderly, and vulnerable. But when they retired, they were left with nothing," James said.
"No one should ever have to deal with the financial and emotional trauma of losing the resources they were counting on to survive," she said. "With this action, we're standing up for New Yorkers who deserve to retire with dignity, and I will do everything in my power to make sure they get the pension benefits they’re owed."
The Diocese's decision to remove the pension plan from the protections available under federal law, its failures to adequately fund, monitor, or insure the pension, and its resulting failure to administer the pension violate New York Not-for-Profit Corporations Law and New York Estates, Powers & Trusts Law, according to a press release issued by James' office.
St. Clare’s Hospital, co-founded by the Diocese in 1948 and closed in 2008, was managed primarily by the St. Clare’s Corporation, a not-for-profit corporation created by the Diocese to oversee the hospital's operations.
The attorney general launched an investigation into the Diocese in 2019 after it terminated the pension that had been in place since 1959. That investigation found "repeated and pervasive violations of the Diocese’s fiduciary duties of care, loyalty, obedience, and disclosure to St. Clare’s Corporation," resulting in failure to pay the promised retirement benefits to its former employees and vested pensioners, according to the attorney general.
For example:
In 1992, the Diocese used its religious status to obtain a federal exemption to avoid the required federal protections for pensioners, such as pension insurance and minimum funding contributions. After obtaining the exemption, the Diocese failed to make any annual contributions to the pension for all but two years from 2000 to 2019, causing the pension to be underfunded by $43 million.
The Diocese hid the collapse of the pension plan from the federal government and former hospital workers who were vested in the plan and rejected all attempts to address the deficit.
In 2007, the Diocese requested and received $28.5 million in Medicaid funds from the state of New York to eliminate the pension’s deficit. However, the Diocese knew the funds were not sufficient to fully fund the pension, despite representing that they were.
The Diocese failed to require yearly audits and accounting of the St. Clare’s Corporation's finances and pension, as required by the St. Clare’s Corporation’s bylaws.
In 2018, the leadership of the St. Clare’s Corporation learned that their liability insurance coverage for directors and officers would not be extended, so to avoid exposing themselves to the risk of personal liability, they unanimously voted to terminate the pension and dissolve the corporation, according to James.
In the petition for dissolution, filed in 2019, the corporation admitted that it owed more than $50 million to the retirement plan and its members and had no means or intention to fully fund the pension.
New York law requires the Office of the Attorney General to approve voluntary dissolutions of New York not-for-profit corporations. Because of concerns about the outstanding benefits owed to the 1,100+ pensioners, James opposed the corporation’s petition and sought answers to why the pension failed to provide the promised and earned benefits and what happened to the $28.5 million in Medicaid funds received by St. Clare’s from New York state.
The lawsuit is a strong step in getting their pensions restored, one pensioner said.
"We have fought to regain our rightful pension for more than three years," said Mary Hartshorne, a St. Clare’s pensioner."We have endured a pandemic and skyrocketing inflation that limited our already depleted resources. We had almost given up on multiple occasions … We finally have light at the end of the tunnel."
The Roman Catholic Diocese of Albany did not respond to a HealthLeaders request for comment.
Collaboration in planning, action, and investment at the federal and state levels can turn the nursing shortage around, new report says.
If policymakers at all levels think more boldly about solving the nursing shortage and improving racial equity, more patients will have access to safe, high-quality nursing services, resulting in healthier populations and stronger communities.
While the shortage has long been a challenge, it has become increasingly urgent, given that the nursing workforce declined by 3% from 2020 to 2021 during the COVID-19 pandemic—the largest such decline in more than 20 years, the report says.
Though COVID-19 narrowed the focus on the nursing shortage, other conditions have contributed to it far longer than the pandemic: a higher education system that is training too few nurses; workforce conditions; and demographic factors, such as aging Baby Boomers and increased life expectancy, the report notes.
Despite recurring nursing shortages, the United States has not adopted a coordinated approach to preventing or responding to the issue, nor has it designated responsible entities at federal and state levels to do so, the report says.
"As policymakers look to fortify our healthcare system in the wake of the pandemic, fixing the national nursing shortage by investing in America's higher education system to graduate more nurses, boosting national and state coordination efforts to support the nursing pipeline, and retaining nurses should be top priorities,” said Jesse O’Connell, CAP's senior vice president for education.
Indeed, federal and state policymakers can take steps to address these challenges through coordinated planning, action, and investment, the report says.
The three main recommendations are:
1. Expand the capacity of educational institutions to enroll and graduate nurses while improving access and outcomes for student nurses of color and overall population health.
Congress should pass the Future Advancement of Academic Nursing (FAAN) Act (H.R. 851/S. 246), which would award competitive grants to nursing schools to enhance nursing education programs. It also prioritizes historically Black colleges and universities, tribal colleges and universities, other minority-serving institutions, and regions with low numbers of medical professionals.
Congress should pass the Black Maternal Health Momnibus Act of 2021 (H.R. 959/S. 346), aimed at addressing the United States' maternal mortality crisis and eliminating racial disparities in maternal health outcomes.
Congress should increase funding for programs authorized under Title VIII of the Public Health Service Act. This legislation is a critical source of loan repayment and scholarships for nurses; loans for nursing faculty development; and grants for advanced education, increasing diversity, and improving outcomes for nurse education.
Congress should provide funding to help nursing schools pay for capital projects, such as buildings, laboratories, and equipment.
2. Federal and state policymakers should introduce new proposals to expand clinical placement capacity and fund pathways from ADN programs to BSN programs.
Congress should directly fund clinical placements for nursing students from historically disadvantaged backgrounds and for those at underfunded higher education institutions.
Congress, state legislatures, and employers should invest in pathways and support services, such as transportation and childcare, to help nurses with an associate degree in nursing obtain a bachelor of science in nursing. They should also help workers in healthcare support roles, such as licensed practical nurses and certified nursing assistants, transition into registered nursing.
3. Create standing bodies to document and advise on issues of recruitment, training, and retention.
Congress should fund the National Health Care Workforce Commission, initially authorized by the Affordable Care Act in 2010. Although members were appointed in 2010, Congress has never appropriated funding to make the commission operational.
Further, Congress should fund and deputize state-level nursing workforce organizations to address state-specific nursing shortages.
Effective leadership requires putting staff at the forefront, as these examples illustrate.
HealthLeaders recently saluted five nurse leaders during National Nurses Week who have taken solid steps to lift up and take care of those around them.
Here's a look at those five who go above and beyond:
"One of the reasons why our employee engagement in perioperative services so high is that we really do care about people," she says. "I'm from a big family and it's always about the other guy, so when I was putting together the leadership team over the last 10 years, my mission was to hire people that have that same vision."
Schedule flexibility is a large part of that, she says.
"As hard as it is when someone says, 'I need to take my mother for a CT scan,' or 'My daughter has a dance recital,' we try to connect with the person and give them what they need," she says.
Mele encourages her nurses to practice self-care and seek joy.
"If you like to knit, if you like to sing, if you like to run or ride a bike, you really need to do it, because during the pandemic, we put a lot of that away because we had no time," she says. "Now, we're encouraging them to get back to whatever it is that they'd like to do."
"If your cup is empty, you can't really help anybody else," she says. "You need to fill your cup to be effective and do the best work that you can."
2. Deborah Washington, PhD, RN, on the value of nurses
The nursing profession is "valued but well-kept secret" that needs to take a big step forward in becoming a player in healthcare's power structure, says Deborah Washington, PhD, RN, Massachusetts General Hospital's DEI health and community partnerships manager.
"What I find to be problematic in this discipline I love is that when we problem solve, we tend to speak only to each other within the system," she says. "The missing piece that COVID has taught me is that the trusted messenger conversations have opened up the realization that nursing leaders need to create a public discourse around the value of the discipline and the difference it makes in terms of healthcare."
To do that, nurse leaders must engage in the media, on social media, and in other public venues to talk about the value of nurses and the difference they make, Washington says.
"We need to be more audacious in terms of using our organizational power, our positional power, and the influence that we have in terms of our voice and values, and by that I mean, having the chutzpah to create programs to address the problems that are of concern to us," she says.
"We need to step out from under medicine or the organizational name and step out of the name of our discipline," she says. "And we need to exercise the power we have in order to make that choice."
3. Mary Sullivan Smith, DNP, RN, NEA-BC, on mindfulness training
When Mary Sullivan Smith, DNP, RN, NEA-BC, was pursuing her Doctor of Nursing Practice degree, she chose as her capstone project, "Mindfulness training for acute care nurses to promote a healthy workplace."
That's because as a nurse, as well as senior vice president, chief operating officer, and chief nursing officer of New England Baptist Hospital, Sullivan Smith knew that nurses busy with patient care generally don't take time to take care of themselves.
Smith Sullivan received her DNP in 2020, and research from that project has resulted in wellness programs at New England Baptist.
"I thought there must be ways to incorporate some of the some more healthy habits into the organization … and that's when I started looking into opportunities," she says. "Establishing a mindfulness practice is beneficial in so many ways, but it certainly hits that those areas that I was concerned about—caring for others more than oneself and not taking enough time to hydrate and get good nutrition."
She partnered with a certified mindfulness instructor who created short mindfulness meditations and taught nurses how to center themselves.
"Not only did the nurses take advantage of it, but other disciplines as well because we put them on Zoom and invited people to participate," Smith Sullivan says.
"Once I finished with the pilot project, I introduced this into our nurse residency program, so one of the aspects of our curriculum is on wellness and self-care and they learn the benefit of meditation."
4. K. David Bailey, PhD, RN, MBA, CCRN-K, NEA-BAC, FACHE, on mentoring
Not only does he have several mentors, but he mentors multiple nurses and healthcare employees, as well.
"For the mentee, the benefit is having that safe space for anything to be discussed. There's no sacred cows that can't be discussed there," he says. "For the mentor, you can use the wisdom that you have earned and learned across your career, and you can provide (mentees) insights without telling them the way they need to do it."
Being a good mentor requires some basics, such as trust Bailey says.
"You have to be able to have open and honest communication, whether things are going well, or especially if they're not," he says.
Good mentors listen, rather than doing all the talking, and they have presence, Bailey says.
"There's some emerging literature coming out about the importance of nursing leadership presence, which is more recognized since the pandemic. But having presence demonstrates that you are walking the talk and that you really are following through," he says.
"It really illustrates to your mentee and to others that you're authentic and that you are supporting them," he says, "but you're also living by what you're talking about."
5. Maria Knecht, RN, MSN, NE-BC on growing nurse leaders
With fewer nurses stepping into leadership, it's up to today's nurse leaders to boost those numbers by understanding current workforce's needs and adjusting those leadership roles to focus on quality rather than quantity, says Maria Knecht, RN, MSN, NE-BC, vice president of nursing and clinical operations at NorthShore University HealthSystem's Glenbrook Hospital.
"When you look at work-life balance and all of those issues, sometimes folks of my generation and in the role that I am in are not always the best role models," she says.
"We have to abandon this whole notion of seven days a week, and 10- and 12-hour days, and give people permission [to be away], like we do here. My leadership team does a good job of saying, 'I'm out tomorrow. I don't want an email. I don't get paged. My co-workers are going to cover me.' And there's a lot of peer support to get that balance."
Once Knecht has recognized a potential leader, she provides them leadership opportunities, such as serving on a task force or leading a project, she says.
"As leaders, we have to be very deliberate about giving them more opportunities," she says.
"The one thing we've not always done well in nursing is good succession planning," Knecht says. "You [must] identify those people very early—maybe it's years ahead of time—and put them on a very formalized path to get them to where they need to be."
A Reading Hospital nurse will treat patients in the field while collected medical supplies will be delivered to the front lines.
Reading Hospital's staff is responding to the tragedy in Ukraine by sending 1,400 pounds of medical supplies and an emergency nurse to the war-torn country.
Jean Ebersole, PHRN for the Reading, Pennsylvania, hospital and her team from the Armada Network, a Christian ministry left for Ukraine this week, prepared to treat everything from primary care to field traumas, according to a press release.
They planned to have a clinic setting based in a home and an ambulance to provide additional treatment in the field.
Ebersole's Tower Health colleagues who have expertise in disaster response, emergency medicine, and trauma helped her prepare for the trip by providing additional training and sharing their experiences in combat and disaster situations.
"The employees at Reading Hospital are a team no matter where they are providing care, as evidenced by the outpouring of support Jean has received from her colleagues," said Charles F. Barbera, MD, Reading Hospital president and CEO.
Ebersole's skills are valuable in disaster situations, such as when she went to Haiti after the devastating earthquake in 2010.
"I can remain calm in terrible situations and I’m good at thinking on my feet. I’ve worked in other areas in the hospital but came back to prehospital," she said. "This is the first time I will have to wear combat gear to treat patients."
Delivering much-needed supplies
The supplies collected by Reading Hospital employees will be delivered to frontline hospitals through the effort of Filip Moshkovsky, DO, a trauma surgeon at Reading Hospital and Ukraine native.
Moshkovsky, who fled Ukraine in 1989 because of religious persecution by the Soviet Union and still has family there, connected with a physician in Ukraine who is organizing medical supply donations and delivering them to frontline hospitals.
"We had no idea what to expect when our collection efforts started," Moshkovsky said. "We ended up with 1,400 pounds of medical supplies, enough to fill four pallets. The people of this hospital and this community are generous, caring, competent, and professional people."
Moshkovsky is also partnering with the Reading Hospital Foundation for a second employee donation drive to benefit families and children in Ukraine.
"I hope to go to Ukraine this summer to provide medical and surgical care, Moshkovsky said. "But collecting medical supplies and other items the Ukrainian people who are in desperate need is the way I can help now."
67% of hospital leaders surveyed are offering sign-in bonuses and 57% have improved their pay packages.
Improved pay packages and sign-on bonuses are being used more aggressively now than in the past four years to fill RN openings, a new annual report says.
Some 67% of chief nursing officers and other hospital senior leaders surveyed are offering sign-on bonuses and 57% said they have improved their pay packages. Those percentages are significantly higher than in 2019, before COVID-19, when just 28% said improved pay packages were part of their recruitment and retention strategy.
Such strategy is crucial when more than one-third (34%) of nurses surveyed said they likely will quit their job by the end of 2022, primarily because of burnout and a high-stress working environment.
Staffing agency Avant Healthcare Professionals surveyed more than 100 senior leaders from various health systems across the United States in February and March 2022 to collect data on the most recent trends in nurse staffing.
Though pay packages are being offered more than in past years, most hospitals and health systems are counting on new graduates (87%) or looking to staffing agencies to fill their RN openings (69%), the report says.
Hospital executives also are looking at external advertising and internal recruitment to help fill positions.
Slightly more than one-third (33%) of respondents anticipate having more than 25 RN openings this year, while 25% claim they will have more than 100 RN openings. Last year, only 11% of respondents said they would have 100 openings or more.
The RN specialty most in demand is the medical-surgical RN (78%), followed by emergency room nurses (69%), intensive care (53%), and operating room (43%), the report says.
COVID-19's impact
Clinical burnout and mental health issues already were issues in the nursing profession, but they increased dramatically in number and severity as COVID-19 exacted its catastrophic toll.
The survey indicated that 73% of respondents stated that the pandemic would have a long-term impact with the loss of bedside nurses to other careers.
The long-term impact response is a sharp 40% increase from Avant's 2021 study when 33% of survey respondents said COVID-19 would have a long-term effect on the well-being of their staff.
'It is my hope that changes in the practices and protocols in the medical setting that have arisen since this event may at least be some positive aspect,' judge says.
Former nurse RaDonda Vaught will serve three years of probation for the 2017 drug error that killed a Vanderbilt University Medical Center patient.
Vaught was convicted in March after a three-day trial that continues to capture the attention of nurses and nursing organizations across the country, many of whom worry that the case could set a precedent of criminalizing medical errors.
Under Tennessee's sentencing guidelines, Vaught could have been ordered to serve three to six years in prison for neglect and one to two years for negligent homicide.
Instead, Vaught received a diverted sentence, which means that if she successfully completes her probation, the charges will be expunged from the record.
"It is my hope that changes in the practices and protocols in the medical setting that have arisen since this event may at least be some positive aspect that has arisen and that going forward, I hope that it prevents this type of situation from happening again," Davidson County Criminal Court Judge Jennifer Smith said Friday afternoon in imposing the sentence.
"We are grateful to the judge for demonstrating leniency in the sentencing of Nurse Vaught. Unfortunately, medical errors can and do happen, even among skilled, well-meaning, and vigilant nurses and healthcare professionals," according to a joint statement from the American Nurses Association (ANA) and the Tennessee Nurses Association.
"The letter expresses, from a professional and nursing perspective, legal reasons why we would humbly request leniency," according to the ANA. "We were compelled to take this action because we all see ourselves in Vaught. Nurses see themselves in Vaught; our peers and colleagues and healthcare professionals beyond nursing see themselves in Vaught."
"Whenerrors happen hospitals and health systems need open lines of communication to identify and understand the series of events so they can update patient safety systems to further prevent errors," Begley said in a statement. "Criminal prosecutions will discourage health caregivers from coming forward with their mistakes and will complicate efforts to retain and recruit more people into nursing and other healthcare professions that are already understaffed."
Vaught has consistently taken responsibility for the deadly error, which occurred when the patient, Charlene Murphey, 75, was supposed to get Versed, a sedative intended to calm her. Instead, Vaught accidentally administered vecuronium, a powerful paralyzer, which stopped the patient's breathing.
In a statement prior to sentencing, Vaught stood at a podium and first turned to face Murphey's family.
"I'm so sorry for what you have lost," she told them. "I will never forget my role in this."
Vaught then directed the rest of her statement to the judge.
"Words alone will never fully express my remorse for my actions," Vaught told the court. "I will never be the same person. When Mrs. Murphey died, a part of me died with her."
Vanderbilt received no punishment for the fatal error.
The criminalization of Vaught's mistake has dismayed nurses across the country who have expressed outrage over the case said that the conviction is unfair. Indeed, the judge acknowledged the vast amount of correspondence—letters, emails, voicemails—the court has received regarding the case.
A petition to grant her clemency has grown to more than 212,000 signatures, and several hundred supporters gathered outside the courthouse Friday morning, beginning with a moment of silence for Charlene Murphey.
"The best we can hope for is to try to learn from the mistakes that were made and to fix the errors in the system that allowed them," rally organizer Tina Vinsant told Nashville television station WSMV. "Obviously something tragic happened but we're also here to support our sister nurse."
Prior to sentencing, Murphey's family members testified as to the painful toll the tragic medication mixup has taken on them, but they all expressed that the victim wouldn't want Vaught to go to prison.
"Knowing my mom, she wouldn't want her to serve jail time," said Murphey's son, Michael. "Mom was a very forgiving person."
A series celebrating nurse leaders who go above and beyond.
Mobile medical vans that take healthcare out into the community around Boston's Massachusetts General Hospital are a part of the institution's decades-long commitment to diversity, equity, and inclusion (DEI).
Deborah Washington, PhD, RN, Mass General's DEI health and community partnerships manager, has been a fixture in the hospital's DEI initiatives since the mid-1990s and is responsible for such programs that serve underserved community members and work to sweep away longstanding inequities.
Washington spoke to HealthLeaders about how nurse leaders can begin to implement DEI in their organizations.
This transcript has been edited for length and clarity.
HealthLeaders: For nurse leaders who are working toward DEI, what is required, generally, for correcting course from bias and inequities toward real and lasting change, first for patients, and also for nurses?
Dr. Deborah Washington: My answer would be the same for each. The nurse leader needs data, a data driven story, for the workforce and terms of recruitment and retention, meaning the demographics of the workforce that they're meeting and the turnover rate. In terms of patients, once again, demographics in terms of the mission of their organization in identifying who they serve and getting the demographics of the geography of those patients where they live and their ethnic identity.
HL: How have you been approaching this at Mass General? What are some DEI programs that have been implemented?
Washington: We have been on this effort of diversity, equity, and inclusion for decades, so we're not newbies. We've had several starts and regroupings around some of the things that I just mentioned: Taking a look at our workforce, getting the data-driven story, paying attention to the national conversation around disparities and equal treatment, listening to the stories of the communities we serve, and designing programs and training and education for our staff in response to those stories in particular. Because through the stories that we collect, not only do we get exposure to the lives that our patients are living, but we develop communication skills for our clinical care services in terms of how we deliver them and how we shape them to be responsive.
COVID changed everything for everybody. For us, the most significant change was understanding the value of bringing services to the community as opposed to the community having to come to us, so we refitted and developed a program around community vans that are staffed by doctors, nurses, and patient care associates who staff those vans to go into the community to do patient education, to deliver the vaccine, [and] to be a presence in terms of fielding questions and stepping deeper into that model of the trusted messenger that rose to the surface as a critical need during COVID. And we're continuing that service, because we are incorporating lessons learned, and this is a model that can forever benefit the community we serve.
HL: What are some other Mass General DEI programs that have evolved?
Washington: We're constantly taking a look at, as an anchor institution, how can we be more effective and supportive in terms of social determinants of health, specifically, improving the economic opportunities for small businesses and the BIPOC [Black, Indigenous, and People of Color] community.
We have a stronger presence in the Black community in particular, because we have expanded our concept of who we serve. Some communities went to one institution for care, and other communities went to other institutions for care. Well, we have decided that as a healthcare system that serves everyone, we're going to break those predictions, and everybody who cares for the community will cross those traditional lines. That is a new model and a new way of thinking about healthcare, in that all healthcare is public healthcare when you really get down to the cases of it.
So even if somebody comes for care in the inpatient environment, we have to keep in mind that this is an episode in the patient and family's life. As a holistic way of taking a look at that human being, we have to realize that for this episode, we're going to keep the context of their community life in mind when we do our treatment planning and when we do our discharge planning.
HL: What kind of results are you seeing?
The trusted messenger piece has been eye-opening in terms of our ability to occupy that space as a healthcare institution. I know that we had a tremendous response to the number of BIPOC people who responded to our presence in the community to get the vaccine when everybody was raising questions about the efficacy and safety of it. So we recrafted our presence and the meaning of our presence, and we're building relationships that are not going to be superficial. We've learned, and we're staring into the face of what is needed, and we're not going to let old traditions and rivalries stand in the way of us moving forward and breaking down some of those barriers.
That's where the CNO is extremely important because what I find to be problematic in this discipline I love, is that when we problem solve, we tend to speak only to each other within the system. The missing piece that COVID has taught me is that the trusted messenger conversations have opened up the realization that nursing leaders need to create a public discourse around the value of the discipline and the difference it makes in terms of healthcare.
HL: And how do nurse leaders do that?
Washington: We need to get into the papers, we need to develop our voice in the public square, and engage in making ourselves more visible. We need to have the CNO voice saying in the BIPOC community, "We as nurses are going to be doing X, Y, Z. Come and join us." We're going to be doing podcasts that talk about our value and the difference we make. We're going to use social media differently. We're essentially a valued but well-kept secret in terms of being a player in the power structures of our impact. Everybody talks about medicine and medicine's impact; well, nursing is not medicine. We have a separate story. And that story needs to be more public.
HL: What are some first steps that chief nurses can take toward DEI regarding employment?
Washington: We need to be more audacious in terms of using our organizational power, our positional power, and the influence that we have in terms of our voice and values, and by that I mean, having the chutzpah to create programs to address the problems that are of concern to us. If I'm concerned that I don't have enough diversity in my nursing staff, I need to reach out to my human resources department or I need to take advantage of my BIPOC staff and say, "Would you be willing to spread the word about this organization in which you work and be an ambassador of recruitment?"
I, as a nurse leader, would be happy to talk to anyone interested in working here. I will be happy to go out into community organizations to talk about our values and how we are aware of the needs of the community and build our presence. We need to step out from under medicine or the organizational name and step out of the name of our discipline. And we need to exercise the power we have in order to make that choice.
A series celebrating nurse leaders who go above and beyond.
Fewer nurses appear to be stepping into leadership, as just 11% of nurses say their idea of a successful career involves advancing into nurse administration and leadership roles, a recent survey said.
It's up to today's nurse leaders to improve those numbers by understanding what the current workforce needs and adjusting those leadership roles to focus on quality rather than quantity, says Maria Knecht, vice president of nursing and clinical operations at NorthShore University HealthSystem's Glenbrook Hospital.
Knecht spoke to HealthLeaders about how nurse leaders can attract nurses to one day fill their roles.
This transcript has been edited for length and clarity.
HealthLeaders: Why do you think so few nurses want to become nurse leaders?
Maria Knecht: There are a couple of things. Generationally, a lot of people are seeing how hard their parents worked and the world in a lot of ways has become very complicated, and I don't know if we've always done our best to nurture and grow those nurse leaders from the get-go, so what's really critical is how do we, as executives, do our part to respond to the needs of the current workforce.
When you look at work-life balance and all of those issues, sometimes folks of my generation and in the role that I am in are not always the best role models, so we, as a leadership team have to change that. I think we have to think about what the current workforce needs. How can we be creative in our own expectations, in matching them with the expectations of this workforce?
Historically, we tend to look at people who have the time to commit to leadership roles, but recently we filled a role here at my hospital with someone who is a young mom with four kids at home. We need to start looking to this younger generation who typically would not have taken those jobs in the past because of work-life balance issues and make them attractive—helping them realize it's the quality of time that you do as leaders, not necessarily the quantity of time.
We have to abandon this whole notion of seven days a week, and 10- and 12-hour days, and give people permission [to be away], like we do here. My leadership team does a good job of saying, "I'm out tomorrow. I don't want an email. I don't get paged. My co-workers are going to cover me." And there's a lot of peer support to get that balance.
HL: What can nursing schools do to increase interest in being a nurse leader?
Knecht: A lot of people have excellent relationships with their community partners, but we have to be more diligent in doing that. We need to be more entrenched in each other's houses and visit each other's houses more. Their clinical rotations should be more deliberate in a leadership component to help them realize that leadership, especially when you're a new nurse, doesn't have to be a formal leader role.
You can start to identify that in your students or in your orientees in their first nursing job of who those people are that you can see exhibiting those leadership traits. They want to go a little bit above and beyond, they take their peers under their wings, they inspire their peers. There's lot we can do with that.
HL: What are some of the attributes of an effective nurse leader?
Knecht: It's important to know what, as a nurse leader, you value and what you stand for, and that you always connect to your "why." I look for people who are enthusiastic and have a desire to make a difference. People who listen, they understand, and they're driven by simply wanting to do the best thing for patients, which is creating a work environment where the staff can be their best and they can be their best.
To be an effective nurse leader, the most important thing is you have to build trust with your team. When the staff feel they can trust them, they're engaged. Leadership [requires] positive realism. It's positivity, but not to a flaw. I worked with people who are positive to the point where they're just not realistic and they're not hearing people, and as leaders we have to be courageous and self-aware and know to admit when we don't know everything. Leaders have to never lose that perspective of "patients first."
HL: How do you recognize leadership potential in nurses?
Knecht: You always should be assessing and observing, and you look to observe those things I just talked about. Who is the passionate one, who is the one to say, "Hey, you guys, we've got this," or who's the one whose staff wants her to be their preceptor? Those behavioral traits that I talked about earlier is what I look for.
HL: Once you've recognized a potential leader, then what?
Knecht: You have to give them opportunities by saying, "We have this opportunity for this one-time task force," or "I need someone to help lead this project; could you be part of that?" As leaders, we have to be very deliberate about giving them more opportunities to get them to understand there is a life beyond those five patients and to help them understand their voices make a huge difference.
I think the one thing we've not always done well in nursing is good succession planning. We're having those conversations here about how you identify those people very early—maybe it's years ahead of time—and put them on a very formalized path to get them to where they need to be.
HL: What would you say to nurses who are on the fence about becoming a nurse leader?
Knecht: It can be scary to go into leadership and that you don't grow when you're comfortable.
As a nurse, when I had five patients, I would take really good care of them, but in management I realized that in the course of a day in that unit I could take care of 30 people, and I multiply that by all those patients every day, every month, every year. That's the piece we always have to remind ourselves as leaders: we make these teams, and they take care of the patients and that's why we all do what we do.
