Children's Minnesota CNO works with local nursing schools to help create a practice-ready workforce.
When Caroline Njau, MBA, BSN-RN, NEA-BC, became senior vice president of patient care services and chief nursing officer (CNO) of Children's Minnesota in the state's Twin Cities last March, one of her first-year goals was to know and forge partnerships with the deans of local colleges of nursing.
The nursing shortage isn’t just about nurses leaving the profession: There's also been a significant disruption in staffing pipeline thanks to nursing schools that are turning away qualified applicants.
To combat the nursing shortage at the nursing school level, hospitals and schools of nursing are partnering to find creative ways to bolster the number of students in programs. Recent examples include:
Fisk University in Nashville, Tennessee, and Galen College of Nursing, based in Louisville, Kentucky, recently announced an articulation agreement to create a new pathway in nursing for Fisk students. Fisk students enrolled in science programs who wish to explore nursing can transfer their coursework credits to Galen College of Nursing, allowing them to go directly into Galen's Bachelor of Science in Nursing (BSN) program.
Missouri State University’s School of Nursing is piloting a Mercy Hospital Springfield program called “Earn as You Learn," which allows nursing students to earn money while completing clinical time and evaluating whether they would like to work at Mercy post-graduation.
The University of Oklahoma has partnered with hospitals in Norman and Duncan, providing additional sites for students studying for a bachelor’s degree in nursing and the opportunity for the hospitals to retain nurses educated in their own communities.
Addressing the challenges
Even without formal programs in place, hospitals and nursing schools can and should work together.
One proactive Minneapolis nursing dean reached out to Njau even before she arrived at Children's Minnesota.
"She said, 'Caroline, how can we be allies? How can we partner?'" Njau recalls. "Early on she said, 'I'd love for you to be an affiliate professor for us in the event we ever need to use your expertise in the academia side of things.'"
Njau now meets often with the dean and her team to address such fundamental issues as the number of students they're bringing in and how many they're turning away; how they're preparing the workforce for critical thinking; and whether they're ensuring diversity and inclusion in recruiting students.
Thanks to that work, she's already seeing success with diversity initiatives through the hospital's highly sought-after paid internship program, which now requires the nursing schools to provide a diverse slate of internship candidates, Njau says. When those interns graduate—and, as Njau hopes, start their career at Children's Minnesota—they will help further diversify her workforce, she says.
"I want to talk about what the challenges are," Njau says, "because the more I understand what the challenges are, the more I can be an ally."
Stepping into the real world
Njau's collaboration with local nursing schools helps better prepare students to confidently step into the challenging real world of nursing.
"Being an affiliate professor for a school of nursing really gives me an opportunity to be able to go and give them some real-life experience," Njau says. "It takes intentionality to make sure they are preparing them well."
It also requires honesty and communication, so Njau can inform nursing school deans whether students doing their clinicals need further instruction in particular areas.
"I can say, 'Here are my challenges with the team that's coming up: they're struggling with critical thinking and struggling with medication errors. How can you better prepare them for that?' And they take that back and use those scenarios," she says.
Another local college has been increasing the number of adjunct faculty from Children's Minnesota so they can precept and provide feedback, she says.
"Promoting that adjunct faculty in a role with a local college is a good thing to do to help us make corrections before they start, and that's something I keep promoting to my team," Njau says.
Nursing school-hospital partnerships won't solve the nursing shortage overnight, but they can keep the staffing pipeline trickling with new nurses who will be better prepared for their new career.
Nearly 90% of NPs go into primary care to serve areas with the greatest need, AANP president says.
The work of nurse practitioners (NPs) is being heralded with proclamations and certificates by U.S. governors as they and healthcare providers, policymakers, and patients join the American Association of Nurse Practitioners® (AANP) in celebrating National NP Week this week, November 7-13, 2021.
NPs provide patients with comprehensive, patient-centered primary, acute and specialty healthcare services in more than 1 billion patient visits each year, according to AANP.
"There are 24 states plus Washington, DC, that have full practice authority, meaning the nurse practitioners in those states can practice to the full extent of their education, their clinical training, and their board certification," she told HealthLeaders earlier this year. "In those states, we have seen that nurse practitioners are five times more likely to work in those rural areas, so it's a huge step in the right direction for people who have not had access to healthcare."
Over the past two years, NPs increased from 270,000 to 325,000 to meet a need, Kapu said.
"We have more than 84 million Americans who lack access to primary care, so about 90% of our nurse practitioners are going into primary care so that they can work in areas that have the greatest need—areas that don't have a provider. Many times, these are rural areas," Kapu said. "That's why we're seeing big growth; because there is the need, and they are certainly meeting that need."
National NP Week is celebrating the NP's role in providing healthcare to those who otherwise might not have it.
"Throughout the COVID-19 pandemic, NPs have been an unwavering, frontline force, providing tireless service to their patients," Gov. Ralph S. Northam of Virginia wrote in his certificate.
"NPs provide high-quality primary, acute, and specialty care services while focusing on health promotion, disease prevention, health education, and counseling, guiding patients to make smarter health and lifestyle choices," Arkansas Gov. Asa Hutchinson wrote in his proclamation.
For more information on NP Week and this year's theme, NPs: Going The Extra Mile, visit aanp.org/npweek.
"I am so proud of the 325,000 NPs in the U.S. who put their patients first, always searching for opportunities to improve health outcomes," Kapu said. "Throughout the many challenges of the pandemic, NPs have remained steadfast and committed to the delivery of accessible, equitable, quality-driven, lifesaving care for our patients."
A culture of strong teamwork benefits both patients and staff, acclaimed chief nurse says.
Inadequate nurse-physician interaction and communication is one of the risk points affecting patient safety, according to one study, but healthcare is evolving to create more of a teamwork approach, says Jeanette Ives Erickson, chief nurse emerita of Massachusetts General Hospital in Boston.
"As nurses, we are connected to the patient's life, whether it's in illness or through times of great joy, or times of personal tragedy, including illness and death. Physicians are more, if you will, disease- and illness-driven," Ives Erickson says. "Over the course of time, both of those roles have started to merge where patients are benefiting from physicians and nurses coming together to develop this sense of team around the patient."
Collaboration and teamwork can provide more than patient safety; they also lead to happier employees, she says.
"Working in a healthy work environment and in a greater understanding of the importance of well-being on each team member leads to satisfaction," she says. "People are working very hard … so caring for and about each other is an important factor today."
Ives Erickson offered five ways for a hospital or health system to bolster staff teamwork and collaboration in its ultimate mission to keep patients safe:
1. Create a strong team that includes the patient
"If you think about the team surrounding the patient, no matter where the practice setting is, if everyone is on the same page, then the plan of care is developed within the team. When I talk about the team, I personally believe the patient needs to be a member of that team," she says. "And so, if everyone is hearing the same thing, and planning the same thing, and acknowledging what each member of the team needs to do to get to the goal that has been set, then the patient is much safer."
2. Make teamwork part of the hiring process
"The whole mission of that organization needs to be based on interprofessional teamwork that's very patient- and family-driven. When members of the team are not valued by [another] member of the team, organizations need to have a mechanism where they talk to the member of the team that [they] might not value. The importance of teamwork needs to be very clear upfront upon hiring, within the team huddles, etc.," she says.
"With the current workload, the teams are working in some instances under-resourced or are working with a lot of new members of the team. So how are we really coming together? It all comes back to those huddles, so that no matter what, the goals for the day are known to the entire team and what the team together can achieve."
3. Embrace handheld technology
"Technology can be a wonderful facilitator if we think about all of the handheld devices that people are using to communicate within the team. Our physician colleagues might not be within the inpatient care environment when the nurse needs to communicate with them. Back in the day, we used to have to call or page them to find them, and now people are using their handheld devices to send each other text messages. It's instantaneous communication that really is a facilitator," she says.
"The days of calling on a telephone would be like breaking the silence when people were trying to do other things and the phone is ringing and ringing. And now you can just look at this text message and respond by either sending the text or calling back."
4. Incorporate teamwork into nursing school curricula
"It first begins in the schools. We used to go in our silos being educated and now there's the recognition of the level of importance of really being educated together. With lots of schools like the one I’m affiliated with, the Mass General Institute of Health Professions, their clinical practicums are with student nurses and students in the therapy programs, and the medical residents or interns are all training at the bedside together. That builds the value in the understanding of what contributions each role group makes," she says.
5. Be an influential role model
"The role modeling that happens between the chief nursing officer and the chief medical officer is of value. Rounding together, holding town hall meetings together, sending out memos together, co-chairing important committees together—that is one of the most important relationships in any organization," she says.
"We also, of course, know that the relationship between the chief nurse and president or chief executive of the organization is very important. The chief nurse really influences how that CEO looks at the importance of nursing—the contributions of the team—and builds that relationship with the CEO that's built on the integrity of the relationships that the team has with each other and with the patient."
"The chief nurse role is so important, and the level of influence that a chief nurse has within shaping an organization becomes more and more important each day and building the support by other leaders within that organization is incredibly important."
'We can’t let our guard down now,' NNU president says.
National Nurses United (NNU) is urging the U.S. Occupational Safety and Health Administration (OSHA) to adopt a permanent standard on COVID-19 in healthcare workplaces, strengthening protections for nurses and other frontline workers.
The COVID-19 emergency temporary standard (ETS), which was adopted last June, has been crucial in ensuring safe working conditions by mandating optimal PPE and other protections, but nurses are calling for ongoing protections.
"The COVID-19 health care ETS has saved lives during the ongoing crisis, but this pandemic will not be over by December," Burger said in a press release. "Nurses urge that OSHA adopt a permanent standard on COVID-19 without delay."
The COVID-19 healthcare ETS has mandated requirements for employers, with penalties for violations, on infection control protections in healthcare settings. Allowing it to expire without adopting a permanent standard would mean more transmission of the virus, more hospitalizations, and more deaths from COVID-19, Burger said.
"Nurses and other healthcare workers haven’t had one day’s rest for this entire pandemic," she said. "We stood up on the front lines of COVID to save lives when we were needed most, including in the days when our employers, with no repercussions, told us that we could wear bandanas as PPE. It was a major step forward when OSHA issued the COVID-19 healthcare ETS in June, and it is imperative that OSHA maintain these lifesaving protections by issuing a permanent COVID-19 standard to ensure nurses and other healthcare workers can protect our patients."
Adoption of a permanent OSHA standard on COVID-19 in healthcare workplaces should be built on current ETS requirements, the precautionary principle, and updated scientific knowledge of the virus, NNU says.
Such a standard should include:
All healthcare employers must have written infection control safety and implementation plans, developed in consultation with non-management employees and their representatives.
All nurses and other frontline healthcare workers exposed to COVID-19 must be provided optimal PPE against aerosol transmission of the virus, including respiratory protection, eye protection, protective clothing, and gloves.
Protective requirements on notification of healthcare employees exposed to COVID-19 in the workplace.
Provision of pay and benefits for those who must take time off because of exposure or infection.
Mandates on screening and testing of patients and visitors, mask wearing, physical distancing, and ventilation in the workplace.
"This is still a dangerous and deadly pandemic. People in the United States continue to be infected and die and nurses and other frontline caregivers remain in danger," Burger said. "We can’t let our guard down now."
As of this week, 458 RNs have died of COVID-19, among 4,547 healthcare worker deaths overall, according to NNU tracking data. Since the data has not been collected in many places, a full accounting may never be known. At least 1,037,083 healthcare workers have been infected, according to NNU.
Careful communication is the top tool for creating a culture of patient safety, CNO Andrea Truex says.
The most effective tool for patient safety? Frequent and thorough communication throughout each shift, says Andrea Truex, MSN, RN, chief nursing officer of Englewood (Florida) Community Hospital, which consistently receives high safety grades.
Under her leadership, the hospital has received 18 consecutive "A" Leapfrog Hospital Safety Grades, a national distinction recognizing achievements protecting patients from errors, injuries, accidents, and infections. Leapfrog is an industry standard for safety, quality of care, and patient experience, particularly for insurance agencies that check grades before recommending facilities to their clientele, Truex says.
Englewood is one of only 41 "Straight A" hospitals to be awarded an "A" in every grading cycle since 2012.
HealthLeaders spoke to Truex about how Englewood has achieved such high safety ratings and how other hospitals can achieve the same.
This conversation has been lightly edited for length and clarity.
HealthLeaders: How do most errors, injuries, accidents, and infections occur in hospitals?
Andrea Truex: The biggest opportunity is miscommunication or failure to communicate. In the medical arena we have several opportunities to do what we call handoff communication. Anytime we are transitioning a patient to different levels of care or between caregivers, that opportunity occurs.
[When errors or injuries do occur], it typically involves a process issue, not a people issue. Sometimes we set people up for failure because perhaps a process was set in place, prior to other changes happening in healthcare, and it sounded good and looked good, and maybe it was put in place by individuals that potentially don't practice at the bedside. And the next thing you know, it really is not an efficient process for staff, and they begin doing workarounds to make it more efficient, and then it presents safety concerns. We need to stop and pause and ensure purpose over tasks to ensure that we're keeping people safe.
HL: How does a nurse executive build a culture of safety and create that expectation?
Truex: From the very beginning, we teach all caregivers that we have a no-passing zone for call lights. That's for the patients' safety but also for the patients' experience so that they know someone is addressing their needs. And that's inclusive of me, so when I'm out and about and a call light is on, I go in the patient's room and that's a great time for me to assess the patient, their white communication board, the content that's on that, see what the patient understands about their plan of care, how frequently we've rounded on them, and if their nurse leader rounds on them.
That's another avenue in transcending my beliefs and practices into the nurse leaders that I have hired or groomed. Many of the nurse leaders have been here quite a long time and they've grown from basic positions all the way up into director positions now and they know my expectations.
But they also do what is called nurse leader rounding every day where the unit director, the charge nurses, and our nursing supervisors round on every patient every day to ensure not only that we are meeting their expectations, but while the nurse leaders are in the patient's room, they also are assessing for some of those safety items as well.
HL: How effective are you finding that to be?
Truex: If you look up our Press Ganey score related to this, our patients are saying that 98% of the time they see a nurse leader every day. We record the rounds and any issues that come up, and that gets emailed to me every night so I can compare our percentage of compliance of rounds to what the patients are saying and there's minimal difference. That means to me that the rounds are very effective and we're connecting with the patient.
HL: What are some of the industry safety standards that hospitals strive for?
Truex: At HCA, we compare ourselves amongst each other always, and we here at Englewood were just recognized as No. 8 in HCA in preventing harm to our patients, plus, this has been our 18th consecutive reporting period that we've been a Leapfrog "A" facility.
The other industry standard is the CMS [Centers for Medicare & Medicaid Services] star rating, and we are a four-star hospital. The highest you can be is a five star and we, at that time, were not able to obtain that because you had to have an intensivist program for your ICU [intensive care unit]. And I'm so excited because we just brought that up live on October 1. So, we believe that in the next reporting period that we will be able to fill in our data and hopefully end up being at true five-star CMS hospital which will be stellar.
HL: Let's talk about the Leapfrog grades. What are some things Englewood is doing to earn those "A"grades?
Truex: Because opportunities for failure can happen around communication, we have every day in every department at change of shift what we call safety huddle. And in that safety huddle specifically on the unit there is a very big focus on who are high-risk fall patients and what kind of lines we have in, because lines are an opportunity for infection. Are there any concerning patients that we want to keep an extra eye on today? It's a great sharing of information from the off-going shift to the oncoming shift.
The other strategy is we do bedside shift report that involves the patient. Both nurses [from each shift] physically go into the bedside, introduce themselves to the patient and assess the lines and drains that are in place, ensure the IV is set at the right rate, look at the Foley catheter that's there, and any other drains they have.
The patient can chime in anytime. We talk about if they're having pain and how that's been managed, and also what the plan of care is and what their goal is for the day. It's a great way to have open communication with the patient and with each other to look that everything is as you want it to be. With a fresh surgical patient, you're both looking at the dressing and seeing what it looks like so that you can compare shift to shift to ensure there's no significant change.
We also, as a leadership team, have morning safety huddle as well, so that there's an extra set of eyes on any of those high-risk items and that we can ask any questions that we have and ensure actions are being taken to get lines out and ensuring people are receiving the appropriate level of care. So those are all great, great strategies that have been a huge help to us.
HL: What is one thing that every hospital could start doing right now and immediately increase their safety rates?
Truex: I would say it has to be a very invigorated focus on handoff communication. Even though that was a National Patient Safety Goal [issued by the Joint Commission] two to three years ago, it is not as hard-wired as it should be. We, ourselves, just started having the ER call report to the floor because it seemed there were a lot of distractions when a patient was going from the ER to the floor.
For every single handoff, not only between departments—when a patient is coming out of surgery, when a patient's coming back from X-ray—there should be that touchpoint that everything is hooked up and the patient's doing well. As healthcare, we could probably prevent some events by ensuring that process was very much hardwired.
Novant executive claimed in lawsuit that he was fired because he is a white male.
The attorney for a former top executive of Novant Health who was awarded $10 million Tuesday by a federal jury says the discrimination lawsuit was not a statement against diversity and inclusion initiatives.
David Duvall's 2019 lawsuit said he lost his job as senior vice president of marketing and communication the year before because of Novant's effort to diversify its top leadership—and he is a white male. The firing came without warning or explanation shortly before his fifth anniversary with the North Carolina-based health system, and he was replaced by two women, one Black and one white, according to the lawsuit.
Duvall accused Novant of violating Title VII of the Civil Rights Act, which prohibits race and gender discrimination in the workplace.
"The jury learned that Duvall was a strong advocate of diversity and inclusion at Novant; that was one irony in his termination," his attorney, S. Luke Largess, said in a statement. "We are pleased that the jury agreed that Mr. Duvall’s race and gender were unlawful factors in his termination—that he was fired to make room for more diverse leaders at Novant Health."
News outlets report the jury said Novant Health failed to prove it would have dismissed Duvall regardless of his race.
"We believe the punitive damages award is a message that an employer cannot terminate and replace employees simply based on their race or gender in order to achieve greater diversity in the workforce," Largess said. "It is plainly unlawful and that was obvious to the jury."
Novant plans to appeal, according to a statement issued by the company.
"We are extremely disappointed with the verdict as we believe it is not supported by the evidence presented at trial, which includes our reason for Mr. Duvall’s termination. We will pursue all legal options, including appeal, over the next several weeks and months," the statement reads.
"Novant Health is one of thousands of organizations to put in place robust diversity and inclusion programs, which we believe can co-exist alongside strong non-discriminatory policies that extend to all races and genders, including white men," the statement concluded. "It’s important for all current and future team members to know that this verdict will not change Novant Health’s steadfast commitment to diversity, inclusion, and equity for all."
ScionHealth will launch via a combination of Kindred’s long-term acute care hospitals and 18 of LifePoint’s community hospitals.
ScionHealth, a new healthcare company, will be created from LifePoint Health's acquisition of Kindred Healthcare upon closing of their previously announced transaction.
ScionHealth, to be headquartered in Louisville, Kentucky, will consist of 79 hospital campuses in 25 states, including Kindred’s 61 long-term acute care hospitals and 18 of LifePoint’s community hospitals and associated health systems.
"As our teams began to examine how best to bring together the operations of LifePoint and Kindred, it became increasingly clear that we had the right mix of talent, services, and assets to reorganize into two strong companies to better serve our patients and communities," said David Dill, president and CEO of LifePoint.
"In forming two companies with unique areas of focus, LifePoint Health and ScionHealth can improve access to quality care, create more opportunities for our employees, and invest in our communities," Dill said in a press release.
The new healthcare company will be led by a management team drawing from both LifePoint and Kindred. Rob Jay, currently serving as executive vice president of integrated operations at LifePoint, will serve as the chief executive officer (CEO) of ScionHealth.
"The prospect of launching ScionHealth is exciting for our teams and our communities, and I'm honored to serve as the company's founding CEO," Jay said. "In forming ScionHealth, we selected a cohesive group of community health systems across the LifePoint and Kindred footprint that would benefit from focused attention, resources, and investment. We are looking forward to extending the legacies of LifePoint Health and Kindred Healthcare, honoring Kindred's important corporate leadership role in Louisville, and creating a new platform for growth and innovation in community healthcare."
At the close of the transaction, LifePoint will combine its 65+ remaining hospital campuses as well as its network of physician practices and outpatient centers with Kindred’s rehabilitation and behavioral health businesses. LifePoint will continue to be headquartered in Nashville, Tennessee, and David Dill will remain its president and CEO.
Benjamin A. Breier, CEO of Kindred Healthcare, will, upon close, depart Kindred Healthcare as a result of the transaction.
LifePoint and ScionHealth will have separate leadership and boards of directors. Each ScionHealth hospital will operate under the same name it does today, and their communities will continue to receive quality care delivered by familiar providers.
Upon the completion of regulatory approvals and satisfaction of customary closing conditions, the acquisition of Kindred and the launch of ScionHealth are expected to be completed by the end of the year.
At closing, LifePoint and ScionHealth anticipate entering into transition services arrangements to support operations at both companies.
The nursing school's efforts 'reflect the true spirit of nursing and of the NP profession,' American Association of Nurse Practitioners president said.
"University of South Carolina nursing students and faculty have volunteered nearly 7,000 hours of service to vaccinate South Carolinians at COVID-19 mass vaccination clinics across the state," Kapu said at the ceremony in Columbia, South Carolina.
"Their commitment, compassion, and courage in the face of an unprecedented public health crisis reflect the true spirit of nursing and of the NP profession," she said. "We cannot thank them enough for their life-saving assistance to patients, and we want them to know how proud they have made our nation's NPs.
"These students, and faculty mentors, represent the very best of nursing and of the NP profession. Their dedication during a public health crisis gives me every confidence in the future of health care and the nursing profession."
At the start of UofSC's spring semester in January 2021, the College of Nursing launched a massive effort to support statewide vaccinations. The first 51 students arrived on the opening day of the Prisma Health Midlands vaccination site, according to the university.
Based on the overwhelming demand for vaccinations, 670 UofSC nursing students and 66 faculty members answered the call, the university said, delivering vaccines at nine Midlands vaccination sites and volunteering 6,839 hours.
Because good leadership is key in retaining nurses, Salazar is taking the culture of nursing excellence she built as chief nursing officer (CNO) for nearly seven years at HCA's Oak Hill Hospital in Brooksville, Fla., before becoming CNE in early 2020, and expanding it throughout the division's 15 acute care hospitals.
"Our next generation of nurses is very important," she says. "My reasons are twofold; No. 1, because our nurse turnover rates are high, but No. 2, two of my daughters are nurses and I have a personal stake in it."
HealthLeaders spoke to Salazar about how she finds and builds strong nurse leaders for her division.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Why is nurse leadership of such relevance to you?
Leanne Salazar: Leadership is really the key to nursing retention, and we experienced a shortage in nursing leaders, as well, so attracting and retaining nursing leaders has been a top focus over this past year. [Oak Hill has] seen a 140% reduction in new nurse leader turnover year-over-year. I was a chief nurse for six and a half years, and we really built a culture of nursing excellence, and that's what I'm trying to duplicate at a higher level up the division.
HL: What are some of those steps you're doing to create a culture of nursing excellence?
Salazar: The first is obviously attracting the best talent, so really leaning in and developing a pipeline of new nurse nursing leaders. I am involved in the interview process of all nurse managers, directors, and up. There are two reasons for that. No. 1, when they get to me, I really am looking for culture; I'm not looking at their degrees. If they already got all the way up to me, then obviously they meet the minimum requirements.
No. 2, I'm looking for somebody who really has the heart and the compassion to lead. They have to take care of people who are taking care of the patients, so it really is an art.
We started a Nurse Leader Fellowship, and that's a 12-month program for new nurse leaders where they meet with me every single month. We kick it off with a three-hour orientation where they get one-on-one time with me and other nursing executives.
Then, for every month for the next 12 months, we have sessions with them where we bring in executives at all different levels to really work with them and to develop them. We do individual development plans to help them grow to meet their professional aspirations.
HL: What do they learn in those monthly sessions?
Salazar: We've had several chief nurse executives who have talked about culture and how you develop a culture. We've done different workshops with them on teaching the "why" behind the "what" of teaching nurses at the bedside. Why we do, for example, bedside shift reporting and what that looks like in a safe culture.
Another [workshop] talks about, how do you hire for fit? What does that look like? They go into detail about what they look for in their nurses when they hire. How do you develop those new nurses? Because remember, we're teaching leaders now, so how do you choose and select the right nurse for your organization?
We had one of our CNOs recently speak about wellness and resiliency. Our next session coming up is about really reconnecting to our "why." This last couple of years has been tough and we've been navigating these uncharted waters together, so you know they've been extremely resilient.
We've had our president [of HCA’s West Florida Division], Dr. Ravi Chari, speak to the group. We've had our VP of human resources speak to the group, and our chief medical officers recently spoke to our obstetrics leaders to help them on some of our quality metrics. It's a multidisciplinary approach to supporting the new nurse leader, and I truly believe what's led to this reduction of first-year nurse leader turnover is focusing on them and supporting them.
HL: Are most of these new nurse leaders new to the company or are they brand new as a nurse leader?
Salazar: Actually, it's both. Most of them are new to leadership or they're stepping up in leadership. Maybe they were a charge nurse or supervisor somewhere and now they're a manager or director. But we also have leaders, managers, and directors that come in from another organization, and we want to assimilate them into the HCA West Florida Division culture and what our standards look like and teach them how we do what we do and why we do what we do. So, they're incorporated into the Nurse Leader Fellowship, as well.
HL: What other kinds of new CNO programs do you offer?
Salazar: We have several. We do the Leadership Development Institute and we go into each market and have all nursing leaders, including the CNOs. That session is really focused on gratitude and resiliency, and I'm really excited about that. We're giving our nurse leaders a journal and we're giving them the power of "moments"—how to make ordinary things extraordinary for our teams. Again, this is focused on taking care of those who are taking care of the patients and that's really what that's about.
For our assistant chief nurses, we have an advanced leadership course that probably 80% of them have gone through. They have to be here for at least six months and then we put them through advanced, corporatewide training and it incorporates different classes and executive projects. It's a good, structured program, and we've seen great success. Our most recent graduate was just promoted recently to chief nurse, so we're really excited about her.
And then for our chief nurses we have a corporate coach that comes in. She's a coach and a mentor and she meets with all my new chief nurses. And then I, of course, meet with them every week for the first three months and then I meet with them monthly.
HL: Chief nurses are more involved now in the business side of a hospital or health system. Is that factored into your new-CNO training?
Salazar: Yes. One great thing about being a nurse executive is that we have a seat at the table—an equal seat to the chief financial officer and the chief medical officer—so that really gives us that voice. And by being there, we are responsible for strategic plans, budgets, and those types of things.
HL: Sounds like you're very hands-on.
Salazar: It's important, because if we can't stabilize our nursing leadership team, then it's very difficult to stabilize nursing, so that's why I feel that our focus on our nursing leaders is critical.
Reports allow hospitals to make 'the most informed staffing decision possible,' COO says.
As nurses are quitting across the country—for reasons including staffing, vaccine mandates, retirement, and taking higher-paying jobs as travel or contract nurses—hospitals and health systems are relying more on contract labor and are faced with constantly changing rates for RNs and other healthcare positions.
They're finding ongoing volatility in contract wages for nurses. Current online job postings in ICUs across the country have weekly salaries listed of up to $6,000 a week, which makes it imperative that hospitals understand how their rates compare to others within their market.
To help organizations address challenges created by the nurse shortage, Hallmark Health Care Solutions (HHCS), a healthcare consulting and technology firm headquartered in New York City, is providing the industry with real-time hourly nurse rates as well as benchmark rates for more than 300 clinical and non-clinical roles.
"We've seen firsthand the struggles that hospitals are having right now when it comes to filling open nurse and RT slots," says William Reau, chief operating officer of HHCS.
"Most hospitals are getting hit with exorbitant premium and agency rates, and really should have a resource that provides them with benchmark data," Reau says. "To answer this need, we've decided to publish competitive rate data and make it available to any, and all healthcare organizations so that they can make the most informed staffing decision possible."
In today’s healthcare labor market, contract labor rates change almost daily, so it’s important to have a baseline as well as a current snapshot of your competitive landscape. The Einstein II Labor Rate Reports were developed to do just that.
With the data in these reports, hospitals and other healthcare organizations can better manage their contingent labor spend by comparing their rates to agency rates within their state.
Hospitals in New York looking to hire travel nurses would find that during the period of September 21 through October 21, 2021, agencies were getting paid $125-$165 per hour for med/surg nurses, according to the HHCS report. Florida hospitals looking to hire temporary med/surg nurses during that time frame could expect to pay agencies $100-$115 per hour.
Agencies supplying intensive care unit (ICU) nurses in New York were paid $175-$209 per hour during that period, while Florida hospitals were paying agencies $146-$175 for ICU nurses, HHCS reports.
Upon request, organizations automatically receive two separate reports. The first report contains real-time nurse rate data which is immediately actionable; the second is the Einstein II Semi-Annual Rate Report which contains three benchmarking data sets—clinical rates, allied-health rates, and non-clinical rates.
The Semi-Annual report is an ideal reference for rate analysis and forecasting. Both reports show high and low bill rates for specific positions within a selected state or for multiple states.
Editor's note: The pay rates listed in the story apply to the staffing agencies, not the nurses' hourly pay rates as previously indicated. This story was updated on October 28, 2021.
