Nurses on healthcare's front lines are a valuable weapon in spotting trafficking victims, an AHA director says.

The American Hospital Association's (AHA) Hospitals Against Violence initiative kicked off its latest gathering in a series of events focused on hospitals’ and health systems’ efforts to identify and prevent human trafficking.

The event, C-Suite Virtual Convening, held this week, was part of ongoing efforts to provide resources to healthcare providers across the nation who are fighting the affliction of human trafficking. Human trafficking—both sex and labor trafficking—affects nearly every community, and victims frequently turn to hospitals for treatment.

Mary Beth Kingston, chief nursing officer at Advocate Aurora Health, AHA Board of Trustees member, and chair of the Hospitals Against Violence (HAV) advisory group, welcomed more than 150 leaders working to support, implement, and amplify strategies to combat human trafficking in the healthcare system, according to AHA. 

Claire Zangerle, chief nurse executive at Allegheny Health Network, Lloyd Dean, CEO at CommonSpirit Health, and Brian Gragnolati, CEO at Atlantic Health System, emphasized the importance of expanding leadership capacity to combat this global issue and encouraged participants to tap into the broad curated resources and tools available through the initiative, AHA said.

Other highlights included sessions on federal efforts to support hospitals in addressing human trafficking; a status report on anti-trafficking efforts in healthcare; and a case study from the Texas Hospital Association outlining work to implement legislation requiring human trafficking identification and response training for providers, AHA said.

It's important to train nurses to spot trafficking victims because of their place on the front line of care every day, Laura Castellanos, AHA associate director, told the American Organization for Nurse Leadership's (AONL) Voice of Nursing Leadership magazine.

"Human trafficking victims are not always easy to spot, much less treat, for both the physical and mental abuse they have experienced," she told the magazine. "Training can help nurses identify and assess suspected victims and understand how to administer trauma-informed care. It can also help caregivers learn how to connect victims with community resources that can assist the recovery process."

AHA’s Hospitals Against Violence initiative has partnered with Jones Day law firm and HEAL Trafficking (Health, Education, Advocacy, and Linkage), a multidisciplinary group of more than 3,100 survivors and professionals in 35 countries dedicated to ending human trafficking and supporting its survivors, from a public health perspective. HEAL Trafficking provides toolkits and other resources to aid caregivers and organizations in creating policies and procedures.

The initiative has two upcoming events for healthcare professionals:

Empowering the Workforce in the Fight Against Human Trafficking

Tuesday April 27, 2021

11:00 a.m. to 1:00 p.m. EST/10:00 a.m. to 12:00 p.m. CST

This working session is designed for clinical, programmatic, and community leaders who are interested or have implemented human trafficking response programs in healthcare settings. Participants will receive key insights, including:

• Actionable steps on building response programs

• Increased knowledge on reporting and educational requirements

• Best practices for identification and assessment

• Strategies for building community and survivor allies

Banding Together in the Fight Against Human Trafficking

Thursday, June 3, 2021

11:00 a.m. to 1:00 p.m. EST/10:00 a.m. to 12:00 p.m. CST

This virtual workshop welcomes all healthcare professionals and partners combating sex and/or labor trafficking. This program will summarize key insights from prior convenings and give participants the opportunity to learn from human trafficking experts, survivors, and healthcare leaders who have anti-trafficking efforts in their organizations.

 

For more information on the Hospitals Against Violence initiative, visit https://www.aha.org/combating-human-trafficking, call 800-424-4301, or email HospitalsAgainstViolence@aha.org

 

Program's goal is to 'make a difference in the lives of those who suffer from health inequity,' new chair says.

Shrinking health disparities for people of color and marginalized communities while educating nursing students through experiential and interprofessional learning will "set us apart from other nursing programs," says Tiffany Morris, DNP, MS Ed., MSN, RN, CNE, inaugural chair of a nursing department that debuts this fall at Elon University in Elon, North Carolina.

Morris, who previously worked at North Carolina A&T State University School of Nursing as interim director, began her role March 1 as chair for the School of Health Sciences' department of nursing that begins in August with about 100 students.

Morris and Becky Neiduski, dean of the School of Health Sciences, have been "intentional" in designing the course curriculum to build "nurses of the future," they say.

"One, we're definitely in the game to combat the national nursing shortage as well as a state nursing shortage," Morris says. "And the paradigm shift in how we are to educate nurses of the future is that Elon has designed a nursing program that will address interprofessional collaboration, diversity, equity, inclusion, and then this holistic approach and critical reflection to solve global world problems."

Addressing Health Disparities

"We know that COVID-19 took the cover off of healthcare, because I think people knew it existed," Morris says, "but it has really opened our eyes to knowing what the disparities are in terms of health equity."

A 2020 study by the North Carolina Health News indicated the state is slow to eliminate inequalities in healthcare so Elon University leaders decided to take the lead on addressing those disparities, Morris says.

"We've got two courses designated to help disparities [and] health equity, and that's just on the ground level," she says.

"Not only are we going to be intentional in the classroom but also in our clinical learning experience," Morris says. "We have experiential learning opportunities, starting with the first course in nursing foundation and health assessments, where we're actually utilizing spaces in the community that typically may be viewed as areas where there's disparity and, I hate to use that word, marginalized communities, but those that typically have less access to healthcare."

Learning Through Interprofessional Education

The School of Health Sciences provides interprofessional education for students to learn collaboratively in preparation for the healthcare industry, Neiduski says.

And while the nursing department's new simulation suite center with rooms that imitate clinical learning experiences will provide state-of-the-art fundamentals of nursing, the program goes much further, Morris says.    

"Often nursing programs are, of course, emphasizing the skill—the technical skill, the tactile skill—of nursing, but our model is going to be a value-based model of healthcare, so we're going to be very agile in population-level data [and] fiscally minded," Morris says.

"If you polled any nurse now and asked, 'What did you learn about how to be fiscally responsible? Did you understand value-based care? How did you use your population data to solve problems?,' they may have been discussed and reviewed, but that's our mantra," she says. "That's going to be our charge where we actually leverage this information to optimize healthcare quality and outcomes."

Of the estimated 100 students in the first class, 50 will be in the four-year bachelor of nursing program and an additional 50 will be in the accelerated 16-month track, Morris says.

"If you really truly want to make a difference in the lives of those who suffer from health inequity," she says, "it is going to be the place to make a difference."

Colorado nurse executives unite to help each other through COVID-19 and other challenges while coalescing the state's voice of nursing.

What began as a regular pre-COVID informal working happy hour of three or four chief nursing officers (CNO) who knew each other from the Denver marketplace evolved into an influential circle of nurse executives from competing health systems focused on helping each other through the COVID-19 pandemic and other professional challenges while enhancing the voice of nursing in Colorado.

Kathy Boyle, CNO of Denver Health, a 555-bed Level 1 trauma hospital, spearheaded the group comprised of CNOs from the state's largest health systems so she and her high-level counterparts could trade professional assistance, information, and support.

Although Boyle and her peers are members of the Colorado Organization of Nurse Leaders, they craved a stronger, more focused connection.

"We wanted a group that was specific to our level of leadership," she says.

And so, the Chief Nurse Executive Collaborative was founded.

Creating Stronger Bonds

The initial informal group evolved and became more formalized in fits and starts. After COVID-19 hit and did away with gathering at local restaurants for their working happy hours, Boyle and the others tried to keep the connection going with Friday afternoon conference calls. That effort didn't work, she says.

"And then in October [2020], I just said, 'I'm going to get a list of the key CNOs in all of our major [health] systems … and try to get us together as a group," Boyle says.

Boyle put her plan in motion and invited key chief nurse executives and CNOs from Colorado's major health systems—Banner Health, Centura Health, Sisters of Charity of Leavenworth Health System, HealthONE, UCHealth, Boulder Community Health, and Childrens Hospital Colorado (CHC)—to join their group and participate in regular virtual meetings through the WebEx platform.

All eight invited nurse executives accepted the request and initially met every day. Virtual gatherings eventually tapered off to three times per week before finally settling on a weekly meeting each Wednesday, which they continue to do today.

The eight-member group discusses everything that is happening in their professional world, which, initially, was dominated by the COVID-19 pandemic. In the beginning, they sought and shared information on COVID volumes, staffing strategies, and how to support their staffs and encourage resiliency as their hospitals filled with critically ill COVID patients.

They also conferred about working with their chief medical officers (CMO); plans for continuing elective surgeries when they were allowed again; workforce equipment; patient care in general; and any innovative strategies they could share.

They didn’t discuss every topic at every meeting, and some meetings were shorter than others.

Currently, the meetings, which are still virtual, begin with a 30-minute presentation from the incident commander with the Colorado Department of Public Health and Environment reporting on COVID response. The nurse executives follow the report with discussions on vaccine progress, how vaccine clinics are functioning, and other relevant subjects.

COVID, Healthcare Laws, and Beyond

While COVID remains at the forefront of their discussions for now, the group also talks about other matters affecting their work, such as health-related issues that are before the state legislature.

Last year, for example, the Colorado General Assembly considered measures related to the regulation of healthcare facilities, behavioral health, prescription drug costs, and substance use.

Also in the 2020 session, the legislature considered the future of the Colorado Nurse Practice Act and State Board of Nursing. All regulatory agencies in Colorado must be re-evaluated every 10 years to determine they are effective enough to continue to exist, and the State Board of Nursing was up for review in 2020. The board and Colorado Nurse Practice Act were renewed.

Building Bridges in Healthcare

The nurse executives have prioritized building alliances with other healthcare organizations to bring consistency and cohesion to Colorado's nurses, particularly because this small group is accountable for most of the state's nurses, Boyle says.

Most of the collaborative's individual members have a strong connection with the Colorado Center for Nursing Excellence, so they ask its president and CEO Ingrid Johnson [DNP, MPP, RN], to occasionally join their meetings, Boyle says.

"We're also building bridges with the Colorado Nurses Association, the state health department," she says, "and anybody else we can think of that we should have a strong connection with as being the voice of nursing."

Looking out for each other

Along with sharing professional ideas and strategies, members of the Chief Nurse Executive Collaborative look out for each other, too. When the nurse executives were working so long and hard during COVID surges—Boyle went eight or nine months without a single day off—the members encouraged each other to step back and take a break, she says.

"One of the things we talked about is that we wanted to support one another in taking time for ourselves," she says. "It's important to recharge, so when somebody in the group says, 'I'm going to take vacation next week,' we're all celebrating that they're doing that for themself."

The camaraderie and alliance that have developed through the collaborative have been inspiring, Boyle says.

"One of the things that we have said is how this has been a great support to us, because we came together in the spirit of being aligned," she says, "and we really wanted to be supportive of one another with COVID because we have very much in common."

"That WebEx face-to-face connection on a weekly basis is very powerful," she adds. "It's amazing, the connections that have been created, and we're really looking forward to someday being together in person."

Having her colleagues as a sounding board and connecting is "kind of a joy," Boyle says. "It is hard to even describe the relief that it is to share with people that are facing common challenges [and] issues."

"We've been meeting for about five months with this regularity," she says, "and it is a huge support to me as the chief nurse."

Health systems are employing temporary nurse leaders to help executives take a much-needed break.

Nursing executives experiencing stress and fatigue from COVID-19 are getting relief, in the form of time off and workload help, from interim executives to provide the break they need to avoid burnout.

Much of the burnout discussion has focused on frontline and direct care nursing staff, especially during the COVID-19 pandemic. But chief nursing executives and other nurse leaders operate within the same volatile environments while also managing organizational, disciplinary, and operational stress, according to the study, Nurse Leader Burnout: How to Find Your Joy.

Some nurse executives have had few, if any, days off since COVID-19 was declared a pandemic by the World Health Organization (WHO) last March, says Brian Krehbiel, a senior partner and expert on interim leadership with WittKieffer, a global executive search firm headquartered in Chicago that specializes in senior-level, mid-level, and interim executive search.

"In hot spot areas hit early on—New York, Seattle, etc.—people have been working 6-7 days a week since March," he says. "The impact on the workforce has been the most acute in places hit hard by COVID and in those places where inpatient capacity is in short supply."

That's why some health systems are placing interim executives into rotation to help current executives take a much-needed break and return to a regular work schedule, he says.

Krehbiel talked with HealthLeaders about this trend. This transcript has been edited for clarity and brevity.

HealthLeaders: How often are health systems turning to interims to give their CNOs a break?

Brian Krehbiel: This is something really new—in the past couple of months—as hospitals have gone through the cycle and it’s become clear that even though we have the COVID vaccine, it’s going to be a slow process. At the end of 2020, nurses were asking if the hospitals were changing their PTO carryover processes and it really shined a light on how little PTO was being used. All in all, stress levels on employees are something health systems are going to have to address fairly quickly.

HL: What are some of the effects, at that leadership level, of working so much?

Krehbiel: I've had the opportunity to discuss the toll this is taking with health system CEOs and HR executives. A lot of nurses have the instinct to sacrifice for the greater good, meaning that they work and work until their cup of energy wears down and stress starts to take a greater toll. Now, a year after COVID started spreading across the U.S., we’re getting to the point where these CNOs are frazzled.

HL: Who are the interim CNOs that you recruit and what qualities and skills do you look for when you're recruiting them? 

Krehbiel: Typically, the leaders looking to fill these roles are late in their careers and want to stay active, but also want more flexibility in where and when they do their work. Most importantly, we look for an interim’s ability to communicate and deal with complex situations. Obviously, talent is important, but we also try to make sure their personality meshes with the organization’s culture well, so they feel at home and there is a high level of mutual trust.

HL: What happens when an interim CNO is placed in an organizational culture and structure that varies from his or her background? Have you seen issues arise because of this? 

Krehbiel: It is hard to send someone from Louisiana to Manhattan or vice versa. We try to make the best match possible so that when an interim enters the rotation at a new organization it is a smooth handoff.

HL: How does adding an interim into a hospital system work, exactly?

Krehbiel: Currently, these search processes are occurring virtually. We can typically find a credible interim within one week compared to a search for a permanent placement, which would take six to nine months. These interim placements are often overqualified, coming into a 200-bed hospital with experience at a 600- to 700-bed hospital. For example, we worked with two interim CNO placements who went to hospitals in the Northeast and were able to get everything stabilized quickly. Now, one of those interims has been asked to stay on permanently and the other did so well that the hospital is delaying its search for a permanent CNO for six months.

HL: How long would an interim serve in that role?

Krehbiel: For COVID-related interim CNO placements, we typically have the interim go for 12 weeks. An average interim placement is a seven-month process, but for [COVID-related help], it would be a bit shorter. It’s also very customized to each facility.

HL: Besides giving nurse leaders much-needed time off, what are other benefits of hiring an interim right now?

Krehbiel: Permanent CNO job searches are taking longer right now, as many candidates don’t want to change cities, schools, etc., right now. We have found it easier to hire interim CNOs quickly compared to filling these permanent roles. Additionally, organizations are often more comfortable hiring an interim virtually, whereas they would prefer to meet with a permanent replacement in person before making a decision. Because these interims are often overqualified, they can usually adjust and transition pretty easily as well.

HL: How do you measure success in these types of placement?

Krehbiel: We take our direction from our client hospitals and measure our success against the priorities they have outlined at the inception of the project.