There has been a generational shift in what to expect from nursing as a profession, according to this CNE.
On this episode of HL Shorts, we hear from Melanie Heuston, chief nurse executive at WVU Medicine, and HealthLeaders Exchange member, about what new graduate nurses are expecting from the job in 2024. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Hear more about how nurses and nurse leaders can help patients engage with their healthcare, in and out of the hospital.
Nurses wear many hats in the industry, but their primary focus is on patient interaction and care delivery.
Both nurses and nurse leaders play pivotal roles in making sure that patients engage with preventative care measures and patient education programs. It's also the CNO's job to ensure the effectiveness of remote patient monitoring programs and to find creative solutions for dealing with social determinants of health.
According to Cassie Lewis, chief nursing officer at Bon Secours’ Richmond market, part of Bon Secours Mercy Health, and HealthLeaders Exchange member, improving patient engagement begins with the day-to-day interactions between the patient and the bedside nurses who care for them.
"Those subtle interactions that they can do with our patients everyday can truly make such a difference in how patients view our healthcare system and how they view their care," Lewis said. "Trying to emphasize this for our teams and making sure…they understand the importance and what they can do for our patients is the first step in helping them engage in a more meaningful way."
Building trust and communication between nurses and patients is also critical to patient engagement, according to Lewis.
"One solution that we have really tried to emphasize here is the importance of bedside shift reports and good handoffs," Lewis said. "It's really important to start developing trust with the patients and including them in their care, versus keeping them on the outside looking in."
Lewis recommended that CNOs leverage technology to build robust, individualized patient education and remote patient monitoring programs, while considering social determinants of health. Clinical nurse specialists, nurse practitioners, and nurse educators all play a key role in these processes.
"We know that it's not a one-stop shop for every single patient that comes in our door," Lewis said, "and while we have great things we can augment with technology […], [we need] to take that one step further."
Listen to this week's episode of the HealthLeaders Podcast to hear more about how nurses and nurse leaders can help patients engage with their healthcare, in and out of the hospital.
The W-2 on-demand staffing model is a win-win for health systems, nurses, and patients, according to this CNO.
A lot has changed in nursing in the past few years, specifically in staffing.
Healthcare has become more virtual, and flexible scheduling models have replaced more traditional ones, and it's up to CNOs to consider innovative staffing solutions to address these challenges.
"COVID taught us that a lot of things can be done remotely," Garnica said. "We have a lot of telehealth, we have a lot of things out there outside of just acute care in the hospital, and that's attractive to a lot of nurses."
Garnica also explained how the competitiveness of the market has increased since the pandemic, which does not help with the nursing shortage.
"Everybody needs nurses, and we're not only competing with hospitals," Garnica said, "we're competing with all of those other venues as well."
Nurses are now looking for flexible schedule options beyond just full and part time, and they are looking for strong benefits.
"That's a challenge for hospitals who traditionally had believed that your core staffing should be about 85%," Garnica said, "[with] very little contingent staffing."
Due to these changes, SSM Health is trying something different.
The W-2 on-demand model
During the pandemic, Garnica explained that SSM Health had to quickly shift to other staffing models out of necessity. The health system began using external or third-party staffing agencies, with contracted nurses who were often coming from faraway places across the country.
"They're doing their contract, [then] they're exiting, and […] although it's a short-term solution, you have a staff and a nurse at the bedside," Garnica said. "It creates some long-term challenges not only with cost, but just around longevity, loyalty, [and] sustainability for outcomes."
Enter the on-demand model.
"An on-demand model gives us the ability to adjust our staffing needs very quickly, use nurses when we need them, flex them, [and] maybe offer [them] to other areas when we don't need them," Garnica said. "It also created a lot of loyalty and longevity with local nurses."
Garnica said the health system now gets local nurses from St. Louis through their partnership with ShiftMed, and since they all work in the area and in other local markets, the nurses can build relationships with one another.
"They're helping to sort of recruit and sustain one another," Garnica said. "So, you're getting this wonderful on demand support that understands the market, they're there to support your ministry, [and] they have relationships with your own staff."
Beginning the process
Ultimately, this new model led SSM Health to convert more than 100 on-demand nurses into full-time staff, and according to Garnica, the first step in making this change was helping the nurses to understand why it was happening.
"Helping our staff understand why we were making that shift and then engaging them in the process was probably one of our biggest successes," Garnica said, "because again, they are our best recruiters."
Garnica said that leadership had many discussions with core staff, and that they provided tools to help welcome and onboard the on-demand nurses. The goal was to have the core staff build relationships and express why SSM Health St. Mary's is a good place to work, Garnica said, and to make the on-demand nurses consider what it would be like to be a permanent employee.
"We offered some unique PRN options and things that we thought would be a nice complement for those folks," Garnica said, "and I think our conversion of those nurses to onboard to our own staff, really I would credit our nursing staff. They really were our best recruiters."
Garnica attributes the decisions of many on-demand nurses to stay on full time to the core staff who made it happen, and also to the idea that the on-demand nurses get to trial the environment beforehand.
"I think there's a lot to be said for when you're being recruited from a peer," Garnica said. "It's not scary to make a leap when you get to try it out."
The on-demand model also addresses the idea of nursing being the same in every health system.
"When you have folks that get to come be a part of your culture, be a part of your hospital, and be a part of the things that you're doing in an ongoing basis […]," Garnica said, "I think it makes it a lot easier because that jump isn't scary."
Outcomes
According to Garnica, the core staff reaction to this strategy has been positive.
"They are really proud of themselves, we update them on folks that they were able to help get moved over," Garnica said. "I think there's a lot of pride and excitement in that."
The nurses also appreciate the relationships that they get to build with more local nurses, and they feel as if they are part of a staffing solution, rather than feeling like a victim of staffing challenges.
"When you're short staffed, it's really easy to fall into a victim mentality [that] feels hopeless sometimes," Garnica said, "and I think this enables them to feel like they were part of the solution."
From a financial standpoint, there are also several benefits, according to Garnica.
"I think looking at areas of turnover and retention, obviously that's a really high-cost business when you're bringing folks in and you're turning them over," Garnica said. "Anytime we can reduce that turnover rate, we're obviously going to save money."
This model also cuts down on onboarding costs, Garnica explained.
"When you have an on-demand partner whose nurse is onboarding, they've probably already been working at our hospital for months, maybe a year," Garnica said, "so that onboarding is much quicker because they're already pretty acclimated."
The health system has also saved money on external agency contracts, and in general by stabilizing their workforce.
"We've had significant improvements in HAIs, patient experience, and those areas, because we don't have such an unstable workforce anymore," Garnica said. "We treat these folks as our own, they are part of our staff, we embed them in our culture."
Garnica said there have also been overall improvements in productivity and morale among the staff.
"When you stabilize the workforce, when nurses come to work, knowing that we're doing everything we can to get support into the building for them and they've built those relationships," Garnica said, "they know that the on-demand nurses are their partners, [and] there's a lot of positive energy around that."
For CNOs who might want to consider using this strategy, Garnica recommends being open minded, and to shift mindsets to understand that the market has changed. CNOs should focus on building those relationships and partnerships, and engaging staff in decision making to help bring about change.
"You have to learn to live with staffing [looking] different than it used to," Garnica said. "There are creative options out there […]. Once you get it going, you can see a lot of really positive outcomes."
The expectations of nursing have changed drastically in recent years, and CNOs need to pivot their strategies to sustain their workforce.
HealthLeaders spoke to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, about how CNOs can keep up with changing workforce expectations and support their nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Changing expectations have led to a trend of new nurses leaving their jobs.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
Here are some of the reasons why new graduate nurses are leaving their jobs.
The key to recruiting and retaining new generations of nurses is strong mentorship, onboarding, and support programs, according to these nurse leaders.
While healthcare changes, so do the expectations of the workforce.
Newer generations of nurses are expecting more technology, flexibility, and reassurance from management, and without that setting, many new graduate nurses are choosing to leave their health systems or leave nursing entirely.
CNOs need to pivot their strategies to meet these new expectations, while balancing the needs of their organization.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, and Gloria Carter, vice president and chief nursing officer at St. Mary Medical Center and HealthLeaders Exchange member, there are several strategies that CNOs can use to improve the recruitment and retention of new graduate nurses and tenured nurses.
Mentorship and support
CNOs must ensure that the work environment is supportive of both new and tenured nurses, with plenty of opportunities for career advancement and mentorship.
Carter explained that the first step is to support the nurse leaders who will be managing new graduate nurses and facilitating their introduction into the organization.
"Mentoring includes ongoing communication, engaging with their staff and having that presence as a leader to establish and maintain a rapport with the new graduates is critical to their success," Carter said, "so that you have awareness what is contributing to them staying in the organization or leaving] …and hopefully you can help support them through the latter to avoid them exiting the organization."
Heuston recommended implementing preceptors and training to support new nurses, while also focusing on making sure that the tenured nurses doing the training are recognized.
"You've got to focus on the retention of your senior staff," Heuston said. "The very first thing I did was talk to senior nurses to see what was difficult for them, and they felt really unrecognized for the work of training new nurses."
Heuston said the solution was building the training into the clinical ladder, in a program called CAPE, which stands for clinical advancement for professional excellence. Within the program, nurses can move up a level and get extra compensation added to their base salary for preceptoring and mentoring. The nurses also receive training on how to function in a training role.
"I felt like really acknowledging the senior staff who are putting that time and energy into training, and training, and training new people and new nurses," Heuston said, "and really being attuned to the newer nurse."
At St. Mary Medical Center, they have students who use the hospitals as part of their clinical rotation, which provides a first impression of the organization and work environment.
"This provides an opportunity for all nurses to mentor future nurses to gain the confidence and skills necessary to develop their clinical expertise," Carter said. "We have to take time to ask and answer questions to ensure we are creating a great learning experience for potential employees."
According to Carter, leaders also have a role in creating a first impression by being visible and approachable for students who are seeking guidance.
"Being visible is extended outside of the hospital with our academic partnerships and community events," Carter said. "Our facility also precepts graduate and doctoral students to ensure we provide opportunities for all future healthcare careers.
At WVU Medicine, Heuston said they piloted an Aspiring Nurse program, in partnership with academic institutions throughout West Virginia and the surrounding states. The goal of the program is to take into consideration the social determinants of health and to give nurses the support they need to continue their education.
"We selected really good partners and developed a contractual agreement with them, where we gave five thousand dollars a semester with absolutely no strings to how they spend it," Heuston said. "What we needed in exchange [was] we developed a role where we had mentoring for them on a monthly basis to the organization."
The CNOs at WVU Medicine will interview each candidate to develop relationships with them early on. Once the students are in the program and go through a signing ceremony, they become integrated into the health system's culture, Heuston explained, and leadership follows up with them on a monthly basis and students can receive support tailored to their needs.
"We rolled it out to our health system, and we have nearly 250 nurses in that program that we know is a guaranteed pipeline," Heuston said, "and there are nurses now going to school that would not have normally gone."
Onboarding
Another key strategy for CNOs is placing nurses within the right departments and making sure that the onboarding process is smooth and efficient.
At St. Mary Medical Center, Carter said the nurses join the workforce in one of the following ways, experienced nurses, new graduate nurses or transition to new specialty. Carter explained the transition program option affords nurses the opportunity to train in a different specialty.
The most common pathways for transition nurses are telemetry to the intensive care unit or telemetry to the emergency department.
"Transitional nurses are highly motivated to make this change," Carter said. "It's the same onboarding process that is provided to the new grads, with less precepting time based upon their previous clinical experience."
"Similar to our nurse residency program, the transition program includes class time and clinical experience in the patient care area," Carter continued. "Training is supported by a preceptor, residency coordinator, department staff and leaders. There are learning modules and additional class time to support their learning."
Carter said the outcomes of this program have been positive, and that the transitional tracks support nurse retention by allowing the nurses to train in new specialties and transfer to another department within the facility.
"It's more important that they stay within the hospital as a whole," Carter said. "It's fine if they want to move from department to department, but as long as they stay at the organization that's the greatest benefit to the facility and the community."
At WVU Medicine, Heuston recommends switching focus to making nurses excited about joining the med-surg units.
"Med-surg nursing is really where we need the nurses, where we need to recruit to, and make the better work environment," Heuston said. "We’re really focusing this graduation class on in-depth clinical experiences in med-surge environments that are welcoming and excited to have them."
Heuston said it's the CNO's job to then give nurses a great clinical ladder to climb so that they want to stay in the field.
"The new generation [wants] to continue to develop and see themselves advance in their career and not have to wait 20 years," Heuston said. "[Not] every nurse [has] to go to CRNA school or nurse practitioner school to advance their career, because all of us need good med-surg bedside nurses that are going to take care of us when we're sick."
This is part two of a two-part series. Read part one here.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
The NICE nurse program helps bring new grads into critical care, says this nurse leader.
On this episode of HL Shorts, we hear from Dr. Natalie Nicholson, associate chief nursing officer at Denver Health, about the impact of travel nursing and how the health system is supporting staff. Tune in to hear her insights.
There might be a surplus of registered nurses, but a shortage of others, according to this report.
Nurses in particular have felt the impact of the workforce shortage in the past few years, and CNOs have been working nonstop to recruit and retain the best talent possible to bridge the gaps.
However, the numbers seem to be shifting, depending on the profession.
Here are the predictions for the nursing workforce, according to a new report by Mercer.
Denver Health is experimenting with a hybrid work model for nurse leaders, says this CNO.
On this episode of HL Shorts, we hear from Dr. Kathy Boyle, chief nursing officer at Denver Health, about how new staffing models are impacting recruitment and retention. Tune in to hear her insights.
Nursing and the expectations of the job have changed drastically in recent years, and CNOs need to understand why to pivot their strategies.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
According to the American Nurses Association, almost 18% of newly licensed registered nurses (RNs) quit their jobs within the first year. A 2024 study found that new graduate RNs are leaving for a multitude of reasons, including their age, health status, supervisor and peer support, job demands, job competence, organizational commitment, job satisfaction, and work environment.
Why are nurses leaving?
Melanie Heuston, chief nurse executive at the WVU Medicine and HealthLeaders Exchange member, explained several additional reasons for this departure from the workforce, including the attitude toward nursing on social media.
"Social media has not been our friend," Heuston said, "I think it's absolutely been a place where people can talk about the negative and not necessarily the positive."
Heuston recommended that health systems focus more on social media and use strategies to improve the nurses' experiences.
"I do think that we as leaders need to own the work environment and I think that there's been some bullying in nursing, which I'm not proud to say," Heuston said, "but it's there, and we've got to get strategies to get that under control."
Heuston also cited the nursing shortage, and how more nurses are necessary to create a better work environment.
"It's a little bit of a chicken and egg problem," Heuston said, "you need more nurses to make the work environment better, as it's one of the ingredients."
According to Gloria Carter, vice president and chief nursing officer at St. Mary's Medical Center, and HealthLeaders Exchange member, another contributing factor is the prioritization of work-life balance.
"It's not just the new nurses, I think overall individuals have learned about having resiliency and focusing on work and life balance," Carter said. "I think when you look at it from that lens, there are individuals that are saying 'I need to be mindful and take that time out for me.'"
Changing expectations
Additionally, there has been a generational shift in what to expect from nursing as a profession, according to Heuston. New generations of nurses want to take advantage of new technologies to advance their nursing practice.
"They want the ease of technology," Heuston said, "and we need to be better at responding to that."
Along with many other organizations, Heuston said that WVU Medicine has piloted virtual nursing to support their nursing staff.
"I like to actually call it virtual patient care, so nurses don't believe we're replacing nursing, we're trying to support it," Heuston said. "It's warmly received by newer nurses. In fact, they're starting to expect it."
Heuston also explained that new nurses want to have a supportive environment where nurse leaders check in frequently and deliberately, and provide feedback.
"Generationally, I think that is more the expectation," Heuston said, "to get a lot of feedback, both positive, and what we need to do to improve."
Building resiliency
CNOs are in the position to bridge the gaps between new expectations and the realities of nursing, which involves building resiliency among new graduate nurses while also improving the work environment.
Now more than ever, according to Heuston, nurse managers have been acting as coaches and counselors due to more generational anxiety and depression caused by the COVID-19 pandemic.
"I think equipping [nurse managers] with better tools to be in that role, because they weren't trained to be in that role," Heuston said, "I think we could do better at getting more resources for them to be better."
For nurses, Carter said it's all about having awareness and accessing your support systems.
"It's also [about] connecting within the community and networking with your friends and family, and just bringing awareness and being open to having the dialogue about what you need individually," Carter said. "Then also being a part of that solution in terms of communicating for others that may be having similar challenges."
St. Mary's Medical Center has implemented a wellness app that nurses can use to track physical activities, such as walking, strength training, and other exercises, and obtain nutrition recommendations and other wellness practices that focus on mental and physical well being.
"Participants receive points that accumulate for submission for a reward card of their choice," Carter said.
Heuston suggested using podcasts, since many nurses engage with that medium rather than old fashioned communication methods.
"I'm very interested in doing [a podcast] with a younger generational nurse who can help to educate me on the needs of the workforce," Heuston said. "I think it's [about] being open to all the wellness support that we can offer our staff other than just a relaxation room where they don’t even have time to go, or putting structures in place where they can go there and feel like they can recharge."
This is part one of a two-part series. Part two will be published Monday, September 30, 2024.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
