Health systems should work to meet patients where they are at and create programs with social determinants of health in mind, says this CNO.
On this episode of HL Shorts, we hear from Cassie Lewis, chief nursing officer at Bon Secours’ Richmond market, part of Bon Secours Mercy Health, and HealthLeaders Exchange member, about how health systems can address the social determinants of health (SDOH). Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
WVU Medicine has invested in a diploma program, says this CNE.
For years in West Virginia, nursing education has taken place within educational institutions.
Registered nurses typically complete a two-to-four-year program, then enter the workforce after earning their degrees and taking the proper exams.
However, WVU Medicine West Virginia University is investing in an alternative route.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, the health system has implemented a hospital-based nursing school and registered nursing diploma program through its Center for Nursing Education.
"We're doing something that's a bit unconventional in the academic field," Heuston said. “We are developing and sponsoring our own 2-year diploma program that will serve as a pipeline of new nurses for our 24 hospitals.”
Heuston explained there are diploma programs that exist across the United States, but that this program is one of the first of its kind.
"We really wanted to be a bridge to people getting further education, so we are developing our Center for Nursing Education to offer West Virginians an alternative to the traditional path to becoming a nurse.”
Program specifics
Heuston described the program as a traditional education with a contemporary approach. The program is free of charge and students are given all necessary materials, including computers, books, and uniforms.
"We have been developing it for over a year, a very short timeline," Heuston said. "We are making an enormous investment in the new school to ensure students are immersed in a state-of-the-art facility.”
Recruiting faculty for the program has been successful, according to Heuston, and so has enrollment.
"We opened our enrollment this past summer on August 15," Heuston said. “Within a week, we had over 100 applicants, and today…we have 620 applicants [who] filled out the entire application for our inaugural class of 24."
The students will begin the program in August 2025, following a rigorous selection process that includes interviews. Enrollment is broad-based, Heuston explained, which is also known as holistic admissions.
"We’re not just looking at test scores," Heuston said. "We're actually going to interview for caring attributes to be ensured that they're the type of nurses that really want to work in a med surg clinical environment."
Program goals
The goal is to promote impatient bedside nursing as a long-standing career, according to Heuston.
"We're going to interview every candidate and we're hoping to expand very quickly," Heuston said. "The State Board of Nursing only allows us to take 24 students until we have the demonstrated outcomes."
"They have been supportive partners," Heuston said. "They want to see us succeed and have shared everything that they've done well to integrate into our environment."
Ultimately, the program is meant to be a pathway for continued education. Heuston said they have signed memorandums of understanding for local schools as well as with West Virginia University, to give the students a bridge to a bachelor's degree.
"We really want to promote the idea within our clinical ladder," Heuston said, "and give them free tuition to get their baccalaureate degree as well."
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
This unique nurse identifier follows nurses for their entire career, says the NCSBN.
HealthLeaders spoke to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, about the NCSBN ID and its applications. Tune in to hear their insights.
The NCSBN ID can be used as a unique nurse identifier, according to the organization.
Health systems are feeling the effects off the nursing shortages as they try recruit and retain qualified nurses who want to continue being a part of the industry.
As more innovative staffing solutions arise, it's up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
The on-demand staffing model breeds loyalty and longevity, according to this CNO.
On this episode of HL Shorts, we hear from Jennifer Garnica, vice president of nursing and CNO at SSM Health St. Mary's Hospital, St. Louis, about how the W-2 on-demand staffing model is addressing staffing concerns. Tune in to hear her insights.
The NCSBN ID can be used in a central database to keep track of nurses and build the workforce, according to the NCSBN.
Amid the nursing shortage, health systems are struggling to recruit and retain qualified nurses who want to continue being a part of the industry.
Part of this equation is ensuring that nurses have career opportunities available to them and options to advance their education. While health systems can work on giving them these resources, it's also up to CNOs and other nurse leadership to take advantage of the systems and tools that are already in place to build a strong workforce.
According to Jason Schwartz, director of member outreach at the National Council of State Boards of Nursing (NCSBN), and Matt Sterzinger, director of information technology, one of those tools could be the NCSBN ID number.
What is it?
The NCSBN ID is a unique nurse identifier, according to Sterzinger, and is used exclusively in nursing. The number is issued automatically by NCSBN during the NCLEX examination process, and it follows the nurse for their entire career.
"Typically, a nurse will go to a nursing education program," Sterzinger said. "They’ll take the NCLEX exam, and then after the exam, they're licensed by a state board of nursing, and then they can begin their career as a nurse."
The information attached to the ID number has to do with the nurse that it's assigned to. According to Schwartz, nurses might have licenses in single or multiple states, and they might have different kinds of licenses. The ID is associated with all of a nurse's licensure history and disciplinary history through the state boards.
"Through our work with the state boards, all of their different nursing licenses across jurisdictions and across license types are automatically linked to the NCSBN ID from their educational institutions, employers, etc.," Schwartz said. "If they're using the NCSBN ID, they have the power then to attach even more."
The data can be found through Nursys, a national database run by NCSBN that contains all of the nurse license and disciplinary information. According to Sterzinger, NCSBN has data sharing agreements through their membership with the state boards of nursing, and they all contribute their license and disciplinary information.
"As a result, we are able to take all that license information and tie it together with one individual," Sterzinger said, "and assign that unique nurse identifier."
In terms of privacy, the NCSBN ID itself is public. Sterzinger explained that there is a subset of license and disciplinary information which is considered to be public record, and users can go to the Nursys database to find that information. Sterzinger compared the NCSBN ID to a vehicle identification number, or VIN number, on a car.
"That identifier is tied to that car, and it is connecting all these different datasets and systems around the life of that car, and it's publicly available," Sterzinger said. "You can walk up to any car, and you can look through the front windshield and down in the dashboard and you can see that VIN."
What are the benefits?
There are several use cases for the NCSBN ID, including use in education programs. According to Schwartz, the University of Alabama in Huntsville is using the ID to ensure that graduate students are maintaining active, current, and valid nursing licenses and tracking their success and their career pathways after they leave.
"With the NCSBN ID, it's possible for an education program to know what percentage of RN grads are going on to become APRNs, or what areas of the workforce they are ending up in," Schwartz said.
The ID can also be used to address workforce shortages and quantify the value of nursing. Nurses are involved in many different aspects of care delivery, Schwartz explained, but the data is captured in different systems, with no convenient way of sharing information.
"With the NCSBN ID, multiple systems can talk to each other, multiple data sets can be exchanged," Schwartz said, "but there's no personally identifying information that needs to travel."
For health systems, the NCSBN ID can help with screening and verification processes, and to make sure that nurses are keeping their licenses up to date. For CNOs specifically, Schwartz explained that the ID can be used to improve quality and training over time.
"If you're able to link the care provided by a specific nurse to a particular outcome over time, what you may find is [that] nurse is having more success than others," Schwartz said. "Are there things that that nurse is doing where we can provide training to other nurses, or perhaps if the outcomes are worse than average, is remediation or professional development needed to bring things on par with expectations?"
The NCSBN ID also provides value to the patient, according to Schwartz. Patients are able to look up their nurses and see their licenses and career history.
"Through Nursys and through the NCSBN ID, we improve upon the transparency of nursing care to the public, [and] to consumers as well," Schwartz said.
"There's a lot of studying going on regarding the nursing workforce, and aging, and where they’re coming from," Sterzinger said. "The NCSBN ID can be used to help researchers tie together different data sets and get those results so that we can make sure that we have a solid nursing workforce in the future."
Nurses being recruited by their peers is key to the success of this staffing model, according to this CNO.
HealthLeaders spoke to Jennifer Garnica, vice president of nursing and chief nursing officer at SSM Health St. Mary's Hospital, St. Louis, about how the W-2 on-demand staffing model at SSM Health is a win-win for health systems, nurses, and patients. Tune in to hear her insights.
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."
