With rising costs in healthcare, CNOs need to brainstorm how to keep expenses down.

Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task.

According to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, the nursing shortage drives up labor costs and turnover costs in nursing. Labor costs have gone down marginally with the consolidation of travel nursing, but many organizations are still requiring the use of agency nurses, which drives up costs.

“Every time we spend time training a nurse, it costs money,” Vozzella said, “[but once a nurse] feels that it’s not a good work environment… [they turn] around within those first three years and leave that organization or unit, [and] it is a significant cost.”

To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.

Redesigning care

One cost containment strategy that CNOs should consider is using technological solutions to change the day-to-day workflows of nurses so that they have more time to care for patients.

At Houston Methodist, Vozzella said they meet with the deans of the surrounding nursing schools, and the number one reason why nurses go to nursing school is still to help people. Nurses want to be at the bedside, not typing into an electronic medical record, hunting supplies, or finding equipment.

“The nurse’s time is precious, and a good thing that’s come out of having a shortage is the focus on nurses doing things that only a nurse can do,” Vozzella said, “or what technology can pick up other tasks that are non-value added.”

Vozzella also recommends using ancillary support staff, such as phlebotomists, to do lab draws instead of the nurse. At Houston Methodist, Vozzella said they also partner with Rice University to help develop robotics that can screen trays to make sure the right tools are present before a tray goes into an operating room, so that the responsibility of checking the trays no longer falls on the nurse.

“[When] nurses have such a high value…and some ancillary support, we can redesign the work of that nurse in order to give that support,” Vozzella said, “so that it offloads that work and [nurses] are able to focus on caring for the patient.”

CNOs should be careful about the designation of work as well, and make sure that they support staff with communication efforts to make sure nurses understand the why of what they are doing.

“We tend to be a little controlling sometimes, or there’s factors like a very tenured ancillary person and a new graduation nurse,” Vozzella said. “It’s sometimes a challenge for that nurse to tell somebody else what to do.”

Care coordination

Additionally, efficient patient care management can help keep costs down by creating a better work environment. There are care milestones that patients must meet before they can go home, and those milestones are met with the help of care management, leadership, physicians, nurses, and advanced nurse practitioners.

According to Vozzella, improved care coordination is beneficial to both the patient and the nurse, as it improves the work environment and provides the patient with some insight into why certain processes are happening.

“It certainly helps patients with a shorter length of stay feeling like they’re a part of their care journey,” Vozzella said, “but it’s definitely helpful for the nurse too, because they feel [like a] part of something bigger than themselves and part of a team.”

Preventative care

Preventative care can also keep costs down. When primary care physicians can help patients manage diabetes or hypertension successfully, they are less likely to have an inpatient admission, Vozzella explained. Technology can help with this, so that patients can have more support at home without having to go into a doctor’s office or to the hospital.

Patient education is important to preventative care, because patients need to know about how different health factors affect their overall health, and nurses are a huge part of that.

“It is an exciting time for nurses to be part of that,” Vozzella said, “because it does offer nurses [the opportunity] to do more preventative care, but also to potentially do that virtually.”

CNOs should look at why patients are coming to the hospital in the first place and strategize ways to create support for them at home as well as in the hospital. Vozzella recommends having a case manager or social worker who can check in with patients and make sure they have transportation, food, and psychological support so that they attend their appointments and prioritize their health needs.

Leveraging technology

Over the past 15 years, according to Vozzella, health systems have moved toward rebuilding facilities to have better environments with natural light and private rooms, but it has just increased the amount of walking nurses have to do daily to see their patients.

“When [nurses] are in a room, they’re typically the only person,” Vozzella said, “and it’s so very isolating for, in particular, nurses that are newer in their career.”

However, bedside nurses are no longer alone with the addition of virtual nursing. Through virtual care, nurses can log in and come on the television screen in a patient room and act as a second set of eyes for the bedside nurse.

“I think virtual [nurses] can be a huge support, but it has to be implemented in partnership with bedside nurses,” Vozzella said. “We have to really work hard to understand where nurses tend to need support and make sure that’s our highest priority.” 

These nurse leaders outline best recruiting and retention practices for CNOs.

The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring and taking their knowledge with them.

CNOs must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.

During the recent HealthLeaders’ Nurse Labor and Compensation NOW Summit, Cassie Lewis, chief nursing officer at Bon Secours Mercy Health, and Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, spoke about strategies to retain tenured nurses, and how CNOs can help transition the knowledge of tenured nurses to new graduate nurses.

Connecting the generations

There are major differences in expectations between Traditionalists, baby boomers, Gen X, millennials, and Gen Z in the workforce. Life circumstances and work-life balance needs are different, some nurses might have children or elderly adults they need to care for, while others are younger and able to work at varying times during the week.

Due to the stressful nature of nursing and current workforce challenges, there are tenured nurses who are leaving the profession entirely and taking their knowledge with them.

CNOs need to strategize ways to keep the knowledge within industry, so that new graduate nurses can learn from them.

“Our environments are really physically and mentally demanding,” Vozzella said, “so what options can we give to somebody who’s at the end of their career?”

Flexibility

One strategy that CNOs should use is to sit down with tenured nurses before they decide to leave the workforce and ask them where they want their career to be in the next three to five years, Vozzella explained. Providing individualized flexibility is key and will keep tenured nurses working at the bedside longer.

“If a more tenured nurse wants to be off all summer, it would be better for us if we allowed that,” Vozzella said, “in order to keep that person working in an intensive care unit or an operating room for five more years.”

CNOs also need to make sure that tenured nurses feel valued. Lewis recommended taking a look at what offerings are being given to incoming nurses, and how that can be balanced with offerings for tenured nurses.

“When you go online, sign on bonuses are exponentially large in some areas, the compression factor is real,” Lewis said. “[We need to ensure] our tenured nurses feel the same value because we don’t want them to feel left behind.”

Compensation is not the only factor, the position of a tenured nurse could become hybrid, where half of their work is at the bedside and half is in a faculty position, Lewis suggested.

“There’s benefit to saying it’s not just monetary compensation,” Lewis said, “but we’re willing to work with you to create some level of flexibility that meets you where you’re at.”

Virtual nursing

One of the best options for keeping tenured nurses in the workforce longer is virtual nursing, according to Vozzella. Virtual nursing would retain the knowledge of tenured nurses and provide new nurses with support so that they feel less isolated.

“[The tenured nurses wouldn’t be] walking as much, but they could continue to speak to patients or…mentor new nurses that are starting out [while] not having to do such a structured 12-hour shift,” Vozzella said. “They could do it for four hours, [or] they could do it from home.”

Lewis agreed, adding that generally having more creative positions in nursing is how to keep tenured nurses from leaving the workforce. Virtual nursing creates opportunities for nurses to do virtual admissions and remote patient monitoring, which would keep tenured nurses from exclusively having to work at the bedside.

Mentorship opportunities

Another way to keep knowledge within the industry is to provide tenured nurses with opportunities to mentor incoming nurses. According to Lewis, one way to do this is to keep an expert or a tenured nurse on call, so that newer nurses can reach out if they need help with something.

“We’re starting to see [this] as a strategy [for] when we can’t get [tenured nurses] at the bedside,” Lewis said, “[and] how [we can] take that knowledge and really use it to help that novice nurse become safer in their practice and feel more confident.”

Lewis also recommended a nurse emeritus program, where seasoned nurses who are close to retirement can mentor newer nurses or even nurse leaders. Volunteer programs or nurse faculty positions are also helpful options since many nurses who leave want to stay connected to their patients.

“Our nurses really do feel connection and callings to do the things that we do every day,” Lewis said, “and so the more we can meet them where they’re at to share that collective knowledge, they’re willing to do it.”

This is part two of a two-part piece, part one was published Monday, March 11^th.

These nurse leaders outline best recruiting and retention practices for CNOs. 

The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring, and taking their knowledge with them.

Nursing leaders must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.

During the recent HealthLeaders’ Nurse Labor and Compensation NOW Summit, Cassie Lewis, Chief Nursing Officer at Bon Secours Mercy Health, and Gail Vozzella, Senior Vice President and Chief Nurse Executive at Houston Methodist, spoke about strategies to improve nurse recruitment and retention, and how CNOs can help create and strengthen the next generation of nurses. 

Challenges

Recruiting and retention challenges have always existed, but were greatly exacerbated by the COVID-19 pandemic. The nursing shortage became more evident as large numbers of nurses left the industry or went to agencies, and academic pipelines were disrupted, Vozzella said.

“Rebuilding our workforces certainly led to looking closely at recruitment strategies … nationally across hospitals,” Vozzella said, “and I think it gave us the opportunity to look and see where we had clunkiness in the recruitment process.”

Lewis agreed, emphasizing how the pandemic affected the different generations of nurses in the workforce.

“We obviously are needing to recruit different skill mixes of nurses because we have the need for expert nurses or nurses with experience,” Lewis said. “But also we are seeing a lot of new graduate nurses coming into the profession.”

This, however, creates a lack of experienced nurses at the bedside.

“Trying to ensure that we are adequately training our newer graduate nurses and giving them that experience that they’re looking for…is very challenging,” Lewis said.

Additionally, nurses now hold more power over where and when they work, since there is a higher demand for them.

“The ball is in their court,” Lewis said. “They have many competing offers, [and] they have many health systems where they can go.”

“I think as chief nurses what we have to balance [alongside directors and managers] as they hire and onboard is doing it with speed,” Vozzella said, “because certainly people are getting multiple offers.”

Another challenge facing CNOs during the recruitment process is that there are five generations in the workforce, according to Vozzella. A graduating class of nurses can now include people from several age brackets, and people who are second-career nurses, and their needs are all going to be different.

“Communication is key when you’re communicating with [different] generations of nurses,” Vozzella said. “We have to be more intentional as nursing leaders and as we implement new strategies to hopefully unburden the bedside nurse of tasks that they don’t need to be doing.”

The perception of nursing on social media also plays a big role in the modern recruitment process.

“I think one of the things that has been very eye-opening is with the presence of social media,” Lewis said. “[Nurses] do talk and there are platforms now for them to talk about organizations.”

“I think we have to make sure that we have the right environment [so] that our culture speaks for who we are,” Vozzella said. “[And we must be] attentive to what is being said on social media.”

Strategies for CNOs

The solution to these challenges involves creating an environment where nurses want to work and where they feel valued and supported, both personally and professionally. This includes providing individualized experiences and the flexibility to have a work-life balance.

“One of the things that we’re seeing with these different generations of nurses is work-life balance means something different to every generation,” Lewis said.

“Even benefits packages for employees, one size no longer fits all,” Vozzella said. “At different phases of life, you need different things.”

“What could be the game changer between one organization and another is that individualized experience,” Lewis continued, “where someone really cares about you as a person and has the ability to have some level of flexibility.”

Both Vozzella and Lewis emphasized the need to strengthen academic partnerships to create strong pipelines into the industry, and the necessity of creating robust transition to practice programs.

“Having a nurse residency program has been … beneficial, because people coming out of school are [just] getting the basics in training,” Lewis said. “When [graduate nurses] are actually starting to take care of patients, they’re mind-blown at some of the things they’re encountering.”

CNOs need to make sure their nurses can come into the industry to practice nursing, rather than getting caught up in administrative tasks. According to Vozzella, this will also help with retention.

“Being called to be a nurse is very special,” Vozzella said. “We have to create an environment [where nurses] can use their calling and can help people. So that’s not typing in a medical record for 60% of your shift, that’s not hunting and gathering for supplies, or trying to find other things.”

Nursing leaders also need to be supported so that they have time to interview, recruit, and select candidates while fulfilling the rest of their responsibilities.

“[CNOs must] make sure that our recruitment teams have those strong partnerships with frontline leaders to make those selections,” Vozzella said, “and [that] we use as much technology as we can to make that a streamlined process, not just for the candidate, but also for the leader whose time is precious.”

This is part one of a two-part piece, part two will be published Wednesday, March 13^th.

CNOs must strategize to combat high projected turnover rates. 

The staffing shortage affects not only the bedside nurse, but also the nurse leader. A new report from AMN Healthcare found that 31% of nurse leaders said they plan to be in a different role a year from now.

According to Allison Guste, Chief Nursing Officer at University Medical Center and Corporate Vice President of Nursing and Clinical Services for LCMC Health, workforce shortages and burnout are two of the biggest issues following the COVID-19 pandemic that CNOs have to face, along with rapid technological changes.

Here's what CNOs need to know about nurse leadership retention. 

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