On this week’s episode of HL Shorts, we hear from Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, about how CNOs can identify which nurses are experiencing burnout. Tune in to hear her insights.
The nurse leaders at AONL looked to the future to solve the current workforce issues.
The 2024 AONL Conference wrapped up last week in New Orleans after three days of brainstorming, collaboration, leadership discussion, and heavy rain.
There were many common themes throughout the sessions and the keynotes, but as expected, workforce development was front and center. Turnover rates are high among frontline nurses and in leadership positions, and even though predictions are positive, the current nursing shortage is going strong.
The nurse leaders in attendance offered many creative and innovative solutions for the different prongs of the workforce crisis. Here are the top five subjects they focused on.
5. Workplace violence prevention
Workplace violence incidents are rising, and even though many physical safety measures have and are still being taken by health systems, there seems to be little to no improvement.
This is due to the wrong approach, according to Mary Beth Kingston, chief nursing officer at Advocate Health. In a conference session, Kingston suggested that taking a more patient-centered approach to workplace violence is the missing piece of the puzzle.
Kingston recommended getting to the bottom of why incidents occur, by meeting patients where they are at, and trying to understand what might be going on in their life to cause certain behaviors. De-escalation training should be meaningful and involve some kind of "customer service" training to help nurses speak to patients, families, and visitors in stressful situations.
4. Addressing burnout
Burnout was a part of almost every conversation at AONL this year. Burnout is one of the biggest reasons for turnover rates for both frontline nurses and nurse leaders. Nurses are expected to do too many extraneous tasks that take away from the time they have to spend with patients, and many of the CNOs and nurse leaders at AONL emphasized the need to remove those tasks from daily workflows.
In another conference session, Linda Alderson, chief nurse executive at Tacoma General and Allenmore Hospitals, and Jennifer Graham, chief nurse executive at MultiCare Health System, spoke about how they are leveraging technology to lessen the workload for nurses.
Graham spoke about how they use a robot called Moxi, who currently works as a delivery robot in the hospital. Moxi is responsible for running supplies and smaller lab specimens to and from locations to assist the nurses on the floor. So far, Graham said the results have been successful in diverting the task of supply delivery away from nurses.
3. Career development
Creating career development opportunities for nurses who want to become leaders in their space was also a hot button topic. In the same session, Kingston gave advice about personal career accelerators that nurses should take into consideration.
Kingston recommended that nurses who want to become leaders engage in professional organizations, and partaking in the opportunities offered by those groups. They should also become comfortable with the idea of taking calculated career risks, and recognize that they have skills that are transferable.
2. Mentorship
Along the same lines, there was a general consensus at the conference that the gap between new graduate nurses and tenured nurses is concerning, to say the least. The idea of mentorship programs is not a new one, but it is becoming more necessary in the current state of the industry.
Erin Kirk, director of patient care services at Norton Children's, discussed in a session how the health system has a mentorship program where nurses can become part of a learning cohort through a nomination process.
In the hybrid learning program, they learn skills such as interprofessional communication and how to problem solve using critical thinking. According to Kirk, 59% of participants have gone on to expand their roles or involvement with the health system since completing the program, which Kirk deems a success.
1. Virtual nursing
To no one's surprise, virtual nursing was the number one trend at AONL in 2024. Not only was the topic the subject of many of the sessions, but it was the main theme in the exhibit hall as well. It is crystal clear that the future of the nursing industry is virtual, and that nurse leaders need to be ready for the implications on workflows and patient care.
Along with Moxi, Graham and Alderson shared their findings from the new nursing care model they are currently testing. The care model involves a unit made up of an RN, an LPN, a virtual nurse, a robot, and a CNA. The model separates the duties of the virtual nurse and the RN and LPN, and outlines the places where they cross over each other.
According to Graham and Alderson, the virtual nurse is in charge of admissions, discharges, dual nurse signoffs, and mentoring and clinical support. The bedside RN and LPN are responsible for physical assessment, patient safety, medication administration, procedures, and other hands-on care. Things like patient rounding, patient education, care plan updates, pain reassessment, interdisciplinary rounding, and connecting with patients and families are all integrated duties that both parties are responsible for.
Graham and Alderson have seen success with this model, and while it still has a long way to go, this is a good example of how CNOs and other nurse leaders can incorporate virtual nursing into their hospitals.
As AONL 2024 continues, nurse leaders are brainstorming how to integrate technology into their workflows.
After day one at AONL 2024, it's clear that nurse leaders and executives have a few common goals in mind to tackle workforce concerns.
Virtual nursing
It's no secret that the largest issue facing nursing today is staffing. CNOs are working hard to lower turnover rates by improving recruitment and retention efforts, and many of them are incorporating virtual nursing as a way to do that.
At AONL 2024, Linda Alderson, chief nurse executive at Tacoma General and Allenmore Hospitals, and Jennifer Graham, chief nurse executive at MultiCare Health System, spoke about how they are incorporating virtual nursing and robotics into their care models. Alderson and Graham estimated that once fully integrated, the new care model, which involves a bedside RN, a LPN, a CNA, a virtual nurse, and a robot, with save the health system $2.2 million per unit per year.
Leadership development
Another way nurse leaders are confronting the staffing shortage and other workforce issues is through leadership development. As more nurses retire from the industry, CNOs need to create mentorship programs for newer graduate nurses so that they can become acclimatized to the workforce and also so they can become the next generation of leaders.
At Norton Children's, Erin Kirk, director of patient care services, spoke at AONL 2024 about the health system's implementation of a mentorship program that empowers nurses through adult learning. The opt-in program is set up as a hybrid mentorship program that uses an external technology platform and in-person sessions to educate nurses who are nominated to participate, as either mentors or mentees.
So far, the program has seen great successes, according to Kirk, in encouraging nurses to continue with their career and leadership development, with 59% of participants having expanded their roles or involvement with the health system since engaging with the program.
More workforce trends
Many leaders were also focused on shared governance, workplace violence prevention, social determinants of health, and the public perception of nursing. There is also growing concern about the number of graduating nurses who are entering the workforce, which ties into the staffing shortage as well.
However, there is hope.
Nurse and healthcare economist Dr. Peter Buerhaus spoke about the latest research on the staffing shortage, which predicts that the nursing industry will grow by 1.2 million RNs through 2035 if entry into the workforce continues at recent levels.
CNOs everywhere will have to wait and see if that happens, in spite of the many challenges that will appear along the way. In the meantime, AONL 2024 continues, so stay tuned for more coverage.
CNOs must help nurses feel both physically and psychologically safe.
With rising workplace violence and burnout rates, it's important for CNOs and other nurse leaders to be aware of the safety and wellbeing of their nurses.
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke about how CNOs can help their nurses feel physically and psychologically safe at work.
Here's what CNOs need to know about safety for nurses.
CNOs must be aware of the mental health of their workforce.
On this week’s episode of HL Shorts, we hear from Dr. Marie Giordano-Mulligan, Vice President of Nursing and Chief Nursing Officer at Huntington Hospital Northwell Health, about how CNOs can identify which nurses are experiencing burnout. Tune in to hear her insights.
Physical and psychological safety should be key focuses for CNOs.
With rising workplace violence and burnout rates, it's important for CNOs and other nurse leaders to be aware of the safety and wellbeing of their nurses.
Safety goes beyond just the physical. Nurses must feel psychologically safe as well—they should be able to voice their feelings and concerns without fear.
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke about how CNOs can help their nurses feel physically and psychologically safe at work.
Workplace violence prevention
There are several investments that health systems can make toward workplace violence prevention. According to Giordano-Mulligan, at Huntington Hospital Northwell Health, they have technology that boosts security, including quick badge alerts, metal detectors, and drones that fly around the campus, which remains well-lit at all hours.
Giordano-Mulligan also said they have signage that displays how respect from patients, family, and visitors is a requirement, and that the hospital does not tolerate violence toward the nursing staff or other healthcare workers.
"[For] any patient that is considered a high risk, we do have enhanced safety measures, and there [are] workplace violence processes in place," Giordano-Mulligan said, "and the staff is very appreciative knowing that they are supported in those processes."
Support is also provided to nurses after incidents occur, in the form of both employee assistance programs and employee health services if injuries are sustained.
"They're also given the option to file a police report as well and press charges," Giordano-Mulligan said, "and we will support them in that because they have that right."
In terms of mental health and psychological safety, Giordano-Mulligan said Huntington Hospital has processes in place for helping nurses improve wellbeing.
"If they need support for any other concerns…there is a process in place to help them with employee support services," Giordano-Mulligan said, "and there's a committee that is very active working with…executive leadership and with team inputs to enhance those processes in the future."
Psychological safety
Burnout is a huge contributing factor to mental health in the workplace, and according to Croland, one of the subgroups that has the highest degree of burnout is nurses who have under three years of experience.
"I've seen lots more people who are only working for a year and then they're choosing to leave the nursing profession," Croland said.
CNOs are also concerned with the public perception of nursing, and how that contributes to participation in the industry and potentially the culture of a health system.
"If you're on social media at all, you've probably seen the TikTok [videos] that are disparaging to the profession," Croland said, "so we have some accountability, I think, in changing that image of nursing."
Croland recommends implementing more transition to practice programs that go beyond orientation and onboarding. Nurses need to develop a sense of belonging in their units and learn the necessary communication skills.
"How do you work in a culture where you can respectfully escalate a concern to another nurse who's working, who may be shutting you down?" Croland said, "and I think transition to practice programs are gaining a lot more traction."
The ANCC has criteria for transition to practice programs that Croland recommended. The criteria exist to help nurses acclimatize better to the profession and become more equipped to deal with the stressors that accompany the job.
"When you think about what we do, it requires high reliability, really high stakes outcomes, [it's] life and death, and that's a lot to put on a young person who's new in their role," Croland said.
CNOs must create environments where nurses can come forward and admit that they are not sure whether they did something right or wrong, or that they made a mistake that affected the patient.
"I think those programs are worth their weight in gold," Croland said, "they have demonstrated successes with reducing turnover, increasing retention, and really keeping people within the profession of nursing."
At a time when nurse leader turnover is stressing the industry, CNOs from all over the country are gathering together to strategize solutions.
The nursing industry is currently facing some of the largest workforce challenges in healthcare, including a nationwide nursing shortage and record numbers of burnout and turnover. Now more than ever, nurse leaders need to come together to address major issues to keep health systems running effectively while improving patient outcomes.
That’s why HealthLeaders has high hopes for the AONL Annual Conference in New Orleans, Louisiana next week, where thousands of nurse leaders will gather to discuss these trends in the nursing industry.
What we will be watching
The conference consists of daily sessions where various nurse leaders will highlight industry trends and provide their insight. One of the biggest topics is technological innovation, and how nurse executives can leverage AI, robotics, and virtual care to promote workforce growth, and improve productivity and patient outcomes.
Another big trend is leadership development, and how to turn nurse managers into effective leaders who set examples in the workplace. Recruitment and retention are also a central theme of the sessions, focusing on how leaders can build safe and healthy work environments where nurses want to work—even for nurse leaders.
The conference comes at a time when high turnover rates among nurse leaders present a real workforce challenge. A recent report found that 31% of nurse leaders said they plan to be in a different role a year from now.
Will AONL attendees come up with the solution to the issue? Probably not, but HealthLeaders will be there to take note of what is and isn’t working.
Other themes include fostering academic partnerships, creating educational opportunities, developing care models, and the importance of mental health care. Attendees will have the opportunity to attend these sessions as well as walk through the exhibit hall.
Stay tuned for more coverage of the event and what you will need to know.
CNOs must stay vigilant and help their nurses avoid burnout.
Burnout is being cited across the industry as one of the top workforce challenges. So, what can CNO’s do about it?
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke at length about how CNOs can reduce burnout among their workforces.
Nurses in different generations have different needs that CNOs must fairly accomodate.
On this week’s episode of HL Shorts, we hear from Cassie Lewis, Chief Nursing Officer for the Richmond market at Bon Secours Mercy Health, about how CNOs can ensure that offerings are equitable between generations of nurses. Tune in to hear her insights.
Nurses everywhere are feeling the effects of burnout, and so are nurse leaders.
Burnout is being cited across the industry as one of the top workforce challenges. A report from AMN Healthcare found that 72% of nurse leaders experience some level of burnout.
So, what can CNO’s do about it?
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke at length about how CNOs can reduce burnout among their workforces.
Identifying the problem
Croland compared burnout to “death by paper cuts.”
“Everybody has bad days,” Croland said, “but it’s when it’s happening all the time and we’re not able to recover from it that I think that analogy comes to mind.”
The first step in addressing burnout is to identify when nurses are experiencing more than just a bad day. If nurses are returning to work the next day and are back to normal, that is likely just exhaustion, whereas burnout presents a more consistent personality shift.
“[It’s] the person who’s no longer engaged, the person who doesn’t participate, or their personality has changed,” Giordano-Mulligan said, “even with collaboration with their peers, they just don’t seem to be the same.”
When a nurse begins to feel this way, it’s important for CNOs and other nurse leaders to intervene and help that individual. Giordano-Mulligan emphasized that outside stressors are a large contributing factor as well. World events and family obligations can bring additional stress into the workplace.
“We have programs that come in to help reduce all of these stresses for employees,” Giordano-Mulligan said. “We have to help these individuals to feel comfortable coming to us so that we can help them with employee support services.”
Along with programs, having a personal connection with each member of a nurse unit is also critical for identifying burnout. Croland explained how that connection and relationship is necessary to be able to notice a change happening.
“Recognizing when there are subtle differences, whether they’re angry or more withdrawn,” Croland said, “those are going to be indicators that something’s going on.”
According to Croland, making sure employees are utilizing resources available to them is also key to preventing burnout. Nurses should have sick or wellbeing days, and CNOs must make sure that they are using them. If nurses are financially struggling, leaders should sit down with them and connect them to employee assistance programs or a financial counselor, or another resource offered by the health system or hospital.
“Sometimes the burnout isn’t necessarily caused by something that’s happening at work, but it’s being exacerbated by something in their home life,” Croland said. “We have the opportunity to connect them through to resources that could help them.”
Strategic solutions
One of the best ways to address and prevent burnout is having personal relationships with staff, and according to Croland, being intentional and having thoughtful conversations with them. At OSF St. Francis, they do monthly mission partner rounding.
“So very intentional, purposeful rounding that the leaders are doing with their frontline staff asking them [questions],” Croland said, “what’s going well, what frustrated [them] in the last couple shifts [they] worked…what problems have you experienced, [and] how can I help?”
Croland recommended making the effort to understand the nuances and pain points that nurses have, and to work to address each of those things, since burnout is often caused by the build up of those little stressors.
Additionally, Croland suggested putting more focus on having micro debriefings at the bedside, to help nurses deal with the frequent whiplash of handling one tough patient situation and then moving on to the next.
“We don’t often times give ourselves as the clinicians the opportunity to process what happened, [or] the opportunity to talk things through,” Croland said. “[It’s important] if you’re a newer nurse, [to take] the time to get the assurances that you did a good job and that you did what you were supposed to, to have that support.”
Giordano-Mulligan agreed, citing her focus on creating healthy work environments and authentic leadership in her career. CNOs need to build relationships with their staff so that when something is going on, the nurse is comfortable confiding in the CNO, and they know they have a safe place to go.
“Getting to know your staff and [having that] relationship building is extremely important,” Giordano-Mulligan said, “and to know when a team member is not who they normally are.”
At Huntington Hospital Northwell Health, Giordano-Mulligan said the hospital has a process called Team Lavendar to help nurses deal with patient losses.
“There’s a team that comes in and helps support the staff and [the other] people involved in that loss,” Giordano-Mulligan said, “to give them the time to decompress, [or] to go off to the tranquility space, and to have the time to come back…[and] go on the next assignment.”
The program also allows nurses to be relieved, so that they can come back to their next shift with the right frame of mind.
“Part of being able to care for others is to care for self,” Giordano-Mulligan said, “because if you’re not in that space to be in a good frame of health or mind, you can’t begin to care for others appropriately.”
