Technology can be a huge disruptor if implemented incorrectly.
On this week’s episode of HLM Shorts, we hear from Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, about the technological challenges that her team faced while building Mercy’s new nursing innovation unit. Tune in to hear her insights.
Transcript (edited for clarity):
Have there been any unexpected challenges or outcomes regarding Mercy’s new nursing innovation unit?
Rocchio: Getting technology to play nice in the clinical environment with that ease of use is a heavy lift, which is why it can be such a big disruptor. If it's not put in and worked into workflow, we end up working around the technology.
So, making sure that the technology we pick is delivering to the satisfaction of the front lines is key. It's as simple as vital signs being taken by a machine and automatically having them documented in our electronic medical records, so nobody has to touch it.
That was a heavy lift with a lot of interfaces and things that you wouldn't think in the background, so our Mercy technology team has really been working overtime to lean in and help us.
This CNO has advice for the huge challenges facing nurse leaders as we enter the new year.
As we dive into the new year, CNOs must be prepared to deal with the new and ongoing challenges facing the nursing industry. Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, has laid out what she thinks are the five biggest issues that nurses will face in 2024.
5. Burnout
Burnout is a widespread issue for clinical staff throughout all of healthcare, especially since the pandemic.
“The roles are so difficult at times,” Dolan says, “and so being able to have a healthy work environment for people to feel comfortable in, and not experience the rate of burnout that they have over the past several years [will be key].”
CNOs should be open and talk about burnout, and validate that it is a real issue. Dolan recommends wellbeing check-ins and holding debriefings after serious incidents with patients, and finding creative ways to help staff adjust when they encounter big life events.
She also says recognizing people and celebrating their wins is crucial, and getting feedback from patients is a great way to give that recognition to the nurses who care for them.
4. Frontline nursing leaders
Retaining frontline nursing leaders will also be on many CNO agendas. Retention is already difficult in nursing, and it’s crucial that frontline nursing leaders be present long-term for their units to help promote teamwork and to maintain a strong workplace culture.
“It’s one of the toughest positions in the hospital,” Dolan says, “So being able to retain and support those frontline leaders will be key.”
3. Innovation
There are all kinds of new technologies arriving at the forefront in nursing, and it’s the CNO’s job to know how to incorporate them correctly into nursing strategy.
“There’s so much great innovation going on,” Dolan says, “but how we incorporate [technology] so that it’s helpful to the nurse and not adding additional burden to the nurse is especially important.”
Virtual nursing and virtual care platforms are keys to the future, according to Dolan. Virtual care in nursing can help with data collection, patient admission and discharge, patient education, and family education.
“There’s many things that a virtual nurse can assist a bedside nurse to complete and do,” she says, “and [they] actually feel like they have more time to spend with the patient.”
Dolan also emphasizes the benefits of wearable technology and smart rooms. Wearables can help nurses monitor vital signs and patient status, freeing up staff so they can spend time completing other tasks. Wearables also have the potential to help with hospital to home care, because patients can continue wearing the technology that will keep monitoring their progress.
Smart rooms and smart room technology also will add to further advancement in patient monitoring, and help take some of the burden off nurses. Smart rooms can hear and listen, which opens up the possibility of real-time transcription of the documentation nurses record for patients. This technology could also help prevent workplace violence or safety incidents from escalating too much, Dolan says.
2. Stabilization of support roles
One of the biggest challenges in nursing is stabilization of support roles. It’s becoming more and more difficult to be competitive in staffing support roles, which Dolan says is a key concern.
“As nursing becomes more and more taxed,” she says, “It’s especially important that we have a support team around the nurse.”
1. Supply of nurses
At the top of the list is the supply of nurses. The demand for nurses is outpacing the supply, and it is essential that CNOs use their influence to implement strategies to help fix this problem.
“Trying to help re-energize the public about healthcare careers and how fulfilling they can be is a key piece and a key role for the CNOs going forward in their communities,” Dolan says.
She also believes that creative partnerships with academic programs and institutions can help produce more nurses. Both healthcare and academic settings are short-staffed and need help, and there is an opportunity for one to provide support to the other, and vice versa.
“If we can be creative in our partnership efforts with those academic settings to help augment their staffing and clinical instructors, and allow them to take additional students,” she says, “that would all be very helpful as well.”
Jumping into the new year
Several other trends will continue to affect nursing in 2024. Dolan believes we’re going to see continued emphasis on quality and safety measures in the workplace, for both patients and staff.
“That whole focus of pay for performance and meeting all of those key metrics is going to be continue to be really important,” she says.
At Ardent Health Services, she says they will see a transition from a patient experience in the hospital to a consumer experience across the whole system. This shift in strategy considers the experience of patients when they interact with system processes, such as making appointments or accessing their health information through their Epic chart.
Additionally, health systems will experiment with new care delivery models. Since there are not enough nurses to support historic approaches, there will be new team approaches to care, Dolan says.
“That whole ability for people to work as a collaborative group, and come together [to] care for a patient,” she says, “I think is going to be key into the future over the next year.”
Nurses want to work with in-house teams that they can rely on, but it’s complicated.
Across the country, nursing unions are citing compensation, working conditions, and staffing issues- and now most recently, outsourcing—as their reasons to go on strike.
Registered nurses at SMM Health Saint Louis University Hospital have announced that they will hold a two-day strike beginning on December 27 to protest the outsourcing of RN jobs and management’s attempts at union-busting. This announcement was made by the National Nurses Organizing Committee (NNOC) and National Nurses United (NNU) following a vote on December 8 that authorized the nurse bargaining team to call a strike.
Why turn to outsourcing?
Outsourcing is not a new phenomenon in healthcare, according to Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association.
“Leaders opt to outsourcing after doing capital and operational cost analysis if they feel that there is a market for certain talents or expertise and they are unable to compete,” she says.
According to the NNU, SMM Health has been outsourcing nurse positions rather than hiring full-time nurses, which the union believes creates a revolving door of staff that do not become as involved in the surrounding community. This has been a concern throughout the industry during the ongoing nursing shortage, and with turnover rates as high as they are now.
Differing viewpoints
From the CNO perspective, there are two sides to the issue.
“Nurses would rather work with permanent members of the team and not a rotating group of nurses that seemingly have less requirements from a system perspective,” Boston-Leary says. “And that is making more money than them, [and] in some cases have lesser experience.”
On the other hand, outsourcing may sometimes be one of the only available options.
“Leaders have to maintain operations by utilizing outsourced talent when they are unable to recruit,” Boston-Leary states. “As much as they abhor [the] high labor spend.”
Even without enough nurses, patients still need staff to care for them, and health systems still need to provide the people to do so.
“When you think about it, a nurse can resign [from] a position with as little as two weeks’ notice, but it could take one to three years to replace that nurse,” says Boston-Leary. “In the meantime, emergency and surgical departments are busy and they need staffed beds, which [are] also at a premium.”
The perspective of the nurses at Saint Louis University Hospital who are going on strike is clear. They believe that the ever-changing staff interrupts patient care and will impact the future of their health system for a long time.
“Temporary, outside agency staff should only be used to fill occasional gaps,” said Sarah DeWilde, RN in the medical-surgical unit at SLUH in the NNU statement. “Outsourcing will only exacerbate the current staffing crisis and further erode the quality of patient care for years to come.”
On this week’s episode of HLM Shorts, we hear from Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, about how Mercy’s new innovation unit could become the standard in nursing. Tune in to hear her insights.
Transcript (edited for clarity):
How do you think Mercy’s nursing innovation unit program will evolve over time?
Rocchio: I think it's going to be the standard in nursing, and I say that because we're struggling, and we've been struggling in med-surg nursing more than any other type of nursing. I think we're going to have to connect it into our staffing and scheduling with a workload tool.
If we are doing something at the front lines, we should have a way to measure it, and I think we're going to start asking these nurses more about how they feel about the patients, and start scheduling them by a workload number to group those patients rather than ratios. That is going to launch in that third phase that we talked about, the workload assessment tool that automatically makes assignments for nurses based on workload of the patients. That helps our charge nurses, and it helps our nurses with how they feel when they go home.
The workload measurement is not just objective, but it's also subjective, how the nurse felt at the end of their shift. I think that's a really important point, how nurses feel going home. We want to send our nurses home still feeling good with plenty of energy to be able to take care of their family, friends, [and] personal lives, rather than leaving so exhausted from work.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
Editor’s note: This is part 2 of a two-part series. Part 1 was published on Monday, December 18.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
Here are some more of the ways that CNOs are improving teamwork going into 2024.
For more information, check out the full article here.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
Editor’s Note: This is part 1 of a two-part story. Part 2 will be published on Wednesday, December 20.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
Here are some of the ways that CNOs are improving teamwork going into 2024.
For more information, check out the full article here.
Healthcare leaders are looking for new ways to strategize and be proactive in the coming new year.
One of the largest pain points for healthcare executives is the workforce, and with healthcare comprising 10% of the U.S. workforce, there is no shortage of challenges.
Healthcare executives gathered at the HealthLeaders UpNext Exchange last week to discuss the workforce issues they’re seeing in the industry and figure out different ways to face those challenges going into the new year. Here are some of the key takeaways.
1. Need for Better Strategy
The up-and-coming healthcare leaders talked about some familiar pain points, ranging from strategy to staffing to implementing new technologies. Many said they are busy and missing time in their schedules to sit down and strategize for their organizations, so they’re looking for new ways to plan while accounting for high turnover and staff changes.
It’s clear that a five-year strategy no longer works. There are far too many disruptions in healthcare, and executives, including CNOs, need to be able to pivot accordingly. Some of the biggest disruptors, like Amazon and Walmart, are forcing traditional healthcare organizations to take a serious look at the competition.
2. Addressing Turnover
Also, turnover rates have been higher than ever, at 105%, in the last few years. Many factors are affecting this rate, including burnout, poor working conditions, and a physical worker shortage. Additionally, the workforce is aging, and there are not enough young people to replace the older generations of workers who will soon be retiring. This makes staffing hospitals extremely difficult, and will be a contributing factor to workforce issues for the next several years.
The same is true for nursing, CNOs everywhere are struggling to staff hospitals amidst a national nursing shortage. Even though there are efforts across the industry to streamline certification and attract more nursing graduates, new strategies for dealing with turnover rates will be a higher priority than ever going into 2024.
3. Streamlining Decision-Making
Another challenge is getting resources from the C-suite. Many executives at the Exchange brought up the disconnect of priorities between the C-suite and frontline workers, and between each department in their respective health systems. They also cited the slow pace of change in healthcare, and how narrowing focus and giving priority to certain challenges first would help speed up change and fix problems more efficiently.
To some of the executives, solving this issue could involve taking a look at who has a seat at the table in decision-making, and sending representatives to the discussion who can then disseminate information to their teams. This would help streamline the process to make progress in their organizations happen faster and more strategically. CNOs must be a part of these strategic discussions to make sure that their nurses have a voice and a seat at the table.
4. Being Proactive
So how do executives address these challenges?
The biggest takeaway from the Exchange was to be proactive. Healthcare executives, including CNOs, should focus on the following three solutions going into 2024:
Engage in strategic workforce planning;
Invest in professional development; and
Foster a supportive work environment.
Executives should consider using tools such as the business model canvas to define their business strategy and address the challenges caused by competition. Strategy tools can also help to identify areas in their health systems that offer opportunities for more innovation.
CNOs play a huge role in the development of nurses on their teams and in creating a healthy work environment where nurses can be seen as “whole people.” Going into 2024, there should be a focus on work-life balance to prevent burnout, and a push to continue the growth and education of nurses in each health system.
The 2024 HealthLeaders UpNext Exchange is sponsored by Collette Health.
There are three w’s that are major pain points for CNOs: workforce, work environments, and workflows, says Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy in Missouri. And Mercy has a solution.
Mercy’s new nursing innovation unit has the potential to become the new standard practice in nursing as it employs new ideas, concepts, and technologies to improve the frontline nursing experience and quality of patient care. The unit seeks to streamline electronic medical record (EMR) charting, decrease workload, and standardize a patient’s care for the entire clinical team, all while improving retention rates and employee well-being.
We sat down with Betty Jo to discuss the impact of the new unit on Mercy’s nursing workforce, and what other health systems could learn.
This transcript has been edited for clarity.
What's the vision behind the new nursing innovation unit?
Rocchio: One of the things that we're pretty passionate about at Mercy is our nurses' experience or joy in practice. This year, we've had an extreme focus on three things: workforce, work environment, and workflows. As we took a look at that, we realized some of the friction that was occurring at the front lines and increasing workload for our nurses. So, we wanted to take a frontline approach and try to solve that with them.
How long did it take to plan and build the new unit?
Rocchio: It took more planning than some of the actual building because we did it with our frontline coworkers and it wasn't just nurses, it was our techs, some of our LPNs, RNs, and then ancillary personnel that are in our units, because that workload is driven by all those intersection points. So, having the frontline staff walk us through a day in their life and then start to look at it from a nursing informatics perspective was key to this work. It took about nine months to actually start to look at what that might look like and what places we needed to touch in their daily workflows.
Where's the funding coming from for the new unit?
Rocchio: The funding is coming from a lot of different places, but one of them is reducing that workload at the front lines [to increase] our retention rate. I don't mind sharing with you that during COVID our turnover rate was right around 28%, and that was right in line with the national average. If you think about it, that's a lot of people leaving your organization and then retraining them.
We're at about 14% today, so we basically cut that in half by focusing on getting enough workforce and then reducing that friction in their day.
When you consider nurse turnover… in the United States today [is] about $50,000 per nurse, when you cut that in half, you're saving a good bit of money. So, the funding is coming from Mercy, but it's coming from the savings and our turnover rate.
What kind of new technologies are inside the unit that the nurses can utilize?
Rocchio: I want to highlight that technology is important, but technology sometimes can be a big disruptor to workflow too. There is some technology that we will talk about, but the innovation is really streamlining the work in our electronic medical record, and some of the technology we're using to do that … is in Epic called Rover and its real-time charting.
Today, we use mobile phones just like we do in regular life. They're secure in our hospital system for our private patient information, but they're using that in the moment to chart. They're scanning all their supplies with it, they're charting with it, they're able to do their assessments and then talk the assessment, and have it go back into the electronic health records.
So, we're saving a couple of hours a day by putting that into the workflow; that's one of the big technologies that we've lifted. It was a heavy lift because we had to standardize that EMR documentation and then we had to make it mobile. We're still going through it, it's not completely perfected, but on this unit, we're working through what that perfection looks like before we launch it across all 45 hospitals.
What are some of the ways that you're seeing technology interrupt workflow?
Rocchio: For example, if we would have launched that Rover functionality to be able to chart in the moment, but we didn't clean up how nurses were actually charting in our EMR, that would have been nearly impossible to be able to do that, and so working on that was key.
The other thing that's key is taking our plan of care that's housed in our EMR and putting it up on an electronic board in the room. So, the patient, the family, the physician, and anybody who enters the room understands what the plan of care is for the day.
That's become important for goal-directed therapy for our patients and that interdisciplinary approach to allow all of our clinical coworkers to understand what's needed for that patient for the day. When it's buried in that electronic medical record, it's hard to know what's going on, but launching it onto these electronic boards is going to be the key to the future.
What kind of nurses are working inside the unit?
Rocchio: We've started on our med-surg units for a couple of reasons. Med-surg nursing has the highest workload, maybe not acuity of patients, but the workload's high there because of the number of patients that they take care of and the different health needs of all those patients. We thought starting on those units would yield us the greatest results.
How are the nurses chosen to work inside the unit?
Rocchio: We did choose certain nurses to develop the concepts … with us, and we chose those people that were constructively dissatisfied. So, you know, the squeaky wheel gets most of the attention. We love those people in this process because they're able to speak up, they're able to tell us what's bothering them, and we're able to solve problems with them in real time.
What's been the nurses’ reaction to the new unit?
Rocchio: It's interesting, it's the first time in my career—and I've been doing this for 30 years—that we are actually changing nursing practice. We are using evidence-based practice out there in the literature to decide what to include and not include, and we're doing it with our frontline.
I've never seen such a dramatic change or plan change with the way that nurses are practicing today. They are so excited because they're contributing.
The plan is to launch the program over 45 hospitals?
Rocchio: We will eventually launch it. Right now, we're still perfecting that innovation unit the way we want it, and we imagine three phases.
The first phase is launching, the second phase will be optimization, then the third will be fine-tuning the workload for the nurse and the tech.
Have there been any unexpected challenges or outcomes?
Rocchio: Yes, believe it or not, getting technology to play nice in the clinical environment with that ease of use is a heavy lift, which is why it can be such a big disruptor, because if it's not put in and worked into workflow, we end up working around the technology.
Making sure that the technology we pick is delivering to the satisfaction of the front lines is key, and it is as simple as vital signs being taken by a machine and automatically having them documented in our electronic medical records, so nobody has to touch it.
So how do you think this program will evolve over time?
Rocchio: I think it's going to be the standard in nursing, and I say that because we're struggling, and we've been struggling in med-surg nursing more than any other type of nursing. I think we're going to have to connect it into our staffing and scheduling with a workload tool.
If we are doing something at the front lines, we should have a way to measure it, and I think we're going to start asking these nurses more about how they feel about the patients, and start scheduling them by a workload number to group those patients rather than ratios. That is going to launch in that third phase that we talked about, the workload assessment tool that automatically makes assignments for nurses based on workload of the patients. That helps our charge nurses, and it helps our nurses with how they feel when they go home.
The workload measurement is not just objective, but it's also subjective, how the nurse felt at the end of their shift. I think that's a really important point, how nurses feel going home. We want to send our nurses home still feeling good with plenty of energy to be able to take care of their family, friends, [and] personal lives, rather than leaving so exhausted from work.
What can other health systems learn from this new unit?
Rocchio: Just to be careful about starting small and trying to get as close to perfect as you can before you start to launch it wide, and about the change management that's going to be needed. When you're changing nursing practice at this level, and doing it right in front of patients and physicians and other caregivers, you have to be certain that you've got it pretty correct before you start launching it across the system. So that's why we started in one unit with many ideas coming in from across the ministry.
