Some of the obvious solutions for health systems are not even options for rural hospitals, says this CNO.
On this episode of HL Shorts, we hear from Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about how the healthcare needs of rural communities differ from those in urban areas.
At Phelps Health, the goal is to create support systems for nurses and to embrace technology, says this CNO.
HealthLeaders spoke to Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about rural healthcare challenges and how Phelps Health is tackling recruitment, retention, and new innovation. Tune in to hear her insights.
CNOs should gear up for the next wave of nursing challenges in 2025.
2024 was filled with many challenges for CNOs and other nursing leaders, and while many of the same ones will continue, there will be new trends and obstacles that leaders will face.
Students know they want to be in service of people, but they don't necessarily know they want to be doctors, says this CMO.
On this episode of HL Shorts, we hear from Dr. Lindsay Mazotti, chief medical officer of medical education and science at Sutter Health, about how CMOs can build pipelines for residents into the healthcare industry to attract new physicians. Tune in to hear her insights.
While many challenges are the same in rural healthcare, the available solutions can be vastly different, according to this CNO.
Health systems of all shapes and sizes are dealing with significant challenges, from staffing shortages to workplace violence, to implementing new technologies.
However, not all hospitals are starting on equal footing.
In rural communities, the challenges go deeper. According to a 2024 report from Chartis, 50% of rural hospitals in the United States are operating in the red, and since 2010, 167 rural hospitals have either closed or moved away from inpatient care.
Rural hospital closures have large impacts on their communities, and CNOs must work to prevent that and maintain patient access to care.
Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, has first-hand experience with the issues facing rural healthcare settings. Phelps Health is located in Rolla, Missouri, which is about two hours from all the major urban areas in Missouri, including St. Louis, Springfield, and Columbia. The health system serves six counties and about 250,000 patients.
Rural vs. urban: What’s the difference?
According to Brookshire-Heavin, the care needs of the rural community are very similar, and include chronic disease, heart disease, obesity, and lack of education and primary care prioritization.
The real difference lies in accessibility and the lack of resources to address those concerns.
"A lot of our residents…have no transportation to get to healthcare," Brookshire-Heavin said. "We don't have public transportation, we don't have a bus, we don't have the subway, we don't have things like that, so that's a challenge."
Even accessibility solutions that more urban health systems use, such as telemedicine, are not options for more rural areas, Brookshire-Heaven explained.
"Maybe if you were going to use telemedicine to serve some remote population, some of our community members don't have reliable Internet access," Brookshire-Heavin said, "so things like that are not even an option."
When it comes to nursing in the rural environment, the philosophy has had to change over the years. According to Brookshire-Heavin, the idea of hiring experienced or specialized nurses is no longer feasible. Phelps Health is focused on partnerships with local colleges, nursing schools, and nursing programs to find ways to get students to join the team.
"What we have found is our workforce is primarily unexperienced new graduate nurses that we have to provide experience to," Brookshire-Heavin said. "We changed our mindset from 'we're going to hire and look for all these experienced individuals,' because they're not there for us, to 'let's grow programs to grow experience and make new nurses.'"
At Phelps Health, the goal is to create support systems, new training programs, and extended training to start new graduates in specialty areas, along with programs that get students involved before they become nurses. Brookshire-Heavin detailed the internship program that pays students to come do their internships at the health system, which has been increasing the number of new graduate nurses entering the workforce.
"We're also seeing those nursing students [do] better on state boards," Brookshire-Heavin said. "They are more successful at one year for retention, [and] when we look at retention, we're seeing that rate increase as well."
Talking costs
Finances in general are a challenge in rural health systems and hospitals, and in the case of technology, Brookshire-Heavin explained that it boils down to a lack of resources to invest.
"You don't have extra to invest in those types of programs," Brookshire-Heavin said. "You are truly trying to keep up with operations and equipment purchases for capital budget, and things just to keep operations going and up to date."
Even for larger health systems, it’s difficult to find the funding for new cutting-edge technologies, and CFOs take convincing. In the rural setting, Brookshire-Heavin says the challenge depends on the financial status of the organization.
"We're very fortunate and we do have resources that we can dedicate to that," Brookshire-Heavin said. "Our organization has really embraced technology, and we do try to look at using technology to do things better."
Brookshire-Heavin recommends partnering with other members of the C-Suite to advocate for innovation.
"As a CNO, I think a big part of that is my relationship and partnership with our CFO to really be able to communicate the needs and the vision," Brookshire-Heavin said, "and the financial case for why this may have cost up front, but what value does it bring in the long run."
Advocating for the community
In terms of community needs, many patients in rural areas lack the resources and ability to invest in their health and wellness, such as public transportation to the hospital. According to Brookshire-Heavin, this issue requires CNOs to have an awareness of legislation and relationships with policy makers and lawmakers.
"We have a government affairs department," Brookshire-Heavin said, "and so I do talk with them and stay in the loop of legislation that's coming, discussions that are happening with legislators, [and I] answer questions and get involved."
Brookshire-Heavin emphasized staying up to date with local organizations and opportunities that can provide more funding.
"I try to stay active with MHA information about legislation, legislative issues," Brookshire-Heavin said, "but also [I look] at grant opportunities and ways to fund programs that we may otherwise not be able to do."
CNOs in rural areas should stick together as well, according to Brookshire-Heavin, and discuss the issues that are confronting their communities. Connections and relationships with other leaders in other organizations are just as important as connections within the CNO's own organization. Brookshire-Heavin also recommends staying current and challenging rigid ways of thinking.
"I think there's a uniqueness about rural healthcare, I find it very rewarding," Brookshire-Heavin said, "but I also think it's important to think outside the box, and try not to be limited by the ruralness of the area you're in."
Health systems need to attract learners to their organizations and give them sustainable career paths, says this CMO.
As healthcare executives everywhere work to overcome staffing shortages, it's important for CNOs, CMOs, and other clinical leaders to focus on providing career advancement opportunities to staff that fit career expectations.
According to Dr. Lindsay Mazotti, chief medical officer at Sutter Health, medical students are thinking differently about how they want their medical careers to unfold.
"The draw of academic medicine is still there," Mazotti said, "but there are people who are wanting to think differently about how they take care of patients and how their careers are sustainable through their lives."
These changing expectations are affecting recruitment and retention, and at Sutter Health, Mazotti sees graduate medical education (GME) as a helpful tool.
"For us, building graduate medical education programs means attracting learners to our system," Mazotti said, "[and] building a compelling reason why people want to come join us at Sutter Health."
HealthLeaders sat down with Mazotti, live from the Workforce Decision Makers Exchange in Washington D.C, to discuss how CMOs can use GME to improved their residency recruitment strategy. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Staffing, workplace violence, and potential legislative changes will challenge CNOs in the new year, according to this CNE.
2024 was a rollercoaster ride for healthcare, and 2025 will likely be no different.
This year, CNOs and other nurse leaders faced a wide array of challenges, from expanding the nursing workforce through recruitment and retention, to tackling new technologies like AI and virtual nursing, and to addressing nurse burnout and wellbeing. Many of these issues are expected to continue, while more will appear on the horizon in the new year.
"We continue to have a large number of early career nurses leaving their organization and maybe even leaving the profession soon after they join us," Norton-Rosko said, "and we continue to see an increasing number of nurses retiring, because at the same time the population in general is aging, so is the nursing population."
Nurses nowadays have more opportunities to be employed in non-traditional roles, Norton-Rosko explained, which creates more competition to keep nurses working clinically at the bedside. Nurses are also experiencing record levels of burnout.
"While they're working to address urgent patient needs, they’re still dealing with the staffing crisis," Norton-Rosko said, "and we need to continue to pull on their expertise to help support the innovation related to new models of care and integrating technology."
Looking ahead to 2025, Norton-Rosko believes that the staffing challenges will continue, along with workplace violence incidents. Change management will be essential for CNOs moving forward.
"We also need to work on striking the right balance between providing care and supporting technology solutions," Norton-Rosko said, "[and] really balance how much change our teams can take at one time."
As for new challenges, Norton-Rosko emphasized the importance of focusing on diversity, equity, and inclusion (DEI), and addressing social determinants of health. Potential policy changes under a new administration will also be a point of concern for CNOs in 2025.
“While nurses play a large role in identifying disparities," Norton-Rosko said, "we need to work really hard with other disciplines to make sure we can then address the disparities once they’re identified."
Listen to this week’s episode of the HealthLeaders Podcast to hear more about nursing trends and challenges going into the new year, and how CNOs should plan to address them.
Partnering with international organizations can help influence nursing education and give nurses global experience, says this nurse educator.
On this episode of HL Shorts, we hear from Dr. Yolanda VanRiel, the department chair of nursing at North Carolina Central University, about how CNOs can create pipelines into the nursing industry by partnering with international organizations. Tune in to hear her insights.
Nurses recruited from international communities help increase diversity in the workplace and care delivery in rural communities, says this nurse leader.
