AHA leader Richard Pollack urges the attorney general to support legislation that would support healthcare workers.
For medical professionals, being assaulted or intimidated can no longer be tolerated as “part of the job,” so Richard Pollack, president of the American Hospital Association (AHA), has asked for the federal government to step in.
Pollack sent a letter to U.S. attorney general Merrick Garland requesting his support for legislation to protect healthcare workers from the "unacceptable situation" of workplace violence.
He offered examples of what healthcare workers have dealt with. In Georgia, a patient grabbed a nurse by the wrist and kicked her in the ribs. In South Dakota, a patient threw a nurse against a wall and bit them. In New York, a medical student from Thailand was called "China Virus," kicked, and dragged to the ground.
Since the onset of the pandemic, violence against hospital employees has markedly increased—and there is no sign it is receding, with studies indicating that 44% of nurses report experiencing physical violence and 68% report experiencing verbal abuse during the pandemic, Pollack wrote.
Healthcare workers have worked tirelessly to provide care and treatment to patients throughout the pandemic—many to the detriment of their own mental and physical well-being. A 2021 survey on violence toward workers in emergency departments included the following key data points:
Among all survey respondents, 80% reported at least one verbal assault in the prior year. Among emergency medicine resident physicians, 89% reported at least one verbal assault in the prior year.
70% of all survey respondents reported experiencing verbal assault multiple times.
63% of survey respondents reported feeling unsafe in the workplace.
Among residents, 96% discussed workplace abuse only with a colleague or no one at all. None of the residents filed formal incident or police reports.
While verbal assault was the most common incident, the study also found that 34% of participants had also reported incidents of physical assault. However, only 20% proceeded to file formal reports. In cases where the violence was toward a resident physician, no formal reports were filed, study authors said.
To protect employees from violent incidents, the Inova Health system developed a rapid-response team to deescalate and contain altercations in their hospitals. With the Safety Always for Everyone (SAFE) team, when a worker feels unsafe in a situation, they call a special number to alert the team and they respond immediately. Once there, the SAFE team will de-escalate and gain control of the situation.
Healthcare workers experience both verbal and physical violence in their workplace, said Kathy Helak, MSN, BSN, RN, FACHE, CPPS, and Inova Health's assistant vice president for patient safety.
Verbal assaults consist of profanities, threats, or slurs towards the worker, she said. In physical assaults, workers are hit, kicked, punched, or even spit on.
Since the implementation of the SAFE team, there have been fewer incidents of violence and staff have felt safer.
"Over the last few years, we have really worked very hard at Inova, as part of our commitment to zero tolerance, to encourage our team members, regardless of the type of interaction, to speak up to report it," Helak said. "And we are engaging in improvement efforts to make sure that we have evidence-based approaches to preventing these types of situations from occurring and helping employees feel safe."
To raise awareness for the violence healthcare workers are experiencing, Nurses Against Violence have planned the United Nurses March for May 12. The peaceful protest will take place in Washington D.C., beginning at the Washington Monument.
"This march is for the healthcare worker that feels alone, silenced, and left behind," the organization said. "Incivility in nursing, including racism … has to be addressed, along with discrimination, poor morale, mental illness, addiction, and the rising suicide rates among nurses alone."
The public health emergency (PHE) declaration for COVID-19 is set to expire on April 16.
Several national hospital associations, including the American Hospital Association (AHA) and Federation of American Hospitals (FAH), signed a letter urging that the COVID-19 public health emergency be extended.
The letter, addressed to U.S. Secretary of Health and Human Services Xavier Becerra, stated that while infections and hospitalizations are decreasing, hospitals and health systems are still treating COVID-19 patients daily. Other concerns listed included the risk of children under 5 years old and immunocompromised individuals getting infected, as well as concerns over rising Omicron subvariant cases in Europe and what it could mean for the U.S.
Joining the AHA and FAH in signing the letter include America's Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, and Children's Hospital Association.
"Regardless of potential new case increases, our members continue to face challenges related to workforce shortages and staff burnout," the letter said. "Continuing disruptions in the supply chain leading to shortages of supplies and a need for further clinical guidance regarding the symptoms of and best practices of treatment for long COVID-19 patients."
By extending the PHE declaration for COVID-19, the Department of Health and Human Services can waive certain requirements for programs like Medicare, Medicaid, CHIP, and HIPAA. Funding for state Medicaid programs, as designated in the Families First Coronavirus Act, is tied to the length of the PHE declaration, which has helped provide coverage to vulnerable populations during the economic downturn.
"The PHE allows our members the flexibilities and resources to respond to the COVID-19 virus, while best serving our patients," the letter continued. "As we move forward, we urge the administration to work closely with patients, providers, and stakeholders to ensure access to care is preserved."
PHE declarations are declared in 90-day increments, with the previous extension set to expire on April 16.
Nanette Mickiewicz, MD, uses her role as CEO to better serve and support the hospital's community.
For Nanette Mickiewicz, MD, the COVID-19 pandemic wasn't her first-time treating patients during a health crisis.
After completing her internship, residency, and fellowship at Cedars-Sinai in Los Angeles, she moved to Santa Cruz to work with a private practice as their infectious disease physician—arriving at the height of the HIV/AIDS crisis.
"I [was] there before there were any medications, and care was mostly palliative, taking care of people when the medications were coming out," Mickiewicz said. Many of the patients she cared for during that time, she said, are alive and thriving today.
After seven years with the practice, she was offered the opportunity to be the director of infections prevention for Dominican Hospital. The new role, along with assisting the Institute for Healthcare Improvement in their efforts to enhance patient safety, marked the beginning of her journey as a healthcare administrator.
"Shortly thereafter, I joined the board of directors at Dominican, which gave me the opportunity to learn more about the operations, the mission, and work more with the CEO," Mickiewicz said. "Then in 2000, I was approached by the CEO at the time to become the chief medical officer."
After seven years as the hospital's CMO, she was approached by the CEO in 2007 who asked if she would succeed her once she retired. Uniquely, throughout the hospital's 80-year history, every administrator or president has been a woman.
"When I first started in leadership here in the hospital, I was the only female in [the Dignity Health] system at the time. So being the lone female voice was always interesting," Mickiewicz said. "I'm really proud that now [the system has] added many women, not only to the CMO ranks, but also the CEO arena, which has historically been more [male]."
Mickiewicz added that the women who founded the hospital were forward thinking in their efforts to "read the signs of the times" and to promote women in leadership. Being both a clinician and a mother, she believes that her intuition has helped her along her career as she navigates and develops relationships with her patients.
"What I would say, though, is I have used my position here as a platform to focus on things that tend to lean toward women's wellness and health," she said. "As well as issues or anything that pertains to children; while continuing to provide the full array of care and support for the community."
One example is her involvement with the Second Harvest Food Bank and leading its annual food drive. Seeing the number of individuals suffering from food insecurity in the community, she uses her influence to draw and bring attention to the issue any chance she gets.
Also, with the completion of the hospital's wellness center, she said that they're able to focus on issues specific to women, such as dealing with menopause and childbirth.
"We are the third largest employer of the community, so I always tell our team, 'we're not taking care of just anyone, we're taking care of each other, and our neighbors, and our school teachers," Mickiewicz said. "And the list goes on and on."
During the nation's first surge of COVID cases, the hospital was fortunate in that it didn't experience the influx of patients that other hospitals were experiencing, so they were able to prepare themselves. According to Mickiewicz, the hospital's first significant wave of patients came in October 2020. A second influx came in early 2021.
"We were blessed with a strong nursing staff, as well as the entire hospital and physicians. Our physicians stepped up in every department and went out of their comfort zones to make sure that our patients and each other were safe during this time," she said.
The community the hospital serves responded in kind to their hard work; from school children writing letters of support, to surrounding hospitals and organizations providing face shields and sharing medical supplies.
"I do believe that the outpouring of support for the hospital really suggests and reinforces that people appreciate the work that we do," Mickiewicz said.
Laurie Steen discusses her pre-COVID transition to academia and healthcare worker's struggle with work/life balance.
After 20 years of working as an occupational therapist, Laurie Steen, OTR/L, CEAS I, CLT-LANA, made the transition to academia in early 2020.
"A lot of people believed in me doing something I didn't think I could do, which was join the academic world," she said. "I have always wanted to but, I just didn't think I could."
Not only was Steen able to successfully transition into a new career. She, along with healthcare workers across the country, readily took on the challenge of providing care during a pandemic.
With the support of individuals encouraging her to do so, Steen left full-time practice in February 2020 for her new role as a clinical instructor at the University of Kansas, her alma mater. Six weeks later, COVID arrived.
Though she was learning how to do a job she'd never done before, teaching during the first wave of a pandemic, Steen believes it was a similar experience for all healthcare workers. She said everyone had to learn to do a job they'd never done before, including those who were in experienced roles.
"I feel like we all had our first day at work in March 2020, and we're all rookies," Steen said. "That's kind of how I feel regardless of healthcare, business, [etc]; because the landscape changed. The context where we worked changed. Our family structure changed."
The adrenaline of the situation, she said, is what helped healthcare workers manage the situation as well as they did in the early weeks of the pandemic. As time went on, many workers began to feel the brunt of the stress and strain of their work, mentally and physically.
"When we talk about being two years out from that impact of COVID, I think we ran out of adrenaline a long time ago and we're trying to figure out how to efficiently and effectively move through our day with a different lens," Steen said. "I think we're a little overly critical of processes, and it's because we don't know what's right or wrong or good or bad and we don't know what could benefit our families or impact our families."
To illustrate the stress and overwhelm healthcare workers on the frontline are facing, she uses the metaphor of having an empty, somewhat full, or overflowing cup. If the cup doesn't overflow by the end of the day, its okay; but now worker's cups are full, and it doesn't take much for them to spill over.
Additionally, there's the issue of work/life balance, where many healthcare professionals struggle.
"As a woman, I have that momma bear, protective nature that at night I want to go to bed and know that I've been there for my family—and I forget myself," Steen said. "I want to make sure I'm doing a good job at work, and I forget myself."
Thoughts like these, she said, can cause negative self-talk and comparing yourself to others, thinking you're not doing enough.
"I think some of the wellness pieces for us begin with [showing ourselves] grace," she said. "Just a little bit of grace every day."
Through a number of "happy accidents," Mari Knettle found her passion for leading and educating others.
The trajectory of Mari Knettle's career has been what she describes as a series of "happy accidents." These instances would eventually put her on the path to being a leader in her field of physical therapy, in both clinical and academic settings.
Shortly after graduating, she was given the opportunity to supervise her own physical therapy student.
"It sparked something in me. I don't know if I had seen that as my career trajectory, that I was going to be in administration, leadership, and education," Knettle said. "I really liked that role of being in education and so I continued to look for opportunities to supervise students and be involved in the profession that way."
To help her prospects in education, she went back to school to earn her doctorate, which would allow her to join a didactic faculty to teach in a college setting. After completing her degree, she began teaching as an adjunct professor at the University of Virginia.
After a few years and having moved across the country multiple times, she accepted a position as medical director for Cleveland Clinic's Center for Health Professions Education – another "happy accident," she said.
"I'm able to expand my reach not just in physical therapy but in an interprofessional education setting," Knettle said. "Interfacing with more than 50 health professions outside of medicine and nursing as well as leaders in the physician and nursing world."
Early on in her career, she noticed that while most physical therapists were women, there seemed to be more men in leadership roles. Now, she's noticed a shift in more women taking on leadership roles in the profession.
"It's important to see a leadership profile reflect the demographic of our profession as a whole," Knettle said. "In gender, in race, in all aspects of diversity, we really need to make sure that our leaders are representing who we are as a whole."
She uses Cleveland Clinic, where the chief of staff is a woman physician, as an example. While she demonstrates exceptional leadership, Knettle can tell she appreciates the women that make up their staff and understands the unique circumstances they face that men wouldn't readily recognize – like being a working mother.
"I think that as a woman working, it's obviously helpful to look at leaders of my own organization and others and see that there are women who are successfully and capably leading," she said. "It inspires me to be a better leader, myself, to serve as a model for younger girls, that younger generation who may or may not see herself in a position of leadership or authority until she sees someone going before her and doing it."
While a person's gender doesn't determine whether they'll be a good leader, Knettle emphasizes the importance of diverse leadership – noting that it's been proven to result in better care.
"The more different perspectives you have when it comes to decision making – decisions about care, decisions about how to run an organization— [the more] strong decisions are being made by having that team of people who are more likely to see different aspects and different perspectives," she said.
Jill Ostrem brings more than 25 years of experience managing hospitals and clinics.
Allina Health has announced a new president for two of the organization's Minnesota hospitals.
Jill Ostrem will serve as president of Mercy Hospital in Coon Rapids and United Hospital in St. Paul. In her new role as president of two Allina Health hospitals, Ostrem will provide executive leadership for hospital operations and facilities management. She will also oversee patient experience initiatives, development of staff and physicians, and strategic planning.
"Jill is a skilled leader with a proven track record of developing high-performing teams that ensure sustained levels of success in complex hospital environments," Lisa Shannon, president and CEO of Allina Health, said in a statement. "Her experience and ability to focus on our teams, combined with her knowledge of Allina Health's long-term focus on Whole Person Care make Jill and ideal leader to ensure Mercy and United hospitals continue to serve their communities with outstanding, compassionate care."
With over 25 years of experience managing large hospitals and clinics, Ostrem has held a number of leadership positions in different health systems.
Ostrem previously served as vice president of operations at United Hospital for Allina, where she oversaw the hospital's clinical, operations, and financial performances.
Previously she served as senior vice president of hospital operations for Jefferson Health, New Jersey (formerly Kennedy Health). She also served as senior vice president of health and well-being For Parkview Health in Indiana.
"I am honored to lead the incredible, dedicated teams at Mercy and United hospitals," Ostrem said in a statement. "Throughout my career I have prioritized working collaboratively to engage teams in our mission and achieve performance goals to provide a best-in-class care experience for the communities we serve."
Ostrem is looking forward to building on the strong leadership at Mercy Hospital and United Hospital, as well as others throughout the system. She's also excited to continue to push the system's commitment to transforming and improving the healthcare experience for patients, staff, and the communities they serve throughout Minnesota and western Wisconsin.
Nearly one-third of surveyed nurses say senior management doesn't support their mental and emotional well-being.
More than half (56%) of nurses believe they're sacrificing their mental health for their job, and 41% are considering leaving the profession for good, a new survey says.
Amid a severe healthcare worker shortage, increased hours, and constant risk of exposure to COVID-19, the survey's results relate to more than stress.
"Our nurses are not experiencing fatigue or burnout; they are experiencing significant moral injury and critical distress to their emotional foundation," said Rebecca Love, chief clinical officer for nurse staffing agency IntelyCare, Inc., which commissioned the survey.
""We know that most of what is being offered to the front lines in terms of whole-person support does not address the moral injury that nurses are experiencing, she said.
While managing their patients' care used to be their primary task, the pandemic has required them to shoulder increased emotional responsibilities.
For example, because of COVID restrictions, family members were not able to visit their hospitalized loved ones, so in the event of their passing, nurses had to notify their families of the death. Many times, nurses made the mobile phone calls or video chats to allow family members to say goodbye to their dying loved one.
Nearly one-third (32%) of nurses see the death of a patient as a significant stressor; however, more than 58% said they aren't offered grief counseling to process the loss themselves, according to the survey.
More than 500 nurses – including certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs) - were surveyed, with 37% said they don't feel supported in their mental health. 41% felt they weren't supported overall by senior management.
And while 72% said they do have access to mental health resources through their job, only 10% said that they have used it.
"The question we should be asking is 'Why aren't they using it?'" said Love. "Is there a stigma we need to get our nursing workforce the help they need to manage the post-traumatic stress of being on the front lines of our health system?"
Love added that pandemic has only further aggravated the industry's staffing shortage. Currently, at some rural hospitals, there's a one to 12 ratio of nurses treating patients. In addition to long shifts, there are constant demands for them to work overtime – many are even asked to work on their days off.
The staffing shortage has persisted throughout the pandemic to the extent where taking time off has become a major challenge. Of the nurses surveyed, 29% didn't take a vacation in 2021, 27% didn't take time off the previous month, and almost 40% are simply unable to.
Michael Keleman will lead growth for the hospital, which is part of the Tenet Health Central Coast system.
Sierra Vista Regional Medical Center, the largest hospital in San Luis Obispo County, California, has welcomed a new COO.
In his new role, Michael Keleman will lead growth in the hospital's service lines and existing programs, while continuing modernization and capital improvement efforts for the organization, which provides healthcare and specialist services including neurosurgery, neonatology, cancer care, and trauma.
"Michael has been an integral member of our Central Coast team and an enthusiastic advocate for the expansion and coordination of services provided by our entire family of services," Mark Lisa, CEO of Tenet Health Central Coast, said in a statement. "This is a seamless fit and I am delighted to have Michael in this role."
Keleman succeeds Eleze Armstrong, who was recently appointed CEO at Doctors Hospital of Manteca, a Tenet Health hospital in Manteca, California.
Keleman has served in multiple leadership positions within Tenet Healthcare. In his previous role, Keleman served as chief strategy officer since 1018 for Tenet Health Central Coast system, which includes Twin Cities Community Hospital in Templeton, CA.
Prior to that, he served as the director of network development for Central Coast's joint venture between San Ramon Regional Medical Center and John Muir Health system in San Ramon, CA.
Before the joint venture, Keleman worked for John Muir Health as manager of systems strategy and business development.
This leadership announcement came the same month that Tenet announced it will reverse course on its plans to spin off its revenue cycle management subsidiary Conifer Health Solutions, citing the division's renewed financial profile and growth potential.
In Q4 of 2021, Tenet reported a profit of $250 million—a drop-off from the $414 million in the fourth quarter of the previous year but an increase from $89 million to $153 million when removing COVID-19-related stimulus grant income. For the fiscal year 2021, net income was reportedly $915 million compared to $399 million for 2020.
More than 400 industry financial leaders participated in the survey, commissioned by AKASA.
The competitive market for talent, vaccine mandates, and employee burnout are the top three concerns impacting healthcare operations, says AKASA, a developer of artificial intelligence (AI) for healthcare operations. More than 400 industry financial leaders were surveyed.
Biggest concerns impacting healthcare operations:
Competitive market for talent (71%)
Vaccine mandates (42%)
Employee burnout (41%)
" These teams are facing labor shortages like never before. COVID-19 has stretched hospitals and healthcare systems beyond the breaking point," AKASA CEO and co-founder Malinka Walaliyadde said in a press release. "And for all the new problems the pandemic has introduced, it has also shone a light on decades-old issues, where healthcare operations teams have historically been understaffed."
To address the concerns identified by the survey, Walaliyadde suggests developing strategies to boost employee morale and recruitment efforts.
The industry-wide staffing shortage has resulted in burnout for many healthcare workers, in addition to financial strain for healthcare systems. With many workers working overtime and extra shifts, it's more difficult to hire additional people.
For vaccine mandates, in February, the U.S. Supreme Court upheld current vaccine mandates requiring healthcare workers to be fully vaccinated, with exemptions for religious beliefs or medical conditions. Consequently, some industry leaders are struggling to hire new talent and retain current members of their staff who have been resistant to COVID restrictions.
Other concerns noted in the survey include rapid employee turnover and limitations on working remotely—with the latter influencing an organization's appeal in the labor market.
As remote work becomes the norm, hospitals and healthcare organizations are competing with other providers across the country for the same talent, according to AKASA.
Such competition puts smaller and rural hospitals and health systems at a disadvantage, because they often have lower pay scales.
The alliance is made up of six nationally ranked health systems across six states.
A group of six non-profit health systems have come together to form the Evolve Health Alliance, a partnership to focus on employee well-being and diversity, equity, and inclusion (DEI) programs.
The formation of the alliance, which was announced March 10, was created with the purpose of improving "the diversity, wellbeing and engagement of their respective workforces and, ultimately, improve patient care in their respective communities."
The member organizations for the alliance include:
AdventHealth, in Altamonte Springs, Florida
Atrium Health, in Charlotte, North Carolina
Henry Ford Health System, in Detroit, Michigan
Intermountain Healthcare, in Salt Lake City, Utah
Northwell Health, in New Hyde Park, New York
OhioHealth, in Columbus, Ohio
Having shared ideas and best practices throughout the pandemic, the organizations will work together to develop resources to enable the health systems to take on additional pressing workforce issues.
"Health systems around the country relied on each other's expertise during the pandemic in ways we had not experienced before," Maxine Carrington, senior vice president and chief people officer at Northwell Health, said in a statement. "We knew clinically that we were stronger together in advancing patient care, but we also recognized the benefit of collaborating with innovative and like-minded health systems to better prepare our workforces for the future."
The idea to form the alliance came during the height of the pandemic when Intermountain Healthcare and Northwell Health worked together to address the staff shortage both systems were experiencing.
"Collaboration is key for healthcare systems to successfully adapt to changing conditions and prepare for the future," Heather Brace, senior vice president and chief people officer of Intermountain Healthcare, said in a statement. "We know this alliance will help us evolve policies, practices, and initiatives that ultimately benefit our patients and the communities we serve."
The alliance will develop leadership management programs, which will allow members of each organization to participate in clinical and non-clinical skills development programing at other member organizations.
Jim Dunn, enterprise executive vice president and chief people and culture officer for Atrium Health, said in a statement that learning and sharing best practices is part of a health system's culture.
"Atrium Health is centered around providing not only the best patient care, but also providing the 'best place to care' for our teammates – so we work continuously to elevate our teammate experience," he said. "Learning from other innovators is critical to success and, ultimately, positively impacts patient experience."