The staffing crisis required CNO Claire Zangerle to get 'creative.' To her nursing teams' dismay, she brought LPNs back into the health system.
As COVID-19 continues to exacerbate the nursing shortage, Allegheny Health Network (AHN) is easing the crisis by welcoming back licensed practical nurses (LPNs) who were once shown the door by most U.S. health systems.
LPNs—alternately referred to as licensed vocational nurses (LVNs)—have been phased out over the last decade by health systems seeking higher-educated nurses who can provide a wider scope of duties.
Although 14% of LPNs remain in U.S. hospitals, many (38%) took their skills to nursing and residential care venues, according to the U.S. Bureau of Labor Statistics. Others work in physician offices (13%), home healthcare services (12%), and government (7%).
Claire Zangerle, DNP, MSN, MBA, RN, FAONL, NEA-BC, chief nurse executive for AHN, based in Pittsburgh, Pennsylvania, looked for "creative" solutions to nurse staffing and saw LPNs as a key. About three months ago, AHN began a pilot program placing LPNs on nursing teams.
HealthLeaders spoke with Zangerle about the pilot program and how it's working.
This transcript has been lightly edited for clarity and length.
HealthLeaders: Let's start off with how the pandemic has affected nurse staffing in the Allegheny Health Network. I've heard you say it's the worst shortage you've faced in 30 years as a nurse.
Claire Zangerle: Yes, that's true. The nursing shortage was concerning and challenging before the pandemic, and it's just even worse after the pandemic. Not only are we seeing nurses retire sooner, but we have a different competitive animal out there right now, and that's the [staffing] agencies because the agencies are luring our nurses away from the bedside to work for much more money than we were prepared and able to pay those nurses.
I had to look at alternatives to fill those holes, and one of those are LPNs and looking to see if I can bring them back into the hospital because there were years when we were not hiring LPNs in the hospital. I'm not the only hospital system doing that. It's almost like we forgot that they existed because we stopped hiring them in acute care. They all went to post-acute care—nursing homes, assisted living facilities—because their model is such that that's usually the highest-ranking nurse in those facilities and they're paying them big dollars.
Now I have to re-look at my LPN rates and say, okay, we still use them in the outpatient area a lot, but we have to look at their rates on the inpatient side and value them more on the inpatient side than we did prior to the pandemic and prior to not hiring them anymore.
HL: Why did hospitals and health systems phase out LPNs?
Zangerle: It was mostly around the research that if you have a BSN-prepared nurse in your facility you have better outcomes—better quality, less errors, and safety is better. People going for Magnet Recognition® had to reach that BSN stat to be able to apply for Magnet and LPNs were throwing that off.
We listened to the research and the research wasn't wrong. BSNs do improve the outcomes. But I don't believe that BSNs improve outcomes at the expense of not using LPNs, and we have had to rethink our caregivers.
An LPN as part of the team is very valuable, especially in the absence of having nursing assistants or certified medical assistants and in the absence of having enough registered nurses, but that was really it. It was like, "Well, look, we don't need you guys and you guys can go work in rehab facilities or assisted livings or whatever," but that's when the nursing shortage wasn't as bad as it is now. Not even close. Now we're circling back and most of the LPNs are saying, "Okay, now we're finally getting some love here."
There are hospitals in the United States that don't hire anyone but bachelor's-prepared nurses and I think that's a mistake. Diploma nurses and associate-degree nurses have great value in our healthcare system and most of those individuals matriculate on to a bachelor's or master's degree and us not recognizing their value is kind of silly. Same thing with LPNs.
HL: Before the pandemic, about what percentage of your nursing staff consisted of LPNs?
Zangerle: Before the pandemic, it was probably about 5% and since we started hiring them again, we are probably up to about 10% of our nursing staff being LPNs and we literally are just starting to do this with gusto.
Even my own teams kind of looked at me sideways like, "What are you talking about? We're not really buying what you're selling." As time went on, I said, "Look, this is an option that we have. We can't get the nursing assistants, we can't get as many RNs as we'd like, but we have a group of people that we could reach out to." We have LPN schools around our region, and we also have two nursing schools that we can matriculate LPNs into RNs if they want to. We have to give everybody the opportunity to do the work if they want to do the work and we have the structures in place to support that work.
HL: How are you fitting the LPNs into your system now?
Zangerle: We have chosen one or two large nursing units—30, 35, 36 beds—at each of our hospitals and we're doing pilot work with what used to be called team nursing but we're calling it blended nursing because we have an initiative with throughout our enterprise called blended health between our provider organization and our payer organization.
There is a cohort of patients that is cared for by a blended team, and that blended team is led by an RN and on that blended team is an LPN and a nursing assistant. Based on their skill sets, they divide who's doing what and they're in constant communication and as team, they're taking care of their cohort of patients.
A nurse can oversee more patients if the nurse has the support at the elbow that they need, and the LPN and the nursing assistant assigned as a team gives them that support. It's just a different care model … and you can have a really good, blended team that is going to deliver high-quality care, a great patient experience, and reduce a patient's length of stay.
HL: Do you see this as a permanent solution for Allegheny Health Network?
Zangerle: I do, because our pilot units really like it. People are going to hear about this and they're going to say, "Well, this is just another version of the old team nursing," and it is another version of the old team nursing, but it's with some contemporary additions of the scope of practice.
I don't know why we would just do it now, and not continue it. The pandemic forced us to go back to this blended team nursing model and made us a little less rigid about not using the team model anymore. We got spoiled, because we didn't need to be as creative—we had the nurses to take care of the patients—but we don't have that luxury, and we're not going to have the luxury for a long time unless something drastic changes and we have more nurses that flood into the market. We just don't have the supply to meet the demand.
All the data and predictions show us that it's not going to get better in the next decade, and we need to have alternative approaches. This is a highly viable alternative approach.
Each hospital is in various stages of execution, but from our standards, objective and subjective data tells us it's working and it's a formula that's good for us. It's not on every unit, it won't work on every unit, and we don't need it on every unit. It's usually on the busy med surg units, it's good on rehab floors, it's good in orthopedics. My next target is to look how we could do this in our emergency department.
HL: What outcomes are you seeing in the last three months with blended teams?
Zangerle: Our patients are getting discharged by 11 am, because that's the goal; the teams are bird-dogging what needs to be done to get the patient out by 11 in the morning; they're working together to figure that out, as opposed to one nurse having to track down all the things that need to be tracked down to get this patient discharged. The length of stay is reducing, which means we're being able to bring in another patient to take that patient's place.
We have a huge initiative going on with hospital length of stay right now and we're seeing that, overall, our hospitals are reducing their length of stay by anywhere from half a day to a full day across the board. And when we drill down to the units, we're seeing the biggest contributor is those units where we have a blended nursing model.
The framework connects with social determinants of health, the widely accepted model that outlines conditions influencing health status and which serves as a reference point for healthcare leaders to define patient-focused community health solutions.
Increasing diversity in nursing is considered essential to improving health equity, according to research that indicates benefits to communication, access to care, and patient satisfaction.
However, only 19.2% of the nursing workforce identifies with an ethnic or racial group, according to the 2020 National Nursing Workforce Survey. An ideal would be for the racial and ethnic minority RN population to mirror the U.S. population, which is 23.7% minority, the paper says.
The Social Determinants of Learning framework, presented at the 2021 National League for Nursing Education Summit, identifies six core factors for schools of nursing to build a more diverse pipeline for school of nursing graduates:
Physical health
Psychosocial health
Economic stability
Physical environment/community
Social environment/community
Self-motivation
The framework, which is detailed in the recently-published paper Developing a Social Determinants of Learning Framework: A Case Study (Nursing Education Perspectives), includes examples of evidence-based initiatives addressing these factors, which can bridge social barriers to learning:
Student admissions: Holistic admissions processes evaluate factors beyond standardized test scores and GPA. Chamberlain has adopted practices using personalized and data-driven approaches to assess student potential and outcomes.
Student success: Personalized learning approaches, developed through the Chamberlain Care Student Success Model, encourage strong student outcomes. Pre-licensure BSN graduates experienced nearly a 13% increase in NCLEX pass rates from 2016 to 2020, and in 2020 the rates were above the national average, according to the team’s analysis.
Mindfulness: An eight-week program integrated into Chamberlain’s pre-licensure BSN program was designed to support student psychological health as part of managing stressors that can be a barrier to student progress. More than 60 percent of participating students reported a reduction in stress levels.
"We are committed to engaging healthcare and education partners to join us in this nationwide effort to ensure that the nursing workforce of the future more clearly represents the communities and the patients we serve," Chamberlain president Karen Cox, PhD, RN, FACHE, FAAN, said in a press release.
"Educators play a critical role in identifying solutions that support more diverse student pathways that align with society’s healthcare needs," she said.
During the 2018 to 2019 academic year, Chamberlain had an enrollment of more than 9,600 prelicensure nursing students, 59% from racially or ethnically diverse backgrounds.
The Social Determinants of Learning framework and research is aligned with the direction of the National Academy of Medicine’s Future of Nursing 2020-2030 report in advancing health equity by creating a foundation for increasing diversity in the nursing profession.
"To support appropriate, equitable patient care, nursing and health professions educators must embrace new approaches for increasing the number of ethnically diverse care providers today’s health care system needs," the paper says.
"As important as that is, there is an even more compelling reason to find new approaches for increasing diverse providers—it is the just thing to do."
Zimmermann, who will assume the presidency January 1, 2024, most recently was the chief nursing officer and vice president of patient care services at Virginia Commonwealth University (VCU) Health System and associate dean of clinical programs at the VCU School of Nursing in Richmond, Va.
She served in the U.S. Army Nurse Corps, practiced as a nurse practitioner and spent 25 years as a nurse executive.
Zimmermann has been an active AONL member; she sits on the board of directors, chairs the AONL Foundation board of directors, co-chairs the AACN-AONL Academic Practice Council, and is a member of the DAISY Foundation board of directors.
Previously, she served as chair of American Nurses Credentialing Center’s Commission on the Magnet Recognition Program and as president of the New York Organization of Nurse Executives board of directors. Zimmermann holds a Doctor of Nursing Practice degree from St. John Fisher College in Rochester, New York. She is a fellow of the American Academy of Nursing.
Sicker patients and higher expenses are contributing to 'profound headwinds' AHA CEO says.
Sicker patients, fewer outpatient visits, and higher expenses for labor, drugs, and supplies will continue to damage the financial health of hospitals and health systems throughout 2021, says a new analysis released today by the American Hospital Association (AHA).
Hospitals nationwide will lose about $54 billion in net income over the course of the year, even after considering federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding from last year, projects the report, prepared by Kaufman, Hall & Associates, LLC.
Because these projections were made based on hospital performance data in the first and second quarters of this year, before the latest surge, hospitals may face even greater financial challenges because of the uncertain trajectory of the Delta and Mu variants in the United States this fall.
Contributing factors include:
Sicker patients. Hospitals are seeing more high acuity, inpatient cases—COVID-19 patients and those who put off care during the pandemic—requiring longer lengths of stay than prior to the pandemic. While such cases are contributing to revenue increases, any gains are offset by higher care costs for treating patients with more severe conditions.
Higher expenses. Expenses are rising across the board, as hospitals face increasing costs for labor, including spending a lot more resources on contract or travel nurses due to staffing shortages, drugs, purchased services, personal protective equipment (PPE), and other medical and safety supplies needed to care for higher-acuity patients.
Fewer outpatient visits. Hospital outpatient visits—which generally have lower expenses and higher margins—continue to grow, but remain down, compared to 2019 levels. They have yet to fully recover after plummeting with nationwide shutdowns and COVID-19 mitigation efforts in the early months of the pandemic.
In recent months, the spread of the highly contagious Delta variant has set back hospitals even more. The seven-day average of new hospital admissions of COVID-19 patients increased 488%, from 1,900 on June 19 to 11,168 on September 14, according to recent data from the U.S. Centers for Disease Control and Prevention.
"America’s hospitals and health systems continue to face significant, ongoing instability and strain as the COVID-19 pandemic endures and spreads," Rick Pollack, AHA president and CEO, said in a press release.
"With cases and hospitalizations at elevated levels again due to the rapid spread of the Delta variant, physicians, nurses, and other hospital caregivers and personnel are working tirelessly to care for COVID-19 patients and all others who need care," he said. "At the same time, hospitals are experiencing profound headwinds that will continue throughout the rest of 2021."
The analysis also found that:
Higher costs of caring for sicker patients and fewer outpatient visits than pre-pandemic levels could lead median hospital margins to be 11% below pre-pandemic levels by year’s end.
More than one-third of hospitals are expected to end 2021 with negative margins.
If there were no relief funds from the federal government, losses in net income would be as high as $92 billion, which further emphasizes the magnitude of losses hospitals will likely continue to face through the end of 2021.
By studying the Tweets of healthcare workers, new research reveals COVID-related traumatic stress as it unfolded.
U.S. healthcare workers experienced high stress levels due to lack of personal protective equipment (PPE) in the COVID-19 pandemic's first three months, according to an unprecedented study by the Emergency Nurses Association that measured traumatic stress of Twitter users as it happened.
Those hashtags started in March 2020 at the beginning of the COVID-19 pandemic in response to a lack of availability of adequate PPE for nurses and physicians on the front lines. A group of clinicians initially created the hashtags as an online petition drive and within a few days, their efforts expanded into a platform for social action that grew to thousands of participants, according to the study.
The study used the availability of PPE as lens to understand the physical and psychological dangers that frontline healthcare workers were feeling.
"In both methodology and in philosophical approach, this is a new type of study for the ENA research team and emergency nursing," Lisa Wolf, PhD, RN, CEN, FAEN, FAAN, lead researcher and director of ENA's Institute for Emergency Nursing Research said in a press release.
One thousand Tweets were randomly selected from a dataset of 443,918 Tweets published by 281,021 unique authors between March 1 and June 30, 2020. In addition to stress levels surrounding PPE, other Tweet topics included fear of illness, concern over the rapid pace of COVID-19 spread, and frustration about being called heroes.
The study tracks the beginning of the hashtag #GetMePPE on Twitter to stimulate stories about shortages of hospital equipment. Early Tweets indicate alarm and panic about the growing pandemic situation in Italy, with warnings to the public.
"The fear (alarm) about the lack of PPE throughout these tweets confirms and reinforces the reality of equipment shortages, and a growing collective conversational outrage from emergency care providers," the study says.
Within days, the #GetMePPE online petition was live and by March 22 there were signatures from hundreds of thousands of healthcare workers demanding the government ensure an adequate supply of PPE, the research says.
As the death toll rises, particularly in New York City, the Twitter conversations move from observations of conditions to more cries for help.
"I feel like we're all just being sent to slaughter," Tweeted a New York City nurse who had contracted the coronavirus.
By late April, the reality of the pandemic is situated within a larger conversation about government response, the study says.
"The findings of this study are illuminating in its message intensity and consistency," Wolf said, "and we hope this study illuminates the need to examine and address the psychological impact of COVID-19 on the future of the U.S. healthcare workforce.
Relationship-Based Care was the right formula to 'come together and provide the best possible care to our patients,' CNO Elizabeth McCormick says.
When Memorial Sloan Kettering Cancer Center (MSK) embarked on its journey to earn Magnet Recognition®, which recognizes healthcare organizations that provide superior nursing care, Elizabeth McCormick, chief nursing officer (CNO), also began to consider new care models.
RBC is an operational blueprint for improving safety, quality, the patient experience, employee engagement, and financial performance and advances the culture of healthcare organizations by focusing on three key relationships: relationship with self, with colleagues, and with patients/families, according to CHCM.
The outcomes appear to be beneficial. A study about RBC published in the Journal of Nursing Administration shows that caring behaviors increased substantially in 12 months.
Verbal behaviors, such as responding to an expressed concern or providing reassurance, increased from 52.17% to 87.5%, while nonverbal behaviors, such as sitting by the bedside or entering a patient room without being called, increased from 47.6% to 73.6%.
Nurse turnover rates also decreased from 9.4% to 1.9%.
RBC has had impact on MSK's outcomes, as well:
Patient satisfaction scores increased from 87.5% to 95% year-over-year.
Turnover among registered nurses dropped from 0.80% to 0.54% in less than 18 months.
Family/caregiver wait times decreased from 20.11 minutes to 14.94 minutes in less than two years.
HealthLeaders talked with McCormick, who is retiring at the end of this year, about how RBC was adapted at the celebrated New York cancer center more than 15 years ago.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Can you provide an overview of what Relationship-Based Care is and how Memorial Sloan Kettering came to adopt it?
Elizabeth McCormick: Relationship-Based Care is a philosophy that guides our practice, but it's also an operational blueprint on how to advance a caring culture within an organization.
The hardest part was getting started because it was so important to take something that seemed vague and intangible and break it down into concrete concepts and action-driven efforts to achieve. That was the biggest challenge for me: to get the momentum going.
I first learned about it through my association with the AONL [American Organization of Nurse Leaders]. I picked up a book about it and it really piqued my interest, so I shared my thoughts and the book with the other members of my executive nursing leadership team. It was [around the time] when we decided we wanted to seek Magnet designation, and one of the central requirements within any Magnet organization is that nursing needs a professional practice model.
For years, the nursing department had practiced primary nursing [when a single nurse is a patient's point of contact and primary caregiver during a hospital stay] as its care delivery model, so that really set me set me on this journey to understand the elements of a professional practice model, and then learning about RBC and whether it could assist us in getting to where we wanted to go. More importantly, putting Magnet aside, it's all about connecting better with our patients, improving the patient experience and elevating our practice, and the outcomes we achieve, so that's what got me really interested.
HL: What was it about this particular care model that made you embrace it so?
McCormick: What resonates with me about RBC is that it emphasizes the importance of therapeutic relationships or relational practices that are necessary in order to deliver the full package to our patients. So not only does it provide skilled and knowledgeable care, but it does it in a way that's really compassionate and caring and includes the patient's preferences. It really advocates for the engagement of our patients and their families.
We were already delivering that kind of care [but] we didn't have a standardized way of communicating it or embracing it. It helped us to identify where there were some gaps and potentials for improvement.
HL: How did you roll it out at Memorial Sloan Kettering?
McCormick: It was literally a journey and parallels our Magnet journey. It's a process that never ends.
After I had become exposed to it, read about it, and talked to my colleagues about it, I shared these ideas with my executive team that quite frankly didn't initially buy into it, so I actually did seek some outside help, some consultation, from Creative Health Care Management.
We held some workshops on site with nurses at all levels from across our care continuum, including nursing leadership, but we also included other interprofessional colleagues as well, to help us all gain a better understanding about relationship-based care as a philosophy and a framework of care. The workshops also helped guide us with very concrete steps to advance within the organization, because you can't improve the culture change or strengthen existing culture without having the associated organizational processes and structures in place that help reinforce it on a daily basis.
We held open sessions like town halls with our nurses and [that] helped us craft our professional practice model, which embraced a lot of the elements of RBC and individualized the approach to Memorial Sloan Kettering. We came up with a half dozen schematic designs and then we put it out to a vote to the entire nursing department. And that's how we selected our version of RBC.
HL: What were some of the concrete steps of MSK's version of RBC?
McCormick: We vetted our values as a professional department by coming up with the slogan "We CARE," with "CARE" standing for compassion, advocacy, relationships, and excellence, so we care every day, every way, and we came up with this really cool conceptual design with a heart and the iconic disease-specific ribbons around our heart.
Years later, we were able to change the dress code for the nursing staff and, again, they participated in decisions about a new standardized uniform, and now that schematic design for our version of RBC is on every single nurse's and nursing assistant's and nursing tech's uniform. So, it became a simple way of breaking down the elements of RBC so that they were understandable to staff at every level. And that staff at every level could reflect on everything they were doing every day as they went about in the delivery of care, and understand how that fit in with the fundamental core values or principles of RBC.
And then in terms of the processes and structures, we were also refining our shared governance structure to engage the staff decision making, to empower them to have a voice to help guide how we communicate with one another because you can't have a relationship without effective communication.
We broadened other elements like how to foster—within an organization that is quite frankly pretty much still physician-driven—the autonomous nursing practice, while also promoting effective interprofessional teamwork, and doing that in a way that also recognizes the need for promoting continuous learning and hardwiring the fact that we want it to be a learning organization, constantly elevating the bar.
HL: How did the nurses respond to it?
McCormick: The first time I started to notice that it was resonating was when the staff came up with their own sort of lingo, where when they saw their colleagues doing something right, they'd say, "That was very RBC-like," or if they saw something that displeased them, they'd say, "That's not very RBC of you." They started picking it up in their vernacular and pointing out the behavior or manifestations of the values we would try to embrace.
If one unit had experienced some things—either a huge impact, high volume, high acuity, or maybe the staff had experienced a tragedy (maybe a staff member became ill and passed away)—another team would reach out to them and would help to foster their resilience by buying pizza for lunch or offering a nice gesture of support. We would see more and more of those kinds of activities occurring throughout the departments.
Other ways that we can measure what's happening with RBC is we look at our strong outcomes. We look at our very consistently high levels of patient satisfaction, and our accolades that we've received because of our consistently high patient satisfaction ratings.
But it's not just about fostering self-care or promoting high-performing teams. There are many elements of it in which you have to break it down into its component parts and then weave it together so that you as a leader and the staff understand all of its components and how it formulates the basis to … come together and provide the best possible care to our patients.
Approved settlement restores the health system and community hospital's ability to compete on quality and price.
Geisinger, Evangelical Community Hospital, and the Department of Justice (DOJ) have finalized an agreement that will allow Geisinger to maintain an investment in Evangelical.
After a period open for public comment, the U.S. District Court of the middle District of Pennsylvania on September 16 approved the agreement, resolving the DOJ’s lawsuit.
Under the deal, which settled a federal antitrust lawsuit, Geisinger Health will cap at 7.5% its partial ownership of smaller, in-state rival Evangelical Community Hospital and will "eliminate additional entanglements."
The settlement prevents Geisinger from exerting control over Evangelical and restores the ability for them to compete with each other on both quality and price, according to the DOJ. The two providers must also implement antitrust compliance programs.
The settlement, however, allows Evangelical to get an electronic health records system and tech support from Geisinger.
"We have always felt that our investment in Evangelical Community Hospital fostered healthy competition and helped improve our region's access to high-quality, affordable care," Matt Walsh, Geisinger's executive vice president and chief operating officer, said in a press release.
"Geisinger’s investment in Evangelical has received overwhelming community support and advances Evangelical’s important role as a vibrant, independent community hospital," he said. "We look forward to our continued progress on projects that benefit the health and well-being of our patients and the community at large."
'We must continually assess how we are structured and ensure we have the best leadership in every role,' CEO says.
RWJBarnabas Health, which partners with Rutgers University to create New Jersey’s largest academic healthcare system, has expanded role responsibilities for seven key executives in a systemwide leadership and management transition.
These senior team members have been promoted to the title of executive vice president (EVP):
Paul Alexander, MD, MPH, has assumed the new role of EVP, chief equity and transformation officer, encompassing accountable care organization management, the employee health plan, and other resources dedicated to building necessary infrastructure. He previously was senior vice president and chief transformation officer.
Nancy Holecek, MAS, MHA, BSN, RN, is now EVP, chief nursing officer, overseeing more than 11,000 nursing professionals and leading the system’s nursing initiatives in strategic planning, fiscal decisions, patient satisfaction, care coordination, and quality. Former leadership positions include senior vice president and CNO.
Gail Kosyla, MBA, FACHE, FHELA, is EVP, system financial operations, where she is responsible for the financial functions as well as treasury operations. Responsibilities include revenue cycle, supply chain, financial reporting, payroll, and budgeting. She was formerly CFO of the system’s Central Region.
Indu Lew, PharmD, has assumed the new role of EVP, chief pharmacy officer, managing the pharmaceutical supply chain, ensuring quality outcomes through performance improvement activities, and optimizing overall pharmacy and patient care environments. Lew was previously senior vice president and chief pharmacy officer.
DeAnna Minus-Vincent, MPA, is EVP, chief social justice and accountability officer, in which she will advance the Ending Racism Together initiative, for both the institution and surrounding communities. Minus-Vincent previously was senior vice president, chief social integration and health equity strategist.
Trina Parks, MHA, FACHE, has assumed the new role of EVP, chief corporate diversity and inclusion officer, to attract and develop diverse talent, and engage respectfully with RWJBarnabas Health’s diverse communities. Parks formerly was corporate senior vice president and chief diversity and inclusion officer.
Eileen Urban's retirement was announced earlier this year. To recognize her vast contributions—including establishing a world-class investment management and treasury function, exceptional management of the system’s $2.5 billion debt portfolio, and serving as a mentor to countless system leaders—Urban was named EVP, treasury and chief investment officer. She formerly was the chief investment officer and senior vice president of treasury.
"To further build upon our current success, we must continually assess how we are structured and ensure we have the best leadership in every role," Barry H. Ostrowsky, president and CEO, said in a press release.
"I am proud of their accomplishments and eager to move forward with this team of diverse leaders who are each dedicated to excellence in their respective fields," he said. "I am equally pleased to further our commitment to equity and diversity, as we continue to elevate the roles and responsibilities associated with this very important part of our mission."
Editor's note: This story was updated on September 30, 2021.
The scammers, via threatening telephone calls and/or email, tell potential victims that their license is or will be suspended or revoked pending an investigation into their activities, and that they must pay a set dollar amount, within a certain time frame, to have the action against them reversed.
Don't believe it, South Dakota state officials say in their warning issued Wednesday.
"The Department of Health and Board of Nursing would like to remind all nurses in South Dakota that legitimate Department/Board business never asks for personal information nor requests payment in connection to any potential disciplinary action," the state's warning says. "No board of nursing operates this way, and all nurses have the right to due process. We will be forwarding all received complaints to the Attorney General’s office for review."
In some cases, the scammer instructs victims to wire or e-transfer money to accounts or recipients located outside the country—another red flag for all potential victims.
South Dakota nurses who have questions regarding their license status should call the Board of Nursing at 605-362-2760. However, because scammers can spoof caller ID, if a nurse receives a suspicious-sounding call from this number, they should hang up and call the number back.
"It's despicable that there are those out there targeting our frontline medical heroes in the midst of a pandemic," saysKim Malsam-Rysdon, South Dakota's secretary of health.
It’s not clear how many of South Dakota’s roughly 25,000 licensed nurses may have been targeted or contacted by the scammers. However, they're not the only nurses being targeted; other states, such as North Carolina and Texas, have issued similar warnings to their nurses.
South Dakota nurses who have been contacted or fallen victim to this scam should contact the state Attorney General’s Division of Consumer Protection at 800-300-1986 or fill out a complaint form.
The program's peer support model helps healthcare workers recognize and respond to stress in their colleagues and themselves.
A stress-recovery method developed by the U.S. military for battle-scarred soldiers is now serving another frontline population who also is battle-weary from a different, but also traumatizing, war—the fight against COVID-19.
Stress First Aid (SFA) teaches individuals, either peer-to-peer or through leadership, how to identify stress in other individuals, in groups or teams, or even at the organizational level, says Maria Lariccia Brennan, chief nursing officer (CNO) of Penn State Health St. Joseph Medical Center.
"Once you identify the level of stress, then it suggests actions that can be taken to deal with that level of stress and what strategies you might possibly use," says Brennan, who in her previous position as a healthcare consultant to the New Jersey Nursing Initiative (NJNI), helped implement a statewide Nurse Stress First Aid program.
SFA's Stress Continuum Model was first developed by the U.S. military for Navy and Marine Corps service members, according to the National Center for PTSD, to assess the level of their own and others' stress responses. It has since been adapted for use by first responders and healthcare workers.
The model illustrates how stress reactions occur on a continuum. Early recognition of stress indicators allows nurses and nurse leaders to respond appropriately to de-escalate the stress reaction before they have the need for more formal intervention, the national center explains.
'We needed to do something'
Brennan, who previously was a healthcare consultant to NJNI until she took the CNO position at St. Joseph's in late June 2021, began to help implement SFA in New Jersey hospitals last year in the midst of COVID-19.
"Every nurse was affected. Most caregivers were affected. And so we felt strongly that we needed to do something," she says.
"What's nice about this program is it's very user-friendly for the staff as well as leadership and what I also like about the program is we're all speaking one language," she says.
It's easy for a nurse leader to step onto a floor, assess the tension level, and ask nurses what kind of day they're having, she says.
"They could say, 'Oh, I think we're in orange today,' and when somebody tells me that, then I know I need a deeper conversation and I need to do something to get that orange down to yellow," Brenner says. "So, it's a very quick way to determine the stress level either in individuals or groups."
Nearly half of New Jersey's hospitals have adopted the program, Brennan says.
"Of course, we'd like to see every hospital adopt it, but of course it's the hospital's decision whether they want to do this now, or if it's the right time for them," she says.
On a scale from green to red
SFA uses the colors green, yellow, orange, and red, as a general framework for identifying stress levels in individuals.
Green means everything is proceeding smoothly, and the individual is in control, with optimal functioning. As stress builds, an individual may experience mild distress and feel irritable (yellow), severe and persistent distress (orange), and finally, stress causing life impairment (red).
"On a really good day, you would be in the green color code with minimal stress that you can deal with," Brennan says. "You just deal with it and it's the normal everyday stress that everybody has every day."
"But then, when you get into what we call the orange level, some type of intervention is needed. Say I'm a staff nurse in the ICU and I see one of my peers acting differently, maybe getting hyper with dealing with a family member or even dealing with another peer," she says. "They may raise their voice and answer a question in a snappy way. You can just see that they're having a difficult day, and that would be orange level."
With SFA as a guide, Brennan would approach that staff nurse and ask such questions as, "What's going on? Can I help you? Do you need anything?" to encourage them to talk and destress, she says. She might also encourage the nurse to take a half hour off the floor or go relax in a designated destress room, which many hospitals have created because of pandemic stress.
"With SFA, you generally don't need any intervention beyond what either a staff member or leadership can handle," she says. "Sometimes, however, a peer may be identified at the red level, which is beyond the scope of a peer or leadership interaction, where we may need to refer the staff member to EAP, [the hospital's] employee assistance program."
SFA also is intended to help nurses recognize where their own stress level lies within the color coding for the purpose of self-care, but that's usually easier said than done, Brennan says.
"Most of us, truthfully, are not good at that as nurses," she says. "We tend to ignore our own personal stress because we're so focused in on taking care of our patients or we're worried about our families that we're the last ones to deal with our own issues."
But self-care is imperative for quality nursing, Brennan says.
"You have to care for yourself," she says, "so you'll be in good condition to care for others."
Stress first aid for anyone, anywhere
Brennan has been at St. Joseph only since June 21, but she's already proposed implementing SFA there and gotten leadership support, she says.
The advantage of SFA is that it can be implemented in any healthcare environment—from large health systems to local first responder stations—and can include healthcare workers such as school nurses and home health nurses, Brennan says.
"It doesn't have to be just for the acute care environment," Brennan says. "The program is really the same, regardless of the healthcare environment that you're in."
