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 CNOs will face in 2024.
For more information, check out the full article here.
Burnout is everywhere, and it has become a matter of patient safety.
It’s no secret that nurses and healthcare professionals across the industry are burnt out.
Nurses are feeling overworked and undervalued, and since the COVID-19 pandemic and the massive nursing shortage, it has only gotten worse.
Nurse and nurse practitioner burnout is known to have a direct impact on the patient’s experience, and now it’s leading to more emergency department visits.
A recent study from the Columbia School of Nursing found two pieces of key information: A sizeable proportion of primary care nurse practitioners are burnt out, and primary care practices with higher rates of nurse practitioner burnout are seeing higher rates of older patients with chronic conditions receiving acute care.
The problem
Out of the nurse practitioners included in the study, 26.3%, or more than 1 in 4, reported burnout, which is comparable to the levels of burnout amongst other clinicians, such as physicians and registered nurses. According to the authors of the study, Lusine Poghosyan, PhD, MPH, RN, and her colleagues, these numbers should cause concern, and they indicate the need for more attention and research on burnout among nurse practitioners, since most of the research currently available was conducted on physicians or registered nurses.
The effects of burnout on patient care go beyond nurse practitioners. The authors cite previous research that states that hospitals with high nurse burnout rates have extended lengths of stay and greater odds of patient mortality. This new study clearly supports the idea that burnout is affecting patient safety, and that addressing burnout must be a priority for health systems.
The study also offers an alternative explanation to blaming exhausted clinicians for lack of care quality. The authors suggest that there are broader failures within health systems that have policies and working conditions which lead to burnout.
So, what’s the solution?
In the study, the authors state that poor work environments for nurse practitioners are those where there is a “lack of autonomy, inadequate support for care delivery, and poor relationships with practice administrators.” These issues carry over into all of nursing, where there are continuous calls for better working conditions and more support from health systems.
CNOs have a responsibility to their nurses to deliver better working conditions and help them maintain a better work-life balance. According to Lisa Dolan, Senior VP and CNO at Ardent Health Services, there are many things that can be done to help solve this issue.
“One of the initial things is just to be open and talk about burnout,” she says, “and recognize that it’s a real situation.”
Dolan suggests implementing wellbeing check-ins and debriefings after serious incidents, and potentially offering support programs for new mothers or those caring for aging parents. She also emphasizes the importance of celebrating wins as they come, and using patient feedback as a method of uplifting nurses’ spirits.
“If we have great outcomes,” Dolan says, “let’s celebrate every opportunity we [can].”
According to this CNO, here’s what nursing leaders are facing in the new year.
2024 is gearing up to be another hectic year for healthcare. With the never-ending stream of new AI technologies on the rise, and the upcoming presidential election, there are sure to be some curveballs thrown at the entire industry, including nursing.
While the impacts of these changes cannot always be predicted, there are many trends that can be.
To get a glimpse at what to expect in nursing this year, we sat down with Lisa Dolan, CNO at Ardent Health Services, to discuss what she thinks are the top five biggest challenges facing CNOs, and the impacts of new technologies and virtual nursing.
This transcript has been edited for clarity.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
What can CNOs do to help mitigate those challenges?
Well, probably one of the biggest things is just to create efforts that reenergize their communities and their markets around nursing and healthcare careers in general. I think COVID-19 initially painted healthcare workers in a positive light, and on the heels of COVID-19 we had a lot of people think, “Gosh, I really don't know that I'd want to do that for a living.” So, really trying to help reenergize 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.
Additionally, I think really creative partnerships with academic settings to help produce more healthcare workers. We've got healthcare settings that need support and staff, but then the academic settings also need help and are short staffed. 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, [that] would all be very helpful as well.
What do you foresee being the next technological trend in nursing next year? How can that technology aid CNOs and their teams?
There's several that I wanted to make sure that I mentioned. I think virtual care and virtual care platforms are key for our future. Virtual care in nursing can assist with data collection. We can help admit patients, discharge patients, do patient education, family education. There are many things that a virtual nurse can assist a bedside nurse to complete and do, and actually feel like they have more time to spend with the patient. So that's a key piece.
Additionally, I think virtual provider support, and what I mean by that is bringing specialist to the bedside, and that might be a specialist in nursing, to offer support to maybe a newer nurse, or it could be a certain specialist physician to see a patient. Where those resources might be scarce, it can help bring that provider or that specialist to the bedside much quicker. So that whole virtual platform is going to be a huge benefit to nursing and bedside care in general.
One of the other pieces that's pretty significant are wearable technologies to monitor vital signs and monitor the patient's status. So that is just going to open [everything] up. One, it allows more continuous monitoring of vital signs. It frees [up] the staff so they don't actually have to do the task of taking vital signs, but can spend time with their patients doing other things.
Then we have just that continuous and reliable monitoring that can then feed into systems, which takes me to AI and the future of taking that information and that data and helping to support the clinician to make decisions. [AI] can even add alerts and pick up things quicker to aid the team at the bedside.
So, lots of technologies. There’s also the whole notion of smart rooms, and creating smart room technology that allows you to monitor patient movement within the patient room. You can look for things like patients who are at risk of falling that might be sitting out of bed, or is a patient turning as often as they should, and then driving alerts to the team to help with an intervention if needed.
One really exciting piece is the smart room that can hear and listen, so the opportunity might be there for transcription, or [doing] documentation just by talking through the room and having that assist with my documentation. Or, if I'm in a potential safety situation, then I could say keywords or call for assistance and be able to get help if I needed it in the room.
What do you think the impact of remote patient monitoring and virtual nursing will be?
I think what we're going to see is significant impact to certain outcomes. I would anticipate that virtual care is going to be able to help us manage our length of stay for patients. It'll eliminate some delays, possibly, in a specialist coming to the bedside. I think we'll be able to pick up on patient deterioration much quicker if we've got continuous vital sign monitoring.
I think that the assistance it provides will help retain nurses, because it's going to free their time from doing tasks, [and] maybe they can use that time to spend with patient at the bedside, with emotional support, actually caring and [doing] compassionate activities with a patient, which is going to be very fulfilling for the nurse. That's typically why nurses go into this career. It frees them up from doing being so task focused and allows them to really take care of activities that are much more fulfilling and provide the patient with support.
How can CNOs help their staff avoid burnout and maintain a healthy work-life balance?
Gosh, there's a lot that can be done. I think one of the initial things is just to be open and talk about burnout and recognize that it's a real situation. We can do things like having well-being check ins, [or] debriefings after a serious patient event, [and] we can do things creatively to help our staff adjust with key life events. You know, maybe offer support programs that are geared toward new moms or people who are taking care of aging parents.
I think the thing that we forget so often is just to recognize people and celebrate wins. If we have great outcomes, let's celebrate every opportunity we have, and then make sure that we harvest especially patient feedback to recognize our nurses anytime we can.
Are there any other trends you’re seeing that you think will continue into the new year?
I think we're going to see continued emphasis on quality and safety measures. That whole focus of pay for performance and meeting all of those key metrics is going to continue to be really important.
I think we're going to see a transition. I know that at Ardent, we will see a transition from a focus on patient experience in the hospital to almost a consumer experience across the care continuum. So, what is the experience for our patients when they interact with the system? That might be making appointments, it may be their experience when they access their information through their epic chart. Those are all key things.
I think the other piece that we'll see a lot of is different pilots on care delivery models. Because we know we don't have enough nurses to support historic approaches, we'll see people do different team approaches to care. The ability for people to work as a collaborative group and come together and care for a patient, I think it's going to be key into the future over the next year.
Violence is on the rise, but so is technology that can turn the tide, as long as those on the frontlines lead the way.
It’s a sobering reality across healthcare: Workplace violence is on the rise.
And nurses, who are at the heart of care, are at especially high risk. In a 2022 National Nurses United survey, nearly half of hospital-based respondents reported an increase in workplace violence, a 57% increase from the rate reported in their previous survey in late 2021.
Here's what you need to know about how technology can help prevent workplace violence.
For more information, check out the full article here.
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.
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