Nurses are considering more than just compensation, says this CNO.
Compensation is not the only factor that nurses consider when choosing a health system. Benefits packages, workplace culture, safety, and flexibility all play a role in the decision-making process.
CNOs should take a look at their health system’s offerings to make sure they are attractive to new nurses and that they are staying competitive in the industry.
During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Robin Steaban, Chief Nursing Officer at Vanderbilt University Hospital, spoke about innovative perks to attract and keep nurses, and how workplace culture and safety play a role as benefits alongside compensation.
Diversifying offerings
First and foremost, health systems need to stay market competitive with both compensation and benefits packages. According to Steaban, that is the minimum a health system can do, along with making sure that employees are fully aware of all of the offered benefits.
“Today’s workforce is so much different than it has been historically,” Steaban said. “So diversifying what’s available for your employees is really important.”
It is crucial that CNOs understand the different needs and desires of their staff. Steaban explained that many nurses who are entering the workforce for the first time do not need healthcare coverage because they are still covered by their parents.
“So how do you create programs that are a little bit diverse for them so that they can still achieve some benefit?” Steaban said.
Flexibility is also a huge need in today’s workforce, and Steaban suggested creating some positions in a health system with associated compensation that offer various degrees of flexibility. This could include an internal travel resource pool where nurses can have more options, or even for working in different hospitals within the health system. The key is to diversify the work and match compensation to it.
There are some newer benefits that health systems should consider offering, including wellness benefits, loan forgiveness, tuition assistance, and compensation for certification or advancement programs.
“All of those things help people change their compensation level and benefits in multiple ways [during] employment,” Steaban said, “versus just straight compensation.”
Culture as a benefit
Workplace culture plays a large role in nurse retention and overall satisfaction. A strong workplace culture will make nurses feel less alone and more like a part of a team, enabling them to ask questions without being judged.
“Every day I run into nurses, and I ask [them] what keeps them here,” Steaban said, “and nine times out of ten they say [their] team.”
Steaban emphasized that people will not stay in a work environment where they do not feel safe or where they cannot practice safely. Because of that, the relationships nurses have with physicians and other technicians are also extremely important.
Nurses also need to have a voice and feel heard and responded to. CNOs should provide opportunities to influence their health system, and they should help nurses be successful, advance their careers, and have the experiences that want to have at work.
“There should be forums and places where nurses can really impact the direction of the organization and the standards of care,” Steaban said, “[so they can] really put their fingerprints on their own work life.”
According to Steaban, CNOs should remember that health systems are businesses with the goal of helping patients, and that change must happen, or the business will fail. Nurses should be included in that change, and change management is a vital part of that.
“At the front line of the care continuum are those nurses,” Steaban said, “if they understand why, and they can put their fingerprints on the process a bit, they’ll appreciate that.”
Presenting culture
CNOs need to show the culture of their health system to potential candidates so they can see the benefits of working there. According to Steaban, this starts with demonstrating on first contact with a new nurse that the health system is not only interested in the work being done, but about the candidate as a person. Candidates should also be connected with the team they would be working with, so they can get an idea of what the culture is in that unit.
“Words are cheap,” Steaban said. “The actual experience of the culture is what will either glue them to you or not.”
Nurse leaders should manage the culture across their organizations and make sure that everyone is walking the walk, not just talking the talk, Steaban explained.
“Make sure that your culture is not just on a sheet of paper, or words of a mission or vision,” Steaban said, “but it’s actually the truth of what people experience when they start working.”
Flexibility
As more nurses are looking for flexibility as a benefit, health systems should evaluate where they can put programs into place to accommodate their nurses’ needs. At Vanderbilt University Hospital, Steaban says they are working on a way for nurses to contribute and describe what flexibility they need, since it is different for everyone.
For nurses going back to school, weekend programs can be beneficial, so that nurses can attend classes Monday through Friday and then work on the weekends. Likewise, for nurses with young children, mid shift assignments are helpful if they need to drop off and pick up their kids from school at the correct time while still being able to work.
Steaban says they also have a robust PRN program, where nurses are able to choose the days they want to work and they can fill in where the organization has needs and have ultimate flexibility over their schedules.
“Self-scheduling is still something we do debate all the time, [and] whether it sometimes can create a lot of stress for nurses,” Steaban said. “You actually get to pick your shifts and you can [give] yourself some time off by putting your shifts [in] early in the schedule or late in the schedule.”
There are also travel program options or short-term programs where a nurse can decide if they want to work frequently for a short period of time and then take extended periods off, so they can craft their life like they want.
“That’s really hard to do on a unit,” Steaban said, “but you can do it as an organization, [and] say we’re going to use those nurses to fill in where we have some gaps, but they’ll work a 13-week contract or 6-week contract.”
However, CNOs should still be weighing the nurses’ flexibility with the quality of patient care, according to Steaban. Nurses need to be spending enough time with their patients to develop relationships with them and fulfill care obligations.
“What’s hard for me is our ultimate responsibility is to our patients,” Steaban said. “If your nurse is changing every two or four hours, I worry about our clinical obligation to patients.”
Career advancement
Nurses are also looking for career advancement opportunities as a benefit. At Vanderbilt, Steaban said they have a career advancement program for staff nurses, with peer mentors who can help walk them through the program.
Steaban also recommends offering certification courses as a way to help nurses specialize in their practice. Continuing education credits are also important for nurses to make sure they meet the criteria for certifications and so that they can uphold standards of care.
“Offering certification courses, offering to pay for [them], [and] paying for the completion of that certification testing [are] all really important,” Steaban said, “and then aligning compensation with those accomplishments.”
Geisinger's CNE discusses their health system's goals for virtual nursing.
CNOs everywhere are talking about virtual nursing, and many predict that virtual nursing will help fill the gaps from the nursing shortage.
Janet Tomcavage, executive vice president and chief nurse executive at Geisinger, outlined what Geisinger wants to accomplish with their virtual nursing model. Tomcavage is a part of the HealthLeaders Virtual Nursing Mastermind panel, a months-long, exclusive series where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing these new technologies.
Here are Geisinger's four goals for their virtual nursing program.
The HealthLeaders Mastermind series is an exclusive, months-long series of calls and an in-person event featuring hand-selected healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on exceling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Geisinger's CNE discusses their health system's goals for virtual nursing.
CNOs everywhere are talking about virtual nursing. Health systems across the country are utilizing their nurses and technology departments to create new programs that have the potential to revolutionize the industry.
Virtual nursing provides new opportunities for nurses to have more flexibility, and for hospitals to use their staff more efficiently. A single nurse can now observe more patients at once, and watch for signs of patient discomfort or distress. Tenured nurses can stay employed longer, without having to worry about working long shifts, and they can support new nurses virtually.
Additionally, many CNOs predict that virtual nursing will help fill the gaps from the nursing shortage, and many health systems have already seen positive results from their programs.
Janet Tomcavage, executive vice president and chief nurse executive at Geisinger, outlined what Geisinger wants to accomplish with their virtual nursing model.
Tomcavage is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.
Geisinger's goals
Geisinger is one of many health systems to embark on the virtual nursing journey, and according to Tomcavage, they are most excited to be fully leveraging technology for the first time as a way to support care. There are several goals that Geisinger has already begun to accomplish with their virtual nursing program.
The first has to do with the nursing shortage, which Tomcavage said everyone is aware of. While there are many things that need to be done to solve the workforce issue, virtual nursing is a key component that can help make a big impact.
"We think of it in terms of really opening up the workforce by creating… a new role for nurses to consider, especially later in their career," Tomcavage said, "those who maybe have left, now have options to come back."
The next area of focus at Geisinger is on care quality. According to Tomcavage, the acuity of patients in the hospital is much higher than it has been in the past, due to both the COVID-19 pandemic and other factors. That along with lower tenure of the nursing staff has created several challenges.
"I think the virtual model can really help us enhance quality and things like fall prevention, hospital acquired pressure injuries…mentoring new graduate nurses…[and] patient education" Tomcavage said.
Another key goal is employee engagement, and how virtual nursing can help their nurses directly. Tomcavage explained how the response to the virtual nursing program has been overwhelmingly positive.
"Once [the nurses] really got a handle on what virtual nursing could do, they've been extremely positive about it," Tomcavage said.
The final area that Geisinger is focusing on is patient engagement and experience. According to Tomcavage, there was some apprehension about what the patient response to the virtual nurses would be, but patients have been enthusiastic.
"The virtual model gives patients that one-on-one time with nurses that's uninterrupted," Tomcavage said, "and you can get through an assessment and not miss anything."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexceling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
As healthcare costs rise, CNOs must brainstorm ways to lower them.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task. To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Here's what you need to know about cost containment, according to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist.
CNOs must strategize to keep tenured nurses in the workforce longer.
On this week’s episode of HL Shorts, we hear from Gail Vozzella, Senior Vice President and Chief Nurse Executive at Houston Methodist, about how CNOs can bridge the gap between tenured nurses leaving and new nurses entering the workforce. Tune in to hear her insights.
With rising costs in healthcare, CNOs need to brainstorm how to keep expenses down.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task.
According to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, the nursing shortage drives up labor costs and turnover costs in nursing. Labor costs have gone down marginally with the consolidation of travel nursing, but many organizations are still requiring the use of agency nurses, which drives up costs.
“Every time we spend time training a nurse, it costs money,” Vozzella said, “[but once a nurse] feels that it’s not a good work environment… [they turn] around within those first three years and leave that organization or unit, [and] it is a significant cost.”
To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Redesigning care
One cost containment strategy that CNOs should consider is using technological solutions to change the day-to-day workflows of nurses so that they have more time to care for patients.
At Houston Methodist, Vozzella said they meet with the deans of the surrounding nursing schools, and the number one reason why nurses go to nursing school is still to help people. Nurses want to be at the bedside, not typing into an electronic medical record, hunting supplies, or finding equipment.
“The nurse’s time is precious, and a good thing that’s come out of having a shortage is the focus on nurses doing things that only a nurse can do,” Vozzella said, “or what technology can pick up other tasks that are non-value added.”
Vozzella also recommends using ancillary support staff, such as phlebotomists, to do lab draws instead of the nurse. At Houston Methodist, Vozzella said they also partner with Rice University to help develop robotics that can screen trays to make sure the right tools are present before a tray goes into an operating room, so that the responsibility of checking the trays no longer falls on the nurse.
“[When] nurses have such a high value…and some ancillary support, we can redesign the work of that nurse in order to give that support,” Vozzella said, “so that it offloads that work and [nurses] are able to focus on caring for the patient.”
CNOs should be careful about the designation of work as well, and make sure that they support staff with communication efforts to make sure nurses understand the why of what they are doing.
“We tend to be a little controlling sometimes, or there’s factors like a very tenured ancillary person and a new graduation nurse,” Vozzella said. “It’s sometimes a challenge for that nurse to tell somebody else what to do.”
Care coordination
Additionally, efficient patient care management can help keep costs down by creating a better work environment. There are care milestones that patients must meet before they can go home, and those milestones are met with the help of care management, leadership, physicians, nurses, and advanced nurse practitioners.
According to Vozzella, improved care coordination is beneficial to both the patient and the nurse, as it improves the work environment and provides the patient with some insight into why certain processes are happening.
“It certainly helps patients with a shorter length of stay feeling like they’re a part of their care journey,” Vozzella said, “but it’s definitely helpful for the nurse too, because they feel [like a] part of something bigger than themselves and part of a team.”
Preventative care
Preventative care can also keep costs down. When primary care physicians can help patients manage diabetes or hypertension successfully, they are less likely to have an inpatient admission, Vozzella explained. Technology can help with this, so that patients can have more support at home without having to go into a doctor’s office or to the hospital.
Patient education is important to preventative care, because patients need to know about how different health factors affect their overall health, and nurses are a huge part of that.
“It is an exciting time for nurses to be part of that,” Vozzella said, “because it does offer nurses [the opportunity] to do more preventative care, but also to potentially do that virtually.”
CNOs should look at why patients are coming to the hospital in the first place and strategize ways to create support for them at home as well as in the hospital. Vozzella recommends having a case manager or social worker who can check in with patients and make sure they have transportation, food, and psychological support so that they attend their appointments and prioritize their health needs.
Leveraging technology
Over the past 15 years, according to Vozzella, health systems have moved toward rebuilding facilities to have better environments with natural light and private rooms, but it has just increased the amount of walking nurses have to do daily to see their patients.
“When [nurses] are in a room, they’re typically the only person,” Vozzella said, “and it’s so very isolating for, in particular, nurses that are newer in their career.”
However, bedside nurses are no longer alone with the addition of virtual nursing. Through virtual care, nurses can log in and come on the television screen in a patient room and act as a second set of eyes for the bedside nurse.
“I think virtual [nurses] can be a huge support, but it has to be implemented in partnership with bedside nurses,” Vozzella said. “We have to really work hard to understand where nurses tend to need support and make sure that’s our highest priority.”
CNOs must bridge generational gaps to maintain a strong workforce.
The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring and taking their knowledge with them.
CNOs must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.
Here's what CNOs need to know about connecting the generations in nursing, according to Cassie Lewis, chief nursing officer at Bon Secours Mercy Health, and Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist.
These nurse leaders outline best recruiting and retention practices for CNOs.
The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring and taking their knowledge with them.
CNOs must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.
During the recent HealthLeaders’ Nurse Labor and Compensation NOW Summit, Cassie Lewis, chief nursing officer at Bon Secours Mercy Health, and Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, spoke about strategies to retain tenured nurses, and how CNOs can help transition the knowledge of tenured nurses to new graduate nurses.
Connecting the generations
There are major differences in expectations between Traditionalists, baby boomers, Gen X, millennials, and Gen Z in the workforce. Life circumstances and work-life balance needs are different, some nurses might have children or elderly adults they need to care for, while others are younger and able to work at varying times during the week.
Due to the stressful nature of nursing and current workforce challenges, there are tenured nurses who are leaving the profession entirely and taking their knowledge with them.
CNOs need to strategize ways to keep the knowledge within industry, so that new graduate nurses can learn from them.
“Our environments are really physically and mentally demanding,” Vozzella said, “so what options can we give to somebody who’s at the end of their career?”
Flexibility
One strategy that CNOs should use is to sit down with tenured nurses before they decide to leave the workforce and ask them where they want their career to be in the next three to five years, Vozzella explained. Providing individualized flexibility is key and will keep tenured nurses working at the bedside longer.
“If a more tenured nurse wants to be off all summer, it would be better for us if we allowed that,” Vozzella said, “in order to keep that person working in an intensive care unit or an operating room for five more years.”
CNOs also need to make sure that tenured nurses feel valued. Lewis recommended taking a look at what offerings are being given to incoming nurses, and how that can be balanced with offerings for tenured nurses.
“When you go online, sign on bonuses are exponentially large in some areas, the compression factor is real,” Lewis said. “[We need to ensure] our tenured nurses feel the same value because we don’t want them to feel left behind.”
Compensation is not the only factor, the position of a tenured nurse could become hybrid, where half of their work is at the bedside and half is in a faculty position, Lewis suggested.
“There’s benefit to saying it’s not just monetary compensation,” Lewis said, “but we’re willing to work with you to create some level of flexibility that meets you where you’re at.”
Virtual nursing
One of the best options for keeping tenured nurses in the workforce longer is virtual nursing, according to Vozzella. Virtual nursing would retain the knowledge of tenured nurses and provide new nurses with support so that they feel less isolated.
“[The tenured nurses wouldn’t be] walking as much, but they could continue to speak to patients or…mentor new nurses that are starting out [while] not having to do such a structured 12-hour shift,” Vozzella said. “They could do it for four hours, [or] they could do it from home.”
Lewis agreed, adding that generally having more creative positions in nursing is how to keep tenured nurses from leaving the workforce. Virtual nursing creates opportunities for nurses to do virtual admissions and remote patient monitoring, which would keep tenured nurses from exclusively having to work at the bedside.
Mentorship opportunities
Another way to keep knowledge within the industry is to provide tenured nurses with opportunities to mentor incoming nurses. According to Lewis, one way to do this is to keep an expert or a tenured nurse on call, so that newer nurses can reach out if they need help with something.
“We’re starting to see [this] as a strategy [for] when we can’t get [tenured nurses] at the bedside,” Lewis said, “[and] how [we can] take that knowledge and really use it to help that novice nurse become safer in their practice and feel more confident.”
Lewis also recommended a nurse emeritus program, where seasoned nurses who are close to retirement can mentor newer nurses or even nurse leaders. Volunteer programs or nurse faculty positions are also helpful options since many nurses who leave want to stay connected to their patients.
“Our nurses really do feel connection and callings to do the things that we do every day,” Lewis said, “and so the more we can meet them where they’re at to share that collective knowledge, they’re willing to do it.”
This is part two of a two-part piece, part one was published Monday, March 11th.
On this week’s episode of HL Shorts, we hear from Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, about how CNOs can use AI to help solve staffing issues. Tune in to hear her insights.
These nurse leaders outline best recruiting and retention practices for CNOs.
The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring, and taking their knowledge with them.
Nursing leaders must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.
During the recent HealthLeaders’ Nurse Labor and Compensation NOW Summit, Cassie Lewis, Chief Nursing Officer at Bon Secours Mercy Health, and Gail Vozzella, Senior Vice President and Chief Nurse Executive at Houston Methodist, spoke about strategies to improve nurse recruitment and retention, and how CNOs can help create and strengthen the next generation of nurses.
Challenges
Recruiting and retention challenges have always existed, but were greatly exacerbated by the COVID-19 pandemic. The nursing shortage became more evident as large numbers of nurses left the industry or went to agencies, and academic pipelines were disrupted, Vozzella said.
“Rebuilding our workforces certainly led to looking closely at recruitment strategies … nationally across hospitals,” Vozzella said, “and I think it gave us the opportunity to look and see where we had clunkiness in the recruitment process.”
Lewis agreed, emphasizing how the pandemic affected the different generations of nurses in the workforce.
“We obviously are needing to recruit different skill mixes of nurses because we have the need for expert nurses or nurses with experience,” Lewis said. “But also we are seeing a lot of new graduate nurses coming into the profession.”
This, however, creates a lack of experienced nurses at the bedside.
“Trying to ensure that we are adequately training our newer graduate nurses and giving them that experience that they’re looking for…is very challenging,” Lewis said.
Additionally, nurses now hold more power over where and when they work, since there is a higher demand for them.
“The ball is in their court,” Lewis said. “They have many competing offers, [and] they have many health systems where they can go.”
“I think as chief nurses what we have to balance [alongside directors and managers] as they hire and onboard is doing it with speed,” Vozzella said, “because certainly people are getting multiple offers.”
Another challenge facing CNOs during the recruitment process is that there are five generations in the workforce, according to Vozzella. A graduating class of nurses can now include people from several age brackets, and people who are second-career nurses, and their needs are all going to be different.
“Communication is key when you’re communicating with [different] generations of nurses,” Vozzella said. “We have to be more intentional as nursing leaders and as we implement new strategies to hopefully unburden the bedside nurse of tasks that they don’t need to be doing.”
The perception of nursing on social media also plays a big role in the modern recruitment process.
“I think one of the things that has been very eye-opening is with the presence of social media,” Lewis said. “[Nurses] do talk and there are platforms now for them to talk about organizations.”
“I think we have to make sure that we have the right environment [so] that our culture speaks for who we are,” Vozzella said. “[And we must be] attentive to what is being said on social media.”
Strategies for CNOs
The solution to these challenges involves creating an environment where nurses want to work and where they feel valued and supported, both personally and professionally. This includes providing individualized experiences and the flexibility to have a work-life balance.
“One of the things that we’re seeing with these different generations of nurses is work-life balance means something different to every generation,” Lewis said.
“Even benefits packages for employees, one size no longer fits all,” Vozzella said. “At different phases of life, you need different things.”
“What could be the game changer between one organization and another is that individualized experience,” Lewis continued, “where someone really cares about you as a person and has the ability to have some level of flexibility.”
Both Vozzella and Lewis emphasized the need to strengthen academic partnerships to create strong pipelines into the industry, and the necessity of creating robust transition to practice programs.
“Having a nurse residency program has been … beneficial, because people coming out of school are [just] getting the basics in training,” Lewis said. “When [graduate nurses] are actually starting to take care of patients, they’re mind-blown at some of the things they’re encountering.”
CNOs need to make sure their nurses can come into the industry to practice nursing, rather than getting caught up in administrative tasks. According to Vozzella, this will also help with retention.
“Being called to be a nurse is very special,” Vozzella said. “We have to create an environment [where nurses] can use their calling and can help people. So that’s not typing in a medical record for 60% of your shift, that’s not hunting and gathering for supplies, or trying to find other things.”
Nursing leaders also need to be supported so that they have time to interview, recruit, and select candidates while fulfilling the rest of their responsibilities.
“[CNOs must] make sure that our recruitment teams have those strong partnerships with frontline leaders to make those selections,” Vozzella said, “and [that] we use as much technology as we can to make that a streamlined process, not just for the candidate, but also for the leader whose time is precious.”
This is part one of a two-part piece, part two will be published Wednesday, March 13th.
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