Want a Nursing Strategy? Build a Vision First!

The CNO at CommonSpirit Health asks if you don't know where you want to go, how can you get there?

Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.

It’s not exactly a news flash to say that staffing will be a top issue for nurse leaders in 2023. Kathleen Sanford, RN, DBA, FAAN, FACH, CNO at CommonSpirit Health, tells HealthLeaders that the massive challenge of recruiting and retaining nurses can be made more efficient when health systems know their mission and have a strategy for achieving it. The following interview was edited for brevity and clarity.

HealthLeaders: What big issues will nurse leaders address in 2023?

Kathleen Sanford: They’re going to continue to help staff with change. And when I am talking about staff I’m not just talking about the nurses. We need to remember that there's a whole team of people in health systems who are getting to be good at change management. Nurse executives must think strategically and have a strategy that's over several years. A lot of people say, “Oh, that's old fashioned now because change is happening so quickly.” I don't agree with that. If we don't have an idea in nursing or healthcare in general of where we want to go, how on Earth can we figure out the right things to do to get us there?

HL: How do you develop that strategic plan?

Sanford: You can’t do strategy unless you have a vision. What do you want to do? What do you want to deliver? You also need to balance change because, while there are many things we need to change, you can't change everything at once. We're going to have to balance what's right for our staff, our patients, or consumers, for the organization, for our communities and for our leaders. That's a tough balancing act. We're going to have to think about that as we set our strategy.

We’ll also have to change the idea of where patients are being taken care of. I’ve been told that we're going to have 16% growth in care outside of the hospital, but we're still going to have a 12% inpatient growth, and probably with higher acuity, too.

HL: How do you see the staffing crisis developing in 2023?

Sanford: That’s the issue that is on everybody's mind right now and that nurse leaders across the country are going to have to deal with this next year, and probably for the rest of our careers. That's going to be the number one issue in 2023. None of those things I’ve talked about—preparing for change, having a strategy, and balancing needs—is going to happen if we don't have staff. 

I get concerned when people talk about having the right number of staff. Nurses are not a commodity. Nurses are professionals who have expertise in different areas. So, it's not just “having numbers of staff.” It's having staff who have the right tools, who are well educated for the work, that they're enjoying their jobs, that they are invigorated by their work, all the things you want in the people who are taking care of you.

HL: What are CommonSpirit’s staffing challenges?

Sanford: There are not enough nurses and other team members to meet the needs of our patients and communities unless we do things differently, and we need to have strategies to do things differently. I've seen various numbers about how much worse this is going to get that range all over the place. The highest one is that we're going to need two million more nurses in the next 10 years, but we're only going to graduate 500,000.

Part of our strategic journey and our nursing strategy at CommonSpirit started with bringing together a large group of stakeholders two years ago and started working on our vision. Our diversity leaders from our various organizations talked about what they’d love to see our system become and what partnerships they would have in this vision. We came up with a long list of projects that were taken back to the CNOs in our seven divisions and reviewed by their nurse executive councils.

Then we held focus groups of nurses across the system to come up with ideas for what the vision should be. When we got down to two different wordings for a vision, we allowed our 45,000 nurses to vote on what they thought the national vision should be.

Kathleen Sanford, RN, DBA, FAAN, FACH, CNO at CommonSpirit Healthcare. Photo courtesy of CommonSpirit Health.

HL: How did you build on that newly agreed-upon vision?

Sanford: Once we had a national vision, we asked ourselves what's the strategy for getting on the list? We prioritized because you cannot do everything at once. Our priorities, given what was happening during COVID, was to come up with four actions.

First is a one-year nurse residency program, the largest finished residency program in the country.

Second, we started our own national staffing agency so that our nurses who wanted to could choose to travel and not lose their seniority.

Third, we developed a virtually integrated care unit that uses virtual care nurses.

Fourth, we started working more closely with academic partners to increase the number of graduates and the diversity of our nursing workforce.

For 2023, our nurses were asked about our second-year priorities, and they told us that they want to have shared governance across the entire system, to have individualized professional development programs for staff, to accelerate our academic partnerships, and to continue resilience and well-being programs, all in that order of priority.

Of course, with shared governance, 45,000 nurses can’t have a say in every decision, but you have to ensure that they know they have a voice at every level, that they have representatives that meet with management to talk about all things nursing. 

HL: When we talk about nurse satisfaction, is the most important element compensation?

Sanford: It’s not about the money. Compensation is not what’s making people leave nursing. It's more about whether they feel appreciated and that they get to do the work that they want to do that they're educated to do, that they have a voice, and that they have a good relationship with their supervisor. Research has shown that most human beings, if the salary is fair and about equal to what other people get for the same jobs, then they’re going to stick with you because they love the work and they feel appreciated.     

HL: How does your nurse residency program work?

Sanford: Hospitals across the country say their highest loss of nurses are in their first year out of school, so I would advise every CNO to look carefully at their residency programs or their orientation. We have revised ours to be one year long. The nurses are paid their salary during that time to take care of patients, but it's not just learning how to attend patients. It's about learning how to manage the intricacies of an organization. We have classes on how to work well with other people, how you get your voice heard, how you deal with violence in the workplace, and how you deal with bullying.

The other piece is that our nurse residents will have 24-hours-a-day virtual preceptors and floor preceptors who work with new nurses so they don’t feel alone.

HL: Can smaller health systems and hospitals that lack the resources and staff still create a vision and build a strategy around it?

Sanford: You can gather 10 people and have a vision of what you want, and a strategy that gets you to that vision. If I was in a small hospital or a small health system, I would look for other systems I could partner with. You don’t have to be huge to get this done. It's about looking at what your vision is for your size and what would work best for you.

The main thing is to remember that there is not a one-size-fits-all solution.