Denver Health is experimenting with a hybrid work model for nurse leaders, says this CNO.
On this episode of HL Shorts, we hear from Dr. Kathy Boyle, chief nursing officer at Denver Health, about how new staffing models are impacting recruitment and retention. Tune in to hear her insights.
Nursing and the expectations of the job have changed drastically in recent years, and CNOs need to understand why to pivot their strategies.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
According to the American Nurses Association, almost 18% of newly licensed registered nurses (RNs) quit their jobs within the first year. A 2024 study found that new graduate RNs are leaving for a multitude of reasons, including their age, health status, supervisor and peer support, job demands, job competence, organizational commitment, job satisfaction, and work environment.
Why are nurses leaving?
Melanie Heuston, chief nurse executive at the WVU Medicine and HealthLeaders Exchange member, explained several additional reasons for this departure from the workforce, including the attitude toward nursing on social media.
"Social media has not been our friend," Heuston said, "I think it's absolutely been a place where people can talk about the negative and not necessarily the positive."
Heuston recommended that health systems focus more on social media and use strategies to improve the nurses' experiences.
"I do think that we as leaders need to own the work environment and I think that there's been some bullying in nursing, which I'm not proud to say," Heuston said, "but it's there, and we've got to get strategies to get that under control."
Heuston also cited the nursing shortage, and how more nurses are necessary to create a better work environment.
"It's a little bit of a chicken and egg problem," Heuston said, "you need more nurses to make the work environment better, as it's one of the ingredients."
According to Gloria Carter, vice president and chief nursing officer at St. Mary's Medical Center, and HealthLeaders Exchange member, another contributing factor is the prioritization of work-life balance.
"It's not just the new nurses, I think overall individuals have learned about having resiliency and focusing on work and life balance," Carter said. "I think when you look at it from that lens, there are individuals that are saying 'I need to be mindful and take that time out for me.'"
Changing expectations
Additionally, there has been a generational shift in what to expect from nursing as a profession, according to Heuston. New generations of nurses want to take advantage of new technologies to advance their nursing practice.
"They want the ease of technology," Heuston said, "and we need to be better at responding to that."
Along with many other organizations, Heuston said that WVU Medicine has piloted virtual nursing to support their nursing staff.
"I like to actually call it virtual patient care, so nurses don't believe we're replacing nursing, we're trying to support it," Heuston said. "It's warmly received by newer nurses. In fact, they're starting to expect it."
Heuston also explained that new nurses want to have a supportive environment where nurse leaders check in frequently and deliberately, and provide feedback.
"Generationally, I think that is more the expectation," Heuston said, "to get a lot of feedback, both positive, and what we need to do to improve."
Building resiliency
CNOs are in the position to bridge the gaps between new expectations and the realities of nursing, which involves building resiliency among new graduate nurses while also improving the work environment.
Now more than ever, according to Heuston, nurse managers have been acting as coaches and counselors due to more generational anxiety and depression caused by the COVID-19 pandemic.
"I think equipping [nurse managers] with better tools to be in that role, because they weren't trained to be in that role," Heuston said, "I think we could do better at getting more resources for them to be better."
For nurses, Carter said it's all about having awareness and accessing your support systems.
"It's also [about] connecting within the community and networking with your friends and family, and just bringing awareness and being open to having the dialogue about what you need individually," Carter said. "Then also being a part of that solution in terms of communicating for others that may be having similar challenges."
St. Mary's Medical Center has implemented a wellness app that nurses can use to track physical activities, such as walking, strength training, and other exercises, and obtain nutrition recommendations and other wellness practices that focus on mental and physical well being.
"Participants receive points that accumulate for submission for a reward card of their choice," Carter said.
Heuston suggested using podcasts, since many nurses engage with that medium rather than old fashioned communication methods.
"I'm very interested in doing [a podcast] with a younger generational nurse who can help to educate me on the needs of the workforce," Heuston said. "I think it's [about] being open to all the wellness support that we can offer our staff other than just a relaxation room where they don’t even have time to go, or putting structures in place where they can go there and feel like they can recharge."
This is part one of a two-part series. Part two will be published Monday, September 30, 2024.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Enhanced simulation and training have been game changers, says this nurse educator.
On this episode of HL Shorts, we hear from Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing, about how new technologies like AI and robotics are impacting nursing education. Tune in to hear his insights.
Nurses are at high risk for death by suicide, according to these studies.
September is Suicide Prevention Month, and CNOs need to be aware of the risks and warning signs among their workforce and provide mental health resources and programs.
According to the American Association of Critical-Care Nurses (AACN), the suicide risks are higher for nurses because of several different reasons, including high levels of stress, hectic schedules, exposure to trauma, workplace violence, and a lack of healthy work environments. Other factors include feeling a lack of support and preparation for the job, leadership concerns, depression, and financial issues.
Hear more about how this health system is tackling staffing and nurse education challenges, according to their nurse leaders.
The nursing industry is always changing. With the introduction of new technologies, new generational needs and values, and innovative ideas about recruitment and retention, it seems like there are always new disruptors and challenges that CNOs have to face.
Dr. Kathy Boyle, chief nursing officer at Denver Health, and associate CNO, Dr. Natalie Nicholson, have been implementing new programs over the last several years that tackle these disruptors and improve the overall wellbeing and environment for their nurses.
To address staffing concerns, Denver Health has started offering a hybrid work model for nurse leaders, and nurse apprentice programs to focus on recruitment and retention.
"Our nurse leaders can work from home a day a month, or every two weeks," Boyle said. "We are now researching this intervention through first qualitative research to see the impact on our nurse leaders, and then now we're studying the impact on staff."
"[The nurse apprentice program] has been a really big support not only to the staff," Nicholson said, "but it has created a pipeline to getting student nurses within the Denver Health walls."
To boost nursing education, the health system has placed over 2000 clinical placements since the start of their longitudinal clinical placement program, Boyle explained, with the intent to continue key partnerships with nursing schools and to support students in their careers and entry to practice.
Nicholson added that Denver Health also has programs that encourage high school students to come into the medical field and help them continue their nursing education and careers.
"In the end, I think what we are encouraging here with our nursing profession is that continuous learning," Nicholson said, "we should never stop learning and we want to support and encourage and grow our nurses in the way that they would like."
Listen to this week's episode of the HealthLeaders Podcast to hear more on how Boyle and Nicholson plan to keep tackling disruptors and improving the experience of their nursing workforce.
A new report predicts a surplus of some nurses, but a shortage of others.
For the past several years, the workforce shortage in healthcare has persisted, especially since the COVID-19 pandemic.
Nurses in particular have felt the impact of the shortage, and CNOs have been working around the clock to recruit and retain the best talent possible to bridge the gaps.
However, the numbers seem to be shifting, depending on the profession.
A new report by Mercer predicts that by 2028, there will be an estimated overall surplus of nearly 30,000 registered nurses (RNs) across the country. Some states will still likely experience shortages, including East Coast states such as New York, New Jersey, and Connecticut, which are predicted to fall short by 16,000 RNs.
Unfortunately, the prognosis is not as positive for other nursing positions.
Nurse practitioners
According to the Mercer report, there will be a nationwide shortage of nurse practitioners (NPs), despite this category having the fastest predicted growth rate at 3.5%.
The report emphasizes that NPs are a critical component of preventative care delivery in the country, and they will remain so in the future. A shortage of NPs could mean disruptions to primary and preventative care delivery, especially when combined with predicted physician shortages.
The report recommends that health systems in states with smaller shortages or surpluses continue to monitor their markets to recruit NPs.
Nurse assistants
For nursing assistants (NAs), the report predicts a shortage of more than 73,000 nationwide. According to the report, NAs make up 8% of the healthcare workforce in the United States, and they were 40% of healthcare support occupations in 2023.
Texas, California, and New York are the states that are likely to experience the greatest NA shortages, which will have a ripple effect on the rest of the nursing industry. The report explains that a lack of NAs will increase workloads for RNs, which can lead to more burnout and increased turnover rates.
Moving forward
So, what can CNOs do?
CNOs must continue to focus on recruitment and retention strategies that consider the needs of their nurses. Offering benefits such as flexible scheduling and career advancement opportunities will entice nurses to come and stay at health systems as well as reduce burnout.
Jennifer Croland, vice president and CNO at OSF HealthCare Saint Francis Medical Center, previously emphasized to HealthLeaders the importance of flexible scheduling and listening to frontline nurses.
"The first thing that I would say needs to be done is you have to listen to the front line and really understand what it is that they're telling us," Croland said. "I think just admitting to ourselves that what we're doing is not working is the first step."
The Mercer report recommends a four-pronged approach to tackling these potential shortages and surpluses.
Understand specific supply and demand needs by occupation and department
Strengthen your labor supply pipeline
Retain existing talent
Lower staffing demands
For more information, view the entire report here.
Nurses are at a high risk for death by suicide, but there are ways nurse leaders can help.
Nursing is an incredibly difficult profession.
Nurses face new challenges, including high stress emergency situations, workplace violence incidents, and death, on a daily basis with patients and families. All of those events can take a major toll on a nurse's mental health, which can lead to more serious problems.
September is Suicide Prevention Month, and CNOs need to be aware of the risks and warning signs among their workforce and provide mental health resources and programs.
Nurses are at risk
According to a 2023 study from JAMA Network, from 2008 to 2019, the risk of suicide was higher for healthcare workers, specifically registered nurses, healthcare support workers, and health technicians, compared to non-healthcare workers.
Another 2021 article published in the Journal of Psychosocial Nursing reported that the available data from the CDC's National Violent Death Reporting System showed nurses were 18% more likely to die from suicide than the general population between 2007 and 2018. The risk of death by suicide for female nurses was twice as high than the general population, and 70% more than female physicians.
According to the American Association of Critical-Care Nurses (AACN), the suicide risks are higher for nurses because of several different reasons, including high levels of stress, hectic schedules, exposure to trauma, workplace violence, and a lack of healthy work environments. Other factors include feeling a lack of support and preparation for the job, leadership concerns, depression, and financial issues.
How CNOs can help
While the numbers are startling, nurse leaders can make an impact. It's critical that CNOs take steps to address the underlying issues that contribute to suicide risks to improve the work environment to keep their nurses safe and healthy.
According to Betty Jo Rocchio, senior vice president and chief nurse executive at Mercy, the CNOs at the health system support the whole person by offering flexible work hours so that nurses can choose how and when they work.
"Mental health and well-being are important for both an individual's personal life and work life," Rocchio said. "Flexible hours and environments support the needs of our nurses and ultimately provide the space for our nurses to deliver compassionate, quality patient care."
Additionally, Mercy has programs in place that support whole health, Rocchio explained, including a robust employee assistance program with an abundance of mental health resources.
"People flourish when we support them as a whole person," Rocchio said, "by tending to their physical, mental, emotional, and social well-being."
According to Deana Sievert, chief nursing officer at Ohio State Wexner University and Ross Heart Hospitals, and HealthLeaders Exchange member, there are two areas that CNOs should focus on: staff support structures and nursing workflows.
"By dividing into these two categories, the CNO can assure a broad focus on structures and supports," Sievert said, "but also a zoomed in view that looks at the day-to-day frustrations that can gather and increase stress and dissatisfaction which thereby impacts mental health and wellbeing."
Sievert also recommended implementing an employee assistance program and a strong-structured shared governance model, but Sievert also emphasized the need for a more proactive approach.
"There are some in the nursing community that I have heard are doing a simple screening of the nursing team, through very brief individual surveys," Sievert said, "to help identify those subtle red flags that could lead to reactions such as depression, anxiety, or even suicide.
Sievert is hopeful that this strategy will become more widely used throughout the nursing industry.
"I applaud those organizations and CNOs that have moved here," Sievert said, "and I am hopeful that this becomes a best practice that many of us adopt."
Advice for nurses and leaders
Rocchio also emphasized the important role that CNOs and other nurse leaders play in creating a sustainable work environment where nurses feel supported.
"It's of the utmost importance for our nursing leaders and teams to have a close professional relationship so they can help and support each other," Rocchio said. "Changing the care delivery model to meet workforce needs, designed and supported by nurse leaders, is the key to a healthy workforce, healthy work environment, and a workflow that supports the best patient care possible."
As a note to nurses who might be struggling with their mental health, Rocchio offered some words of wisdom.
"Mental health is critical. As nurses, we tend to set aside our own needs and take care of others first. We must remember that before we can take care of others, we must first take care of ourselves. It's imperative because our families, friends and patients need caregivers who are mentally, physically and emotionally healthy. Supporting our team and paying attention to their needs supports a healthy workforce and environment. Healthcare and nursing put patients and caregivers at the center of our care model because people matter!"
Sievert also had some words of encouragement for nurses.
"First and most importantly, ask for help. We are all here and hope that there is comfort in being able to reach out. Then I would encourage reaching out to your nursing leaders. I assure you we do care about you. We want to help, and we want to support you. Please do not let the stigma that often still exists stop you from asking for help. You are too important to us!"
The 988 Suicide and Crisis Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a trained listener, call 988. Visit 988lifeline.org for crisis chat services or for more information.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
There are many benefits to nurse staffing ratios, for nurses, patients, and health systems, says this CNO.
One proposed solution for ensuring proper staffing is staffing ratios.
Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.
"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."
The significant changes in healthcare have also impacted nursing education.
On this episode of HL Shorts, we hear from Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing, about how nursing education has evolved to fit the needs and values of the new generations of nurses. Tune in to hear his insights.
Adequate nurse staffing ratios are associated with better patient outcomes, says this CNO.
The nursing shortage impacts other nurses by causing burnout and exhaustion, and inadequate staffing directly affects patient safety and experience.
CNOs must be aware of those risks and consider all possible staffing models and solutions so that they can make the best decision for their hospitals and health systems.
According to the American Nurses Association, proper nurse staffing improves patient outcomes and satisfaction among nurses and patients. One proposed solution for ensuring proper staffing is staffing ratios.
Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.
"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."
What are the benefits?
According to Tilton, higher nurse staffing ratios can reduce the likelihood of adverse events, falls, and patient deterioration. In this case, nurses have more time to monitor patients and spot warning signs, and they can intervene quickly when complications arise.
"Optimal staffing ratios enable nurses to conduct thorough assessments, administer medications safely, and implement proper infection control measures," Tilton said, "thereby minimizing the risk of errors and harm to patients."
Proper staffing ratios can also help mitigate burnout and job dissatisfaction, Tilton explained, by lowering workload intensity, stress, and fatigue.
"When nurses are not overwhelmed by excessive patient assignments, they can maintain a healthier work-life balance, experience less emotional exhaustion, and feel more engaged and fulfilled in their roles," Tilton said.
Additionally, staffing ratios can allow nurses to practice at the top of their license, according to Tilton. They provide more time for professional development opportunities as well, such as continuing education, specialty certification, and leadership roles.
"Nurses can collaborate more closely with interdisciplinary team members, participate in care planning, and contribute to quality care initiatives," Tilton said, "when they are not overwhelmed by excessive workload demands."
Financial impact
Just like with any new program or workforce strategy, CNOs need to be able to justify the cost to the rest of the C-Suite.
"While ensuring appropriate nurse staffing ratios may require upfront investment," Tilton said, "it can yield long-term financial benefits for healthcare organizations."
There are several financial benefits to staffing ratios that can lead to saving more time and money for both the nurse and the health system.
"Improved patient outcomes, reduced lengths of stay, lower rates of readmission, and higher patient satisfaction scores associated with optimal staffing ratios can lead to cost savings, enhanced reimbursement rates, and increased revenue generation," Tilton said, "for hospitals and healthcare systems."
Proper staffing ratios also lower nurse turnover rates, according to Tilton, which is an additional financial benefit as well as a solution to the staffing shortage.
"Organizations that prioritize nurse satisfaction and retention by maintaining safe staffing levels can avoid the high costs associated with recruitment, orientation, and turnover of nursing staff," Tilton said.
Overall, Tilton explained, staffing ratios for nurses promote patient safety, quality of care, and better organizational performance.
"By prioritizing adequate staffing levels and workload management," Tilton said, "healthcare organizations can achieve better clinical outcomes, enhance the patient experience, and create a supportive and sustainable work environment for nurses."
Legal implications
While there is no current federal legislation mandating nurse staffing ratios, several states have legislated standards for staffing ratios or have made attempts to do so.
California has had legally mandated staffing ratios since 1999, which according to National Nurses United, are based on individual patient acuity and are designed to fix unsafe staffing in acute-care settings. The California staffing ratios require numerical RN-to-patient ratios as well as a patient classification system. The law also regulates the use of unlicensed assistive personnel and restricts "floating" nursing staff.
Implementing staffing ratios, however, requires levels of nuance depending on the health system.
"It’s important to note that the impact of legislation mandating staffing ratios can vary," Tilton said, "depending on factors such as geographical location, healthcare setting, patient population, and resource availability."
Health systems might run into several implementation challenges, Tilton explained, including budget constraints, potential staffing shortages, and a resistance to change from staff. These roadblocks can impact the effectiveness and outcomes in a mandated ratio scenario.
"Policymakers, healthcare leaders, and stakeholders must carefully consider the unique context and implications of staffing ratio legislation," Tilton said, "to maximize its benefits and address potential challenges effectively."
