CNOs and CFOs must learn to speak each other's language, says this nurse leader.
On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, about how CNOs and CFOs can better communicate with each other. Tune in to hear her insights.
A new report shows that lowering nurse manager span of control improves clinical and financial outcomes.
Amid high burnout and turnover rates, nurse leaders should take a closer look at a key piece of the workforce puzzle: nurse managers.
Nurse managers need time and support from leadership to complete their tasks. According to a report published by the American Organization for Nursing Leadership (AONL) and Laudio, this could be accomplished by lowering span of control.
Span of control refers to the number of employees that nurse managers are in charge of supervising. According to the report, the median span of control for nurse managers is 46 employees, but 25% of all inpatient nurse managers have spans of control higher than 78.
The problem
According to Rudy Jackson, senior vice president and CNE at UW Health and a HealthLeaders Exchange member, nurse managers often have to perform many different duties. As a result, they’re often stretched thin.
"We put so much incredible pressure on our nurse managers to manage finances, culture, patient experience, quality, [and] keep turnover rates [and] length of stay down," Jackson said. "Yet we have all of these things that we put on their shoulders before they're able to get those things done."
Jackson said UW Health is making a significant investment in reducing span of control for nurse leaders. They’re looking at metrics like total headcount per nurse manager vs. how many pilots they are working on, as well as workforce diversity.
Jackson said a recent study has helped the health system understand what “we can eliminate off their plate” to make their jobs easier.
High spans of control also impact turnover rates.
According to the report, managers with higher spans of control face more turnover costs and incremental overtime.
Nurse managers are often swamped with busy work, leaving little time for job development. Jackson said that with more time, nurse managers could develop relationships with their teams, improve quality outcomes, improve the patient experience, and ultimately reduce costs, turnover and vacancy rates.
"What I need are leaders," Jackson said, "and reducing that span of control is going to allow us to move those individuals into a leadership role where they're truly able to guide their teams."
The solution
The ultimate goal of lowering span of control is to give time back to nurse managers while also keeping costs down.
The report says that a financial case can be made for reducing span of control, when possible, even if it means splitting larger departments into smaller ones. According to the report, leaders should consider reducing or reallocating administrative tasks to offload the nurse manager's burden, while leveraging technology.
Additionally, the report says that giving more time to nurse managers to meaningfully interact with staff lowers RN turnover rates, which in turn lowers hiring costs.
To Jackson, the answer to this issue will vary depending on the size of a health system and its resources.
"When you look at the control data for an organization like UW Health and you compare us to others, we do have a lot of resources that support our managers," Jackson said.
"It's a matter of trying to understand what exactly are those individual things that are impacting our leaders," Jackson continued, "and how can I leverage technology to offset some of that burden?"
UW Health developed a nurse manager council so that nurse managers have a venue to voice innovative solutions, questions, problems, and concerns. Jackson said UW Health will soon be conducting time studies with managers across the health system to better understand where nurse managers are spending their time.
"One of the solutions I heard recently from a CNE was [that they] give [their] managers a day off once a week, and … in theory, that would work pretty well," Jackson said. "The reality is that the work doesn't stop."
"As CNEs, we need to start thinking about innovative solutions, leveraging technology, offering the appropriate support," Jackson said, "but [doing] so in a manner that doesn't add additional cost to organizations that already exist on razor thin margins."
What about assistant nurse managers?
According to the report, the assistant nurse manager plays a critical role in this strategy.
The study found that 56% of nurse managers are supported by at least one nurse manager. Of that number, 4% of nurse managers have all team members reporting to the assistant nurse manager and 18% share the direct reports, while 78% have all team members as their direct reports, without including the assistant nurse manager.
The report says that RN turnover is lower when assistant nurse managers are part of high span of control teams, which ultimately reduces costs. However, the data also shows that too many assistant managers can become counterproductive and lead to high turnover, possibly because roles are less clear.
Jackson has experienced working in environments with and without assistant nurse managers, and UW Health is now trying something new.
"What we've challenged our team with is start looking within," Jackson said. "What resources do we have internally that can allow us to start to decrease that administrative burden to those managers so that we can get them out of their office and elevate the roles of some of the others?"
UW Health deploys full-time charge nurses called care team leaders (CTLs). Jackson said they are looking at how CTLs can help offload the burden from nurse managers.
UW Health is also leveraging technology to help with administrative burdens.
"We're looking at technology to remove the burden of scheduling," Jackson said. "We've got to be able to put pressure on our IT departments to find those solutions that help nurses and help the organization make our leaders more efficient, [and] support our nurses even better."
In health systems where creating new roles is not possible, Jackson recommended making existing roles more supportive to the nurse managers.
"I think there's a lot of different ways to utilize the assistant manager role," Jackson said, "but I don’t think we need to be stuck with the solution that the assistant manager is the only way we're going to fix the manager span of control."
TheHealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders CNO Exchange event and becoming a member, email us at exchange@healthleadersmedia.com.
One of the biggest challenges when implementing virtual nursing programs is determining which metrics to use to measure ROI.
Jason Atkins, vice president and chief clinical informatics officer at Emory Healthcare, outlined how the Atlanta-based health system is implementing virtual nursing and the five metrics they use to measure the success of their program.
Atkins is a part of the HealthLeaders Virtual Nursing Mastermind program, in which several health systems are discussing the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Metrics
The first metric, according to Atkins, is nurse satisfaction and nurse engagement. This data is collected via surveys that go out to the nurses.
"We do pulse surveys to make sure that we're asking questions around, 'Do you have the tools you need for your work?’ and, ’'Do you have the staffing and resources that you need for your work?'" Atkins said.
The second is patient satisfaction. Patients must be made aware of the cameras and what their interactions will be with the virtual nurse.
Atkins said that explaining the virtual nursing process to the patients will gain their trust and engagement.
"We really want to make sure that we're explaining the why behind this to our patients," Atkins said, "because they're going to see a camera in their room and that could certainly give someone a sense of privacy invasion."
Length of stay is the third metric. The virtual nurses are completing discharge planning, education, and facilitation, and according to Atkins, they are the link to the interdisciplinary rounding process to make sure that milestones and barriers are worked before discharge day.
"Making sure we've got prescriptions set up, we've got their med reconciliation done, we've got all their discharge milestones such as transport or subacute care." Atkins said. "All of that stuff should help decrease our length of stay."
The fourth metric is readmission rates, which are often dependent on discharges, education, and follow-up planning.
"Making sure that the patients who are discharged have their follow-up appointments before they ever leave the hospital," Atkins said, "so they can get that good continuity of care and not get readmitted to the hospital."
The fifth and final metric is cost and productivity. Atkins explained that the goal is to offload the burden of care from the bedside nurse, while making sure that there is a return on investment.
"It's not just adding on new staffing or thinking about how [to] increase the ratios on the nurses," Atkins said. "It's really about a return on investment based on those other metrics [and] hopefully quality of care improvements as well."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling 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.
The old ways of growing the nursing workforce are no longer working, so it’s time for some new strategies.
The greatest challenge facing nursing leaders today is workforce development. Health systems are in dire need of solutions that improve both recruitment and retention.
These challenges come at a time when workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover. Virtual nursing and other new technologies like AI have also had an impact on the workforce and need to be considered when strategizing.
Here are four ways CNOs can move forward and build a strong, healthy, and happy workforce.
Nurse leaders must rely on each other and build resiliency amongst nurses.
Paula McKinney knew from a very young age that she wanted to be a nurse.
She began her career in 1986 at Toumey Regional Medical Center in South Carolina. After moving to Indiana in 1989, she advanced to nursing education to include a master’s degree in Community Health from Indiana Wesleyan University and a Doctor of Nursing Practice from the University of Southern Indiana.
McKinney created a dual nursing career as a nurse leader and nurse educator. She advanced her career in nursing leadership from manager, director, executive director, and then to chief nursing officer. She now serves as the vice president of patient care services and CNO at Woodlawn Health and is a HealthLeaders Exchange member.
On our latest installment of the Exec, HealthLeaders sat down with McKinney to discuss her journey into nursing, and her story of resiliency as a nurse and leader. Tune in to hear her insights.
Geisinger is leveraging virtual nursing technology to improve quality of care.
On this week’s episode of HL Shorts, we hear from Rebecca Stametz, vice president for digital innovation at Geisinger, about the virtual nursing models at Geisinger. Tune in to hear her insights.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling 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.
Mount Sinai is using several pieces of technology to improve care coordination.
As more virtual nursing programs pop up throughout healthcare, more technology is integrated into health system workflows, and it's important that nurse leaders understand the capabilities and potential applications.
Clair Lunt, senior director of nursing informatics at the Mount Sinai Health System, outlined how the New York-based health system uses technology in its virtual nursing program, and how they plan to expand the program in the future.
Ms. Lunt is a part of the HealthLeaders Virtual Nursing Mastermind program, in which several health systems are discussing the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Technology
According to Ms. Lunt, Mount Sinai uses virtual nursing for admission and discharge documentation and patient education. They are using several pieces of technology including TVs and cameras.
"There is what's called a bridge, which is the platform where the virtual nurses can actually log into [their] systems and see [their] patients," Lunt said.
The cameras are placed above the TV in the patient’s room and paired with a high-resolution zoom camera next to the TV.
"Those cameras are used to home or zoom right in on wounds or medications or blood products that you need a second set of eyes on if needed," Ms. Lunt said.
There are also pillow speakers with microphones that patients can use to call the nurse.
"They can speak through it, and they just talk to the pillow speaker when they're answering," Ms. Lunt said, "and the virtual nurses can hear them."
Future applications
Over time, Ms. Lunt believes the program will go beyond virtual nursing.
"Other platforms will want to be able to use the technology to be able to care for patients at a multiple number of sites," Ms. Lunt said, "rather than have people based at each site."
For instance, someone from the MRI department could use the virtual platform to help patients complete -questionnaires, rather than having a bedside nurse dothem. Pharmacists could also use the platform to go over new medication information with patients.
Ms. Lunt said the platform could also be used for home rehab programs, with virtual nurses working with patients at home to complete physical assessments prior to pre-authorization, freeing up the clinician to work with the patient.
"They can just pop in and just talk to the family and the patient," Ms. Lunt said, "you can actually pull the patient's family members into a call without them actually having to be in the room with the patient."
The idea is that virtual nursing will expand to improve patient care overall, Ms. Lunt explained.
"So that care coordination piece, I think will become favorable for a lot of different disciplines," Ms. Lunt said, "not just virtual nursing."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling 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.
This health system has four goals to reach with virtual nursing, says this CNO.
The potential of virtual nursing seems promising as many health systems begin to brainstorm and implement programs of their own.
Sarah Brown, CNO at UnityPoint Health, laid out how the Iowa-based health system has set up their virtual nursing program and what their four goals are for the future.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind panel, where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Here are the four phases that UnityPoint hopes to achieve with their virtual nursing program.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling 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.
Mentorship between new and tenured nurses is mutually beneficial, this nurse leader says.
On this week’s episode of HL Shorts, we hear from Dr. Jennifer Mensik Kennedy, president of the American Nurses Association, about how CNOs can create mentorship opportunities to help retain nurses. Tune in to hear her insights.
UnityPoint's CNO discusses the future of the health system's virtual nursing program.
The potential of virtual nursing seems promising as many health systems begin to brainstorm and implement programs of their own.
Sarah Brown, CNO at UnityPoint Health, laid out how the Iowa-based health system has set up their virtual nursing program and what their four goals are for the future.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind panel, where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.
Starting goals
Many health systems are using virtual nursing to offload work and give time back to nurses to be at the bedside. And at UnityPoint it's no different.
"Our goals with it initially, and I would say they have morphed a bit over time," Brown said, "[were] really to redesign the work so that we could remove some work from our nurses that were at the bedside to try to make their experience while they were at work better."
Brown said UnityPoint wanted to set up the program in a way that did not sacrifice quality or patient experience. The main focus was on improving the bedside nurse experience, and that remains a priority, along with efficiency and quality goals.
"I think the efficiency piece comes when we’re getting high, 90%, maybe even 100% of our admissions on our med surg inpatient united completed within the first four hours," Brown said. "That's not something we could have said before."
Brown attributed that success to how they resourced differently. There is now more focus and consistency with the people doing the admission and discharge processes, and so they are able to do more of them. Brown said they are heading toward a retention goal with the program as well.
"With that experience, they catch more things," Brown said. "I think where we want to go is then more focused on our new-to-practice nurses that really need more of a mentor [or] coach sort of role."
What's next
Brown sees UnityPoint going through four evolutionary phases with the virtual nursing program.
Phase one includes the admission and discharge processes and other documentation needs, along with some care planning and patient education.
Phase two will focus on operations and implementing in-room technology. This would enable the virtual nurse to help check medications, blood draws and other processes with the bedside nurse in the room. They could also help assist with documentation during a rapid response situation, and help with virtual rounding.
"I think we are a bit hampered with moving forward in the other phases without the in-room technology," Brown said, "so that piece will be really important to us."
The third phase is expanding the program to allow for monitoring on a broader scale. Virtual nurses could then act as eyes in the sky, to look for deterioration, sepsis, or other patient conditions.
At that point, the health system could move to the fourth phase and use virtual nursing for mentorship of new-to- practice nurses.
Brown said that three years into the program they have really matured the first phase, but they still have a long way to go to get to the long-term goals.
Additionally, Brown is hopeful that UnityPoint can implement virtual care in the EICU.
"Like many organizations, we are at max capacity in many of our hospitals on a daily basis," Brown said. "I have this idea that there has to be a way we can incorporate virtual waiting room monitoring or virtual nursing in our emergency departments as well."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onexcelling 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.
