Joni:

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works. I'm thrilled to introduce our episode guest today we have Johnna Smith. Johnna is the Chief Nurse Executive at Southern Illinois Healthcare St. Joseph Memorial Hospital. With an extensive career in nursing and healthcare administration, Johnna has become a respected leader, known for her commitment to patient-centered care, operational excellence, and fostering a collaborative work environment. Under Johnna’s guidance, St. Joseph Memorial Hospital has implemented numerous initiatives to enhance patient safety, improve clinical outcomes, and foster a culture of compassion and respect for leadership and vision to continue to inspire those around her, setting a high standard for nursing leadership. Today we're talking to Johnna about how she approaches workforce innovation through constrained idea generation. I can't wait to dig in. Welcome Johnna to the show. 

Johnna: 

Awesome. Thank you so much for having me today.

Joni:

Absolutely. My pleasure. So I have really enjoyed learning about you, the initiatives that you're doing in your organization. I'd love for you to share, really just start by explaining how your organization fosters a culture of innovation, particularly in the context of nursing and healthcare workforce stabilization.

Johnna: 

Sure. So workforce stabilization has been a top initiative for Southern Illinois Healthcare for the past two years, and we're going into our third year. I think for many organizations, workforce is top of mind. Knowing that so many nurses during the pandemic, some decided to leave the profession. Some wanted different flexibility, some took down the travel road. We're starting to see those nurses coming back to our organizations, which is great. Like we are welcoming them back with open arms. And so for our team here at Southern Illinois Healthcare, we have a multidisciplinary team that has really worked on our workforce. So it's not just a nursing problem, it's every discipline that needs that support. So for the nursing side, we have a strategic team. It's voluntary for individuals to be on our team and no idea is a bad idea. It's kind of my philosophy. So super proud of the work that the team has accomplished in the last two years, and again, excited to see what ideas they bring for this third year as we start to dig in and understand what we can do and what we can own as the nursing profession in the workforce. So it's not just a human resource problem. It's like we all take a piece of that pie and we all take in that ownership. 

Joni: 

That is beautiful. Johnna, I think you touched on two things that are really important in that it's really about everyone. A rising tide lifts all boats, so to speak. And then what I love, what really resonated with me is that you said no idea is a bad idea. I really appreciate that. Can you lean into that just a little bit more and tell me more about how that kind of threads throughout your culture?

Johnna: 

Sure. So, not just within our workforce strategies, it's part of the culture within our departments. So even at the department level, our nurses, our technicians, they do problem solving. They have idea generation boards, so it could be something on their unit that they're wanting to solve. So they take that idea and they put it up on their idea generation board and they work through that process of how are we going to solve this for ourselves? So it's not just leadership coming up with things. We get it down to our staff level and allow for them to come up with ideas to make their workforce better in the day-to-day work that they do caring for patients. So it's really exciting to see. I love the creativity that our teams come up with. We have everything from idea generation boards. 

You have to celebrate. So at the end of the day, you have to celebrate the good work.That's what keeps things going. The work we do is hard, so you have to find a way to make it fun and find a way to celebrate it. We have boards that are coffee-themed today. I had a new board put up in our med-surg department. That's a taco theme. That team is going that way. I was like, I want to celebrate with you guys. I love some good nachos. So I have a Disney theme in my ED. So they went down the Aladdin route, a baseball theme. I mean, it's just the creativity that you see, but it engages the staff and then they're like, okay, if I can see that my ideas are taken seriously, and I see that I have input into these ideas and how to fix our problems that we deal with on the day-to-day, whether it's a big or a small, because either way it's something that we need to work through. They'll stay engaged and they'll keep presenting those things, whether it's a big thing or a little thing. And leadership supports them and helps them talk through it and provide the resources that they may need or connect them to the right person that can help fix that. So it's from our top down and it's just really exciting to see the work that everybody is putting into lots of problem solving, not just around workforce. So I'm really proud of the work.

If we lean back onto the workforce side that our team did this past year, we are in a rural area, so we don't have a lot of people moving to our area as a nurse unless your spouse is moving here for work. So that really looks like our team connecting with our nursing schools and how we support them. We know faculty in our nursing schools is so important and there's not a lot of people that want to go into academia. The pay is very different than if you're on the hospital side of things. I would love to talk about the work that we did with our nursing schools because I'm really proud of how much our nursing leaders from our inpatient side, but also our nursing professional development team, dug in and said, how do we support them? So one of the great things that we saw this past year are some of our nurse leaders stepped in and became adjunct faculty with our nursing schools, which was awesome. 

Joni: 

That's incredible.

Johnna: 

And so what that really allowed for us to do was, one, we know our system better than no other. So we got to provide a really awesome clinical experience for those students. We developed relationships with them and they are now coming to work for us. And so again, but it also provided that support that our community colleges and we have one BSN program here in Carbondale, the support that they needed in order to make sure that these nursing students could have a clinical rotation and have the right size clinical rotation so they could get the experience they need before they graduate. So that's probably something that we're very proud of as an organization, is being able to step in and support our nursing schools.

Joni: 

Johnna, that's incredible. There's a lot of talk these days about academic practice partnerships, and I love community care and I have been in community care in smaller communities before where we really have to, we are constrained in a lot of ways. I'm a little bit biased because similar to you, I feel like no idea is a bad idea. Let's just try it and see. Sometimes those constraints, even though they feel like they put us in a box, I feel like they make us quite innovative and nurses are masters of working around problems.

Johnna: 

Oh yeah, Absolutely.

Joni: 

So I love hearing that some of your nurse leaders in your system stepped into adjunct or faculty roles. To me that is, I don't know, maybe low hanging fruit, for lack of a better word, to develop academic practice partnerships. Because you're right, nobody knows your system better than your leaders, and probably you're the best cheerleaders for your system to be able to pull students in. So Johnna, that's incredible. So tell me a little bit more, what specific programs or initiatives are you implementing to engage individuals, maybe even a little bit earlier in the pipeline? So high school through their bachelor's degree in nursing, and how do these programs help in retention and early professional development in your system?

Johnna: 

Sure. Yeah. So again, another realization over the past couple of years is we have to start earlier. So many times, kids, teenagers by their freshman sophomore year, they know the path that they're going to take. So for us, one thing that we started this past year at the high school level is we have a cohort of healthcare student workers. And so they can be in high school or they could be early on in their nursing career or healthcare career. 

Joni:

Nice. So it allows for them to come in. It provides a flexible schedule so they don't work 12 hours. They may work four hour blocks or six hour blocks, less hours per week where they can come in and start to learn about healthcare and start to learn a little bit about patient care. So we don't necessarily send them off on their own. They do go through an orientation, but they also are able to come in and assist with a lot of things. But they're also developing that relationship with the staff, with the physicians, with that nurse leader and with our organization. And then our goal is to grow them. So they may come in as a healthcare student worker in the first semester, and if they're in nursing school or they've completed a CNA course, our next goal is to get them into that next role that makes sense for them. And so our last cohort, we've been able to place individuals into that next step of a patient care tech role. And then as they do that role, they're, again, more autonomy. They're doing their true patient care. And as they go through their nursing program, our goal is to then, if they're a bachelor's prepared student, we're going to say to them, okay, it's your senior year. Let's do a student nurse extern for you, and now you're going to work one-on-one with an RN. 

And our goal is to get them into the RN residency program, but they're going to have some tools and some knowledge in their toolbox to feel better prepared outside of just getting that clinical experience that they get with their nursing program. For our ADN students, which we see primarily a lot of them because most of our feeder schools are associate's degrees, we talk to them about our transition to the practice program. So once they obtain an LPN license, then they can go into our transition to practice program, which allows them in their final year of their associate's degree, sometimes they go, so it's a little bit later for them, they're going to partner with that RN. We do really try to protect their time and the most they can work is 24 hours, but they're partnered with that RN. They're learning how to do assessments, they're getting to look up medications, they can do procedures. 

And so they're really, again, hands-on getting to do a lot of great things. And then we want to transition them into that RN residency program as they graduate from their ADN program. So we're really trying to find ways to start them early and then stair step through what they're eligible to do and really provide more of an experience for them before they just go from, I've went through clinicals and now I'm going into this residency program and I haven't got to do a lot of hands-on, I've had maybe one or two patients at a time. So here they get a full team of patients with that support of that registered nurse, and we're just seeing such really great things with that less orientation time, they feel more confident. I always say we talk in hospital lingo because we abbreviate everything. So lots of fun things with that.

So they get to learn and they get to develop, and the feedback from them is they're more comfortable in their clinical setting. They understand things. They're not so afraid to say, I'll go try to do that IV, or I'll go try to put that foley catheter in because they have that competence. They've been working and they've been getting that experience. So that's one of the avenues that we've taken and that we're again really proud of and continue to, every semester we take a step back and say, okay, what went well and what can we do better? And we talk to those students that have gone through. So while the healthcare student worker is new to us, getting ready to start that second cohort, our first cohort gave us a lot of really great feedback. Here's what we loved, here's what we think you could tweak a little bit to make it better for the next group. And so that's what we'll do.

Joni: 

Y'all are really co-creating that program together, which is incredible. I think back to when I was in nursing school, I didn't have anything like this program, but I specifically sought out a patient care tech position for this very reason. I was scared. All of these sorts of things. I imagine this has some great benefits for your team members who are there who are kind of pouring into these students. I'm curious, what do they think of the program?

Johnna: 

Yeah, so we've gotten really great feedback from our staff. One group that has really dug in with our nursing students is our nursing professional development outcome leaders. We call 'em into PDLs. They're not the traditional, I think back when I was a nurse on the floor, we had educators that were on the floor. So these are 10 times greater than that. But that group has really, really dug in with our nursing students. So again, part of an idea that they had was, okay, we need to figure out a way to develop relationships with these students and their clinical instructors. What can we do to help support? So they go in and do post-conference teachings with the students, and the feedback from that has been tremendous. Again, sometimes we have some of our staff that are teaching these clinicals and they're wanting to dig in just as much as the students are, but students are like, we love this.

They'll go in and run a mock code with them. They have done things that students don't typically get to see. So they go in, they spend 30 minutes of the post-conference doing education and answering questions and showing them equipment, letting it be so much more fun when you do that versus a PowerPoint. So those nurse leaders too have developed good relationships with those clinical instructors and with the students. And again, it shows them we're all about professional development. You have to be in nursing. You can't just think that you're never going to pick up a book outside of nursing school. You are, you're constantly reading and constantly learning, and you have to stay up to date on the most evidence-based practice for things. And so it shows them as an organization, we're willing to develop you and invest in that professional development even as a student. So we're going to continue on as you're a nurse with us as well.

Joni: 

That's so good. Johnna. I mean, to me that's like the epitome of academic practice partnerships. I mean, when you have team members that are just kind of intertwined into the academic setting who get to know the clinical instructors, the clinical instructors are in your environment, you're all pouring into the students. Your students end up becoming your employees. I mean, that's beautiful.

Johnna: 

It's honestly the perfect, it's what you want. And as you go into nursing, your goal is to help people. And as you go into leadership, your goal is to continue to help people. But it's a broader span, and we just know. I mean, it's no secret that Nationwide Nursing School only teaches you what they can teach you during that nine or 12 months or if you're in a BSN program, longer. But it's really when you hit the department and the floor that you're on that we have to continue to pour into them and get them to a good spot where they feel confident and they know their resources and they can ask questions. They have a safe environment. So we love our partnerships. So like I said, I'm excited to see what the team comes up with this next year and how we can continue to support our academic partners.

Joni: 

You're really taking a systems view on how to build your workforce, which sounds like a successful strategy to me. So I can't wait to see and continue to hear how this program builds and grows because we definitely need this evidence in the body of knowledge. Absolutely. Absolutely. So tell me, looking ahead, what are the next big steps for your organization in continuing to innovate and improve nurse retention and recruitment? Anything else that you're working on that you feel like your team members are just excelling at in this space? Any success stories you want to share with us?

Johnna: 

Sure. I think one of the things that we're looking at is the leveraging of technology. I think everybody's trying to figure that out and how do we look at practices that we've been doing and how do we automate some things and take some things off people's plate. So I think there's probably some things in our future that will help not just our nursing staff, but our nurse leaders as well. I think for us, it's digging into what does flexibility mean? It's the hot topic that's out there. In the middle of COVID, when we had nurses leaving to take travel positions, we very quickly stood up what we call an internal foot pool, which is much, it's run by the same philosophy of agency. It's a PRN type thing, dollars paid at a higher rate for these individuals. That's been very successful for us.

We're kind of at a point now of trying to understand what does our course staffing look like? What does contingent staffing look like? What does flexibility look like? Because these students do want to work, but they might not be able to work 12 hour shifts. But as a nurse leader, how do I do that because I have patients that are here 24 hours and to take a staff member out of that mix creates more workload for others. So I think for us this next year, that's really one of the things that we're going to dig into is that flexibility piece and trying to understand what does that look like for those that are our patient care techs in school along with, it's a little bit easier for our nursing staff. Sometimes they're doing 12 hour shifts. Most of your postgraduate schools are online now. You're not having to go into the classroom. But again, what does flexibility look like because it looks different for every single person. But again, opening up our mind to how we can do it differently to meet our needs, but also the needs of the nursing staff.

Joni: 

Yeah, absolutely. I love that, Johnna. You're right, because even if I just think about myself over the course of my career, what I need today is totally different than what I needed 15 years ago when I had little bitty babies and was in grad school and all of that kind of stuff. And so not only is it different for everyone, but it's different for everyone at every point in life.

Johnna: 

Absolutely.

Joni: 

Absolutely. It's so complex. It really is. And so I love that you and your team are all thinking about this together and just trying and seeing what works. I mean, the people who do the work are often the people who have the solutions. 

Johnna: 

Yep, Absolutely.

Joni:

I love that y'all are leaning into that. So Johnna, I am always curious what other leaders are doing or reading to sharpen their skills or to pour into their souls and nourish their souls. You have a unique perspective on healthcare. There are four hospitals in your healthcare system. You take care of a lot of rural areas. You tend to function within a lot of constraints that many other organizations may not necessarily have. And so I have no doubt that that has shaped how you think. So I'm curious, what are you reading? What are you learning about? What are you doing to spur your thinking or spur yourself on?

Johnna: 

Sure. I think for me, my passion lies around workforce and especially recruitment and retention. So anything I can get my hands on that pertains to those topics I'm interested in. So I've learned a lot. I've been able to connect with a lot of different organizations. I may listen to a podcast or I may listen to a webinar and I'm like, oh, that may work for us, or we may have to put a different spin on it, but let's dig into that and see what we can learn and grow from. Or can I connect with that nurse leader and learn from them? And so for me, that's where my passion lies right now. I'm excited this next year to see where we dig. We've done a ton of recruitment efforts. We feel like that's a good path for us. So I'm excited to see because what retention looked like 15 years ago when I was a nurse leader on the floor looks slightly different now. So back when I was a nurse manager on the floor, which I know I feel it feels like forever ago because with COVID and everything, but when you hired somebody in, your goal was to try to retain them in your department for as long as you possibly can.

What we know to be true is the generations coming in, they already have a plan in their mind. I'm going to work here for two years. I'm going to go here for two years. I'm returning to school this year, and they know what they're wanting to do. I watched my son do it, and I'm like, how in the world at the age of 18, did you already have your life plan for the next 10 years? I didn't have my life plan for the next day, let alone 10 years. So I think for us, it's really how do we retain them in our organization? How do we create pathways for them to grow? How do we fill their cup with that professional development and get them on the pathway that they want to go to keep them here in Southern Illinois because our patients in our community need them and we need that expertise to stay here and not necessarily leave us because we didn't support their growth in their development. So it's really switching that mindset and saying, okay, my goal is to keep them here for what they say they're wanting to work in my department. And then how do we connect them to a nurse retention or to our talent acquisition team to say, okay, here's the next steps they want to take. So do we need to scholarship them? What is it that we need to do to get them to where they want to be and to keep them here in our organization and in Southern Illinois,

Joni:

You're really taking a holistic approach for each person that's coming into your organization, which is pretty phenomenal. Johnna. I mean, that takes a lot of intentionality and a lot of work to do. So kudos for you to you and your organization, and I love that. It sounds like to me that you kind of collect people in addition to other evidence as well. What I heard from you is that you would talk to other leaders and kind of pick their brain. I love that. That is a great strategy to grow and to continue to learn. And I think you made a good point that you're constantly thinking about how to retweet certain things like that sounds great for Chicago or inner New York, but how can we change that for our healthcare team and our communities? That's fabulous. 

Johnna: 

I think we all have the same problems. I think if we talk to any nurse leader, whether you're in the Midwest, the east coast, we're all dealing with the same thing. And I think we can all learn from each other. Again, there might be things that will work. It may not be the perfect design for how it's handed to you, but how can you take that and manipulate it and keep the core of it and turn it into something that'll work for your organization?

Joni: 

Yes. So Johnna, we've talked about quite a bit of things today and you have some really novel solutions that you're doing in your healthcare system. Ultimately, what would you like to handoff to nurse leaders at every level and in every setting today?

Johnna: 

I think of philosophy: no idea is a bad idea. Try anything once. If it doesn't work, go back. But do your research. So dig into those nursing magazines, dig into articles, reach out to your colleagues. I always like to say if somebody's implemented something, okay, tell me the pros, tell me the cons and tell me as you implement your lessons learned. I don't want those same pitfalls for myself. So if I can, I'm sorry you had to go through it, but if I can learn from you and not put myself or my staff through that then, and I just think, think differently. Open your mind and don't be afraid to try something. It may not be upfront. This may not work, but let's give it a try and you're going to learn something from the process no matter what.

Joni: 

That is gold, Johnna. It really is. I have no doubt that just like you collect people and lessons from other people after other leaders hear this podcast today, they're going to want to reach out to you, Johnna, and learn from you. So where can people follow you or connect with you to find more of your work or pick your brain even as they lean into workforce?

Johnna: 

Happy to share my email address, so you can always contact me through my work email. It's Johnna, johnna.smith@ih.net. I am on LinkedIn as well under Johnna Smith. So you can find me out there. Shoot me a message. I'm always happy to connect, very passionate about the nursing workforce and nursing leadership growth and development. So if you're a new nurse leader and you're not even sure where to get started, reach out. It takes a village and our communities need us and our staff need us. So anything that we can share to make things better for any organization, I'm always happy to do that. And I'm sure I'll learn something from you that you're doing that I may want to steal. I always say I'd rather steal something that’s good. We don't need to reinvent the wheel.

Joni: 

That's right. Absolutely. Johnna, that gave me all of the feels because it's clear that you are dedicated to helping others no matter where they are in their career and what setting they're in. So everyone, be sure to either email Johnna Smith or connect with her on LinkedIn. Johnna, I love the way that you're leaning into thinking about workforce development, retention, and recruitment so that we can continue to have a robust profession. So thank you for sharing such expertise and wisdom and ideas with us today. I really appreciate it.

Johnna: 

Yeah, no problem. Thank you so much for having me.

Joni: 

Absolutely.