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Episode 99: Innovating the Nursing Workforce: Texas Children's Hospital's Success Story

May 24, 2023

Dani:

Welcome back to The Handoff, the podcast for nurse leaders from Trusted Health. I'm your host, Dr. Dani Bowie. This is our final episode of the season, and I'm delighted to share my conversation with Dr. Jackie Ward. She's Assistant Vice President and Chief Nursing Officer at Texas Children's Hospital. Jackie brings a wealth of experience and insight into the world of nursing, and I'm confident you'll love her story as much as I do. We discuss the innovative nursing roles and strategies that Texas Children's Hospital has implemented, not only navigate the challenges of the pandemic, but also to create a flexible and supportive environment for their nursing staff. From work-life harmony to professional advancement, and the future of the nursing profession. Jackie's insights will both inspire and enlighten you. Here's my conversation with Jackie Ward, and we'll be back with season eight of the handoff before too long. Jackie, welcome.

Jackie:

Thank you Dani. It's a pleasure to be here.

Dani:

You know, Jackie, you have quite a distinguished career and a pretty comprehensive specifically at Texas Children's Hospital. Can you help provide some highlights of your career journey and, you know, what has inspired you to stay with TCH for all of these years?

Jackie:

You know, I think I am so proud to be the system Chief Nurse Executive for the largest children's hospital in the nation. And that comes with a lot of responsibility. As a, a graduate nurse starting back in 1993 here at Texas Children's, it was the place that I knew I wanted to work for many, many years. For a variety of reasons. It is a place to grow. It is a place where your professional development is at the forefront. Your leaders support your professional advancement. And Texas Children's is so large, you know, almost 20,000 employees with over a hundred locations here in Houston, as well as in Austin, that there is no reason that you need to have a career somewhere else. That whatever you choose to do, you can do it here. And so my career has flourished because I've been awarded the opportunity to advance in a variety of progressive roles and have had the ability to work on organizational priorities and strategies that have fulfilled me right, as a, as a leader. And so those are things that made me really understand the fact that where I wanted to be in a career is, was a place that I didn't see it as a job, but that I saw it as a calling. And so that's how I consider my, my journey here at Texas Children's, and it's been a fulfilling one for me.

Dani:

That's amazing. We've had some conversations and you've mentioned how mentorship has been so foundational to your professional development, and I would just love if you could highlight some of those pivotal mentorship moments or principles that have influenced and shaped your career as well as, you know, how you're carrying out that legacy today with being a mentor yourself.

Jackie:

I've had some very strong, capable, inspiring mentors throughout my career. Three specifically. And one many years ago, early in my leadership journey shared with me that having a mentor is critical to round out how you propel your career, how you see things on your journey, and how you respond to things on your journey. Cuz you need someone who you can bounce things off of someone that's safe, someone who may not totally understand what you're talking about, but understand the principles by which what you're talking about. And so I've had three amazing mentors who have been along this journey with me, and it is something that as I journeyed with them, I realized that people saw me as a mentor and I began having people reach out and say, could you mentor me? And as I did that, I noted that it was more than just the mentoring that I gave them, it was what I gained out of mentoring them.

You always hear that mentoring is a two-way bidirectional approach, and I believe that because I learned so much from the mentee as they learned from me. And so over the course of my career, I have had dozens of mentees that I have even seen grown up here at Texas Children's and Advance, or one then if left Texas Children's that I still mentor because I believe that's key. You need someone who can guide you, who you can trust, who you admire Yeah. Because of their journey. And so I, I give back as it relates to mentorship, because so many people gave so much to me

Dani:

That's really powerful. Would you, you know, I've had conversations with leaders around mentorship. I myself have been mentored. It was a pretty impactful portion of my career journey early on. And specifically I reached out, I was part of a professional chapter and reached out to the leader of the professional chapter and was just like, you know, I'd really love it if we could spend some time together, both around some school that I'm doing for my masters mm-hmm. <Affirmative>, but also just beyond to think differently to get exposure to healthcare. Would you recommend, you know, as people are thinking about trying to find a mentor, you know, within your organization, would you recommend in a professional organization outside, like kind of what, what have you seen or experienced that's been really impactful for you around searching out and finding that right mentor to build that, those relationships?

Jackie:

Well, Dave, I think it'd be a little bit of both, right? It depends on what you meet in your mentor. It depends on what competencies, what areas of opportunity you may have as an individual that you wanna grow in, right? So based on that, I believe you can identify people in your circle whether it's in the industry or you may identify someone that you're not even an associate of, but you see them in an industry and they're propelling and they're successful and they're doing well. And you may say that's a competency that's, that's really prevalent in that industry that I need to build for my success. And so I believe it could be either or, or both. And I think either are, are, are are totally appropriate. Most of my mentors have been in the industry of healthcare. But I do have friends that are in other industries that as I am engaging in our personal, my personal life, that I do talk to them about certain things, but they're not identified as a, as a mentor. Right? Yeah. So I think it's, it's, there's no wrong answer. It's just about what you need and what gaps you may need to close and, and what you wanna expound on in your journey.

Dani:

Yeah. You bring up a really good point about thinking not only mentorship within our own professional path and career, but beyond in different industries. Learning from those that you know, whether it's in marketing or whether it's in technology, I mean, there's so much to be learned that can be applied back into the environment in which we work, which is healthcare. So that's a really good good point. You know, I would love to learn more about TCH and some of the unique programs that you've developed to build and sustain a healthy workforce pipeline currently and, you know, in the past and, and what you're thinking about that for the future as well.

Jackie:

Well, you know, nursing as a workforce, as you know, Dani is in one of the most challenging positions it has ever been in, in the history that in my journey as a nurse. And so at Texas Children's, we really have embraced that. We know that the pandemic has presented a challenge that we have never seen before, and that we hope to never see again, but we've gotta keep moving forward and we have to put what the challenges the pandemic brought to us. Not totally in the rear view mirror, but to thrive out of that. And so from a nursing perspective, it takes children's. We've done quite a, quite a few things to stabilize our workforce. First and foremost, I think it is important to note that we have a president and chief executive officer with Tamar Wallace, who is a visionary and he understands how to stabilize in this environment.

And so he's been an encouraging force for nursing at Texas Children's. To start that off, he identified that we needed to stabilize our workforce, not just nursing, but the workforce in general. We're over 20,000 employees, almost 20,000 employees. And so the pandemic created some challenges. So he championed what we call the Tomorrow together campaign, which is a workforce campaign. It was a bold action, it was an investment in the workforce up to over 130 million for our workforce. And it included salary increases for every employee. It included a 1, 2, 3 retention program that focused on providing employees their paid time off that they had lost throughout the pandemic. It, it incorporated a host of things, but that started at the top. And I think that is what is such an amazing part of Texas Children's, is that not only do we see it and feel it, but the vision starts from the top and you can see it unfold.

So that was the first thing. So from there, I had a foundation that I could just run with at the, as the system chief nurse executive. So I was able to, to leverage that foundation and then create other programs for our organization for nursing as it relates to retention. You know, to keep your experienced nurses today in the workforce, you've gotta be flexible. So I charged every leader to have a retention strategy that focused on our tenured staff, our new staff, and those that are in the middle because you have to meet them all where they are. Right? And so we have different strategies based on where our teams are from, flexible scheduling from the nurse who needs to be home to get her child off the bus. So she wants to work the first six hours of a shift and someone else works the bottom six hours shift.

So we have shared shift programs flexible scheduling, we have scheduling committees. Nurses need autonomy and decision making about things that impact them. So from a scheduling perspective, it is self-scheduling. And we are growing, and I think I've shared this with you, Dani, before we're growing to say it's not self-scheduling when you put down when you wanna work, but a leader adjusts that, right? It is self-scheduling when you work with your colleagues at the front line to say, who needs to work when and how is that gonna benefit me as a staff? Right? I have things in my personal life that I need to manage. Let's all work together as a unit of 60 or 70 nurses. We can figure this out. That's what self-scheduling is.

Dani:

Hmm. You that's a really good call out. And, and I wanted keep on, but self scheduling, right? The, the very premise of it itself, but what you just called out was, it's almost community scheduling. You're building the autonomy through the relationships with your peers because we do have a job to do. You're running ops 24 7, patient care delivery is fundamental and ensuring you have the right staff at the right place at the right time, but allowing the workforce to build the relationships with each other to manage, like, we know we need to get this many nurses today, so let's work together on how we can get there and own that. I think it's a really good call out and something that I haven't heard a lot of people mentioned as a portion of self-scheduling. So I just, that really stuck with me. So thank you for sharing that. And also the fact that, you know, you had a C E O that was looking at the whole workforce and how to recover the whole workforce and recognizing nursing has been hit hard, but it's in the ecosystem of the full workforce and the care continuum for, for healthcare,

Jackie:

Right? Because we can't do it alone, right? You can't do it alone. And so you can't carve out one group as an importance and he never does His vision around vision structure and people with people being the most important component of that equation is all people, everyone at Texas Children's has an important role. And they, when you pull all of those people together centered around encompassing that patient who is at the center of all of that, that is what our mission is. And so we are one team. And and you can feel that in that's a part of our culture. We're one team, we're one amazing team.

Dani:

That's great. You mentioned a bit more about, you know, the retention strategies and how you're looking at it through the whole continuum of your workforce, both new nurse to mid-career nurse and beyond, and how you've challenged your leaders to think about those strategies and, and be nimble and flexible in that. How are you guiding those leaders? Are you giving any support in and helping them develop those plans or any principles outside of flexibility, which you highly emphasize to continue to build into that retention ability of TCH and the culture that you have in place?

Jackie:

So one of the things, Dani, that is really important to me is to make sure that, to ensure that every level leader, cuz we have a lot of levels of leadership in nursing, is that they understand how important their role is at every level. And one of the things that I share all the time is that every level is important, but that frontline leader, that manager who is directly connected to that staff member makes or breaks a staff member's experience, right? Our c e o tells us all the time and is in one of his maxims, is that the, the highest performing organizations are those that have the highest performing frontline leader, meaning the manager. So I have several venues in which I engage with them to talk with them about my vision, to talk with them about our vision through our nursing strategic plan where retention is a significant filler of that.

We have components that we've built in generational nursing is a component of our strategic plan that we focus on for retention. So what does that mean? Having them to develop strategies that meet each of these generational tenured nurse groups where they are, whether it's the nurse who ready to go back to school to advance her career in advance her education. Well, we have support around that. We have scholarships that we can offer. We have nursing excellence awards that they can apply for that financially supports them to go back to school. You know, when you think about the, the new nurse, well we have focus groups that we hold with them throughout different points of their career to say, how are you doing? Because we know that they make up their mind write it about the one year mark whether they're gonna stay or not.

Right? And so that's right when they finish their residency program, well we don't wanna invest the amount of financial capital and the human resource capital and then to lead. So we need to know how they're doing along the way. So we have focus groups that we, we hold with them. I hold what we call just Jackie. It is a informal discussion with the chief nurse executive where we have lunch and we just chat. How are things going? What do you want me to work on? What are some of the things you need me to focus on? And so when you and I do that with each tenured level of staff member, there's a group of 10 or 12 that I meet with a couple of times a month and we talk about those things. So it's the connectedness and the embeddedness that we are focusing on with every level of leadership.

 We have tons of strategies. Dani, I could talk for a full day about what we're doing. You know, for those 10 nurses who may be just may not wanna stay at the bedside for 12 consistent hours with a patient load. We've created expanded roles, roles where they can help the new nurse. So we have an instructor role. We are in the experienced nurse rounds on the floor. She's that extra support and extra set of eyes for that new nurse. So we're doing those wraparound services for these new nurses. So there's a host of things that we could talk about.

Dani:

Yeah, I'm, I'm hearing that and you, you hit the nail on the head when you talked about the impact of the frontline nurse leader or manager and just how transformational they are to the organization, both in carrying out operational duties as well as strategic vision. I mean, it's, it's a very complex and dynamic role and I love how you're, you're supporting them. And then also the nurse instructor role, which I had learned about that a little bit prior in our conversation. And that role to me is something that I wish I'd had when I was a new nurse to be able to get that extra clinical support. I had questions and the first year of practice is really quite daunting. You know, you recognize the importance of caring for human life and just how important the role the nurse is. And so getting, giving them that wraparound service is, is pretty cool. Just one more kind of focus on retention. I know that you've also mentioned you have like a nurse retention specialist. Yes. Another role to focus on this and it's very innovative. And I would just love if you can share with our listeners a bit more about that role and how you're using that role at TCH.

Jackie:

Yes. So the nurse retention specialist is a new role that we created here. We have two of them. Both of them were former leaders, which makes it even better because they understand the challenge of retention being at the leader level. And I created this role because more than 30% of our leaders were promoted to their role in the pandemic, right? Their new leaders leadership development courses had kind of curtailed because of the pandemic. And so when you tell a leader, I need you to focus on patient care, I need you to focus on staff, I need you to focus on retention, I need you to focus on quality, I need you to focus on all these things. I knew that they needed a level of support who they could have as a consultant, right? And so the nurse retention specialist was birthed out of that.

I wanted them to have someone who was strategic minded. These roles, both of them report to me as the chief nurse, and they are part of the cabinet of the nurse executive team. They develop strategies, they partner closely with our human resources department. They evaluate our analysis. They an, they do analysis of our exit data. They actually conduct some exit interviews. They are actually the ones who develop strategies based on what's happening in a unit. And they partner with that leader. They don't own it. They partner side by side with that leader to say, what's happening in your unit? Tell me a little bit about the culture. They look at their data, they help devise evidence-based strategies for that leader to implement. And then they help the leader develop a plan for monitoring what's going on. And it has been really successful. And the leaders have said that they, they value this role because they know they have another partner and someone who is experienced in leadership who understands.

And so we've seen great success in our, our turnover and our retention. We were at our highest at right at about 18% and we're at 13.6 today. So all of these retention strategies are working. And I was happy, Dani, not happy, but I was like, well, a 17.99 is not bad when you think about the national average of 27, right, <laugh>, yeah. But we know that we were be below 10% prior to the pandemic. So right now we sit at 13.6 this month. And I am ecstatic about it because we're seeing the progress and the success of all of these strategies and the hard work of my leadership team. It's their work. They're seeing it in the metrics and people are seeing it, the staff are seeing it, that we're investing in them. They're our number one commodity right now. And so we are doing all that we can to make them feel appreciated and recognized. And so we're seeing it in the numbers.

Dani:

Yeah, I love hearing the, you know, the wraparound services, you providing it to your frontline nurses for retention, but also to your managers and that support of leading those strategies, which I mean, that's amazing. Again, as I was listening, I was like, man, when I was a new nurse manager, I wish I had that as well because me too <laugh>, you know, you need someone to bounce ideas off of because it, it, it can be like, I've tried this, I'm not sure it's working what is in the evidence, but you don't have as much time to review the evidence or the literature because you're leading team. So I, I am really inspired and impressed. And you're right, your metrics do show your effort towards that. You, you, so we're focused on retention, which is I think key, but you've also have a pretty strategic plan and initiative around pipeline and bringing in new nurses. And can you just elaborate a bit more on your, also building your pipeline and generating new nurses into TCH? Because I think you're catching them and holding them and building them up. But I would love to hear a bit more about how you bring them into your health system.

Jackie:

Great. So as you know, we sit in the mecca of the Texas Medical Center, and I also say that's the mecca of academia too, right? So we've got some of the most highly rate nursing schools in our area. And so I partnered very closely with the deans. It was clear as the pandemic was unfolding and nurses were either choosing not to be in the profession anymore or choosing to go work other places. It is not a secret that pay was an issue during the pandemic that nurses were leaving for pay. And so I quickly shared with this leadership team as well as the organization, that our approach was going to have to be grow our own nurses. Because the comp competition for the experienced nurse was really great. Texas Children's is great. We have one of the greatest culture. However, there are some personal reasons why people were choosing to leave.

And so we had to develop a pipeline. And so we, we called it our Grow our Own, and we started with graduate nurses. We knew that that was going to be, they were pushing them out hundreds at a time. And so we were going to be hiring hundreds at a time. I set a goal that we needed to hire 500 graduate nurses in a year, and we did. And so we started with bringing on the graduate nurses, but I wanted to get further upstream in that pipeline to get them more, more ready when they got to the clinical setting. Cuz remember Dani, they were in school during a pandemic. Yeah. They hadn't touched a patient. So I wanted to ensure they had some acclimation to the healthcare environment. So we created what we call patient care technician physicians, which a senior nurse in school, nursing student, and they would work however many hours that they could.

And there was a curriculum that we developed to matriculate them from being a professional student nurse or patient care technician, to then becoming a graduate nurse on the same unit where they had been working while they were in school. They knew the culture, they knew the people, they knew some of the processes because they had been here for six months to a year. And so that was our pipeline. We also created a tandem nurse role, which was a nurse, maybe it was a graduate nurse who wasn't quite ready to go into a full unit patient assignment, but they worked as a tandem nurse in the I C U or in a high acuity area. And it was a support to the existing nurse already here at Texas Children's. So we, we had a, a good, nice depiction of how all of that worked between the P c t, the gn, the tandem nurse during the height of our pandemic as well as the experienced nurse that we were attracting. So we've been pretty successful with this strategy and have really been able to expand our capacity without having to leverage as much overtime and premium pay because we've been able to hire and have been able to retain.

Dani:

Yeah, I mean those are the two, two fundamentals I'm hearing is at your, your loft league lofty goal of 500 new nurses and you're able to achieve that. And then your amazing retention metrics comparative to the rest of the nation is amazing. And I, I like hearing the tandem nurse role again, it's a new one. I'm learning. I'm learning all these new things that I was like, man, that's a great idea. These are all great ideas that I think a lot of our listeners are probably listening to and saying, yep, that is a great idea. And I I probably, they probably wanna reach out to you and learn more.

Jackie:

Absolutely.

Dani:

You know, we've, this, this podcast has really been around the workforce flexibility, which you mentioned a bit about flexible scheduling. And I, I was just hoping you could elaborate a bit more on the concept of flexibility and what it's meaning to you as a nurse leader as well as the nurses that you serve today. And kind of tying that into also what you think the future of nursing and where we're headed and, and, and who we should be in the future would be really helpful.

Jackie:

So as a nurse first, as a nurse leader, second as a mom, and as a wife, the majority of nurses in the healthcare field today are women. Right? And I believe that if we're going to be successful as a profession, we're going to have to begin to focus on meeting our nurses where they are, meaning nurses that are moms and, and, and wives are not gonna sacrifice their families, right? And there are decisions that nurses make all the time about their career because of them being a wife and a mother. And so I believe that from a flexibility perspective, we're going to have to rethink what flexibility looks like for the future. I think that is because of our profession in general, but I also think it's because the generation, you know, the generation of our, our our younger generation want options. They wanna tell you the options, <laugh> <laugh>, and they want you to make the option, right?

And, and, and we laugh about it because when I started, there was nothing available but a night shift nurse position, 11 to seven. And I was like, thank you, Jesus. I got a job at Texas Children's and I'm working nights. I, I took what I could. We are different. It's different now, and I think it's different for a reason. And we are going to have to rethink how we look at our workforce from a wellness perspective. Wellness is not just about ensuring that you're eating right and all these things. Wellness is about your mental capability. It's about your emotional capability. It is about the spirit of togetherness and, and connectedness. There's so much about wellness that we are gonna have to focus on more so than we've ever done before. And that aligns with flexibility. Work-Life harmony is what our vice president Susie Harrington of our wellness program for employees, that's what she calls it.

It's not work-life balance anymore. It's work-life harmony. I used to think about it as blending, right? Because it doesn't balance, there's no balance between what I do and how my personal life is something gives and something does it right? And so I believe those are the things that we're gonna have to focus on. Diversity, equity, and inclusion. That's what our younger generation focuses on. They believe in equity and equality and what are you doing to make this a, a very positive environment for me to work in. That's all about culture. And so when I think about the workforce of the future, and we are really focusing on that here at Texas Children's, we are, we had some sessions last week about the future of the workforce that is being led by Linda Aldridge, our Chief Human Resources Officer. So it, it, it's, it's not about what it used to be about. It's about the things that are, what we're focusing on the future, wellness, scheduling, flexibility, meeting them where they are, professional advancement. Not everyone wants to be a leader, but everyone wants to grow. And what does that mean for you as an employee? So that's what I think we are working towards at Texas Children's and what I think the nursing profession as a whole, it's going to be to focus on.

Dani:

You mentioned a great point. When, when I entered the workforce as well, I had to work nine hour nights and I didn't even know I could ask for like, voluntary time off. It was just like entered in the height of the recession, 2007. And so it was like, just thank you for a job and nine hour nights was miserable, you know, but it, it doesn't mean that was the right way. It just, it is what it, it was at that time. But I have heard from leaders across the country that it has changed into, as you mentioned, the workforce is telling us what they want and they want us to respond to that. And it isn't just, thank you, I have a job, thank you, I have a job. And now you have this work life harmony and ability to progress or choose, you know, what's important to you for whether it's your family, your career, your spiritual wellbeing, et cetera. So I love hearing that. Jackie, this has been really helpful, impactful. I love the story of P C h, all the innovative roles that you have in place. I would love to end the conversation with asking you what you would like to hand off to our listeners today.

Jackie:

We'd just like to hand off to the listeners today that the nursing profession is one that's so notably recognized. And so I think as we think about our population aging and we think about the challenges of healthcare, nursing is at the center of that. And if you have the ability to impact the, the livelihood of a nurse as a leader or as a colleague to a nurse, or as a colleague, as a nurse, we've gotta come together and, and continue to advance the profession of nursing for the betterment of our country, the betterment of our world when it relates to healthcare and the advancement of healthcare. I appreciate you, Dani, for asking me to share the story of Texas Children's. I believe it's a great story. It's, it's a great formula, you know, of having a strong workforce, having strong partners who can augment our workforce when we needed it throughout the pandemic. Such as trusted to augment our staffing and, and to be able to take care of the patients that needed us in the community. We had a charge by our community that they needed us and we needed to answer that like we have since 1954, right? It was nothing different. So I just leave that to your listeners knowing that I highly respect the profession that I spent 29 years in and have loved every minute of it.

Dani:

Very inspiring. And I would agree we are a community of nurses together. And that that is our mission, vision, and purpose is the health and wellbeing of those that we serve as well as each other, right? We're in it together. We're, we're on the same team fighting for the same cause. So thank you so much Jackie. Appreciate your time and it's been wonderful listening to your story and it's been wonderful having the partnership with TCH as well.

Jackie:

Thank you, Dani. I appreciate it.

Dani:

And with that, we've concluded season seven of The Handoff, but we're already hard at work on season eight. We're still determining the focus of next season. So if you have thoughts, suggestions, and are interested in joining as a guest on the podcast, please don't hesitate to email us at thehandoffpodcast at trustedhealth.com. Thanks so much for your support for this season, and we'll be back soon.