Brian Zimmerman, Beckers (00:00):

Hello everyone and welcome to today's webinar, nurse Retention in the Era of Workforce Flexibility, Real World Lessons from Health Systems. My name is Brian Zimmerman and I'm pleased to serve as your moderator today on behalf of Becker's Healthcare. Thank you so much for joining us. So before we get going with the conversation, I want to cover a few quick housekeeping instructions. We'll start today's webinar with a panel discussion. We certainly welcome any comments or questions. You can submit those throughout the webinar by typing them into the q and a box you see on your screen. Today's session is being recorded and will be available after the event. You can use the same link you use to log into today's webinar to access that recording. If any trouble, anytime you have trouble with your audio or video, please try refreshing your browser. You can also submit any technical questions into the q and a box. We have folks on the backend who can help out with those. So with that, let's meet this outstanding panel of leaders. I'm going to tap on each of them to introduce themselves, share a bit about their professional background, current role and organization. Agnes, why don't you get things going there?

Agnes Therady, Franciscan Health (01:03):

Good afternoon. Thank you for the opportunity to be in this panel. So I'm a nurse of 40 years. I served across continents the last 27 years in the United States. Currently I work as a senior vice president and chief nursing officer for Franciscan Health, the Catholic Health Ministry of 12 hospitals, mostly in Indiana, but one hospital in Chicago, Illinois. Joyfully serving in the role and being responsible for acute care standards of care and practice, as well as post-acute care, which we have home health and hospice. And we also have four pay centers for Franciscan Health. Prior to that, I did work in the federal health system at the VA for five years and the county health system in Chicago at the Cook County Health and Hospital System.

Brian Zimmerman, Beckers (01:54):

Agnes, great to have you here. Appreciate you bringing your experience and expertise to this panel today. Darius, let's meet you.

Darius Love, Orlando Health (02:04):

Super excited about being here with you guys. Thank you for having me. Darius. Love. I am a neuroscience nurse by background. I have the opportunity and the joy of leading at one of the most happiest places on earth in the great city of Orlando, Florida. I'm a part of Orlando Health. I'm the a VP for workforce optimization and redesign. I get to create and invite team members on the journey for innovation and optimization as it pertains to the work that we are called to do. Orlando Health is a 52 bed hospital system, about 35,000 team members, the only level one trauma center in central Florida. And again, super excited about being here with this amazing panel and spending time with you guys.

Brian Zimmerman, Beckers (02:54):

Amazing to have you Darius as well. Looking forward to hearing from you. Terry, meet you.

Terry McDonnell, Duke Univ Health (03:00):

Good afternoon. It's a pleasure to be here. I'm Terry McDonnell and I have the pleasure of serving as the Chief Nurse Executive for the Duke University Health System, which is an academic medical health system in North Carolina. We have three acute care facilities and about 27,000 employees of which I serve and support about 11,000 of them. I come from a background in oncology. I am a nurse practitioner by trade and training and I've been caring for GI Oncology patients for about the last 25 years.

Brian Zimmerman, Beckers (03:36):

Excellent. Thank you for being a part of this, Terry, and you're all making me feel quite lazy. It seems to like you've worked on a lot going on. Janice, go ahead.

Janice Walker, Advocate Health (03:47):

Thank you Brian. So I'm Dr. Janice Walker. I am blessed to serve currently as the regional Chief nursing Officer for Advocate Health in the southeast that covers the states of North Carolina, South Carolina, Georgia, and Alabama. Advocate Health has a Midwest region, which also includes Illinois and Wisconsin together. Advocate Health System is the third largest, not-for-profit healthcare system in the United States for about 160,000 employees, of which 48,000 are nurses. I've been here since January, so 10 short months Prior to that I was the system chief nurse exec for Baylor Scott White Health, which was the largest, not-for-profit healthcare system in the state of Texas. So I traded in one state for multiple states, but very blessed to be called to nursing and called to leadership and happy to represent today,

Brian Zimmerman, Beckers (04:46):

Happy to have you and to get your perspective, some of those regional differences that you've probably seen as well. So thank you so much for being here. Brian, go ahead.

Brian Weirich, Bon Secours Mercy Health (04:55):

Hey, good afternoon everybody. Thank you for having me. I am Brian Weirich. I'm the Chief Nurse Innovation Officer for Bon Secor Mercy Health. Bon Secor is 50 hospitals in six markets over four states. We also have a couple hospitals in Dublin, Ireland. Our hospitals range from large level one traumas to very rural critical access and everything in between. Prior to this, I've held system nursing roles, market, CNO roles and CNO roles of facilities for the last eight years and have been a nurse for the last 18 years. Happy to be here.

Brian Zimmerman, Beckers (05:31):

Happy to have you, Brian, and I'd appreciate that you spell your name the correct way with an I. We all know that YY is not a real vowel, but let's move on here. And Brian, we'll begin with you. You can kick us off on this first question, which we've been talking about workforce for quite some time now in healthcare, but for a while, recruitment was really where we were talking a lot about filling vacancies and that sort of thing. I think at least the tenor of conversations I've been having, retention seems to be more of a pivotal focus in recent years. Can you talk a little bit about how Brian, you've refined your retention strategies and where have you seen success?

Brian Weirich, Bon Secours Mercy Health (06:16):

Yeah, great question. Recruitment is still a top priority. Everybody's going to have their pipeline schools, their partner schools, the workforce, the nursing workforce is the heartbeat of a hospital. So after you get that recruitment done, retention to your question has really shifted a little bit, at least from my perspective. Previously, we focused a lot on culture, the magnet journey, the overall culture and just leadership to keep people to want to stay. But the workforce is changing and evolving, especially post pandemic. The early careerists coming out have a lot more options than we've ever had in the past, and that's not just within a hospital, but that's outside the acute care setting, remote jobs, working at Walgreens and Walmarts and that part of the industry is looking to recruit nurses. So it's shift a lot. Now. These nurses really want flexibility. They want options, and this is the generation that lives in their phone. So if you can present those flexibility and options in a mobile app in their phone, that's what they're used to. That's the way they live. And two health systems that I've been at have had a lot of success kind of migrating that way, making it easy for them to get their schedule, pick up additional shifts and kind of create that work-life balance that's important to them.

Brian Zimmerman, Beckers (07:38):

And can you share a little bit more details too about sort of integrating that solution? What change management did that entail? How did you help drive adoption? Those sort of details. Brian

Brian Weirich, Bon Secours Mercy Health (07:51):

Depends on where the starting point is. Some people are, especially in even some health systems that I work at in the rural critical access hospitals, we're still doing paper scheduling. So that's a bigger lift, right? Others, you have a scheduling system in place. But to get a platform, a mobile app platform that can work with your existing schedule because you don't want to be too disruptive with a schedule, right? You want to take the scheduling process and make it easy. So identifying a partner in the industry that can sit on top of your existing schedule and just make it easy and live in the nurse's phone creates minimal change management. Again, this is a very tech savvy generation. They pick that up very quick and most of them are asking for this. If you have web-based or if you're still communicating by email, everybody knows the pains of that. You send an email out two weeks later, nobody has read it and they're missing key points about schedule deadlines or upcoming, upcoming due dates. So this makes it easy with nudges. Everybody gets the alerts on an app icon, not a web-based app, but an actual mobile app. So change management becomes very easy for this generation.

Brian Zimmerman, Beckers (08:57):

Thank you, Brian. Janice, can you talk a little bit about where you've seen success with retention strategies lately and how those have shifted perhaps in recent years?

Janice Walker, Advocate Health (09:07):

I love Brian's answer about the need for some type of electronic communication device that sits on nurses' phones. And I had that both at Baylor and we have it here where you can send out instant alerts of short shifts that might have a little incentive pay with them, maybe not, but it's the constant communication at the fingertips of the clinician to say, Hey, listen, I can't work a whole shift, but I can give you four hours. I can give you eight hours. The flexibility of that is massive. And also in terms of feeling like they are one related to the current need that's being pushed out electronically. So that's number one. Thank you, Brian, for setting the tone of we have to have a device in our clinician's hands if they choose to use it. The thing that I think that we focus on currently is creating that retention environment that is magnet centric, but also may be Pathways to Excellence, which is another amazing accreditation that the A NCC offers because both of those must haves really assist the voice of the nurse coming to the table to control their practice and in their environment.

(10:32):

And in my experience, once a hospital system starts to navigate to clicking off nearly all of your hospitals either magnet or pathways, you really see a change in the retention numbers. The outcome numbers show the worthiness of the investment behind pathways as magnets or marching at advocate is to slowly but surely, and particularly in my region, is to mature each one of these organizations to that nursing excellence infrastructure brought to you by the accreditation of Magnet or Pathways.

Brian Zimmerman, Beckers (11:12):

Yeah. Janice, do you believe that sort of speaks to the general theme or general desire among nurses to want to be excellent, to want to deliver excellent care? Do you think that sort of aligns there?

Janice Walker, Advocate Health (11:25):

I think Brian, they want to be heard and they know what excellent care feels like and how they can bring joy back to the work. But without listening attentively and listening to their voice and the control of their practice, it's really hard to create that in the environment of pathways and Magnet mandates it, and you work so hard for that accreditation and you see the outcomes behind it, you don't want to lose it. It's becomes part of your DNA.

Brian Zimmerman, Beckers (11:55):

Appreciate those details. Janice. Terry, let's hear from you.

Terry McDonnell, Duke Univ Health (11:59):

Well, we've got, I mean, the systems and the mechanisms absolutely need to be there to support picking up gig shifts and the flexibility in the workforce. We're right now supporting five different generations in the nursing workforce, and each and every one of them has a different set of expectations. But when you really dig down into the core of it, it's around engagement and value, which speaks a little bit to what Janice is referring to. Magnet is a tool that we've all relied upon, but I think the workforce is evolving faster than Magnet is able to keep us current. And what we're really starting to focus on are the needs of nurses who are in that zero to three year tenure with us. How are we as organizations really supporting their onboarding? How are we supporting their ability to flex from discipline to discipline? We've got a workforce that starts maybe in med surg or in the ICU, and they realize very quickly maybe they want to learn a new skill shift to something different. So there's a whole body of work that we've dug into around education and transition of the workforce within our system. How do we really demonstrate to our nurses when they're joining us as a new graduate that they really have the opportunity to build and grow and travel through the continuum of their career to the end of their career. Maybe they're pursuing doctorates, maybe they're pursuing other skills in other disciplines, but we need to be adept at supporting them through all of that while keeping them engaged as part of our workforce.

Brian Zimmerman, Beckers (13:49):

And Terry, follow up for you there, thinking about that, I think painting a picture and engaging with them in terms of what their career can look like, how do you also, I guess when you're maybe moving someone away from med-surg or things like that, how do you also strike the balance of you also need people in certain places, you want to be able to help people along and move them to where that they want to go, but you also have needs as a system of where you need people. So how do you think, I guess, about striking that balance to be?

Terry McDonnell, Duke Univ Health (14:22):

That's a great question and a very current topic. That's something that we've been working heavily on within our health system because how do you get that excitement and joy and fulfillment for staff in those areas that I would say over the last five years have maybe been a little bit downplayed. They're not as sexy as the ICU or being in the ORs, but what we're also seeing in this youngest generation of nurses is that they really do value excellence in clinical care. So what we are starting to build is a culture and a narrative and support around really ensuring that they've got those well-rounded foundational skills that they get working in med-surg for six months to a year. We can offer incentive and support to help keep them or help entice them to that area, and then we keep them engaged. And then when the time comes and they're thinking about what they've learned and how they carry those skills to other areas, we've actually stood up a group of our senior nurses to act as career counselors to help those nurses then identify what their next steps are going to be. But we are constantly reaffirming the value and the importance in ensuring that you start off with those really strong skillsets in those areas like MedSurg.

Brian Zimmerman, Beckers (15:49):

Thank you so much, Terry. Darius, moving to you now.

Darius Love, Orlando Health (15:53):

No, super excited because Brian, Janice, and Terry all said buzzwords that live in the work that I do, it's easy it, we have to be adaptive and we have to be agile enough to move with the direction that the workforce is going. And so to Terry's point, the workforce is actually telling us what they want. And so we have to as leaders be able to lean into that. And so what we've done at Orlando Health, we've done several of those things that have already been mentioned, but the way that we've leaned into retention strategy for the organization is really looking at the lifespan of our clinician. And so what we've said is strategically set leaders in those life cycles to really own what that looks like. So from a pipelining standpoint, we have an executive leader that works with not only our universities but our high schools to really create pipeline and really create and work with our site leaders inside executives to create capacity for shadowing moments and for preceptorship, my work fits in once we get you in, how do we make work easy and efficient?

(17:11):

Because when we talk about workforce stability, investment in the work that we're called to do becomes super important. People want to come to work, do a good job. 12 hours is a long time to be somewhere. And what we've historically asked our clinicians to do is to accomplish in 12 hours where it really takes 16 hours. And so how do we scale that back and create efficiencies and how do we capture their voice to Dr. Walker's point, to lean into that journey? How do we capture the voice of our front line team members to continue to tell us what we need? And then we have another executive that's stationed when we talk about standardization, we have people that float everywhere and how do we create standards and practice that are standard across the enterprise so that if I do have to float, nobody wants to float, but if I do have to float and I end up somewhere that the practice looks the same and so I'm in a new place, but that we practice the same.

(18:13):

So the nuance is not you do it differently than we do somewhere else. The nuance is how do I make those people connections to help me get through the shift that I'm called to? And what we've seen through that life cycle is huge wins post pandemic from a retention standpoint, we exceeded the goal that we set for decrease in retention for this past fiscal year, and it's really leaning into, I believe, the approach from a holistic standpoint, what does this mean from the clinician, from a mind, body, spirit standpoint, and creating really that structure and strategy, that strategy that aligns all of that

Brian Zimmerman, Beckers (18:57):

For you. Darius. And then Agnes, we'll get to you. You've been very patient, so we will get to you in just a moment. But Darius follow up for you in that what's come up, obviously it's come up on this panel already, but the importance of gathering that information, elevating the nurse's voice and adjusting the work accordingly. I guess my follow up for you is also you have to take all that feedback in, but I imagine you can't act on all of it. There are some things that cannot necessarily be changed or changed right away. So I guess how do you think about bringing the voice in, but also getting that feedback loop to close the loop with folks when you haven't acted on it and letting 'em know when you have

Darius Love, Orlando Health (19:39):

The work of the cross-functional team is invaluable. So really including the clinician on the journey, not just the initial intake, but you've given us this data and you've given us this information as leaders, how do we create a sense of ownership and really driving and driving the change? And the ownership is not just the leader's responsibility, it's our responsibility. So our clinician's journey with us. So no, we can't do everything at one time. We would love to, but these are our priorities and this is how you impact what our priorities are. And I don't set the priorities, we lean into them from a strategic standpoint and we elevate the voice of our clinicians. So you said that this is a priority, so we know this is what we're working on first and this is what we work on second. And then I think it's, it's nothing new, but it's still as invaluable as it was when it was introduced a stoplight report or a variation of a stoplight report.

(20:43):

We've captured your voice, this is what we're doing now. This is in the yellow section and it's more to come or this is red and this is just not on our radar currently. Not saying that it won't come back up, but again, including I think our workforce wants to be included on the journey. We know, I think that they have understanding that nothing happens in a day, we wish that it would, but from a sustainability standpoint and a joy at work standpoint, being a part of the journey I think is super important. And I think that that's what the workforce wants,

Brian Zimmerman, Beckers (21:17):

Transparency there. And also tying back changes to sort of the mission, so to speak. Everybody knows what the priorities are and if you tie it back to that, people will understand. Agnes, turning to you now. What work are you doing on the retention space? What's been effective? What would you like to add to this portion of the conversation? You're still on mute there.

Agnes Therady, Franciscan Health (21:43):

I must say thank you for this fascinating conversation. And what I could glean from what the panel members shared was some best practices that we have available to us, and sometimes the best practices don't stick with a particular group of staff or maybe an organization, but what has worked well for us? I would say that our nursing staff, including our entire workforce of 19,000 plus, they generally lean on to our ministry's mission and values. And one of our values is joyful service and fidelity to our mission. So if we ask our nurses when we do the walking rounds or we do town halls, what makes you stay here? We have pretty good longevity. We don't see some turnover except during the pandemic. And the response is, so to speak, very predictable. It's the values. They love the values of the Franciscan system. So when I look at that and I wonder, so the staff want to stay with us, but they also want to be listened to.

(22:54):

So we engage in purposeful rounding leader rounding, which is also accelerated by town halls by the senior most leaders, the CEOs, but the managers and above do rounding and collect firsthand information. We also do stay interviews just so that we can anticipate if there is a potential content or dissolutionment among a particular group of nurses, and how could we turn them, turn it around and make it work for them so that they will continue to stay. It had been a success. Our pilots and two hospitals turned out to be hugely successful. So we encourage the frontline managers to do stay interviews. We got all our managers, not managers, sorry, our CNOs to be able to read the book on stay interviews, which was a bestseller, and then they took excerpts of it and shared it with their managers. The other thing that works with them, as many of you all mentioned the panel mentioned is that they want to feel engaged but in meaningful ways.

(24:00):

So we started shared collaboratives and frontline staff are part of our shared collaboratives. Every service, every department has got a collaborative that is led by a director, but we are involving frontline nurses to be part of the co-chair of the collaboratives. For example, recently we started as staffing committee collaborative, shared collaborative at the system level where they understand why do we have acuity based staffing? Why don't we go to the typical nurse to patient ratio staff and what's in it for them? They're so engaged in it that they are the team that's making the decision for how should we do staffing? What should be the model of nursing in a med-surg unit versus a critical care unit versus a step down unit or for that matter, the er. So engaging the staff in meaningful ways to be able to say shared decision making. One of the tenets of magnet and pathway to excellence is being working because the staff feel like, wow, they're listening to us and not only listening, but also responding like how DARE is mentioned, closing the loop on communication.

(25:16):

Then they feel like whatever they've contributed is working. Recently, we had some forums at the foundation level for nurses and other coworkers to share ideas on innovation, and there were 70 plus entries, which talked about simple solutions for challenges which we can have return on investment. At the same time engaging the staff. It was fascinating to hear the participants, including frontline nurses, talk about some things that meant the most to them and for which they're seeking foundation dollars to improve and innovate the processes. So my focus really is to say, how do we take the culture of an organization and turn it around where they feel valued, respected, have the joy of working and meaningfully communicate with us what matters to them the most?

Brian Zimmerman, Beckers (26:14):

So many themes that tie in throughout this conversation. Agnes, appreciate you elevating those where I want to go next, and Agnes, we can begin with you and it goes into some of the engagement aligns with having nurses in conversations about how things should be staffed, I think. But to Terry's point as well, the multi-generational workforce has different needs and in terms of flexibility, flexibility can mean different things to different people. So I guess my question we could begin with you, Agnes, is how are you executing on that flexibility and tailoring flexibility to a team that has everyone's in different phases of life, have needs require different times of day to do different things? How do you think about flexibility as it applies to the broader workforce but making it personalized in some ways?

Agnes Therady, Franciscan Health (27:06):

Sure, that's an excellent question and a point we're discussing. So when we talk about flexibility at Franciscan, we had some form of flexibility afforded to the nurses and the bedside team by way of self-scheduling, but it became the norm and people wanted more than that. And as you can say, as Terry mentioned, there's a certain group of workforce in our five generation workforce who want to be keeping bankers hours. They don't want to work on weekends. They would rather work nine to five or they would like to cut down the pandemic. I think it was a blessing in disguise in some ways because it taught us what our staff want from us. So there are some who want to work weekend hours. There are some who want to work only weekday out, some who do not want to work nights. So we have this wide range of understanding what flexibility means.

(28:04):

And I will tell you an example. I did a round of one of our hospitals and I asked the staff, what does flexibility mean to them? And they gave some very revealing things. First they said unanimously, don't take away ourselves scheduling. Allow us to be able to swap sheets without making it tedious on us and give us the ability to be able to pick up extra shifts as we want. And so now we are working with a company called Trusted Works who will help us to be able to use this, what Janice mentioned, the tool or I think it was Brian mentioned the tool that they can have it on their mobile app and they can pick the extra hours. And we are not giving them the 12 hour shift option only. It can be multiples of four hours, four hour shifts, six hour shifts, eight hour shifts, 10 hour shifts or 12 hour shifts.

(29:02):

We need you all and we can find a place for you. So the tool basically does the, I think it is an AI based tool to be, I think it is, which helps to predict what the staffing needs are and match it up with the staff needs. And also an advantage in that is the staff pick it because they want to pick it, not because they're dreading the call from the manager to say, can you come and work that? One more shift for us. This shifts are open to them and they can pick depending on what they think they want to work. And because we are transparent with the full master schedule, there could be some staff who may be working in one of our region hospitals, for example, Indianapolis, but they have relatives for which they're gone for a weekend to work in 60 miles away, but they have the competencies to be able to pick the shift, a six hour shift for some extra things to work in one of our other hospitals because it is competency driven.

(30:07):

And so the staff are loving the idea of it. We are doing the pilot in two of our hospitals. We hope that it'll work out and we think that we want to expand it to the level where we can open it up. Not to nurses, but all other workforce members who do 24 7 work, and we think that will be the game changer in terms of being really flexible. And then of course we did, I want to kind of put forward, make a shout out to our teams, which we built a internal travel poll. We currently have 397 members working, and in a span of 20 months, we were able to save the system $11.1 million by replacing agency with our own internal travel pool. This is an example of a typical gig worker. They only pick up ships that they want to pick up, but we have placed for them.

Brian Zimmerman, Beckers (31:06):

And I think that win clearly, I'm sure many on the leadership team appreciated that. So I appreciate you sharing that, Agnes. Sure, Brian, I'll get to you in just a moment, but Terry, you sort of started us off thinking about the multi-generational workforce and that, so I want to give you some space to talk about what it means to tailor flexibility. And then Brian, I'm going to tee you up a little bit differently on this question, but hold tight there. But Terry, go ahead.

Terry McDonnell, Duke Univ Health (31:35):

So I think again, the staffing models are one component, but it's also where the work takes place and the work that people choose. And that's where I think we've had to really respond fairly quickly. So when I think about the baby boomin generation, they want to be able to job share, they want to be able to utilize their skills in teaching virtual nursing. So we have options for them to plug into different areas of nursing where they can use their skills in their competencies, but maybe they're working from home. Maybe they're only coming into a central work area one day a month or one day a week. Again, that's a different level of flexibility than we've ever traditionally thought about in healthcare. New nurses transitioning fairly quickly to ambulatory because again, it offers a young mother maybe a better workday and work option than perhaps the traditional 12 hour grind on a rotating schedule.

(32:42):

So I think we've had to open ourselves up and think differently about the offerings we give to each of those generations to help tailor to their needs. Also what challenges them intellectually and what they're looking to do in their professional day-to-day life. And what we're hearing more and more is it's maybe not one thing, it's maybe a couple things where they want to leverage their skills in different ways at different times. So that's really placed a lot of demand on, I would say the brains and critical thinking skills of our executive nursing team and our education teams. But it's also opened up a lot of opportunity for our workforce, and that has led to retention because we're giving people options within the system. They don't have to sit online and find the thing that looks attractive to them elsewhere.

Brian Zimmerman, Beckers (33:36):

Thank you so much, Terry. Appreciate you walking us through your approach there. Brian, I want to come to you now and frame this up for you in a little bit of a different way, thinking about tailored personalization, that sort of thing, but also drive your recent experience or relatively recent experience. I believe you were incognito for I think a number of weeks, 13 maybe, if I'm remembering correctly as a nurse and bringing those learnings back. What did you learn on the ground as being a nursing executive, a clinical leader on the ground, sort of shoulder their shoulder with folks on the front lines there?

Brian Weirich, Bon Secours Mercy Health (34:14):

Yeah, thank you. This was an interesting social experiment for me. So this was about 18 months ago while in an executive rollup post pandemic, and every leadership was remote and I kind of felt disconnected. So I did a 13 week travel assignment on a MedSurg floor during the tail end of Covid and full 13 weeks night shift. I learned a ton. I could test my assumptions of innovation, also stay close to the bedside. And one of my biggest takeaways with this, you have to take the manager out of the negotiations when it comes to picking up ships and incentives and so forth. That first question, everybody kind of went into how important culture is, and managers are crucial in establishing culture on a unit, healthy culture, what the priorities are. And if they're stuck in an office building a schedule or fever, virtually texting people to come in and the price of that continues to go up, nurses are smart and they're going to wait till the end.

(35:18):

That's not the best use of their time. It's really bad for culture, especially during the tail end of the pandemic. So I saw that play out from a different lens. Hey, does anybody want to work tomorrow? We're going to be in trouble. What are the incentives? Well, here's what the incentive is I can offer, and it has escalated higher that if it does, I got to talk to the house supervisor and the CO and bring it back down. And I got to witness the conversations that nurses had and they were having very real life thoughts about whether to pick up another shift the next day. One in particular was if this was night shift for me, so seven 30 or 8:00 PM for a day shift or leaving and to come back in the next day, she said, I'll have to arrange childcare for 13 hours.

(36:05):

You're asking me now, I'll have to go home and spend an hour lining that up. And the incentive offered right now, I'll, I'm not interested in it wouldn't cover childcare, but it was truly the 25th hour. We're trying to find coverage for 11 hours later. But I watched that play out time and time again and I've been on the CNO side of that. But to see the bedside nurses process and think about what it would take for them to pick up a shift was interesting, but it always involved. Where I did this assignment at didn't have an app or any kind of automation. It was the manager texting constantly group text and then individual text and then the individual phone call. And we all kind of know that decision tree. But it's very fascinating to see and I think not great for culture and we did just establish how important culture is.

Brian Zimmerman, Beckers (36:54):

Yeah, that's a great point. Great tie in terms of making sure this flexibility supports culture and aligns with those values and goals. Janice, can you talk a little bit about how you think about tailoring flexibility and then we'll hear,

Janice Walker, Advocate Health (37:08):

So I heard such great stories and as clinicians we learn as storytellers, we can read books, but we learn by stories telling. So thank you Brian for sharing your true boots on the ground testimony there. So what I have to share has to do with the flexibility of a leader. We know from publications that have now hit the press from the HMA Academy as well as A ONL about the scope and the span of nurse leaders, particularly nurse managers. So some flexibility that we have built at Advocate and continue to test is job sharing of nurse managers for a unit. They might be at the age where they do have small children and they cannot keep giving and giving and giving for 24 7. So we have some units that co-lead as co nurse managers and they do it very well because they want it to be successful.

(38:11):

It's their work-life balance and they want the experiment to be successful and they don't want to lose that prestigious honor of sharing a unit with another nurse leader. And then something that we recently published, I think it just hit Becker's, it's the other side of advocate, which is Illinois and Wisconsin. And so my peer Dr. Jane Dust, just which we have now getting ready to move to the southeast, a designated float pool of interim nurse managers. Lemme say that again, a interim advocate employed float pool of nurse managers. Because what happens today, if a nurse manager leaves, we typically give that unit to another nurse manager, a high performing one that stretched them, even thinner not being there for their people. And sometimes they're successful and sometimes they're not. So the model we've built is a float pool of a handful of very talented nurse managers that serve in the interim role because they have all the technology mastered, whether it's our productivity standards, our quality scorecards, our recruitment process.

(39:31):

And so they travel from unit to unit being an interim or from campus or from city to city because they know the advocate way and they're very successful at it. And then they stand there for the handoff to the new leader and they go back to the float pool and look for their next interim. It prevents us from having to outsource interim nurse managers or give that heavy burden of multiple units to our highest performing nurse managers. And we might even burn them out a little bit, Brian before we should. So those are two nurse leader innovation topics that I think are so, so important to be innovative with the nurse leaders. Also with flexibility versus our own staff because we know from the literature that the strongest units exist because of the strongest leaders. So protect their time, protect their work-life balance, protect their joy of work so they can protect the staff that work for them.

Brian Zimmerman, Beckers (40:37):

And follow up for you there. Janice, when you think about assembling such a team, obviously as you flag they need to be excellent nurses at what they do. Are there any other traits you're specifically looking for in the folks who are going to be a part of that floating interim nurse manager pool?

Janice Walker, Advocate Health (40:54):

They have to be relationship based. They have to know that they're there for a short period of time to correct and lean in and listen attentively to the hottest spots of that particular unit, build those relationships, teach the quality metrics that need to be taught and grow the staff while they're there. You never know. In healthcare, it's a very small world. You never know when that interim leader will then need take a permanent unit and remember some relationships that they built across the city campus. So all about the tools to the toolkit that the interim leader brings to the table. It's no different than a permanent leader and you have to tool them up. We have to invest in our leaders that can never ever be part of budget negotiation as classes for our leaders. They're vital. The return on investment of your leader investment will show over tenfold, but you have to keep it front and center to all of our financial challenges and not let it get cut.

Brian Zimmerman, Beckers (42:05):

Yeah. Thank you Janice. Darius, coming to you now to talk about how you're thinking about flexibility and any reactions you have to what you've heard?

Darius Love, Orlando Health (42:15):

I think that it is definitely no different here and probably my response would be no different than anybody else's and especially very little deviation from what we talked about earlier is really capturing the voice of the workforce. They tell us what flexibility is and how do we create structure around the feedback that we've been given. And so my story is when we had entered a space of stability in the workforce, and historically when we talk about flexibility, it has been we move you from 12 hour shifts to eight hour shifts, and that's flexible because that's what we could do and for a certain moment in time. But when we leaned into that, what we found out very soon was that the eight hour work hour offering for some of those clinicians and the team members on the units that we went live with was disruptive to their workflow and they did not enjoy it, wasn't beneficial to them.

(43:26):

And so what was nice is that in healthcare, we do several things at the same time. And so we were getting our virtual nursing up off the ground and instead of having that team member come in for eight hours onsite at the clinical space, we had that team member go to our virtual space and lean into all of the administrative work that could be accomplished for that unit in that space. So what we really ended up leaning into, and it was a win-win for the organization because we all know that we need FTEs for virtual nursing or how do we augment what that looks like? And so we utilized and started flexibility in our central staffing office and for our float pool. And instead of working three shifts or what have you at the site, we took a team of CSO, we call our full nurses CSO team members.

(44:25):

We took a pool of our CSO team members and really flexed their schedule. So they would work two units, two days or two shifts on the floor, and they give us a virtual and they give us a virtual shift. And it really created a win for the team that's at the bedside with the patients. And we were able to highlight efficiencies created for the bedside clinical team, but it also gave the nurse working in the virtual space a different lens in which to look through the work. And so they really became our champion for patient experience compliance with things that were missed on admission assessments or admission intakes, and really became champions for even efficiencies created with our MRI screenings and pre-procedural checklist. So we heard and we used the data to really drive decisions and again, we were nimble enough to say, oh, this isn't working. So how do we shift and pivot in real time and create avenues where everybody wins or we get as many wins as we can. So really capturing the voice of the team member being open and willing to shift and pivot when we need to be. And really, again, closing the loop on what has this done for practice as a whole? What wins and efficiencies have we created from really taking your feedback and creating applicable pathways and avenues.

Brian Zimmerman, Beckers (45:58):

Yeah. And Darius, was there any hesitancy when you first made this change? Or if there was, how did you navigate that or pretty much was it the opposite? Were they just gung-ho to do it? I guess can you share some details there?

Darius Love, Orlando Health (46:11):

So the team members made it easy. They said that it wasn't working for them, and that's all we needed to hear. So if it's not working for you, what can we do? Because if we continue to do things that don't work for our frontline team members, when we talk about credibility and wanting to be engaged on the journey, we compromise those things. So how do we again, capture that and say, Hey, you said it isn't working. This is the idea that we've had or that we've come up with as a group. We've taken it and now we are leaning into it in a different way. These are our anticipated wins, is what we think that we will gain from that. This, are we off and do we need to come back to the drawing board altogether or is this spot on and speaks to the feedback. So the team makes it easy to lean in. They won't steer you in the wrong direction.

Brian Zimmerman, Beckers (47:17):

Thank you. There is, it's been a pleasure walking through this conversation with you all. Time flies when you're having a good time and talking to leaders like yourself. But I do want to get to, as we come to a close of our time, I want to give each of you 30 or 60 seconds or so just to share some final closing thoughts. I leave it to you how you want to tackle that approach, that it can be something you want to reemphasize a point that was made that you want to make sure people take away from this. Or if it's something we didn't get a chance to get to or discuss that you want to be sure to flag for our audience, take 30 or 60 seconds and share those. Darius, go ahead. We'll begin with you.

Darius Love, Orlando Health (47:59):

No, I've enjoyed our time together. Words to leave everyone with. I wish I would've come up with this because it is an amazing, I can't take credit for it, an amazing quote or way to lean into work. And it's from Press Ganey. Dr. Jeff just said, our team members want hope and a plan and those things inspire the journey. And so how do we take that and continue to lean into that with every facet of work that we do? This is a marathon, it is not a sprint. And how do we bring literally, literally bring everyone along with us as we reimagine care for the future, not even post pandemic anymore as we reimagine care for the future and really set stage for care that has never looked the way that it has before. And so how do we do that collectively? How do we do it all together? How do we invest in our teams and our leaders? How do we build agile and flexible teams that really continue to rise to the occasion? I think that leaning into the work, tackling it that way, we are in it together. Nobody is an island to themselves and we are only better together would be probably the conglomerate or the synopsis of my final words to everyone.

Brian Zimmerman, Beckers (49:32):

Thank you Darius. Appreciate that. Agnes, go ahead. Still on mute there.

Agnes Therady, Franciscan Health (49:43):

Sorry about that. To what Darius said, the significance and the importance of taking your team with you, how you could model the behavior of re-imagining healthcare for the future and engaging our staff to think that way as well. We all know the same. That culture sometimes comes in the way of strategy. So we come up with very many strategic things. But if we leave our staff alone and don't socialize with them, don't engage them in the conversation of the journey going forward of innovative ways to provide care, innovative ways to take care of our coworkers, then we probably are losing out on the strategy. So don't let the culture come in the way of strategic changes. Engage the teams to think strategically from the bedside to the boardroom. That's what I would say. And let every level be recognized for their contribution. Because personally, my thing is everyone matters in healthcare.

(50:53):

No idea is too small or not imaginable, or maybe it is just a concept. But we can take from concept to completion if we engage everybody, frontline, middle management, senior leaders, as well as the interdisciplinary team. I want to mention something, Brian, and that is the role of hr partnering with HR for retention strategies has worked in our system. And sometimes they become the eyes and ears for clinical leadership because they can bring in a perspective from the outside and it has helped us. So when we had the retention strategy meetings, it was a CNO council with the HR talent acquisition team that brought great ideas to work. I just wanted to put a plug for them.

Brian Zimmerman, Beckers (51:46):

Yeah, that's an important point. And sort of also highlights Darius's points to bringing everybody along. Everyone's got to come on the journey together. Agnes, thank you so much. Terry, go ahead.

Terry McDonnell, Duke Univ Health (52:00):

Thank you for the opportunity to come together with this panel today. I would say that I think we are at a very exciting juncture in nursing. I think it's nursing's time and opportunity to really lead in the space of innovation and maybe departing from some of our legacy practices and really allowing ourselves to think differently and encourage our staff to bring the ideas that perhaps would've historically been a flat out no, or we don't do things that way to now. How can we get to that and how do, and I think the opportunity is for nursing to lead as team members in the modern age of healthcare.

Brian Zimmerman, Beckers (52:47):

Thank you so much, Terry. I appreciate that. Truly, truly appreciate the general theme here too, of really thinking about your people and knowing them and supporting them. Janice, go ahead.

Janice Walker, Advocate Health (53:00):

So I'm going to jump on the boat that Terry is selling. That innovation is front and forward to us, and it's coming. It is coming with the ambient listening of AI and documentation that previously started with our physician partners in their clinics. So it's coming front and center to acute care, and it's frightening for bedside nurses. And as leaders, we have to be there to help navigate. It's completely different than the way they practice. We have taught them to narrate care, but this is different. And the narration becomes your documentation, but the light at the end of the tunnel is shining so bright about their workload that as leaders, we really have to lean in and listen to them about their concerns. And then I want to share one more nugget that I believe follows on what Darius talked about with closing the loop of communication on things we can't get to now but can get to in the future.

(54:02):

So one of the things that I learned early in my career and have watched it be successful is you have to pause and celebrate successes and you have to post them and you have to publish them because our mind is very short in remembering the things we did correct based upon listening to the voice of the nurse, creating a process improvement team and improved a process. But we forget very quickly how we smoothed out those edges. So the best huddle boards that I've seen in my career that talk about all the process measures, take around the huddle boards, banners of what you have really corrected. And let's don't ever forget the process through that huddling process that we solutioned. So just think of the basic huddle board on our units outlined with success stories that are now no longer a problem that belong on that huddle board. So pause, celebrate nurses turnover on units. We're never going to stop that. And they need to see the successes around the border.

Brian Zimmerman, Beckers (55:17):

Seeing those successes go to your point too, in terms of this is an opportunity, it's a little bit scary, but if they can point to those successes, they can imagine future successes to come. And to Terry's point as well, it's a pivotal time for nursing, healthcare.

Janice Walker, Advocate Health (55:33):

They forget what we have helped them solution very quickly. Still so many challenges in front of them, right?

Brian Zimmerman, Beckers (55:41):

Yeah, sort of human nature in that regard, right? You kind of forget the positive sometimes. So thank you Janice, and appreciate how you built on Terry's comments as well. Ryan, I leave it to you to put this wonderful conversation, put a bow on it for us. So go ahead.

Brian Weirich, Bon Secours Mercy Health (55:59):

Yeah, thanks. I'm actually taking notes here. You've got a great panel and I'm looking to learn as well. So Darius and Agnes both kind of had a theme about re-Imagining Healthcare. And Janice mentioned innovation. And I love what Terry said. We need to depart from legacy practices. So all four of those had a common theme. And now with my innovation hat on, there is technology emerging. Technologies are evolving so rapidly. I'm sure in our daily life we're leveraging some of these to order an Uber or have groceries delivered. It does make life easier outside of the hospital and it can inside the hospital too. So for the leaders on the panel and leaders who are watching be a leader, take the risk, take the opportunity, help shift culture. There's technology specifically in this space that can help with staffing. And we alluded to it through the conversation and Janice and Agnes both talked about success. If they have had with this, I would be open to bringing this technology in to automate this significant piece of work, which is the scheduling piece. It's very complex and it doesn't have to be, and ultimately, I'll go back to a comment I said earlier, give the nurse managers an opportunity to lead. That's what they're there for. To set the culture on a unit and lead, not be in an office, building a schedule, begging people to come in.

(57:27):

We now have an easy button for that.

Brian Zimmerman, Beckers (57:30):

Thank you so much, Brian. Thank you. Thank you, Darius. Thank you, Janice. Thank you, Agnes. Thank you. Terry. Truly appreciated the opportunity to have this conversation with you all. I also want to thank Trusted Health for sponsoring this webinar. To learn more about what we discussed today, you can check out the resources section on your webinar console and fill out the post webinar survey. Thank you so much for joining us. Hope you have a wonderful rest of your day.

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