Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast from Works, healthcare's flexible staffing platform. Today we're thrilled to welcome Dr. Tiffany Murdock as our guest. Tiffany is the senior vice president and chief nursing officer at Ochsner Health, where she is setting the strategy and vision for nursing practice across the organization. In her leadership role, Tiffany oversees nearly 10,000 nurses focusing on clinical excellence, quality of care, education, and workforce development. Working closely with the chief quality officer, she is dedicated to enhancing the system's quality standards and ensuring the best patient outcomes. Tiffany joined Ochsner's leadership team in June 2023, bringing with her a wealth of experience from various executive roles and healthcare. Before joining Ochsner, Tiffany served as the chief executive officer of Singing River Health System, where she led a team of over 3,500 employees dedicated to delivering exceptional care along the Mississippi Gulf Coast.

Her previous roles include Regional Chief Nursing Officer at St. Joseph Health System in California, and System Chief Nursing Officer at Asante Health in Oregon. Tiffany's educational background is equally impressive. She holds a Bachelor of Science in Nursing, a Master of Science in Nursing, an MBA in Healthcare Administration, and a Doctorate in Public Health Executive Leadership. Today Tiffany joins us to share her insights on several crucial topics in nursing and healthcare leadership. We'll be discussing key workforce initiatives at Ochsner Health, strategies for improving nurse retention through technology and innovative care models, ensuring nurses have a strong voice in organizational decision making, leveraging educational partnerships to align nursing education with professional demands and fostering kindness and purpose within the nursing profession. So without further ado, welcome to The Handoff, Tiffany.

Tiffany:

Oh, thank you so much. I am very excited. That was a lot of stuff about me, so it's always weird to hear all that, but I am super excited about this. Thank you so much for having me.

Joni: 

Absolutely. Well, it is definitely warranted. You've done some incredible work across your career. You've contributed well to nursing and healthcare as a whole and you still are. So I'm excited to dive into some of our topics today and just enjoy a great conversation with a fabulous colleague. So Tiffany, Ochsner Health has an incredible reputation. Tell me about some of the key workforce initiatives that you and Ochsner are currently implementing, particularly if you have anything that's aiming to make it the easiest, most wonderful, best place to work for nurses.

Tiffany: 

Yeah, absolutely. Even before coming to Ochsner, I knew the reputation. I knew that it was one of the largest groups of nurses in the Gulf South and they were doing some incredible things with virtual nursing. But part of my onboarding was I wanted to get in front of all 50 campuses and hear what the nurses said would make their lives the easiest and best place to work at Ochsner. And so we're working with our incredible HR team and talent acquisition team and our IS. Some of the things that we have been able to do is start with the pipeline way, way upfront. So in high schools, being able to remind people that we are in healthcare. But also on the IS side…so technology. We've saved 11 million clicks just through IS and IT work with Epic. 

Joni:

Wow!

Tiffany: 

Yeah, I know. Because we always hear in nursing all the regulatory requirements like, “oh, you have to document this, you have to document that.” And our IS teams and our Epic analysts have worked with our frontline nurses to really say, “what do we actually need to be doing? What are the absolutes so we can get back to the bedside? And so this past year, we saved 11 million clicks, 10 minutes, of saved work time in Epic, which is huge.

Joni: 

My word that's like mind blowing. It's so funny when I talk with colleagues who aren't inside healthcare who don't have a concept, but 10 minutes, that adds up so quickly. Oh, my word, Tiffany.

Tiffany: 

Yeah, it's huge. And then if you add virtual nursing, I mean, Ochsner's been the pioneer of E-ICU and some of the other virtual nursing platforms. 

Joni: 

Incredible. 

Tiffany: 

But this year we have what we call our “Road to 600 Beds.” And so we’re working toward 600 beds across the health system to have virtual nurses doing the discharges for our nurses, which is another 26 minutes of time when you do a time study. And so, now you're getting close to an hour, and next year we're going to implement the admission work, which is another 30 minutes. And so, just going to the nurses and asking them what takes time, hunting and gathering the work we do in our EHR and medication administration. We have taken pharmacists and put them at the bedside passing our meds. So anyway, I remember being a floor nurse 18 years ago and I could not even imagine the time that would give back to take care of our patients.

Joni:

Wow, Tiffany, there's so much in that answer. First I have to say, the “Road to 600 Beds” that sounds incredible and sounds visionary and is inspiring even in and of itself. So kudos to you and the leadership team at Ochsner for setting the vision and the purpose behind that work. 

And then, so many times we think that innovation and transformation itself is like this big gigantic thing. And it is, when we take it from a big-picture perspective, I love the way that you are breaking it down into manageable chunks and breaking it down into very specific outcome and output measures. I mean, again, that stuff adds up super quickly. So wow, that's beautiful work. And then bringing pharmacists to the bedside be still my nursing heart. 

Tiffany: 

Well, the outcomes, the quality outcomes are unbelievable in terms of med reconciliation. We're reducing readmissions. I mean, it's wonderful for our nursing profession, but for our patients it's really exciting too.

Joni:

Yes, absolutely. And our pharmacists, they are rockstar colleagues. I mean, we're BFFs with those professionals. So kudos to y'all for keeping the patient central. Not only thinking about what's best for our team, but really the driver is what's best for our patients and letting that drive it. That's incredible, Tiffany. I love that. So you mentioned quite a few things. You mentioned strategies for retaining nurses through process improvement and leveraging the voice of the nurse. You mentioned technology kind of threaded throughout that. I'm curious, what kind of strategies have you found effective in, if we can dig a little bit deeper into improving nurse retention, maybe particularly through integrating technology and innovation in patient care models?

Tiffany: 

So it's really great, just in the state of Louisiana in the next year, over 10,000 nurses will be of retirement age. And so this pipeline is really important, but even more important, is retaining our experienced nurses at the bedside. And I think how we're going to be able to do that is through technology and meeting them where they're at. So allowing for people to work from home doing this virtual nursing platform, allowing for using their expertise as virtual preceptors, so it extends the life of their nursing career. I think that it's also just giving people opportunities to go into E-ICU and continue to monitor the patient kind of in the background. So I think from a retention standpoint, it decreases burnout because we're giving them the tools they need to do the great work that they do. But I think also for people towards the end of their career, it extends it because I can't even imagine not being a nurse in some capacity, even when it's time to retire, which is going to be a long time. Similarly, I think if we can give moms flexiblity (I have a six and an 8-year-old). I think to have had the option of doing something from home one day a week. I would pick up an extra shift to do that piece of it. 

Joni: 

For real. Yes.

Tiffany: 

So I think that just trying to give people different models of care. I mean the pharmacist model piece of it, the virtual nursing, E-ICU, tele-stork, it's also helping our rural areas where it's harder to fill these really important roles of OB, but it's small numbers, high risk, and I think technology allows for us to bring even the expertise of the nurse to the bedside in places where they may not have the population to have that expertise.

Joni: 

Yeah, that's incredible. Tiffany, you mentioned an intervention in the midst of all of that beautiful work that I can't say I've heard too much about, honestly. You mentioned virtual preceptors, and when you said it, my mind was just like click, “Oh, that makes total sense.” But I haven't heard too many leaders talk about having virtual preceptors, which is interesting, but you're right, a great way to keep nurses engaged in the profession and contribute all of that brain trust back into the profession. That's incredible. How long have y'all been doing virtual precepting? 

Tiffany: 

So it is very, very new. We have an incredible SIM lab. Our SIM lab leader is a physician who actually, this is what he does. And so they talk about it a lot for physicians, the whole VR, doing surgery, teaching residents. 

And we have done such a great job on our pipeline. We have thousands of brand new nurses coming into the workforce, but not enough preceptors. And so I said, how do we think outside of the box, get in the circle, get outside of the circle, whatever it takes to get these people onboarded. And so we started thinking about, okay, how do we do virtual precepting? We had a group of nurses, nursing leaders at the bedside say they did some research on a virtual simulation to be able to start teaching new nurses. And so we are going to invest next year in the technology, but until then, using EICU to teach our ICU new grads, we have a pediatric platform that we can use to show our PICU and CVICU. We are in the infancy of it, but it just took, nurses are really innovative and we'll do whatever we can to get the job done. And this is just one of those things that kind of blossomed.

Joni: 

That is beautiful. I would love to hear more about this as you continue to mature in this space because I really haven't heard a lot about virtual precepting, and that makes great sense. So I hope that works well for you because I'm going to keep my eyes on you. 

Tiffany: 

Me too.

Joni: 

Well, you have done a great job of listening to nurses at Ochsner amplifying their voices, and we have threaded that theme all throughout Season 10 of The Handoff because we can't make decisions about nurses without nurses who are actually doing the work and care and know the issues and probably know the solutions as well. What ways are you ensuring that nurses have a strong voice in your organization's decision making processes? And how does this impact patient care and nurse satisfaction or system outcomes?

Tiffany: 

Yeah, so I feel incredibly grateful. Our CEO, Pete November sees the value of the nurse and the nurse's voice. One of the things that we always talk about is that nurses have always been looked at as an expense, like, “oh, it's always just about labor.”

And I think Pete, through him and I having conversations strategically and our CNOs have shown that nurses are the revenue generator engine of the health system, both inpatient and outpatient. Every single dollar that passes through the system is probably touched by a nurse at some point in time. And so I think that brings the value of, “hey, if they can figure out how to open beds during COVID, if they can open new towers, it takes nurses to do that, then we have to start looking at them differently.” And I think that over this past year, going and hearing that we want competitive pay. We want to be valued in that. We want to be the easiest place to work. We just want to be able to do our job and take care of our patients. And lastly, we want to voice. And so we have a clinical nurse advisory team that from all over our system, from different states that come together monthly and talk solutions. One thing, it is so small, we wanted a badge. They were very innovative and came up with their own QR code to get into different systems. 

Joni: 

Of course they did.

Tiffany: 

I was like, “Well, let's try to do this a little more safely. And so IT came in and developed what we call our “badge buddy.” And so they can literally badge in one tap to the system saving maybe three or four minutes, and the frustration of having to type your password in 20 times.

Joni: 

Totally. Absolutely.

Tiffany: 

That's one small thing. And then we have another huge thing where we bring a thousand nursing leaders together. We had our first retreat last year and this year we've doubled the size of it. It'll happen in March and just come together on developing a nursing strategy that's going to drive system strategy. So I'm sorry, that was a lot of words, but there's all kinds of things that we're doing.

Joni: 

That is exactly what I was looking for. So you mentioned several things in there that particularly resonate with me. The first one that I'm probably going to just absorb into my vernacular honestly, Tiffany, is that every dollar flows through the nurse for our organization and how true that is. I mean, nurses are touching every single aspect of patient care, of organizational strategy just by nature of the sheer size of the workforce in our organizations, but also the nature of the work of all of the departments that we're in and providing 24-7 care. So while that focus, the financial focus on the power of the nurses' voice and work to affect change, that's powerful. So I'm going to thank you, Dr. Tiffany Murdock. I will quote you from now on.

Tiffany: 

It comes with great responsibility though. It comes with, so we have to educate our nurses differently. I would love to see schools start to do healthcare economics for our nurses. I mean, because if they know what's being done and why we need to get patients through the system quicker, number one, usually there's something bad that can happen to the patient in the hospital. And two, it's utilization of resources that we don't need to spend that we could be spending on something else. And so I think connecting the dots with healthcare, economics and nursing is going to be our next great goal.

Joni: 

I wholeheartedly agree with you. And that's your MBA shining through right there. I'm totally biased too. I also have an MBA, and I agree with you. I mean, again, totally biased here, but nurses are so incredibly smart. I mean brilliant. And it's so impressive to me when we give even just a little bit of education to nurses, how quickly nurses rise to the occasion and to the topic and really start to practice at the top of their license in that space. And finances is one of those spaces where I've seen it over and over again in my career. When we teach nurses the economics of healthcare or about payer mixes, nurses can ask great questions and figure things out, and we just sort of multiply the brain trust and the collaboration. So I mean, it sounds like you're definitely doing that at Ochsner. And then you mentioned the big and small ways that you're transforming. And we have to have all of those ways to sort of add up. And I mean, we know it. Nurses will work around and through a problem. And Tiffany, it takes a great leader to thank nurses for that and pivot to spread and scale that kind of workaround solution across a system in other ways that align with IS and regulations and all of the things. So that's beautiful because Tiffany, not every leader welcomes that. I mean, I've personally witnessed that in my career where nurses will work around a problem and a leader's like, “Why did you do this? We're going to totally eliminate that.” Rather than pressing into that tension of “here's where we are, here's what we need” and then helping the system meet in that emergence transformative space. So that's beautiful, Tiffany.

Tiffany:

Well, the workarounds are, they're doing them for a reason. At the end of the day, they just want to get their job done. So it's up to us as leaders to figure out a safe, unrestricted way for them to do that. So it's very exciting.

Joni: 

Yeah, I love that. I love that. Well, your organization has partnerships with several academic institutions, academic practice partnerships is another space that we focused on in Season 10 and threaded throughout conversations. It's having its moments in healthcare rightly. And you mentioned kind of in the first part of the episode that you're sort of backing up your pipeline even and thinking earlier and earlier. So how are you leveraging your relationships with academic partners, academic organizations to ensure that nursing education aligns with the evolving demands of the profession? Because I mean, we are evolving fast. 

Tiffany: 

Very different than when I was in school for sure. Some of it is. So I think the precipice of even getting further back into high school is there was a paper done, and I cannot remember, I was trying to think while you were talking, is that they went into high schools like eighth grade and ninth grade and started asking people about what careers that they were thinking of as they were hitting high school. Not one single class brought up nursing. There was no not one person. And so that was such a dramatic change from decades ago where that was a career pathway for some individuals. And so we knew that we had work to do. So how do we get people introduced into healthcare? I think it was also kind of our persona too from a nursing standpoint. We went through COVID where we were heroes, then we became the enemy, and then kind of a martyr mentality.

And so I think it's up to us too in the profession to show that we are professionals, that it isn't about all of the other things. It is about, because our purpose is to take care of our communities and the patients that come into whatever facility we are that nurse in versus kind of the martyr piece of it. So I think that's one step. 

And then the academic partnerships have been amazing. I think that especially with technology, people understanding the EHRs and people understanding regulatory, people, understanding AI, the things that can, our partnerships help develop curriculum, which I think is really, really important because we have some nursing students that are coming out of school that have never worked 12 hour shifts, that have never worked a night shift. And it's unfair if that person leaves. 

I try to speak to anyone who is leaving the profession within the first year and they're like, “this is not what I thought nursing was about,” which is so sad for me. One, because we didn't prepare them, and two, because we are not connecting the dots to their purpose. And so I think that we are trying to get further ahead than just their senior year precepting, but having year-round nurse techs, having them work in the field that they want to work in. So it's not a shock to the system when they get out of school. And our partners have been really great to allow for that.

Joni: 

Wow. Tiffany, you mentioned in your answer connecting the dots to their purpose. It's so interesting that you say that because too many times when we have nurses leave the profession, especially as novice nurses, I feel like historically in nursing, we've always made it about that nurse, that person, like, you weren't a good fit for us for some reason. It's all about you. And sort of finger pointing, but you sort of reframed that in your answer to say it's really more about us as a profession and organization, healthcare in general, that we haven't done what was needed for this person to be successful, and we haven't connected the dots to their purpose and their passion. That's pretty powerful, Tiffany.

Tiffany: 

Well, I know that anytime I, because people are going to have bad days in their job, I think of people that are working in a hundred degree heat doing manual, really difficult labor all day long. And then I think about different jobs and different things and always come back to purpose. If they can do that every day because their purpose may be that they're working to make whatever road that is or to feed their families, whatever that looks like. My mom died really young, and anytime I have a hard day, I reconnect with the fact that I said that I'd never let another family member feel the way I did when I walked out and my mom had died. And I think we lose that in the chaos of the day or all of the things that happen. But I think our job as leaders and as nurses, because I feel like every nurse is a leader, is to remind people about that. And if you need help, you need to have your best friend that can remind you of what you're doing. And because it's not like some of these young nurses coming out, they don't know. And we have to stop doing the whole “eat the young” situation and really raise our people. So I'm sorry, that was a long answer. I'm pretty passionate about that. 

Joni: 

No, no, I love it, Tiffany. I love it. It's great conversation. And it kind of leads me into my next question because you have threaded this theme throughout your answers, which I love. It shows that it's a core piece of who you are as a leader and how you function. And so we are in a time when the nursing narrative has shifted pretty quickly over the last couple of years. And it's interesting because as I've talked to nurse leaders across the United States, I think everyone has sort of heard this resounding theme of martyrdom, which is really interesting as we're recovering from the COVID19 pandemic and sort of resetting everything. And you've mentioned connecting people's purpose and to their work. How are you working to bring kindness back to the profession and help nurses reconnect with their purpose? So can you dig a little bit deeper into that for me?

Tiffany: 

This makes me really happy. So we actually here at Ochsner started something called “trust huddles” a few months ago, and just having the conversation about the 13 behaviors of how you can trust individuals, but really getting back to the humanity of each other so we can have the tough conversations. And so I've been speaking to my nurse leaders about how we have to get away from saying, and I feel like I've said this my whole career, that someone is a really great nurse that they, that's just how they are from a behavioral standpoint. That strips professionalism from nursing, period. No matter what kind of day you're having, if we are considered a profession every day, we have to step above whatever that feeling is and have to be kind and have to be professional, not just to our patients and our patients' families, but to each other. And so it's really challenging people to get to know each other through the trust huddles, remember that we're all human beings, but also to be able to have the hard conversations around the citizenship entry to be a nurse at Ochsner because we are going to hold ourselves to a different level. And part of that is through kindness and purpose and professionalism. So again, this takes time. It takes some feelings, like people are going to have feelings about it. But I just think that, again, we owe that to the people we take care of. The least they expect is that they're going to get good quality care. What they are hoping is that we are going to be kind to them while we're giving them that quality care.

Joni: 

I am pausing because my mind is in all different sorts of spaces right now, because you just mentioned the least people are expecting is good quality care, right? You're so right. That's the bare minimum of I'm trusting you just to take care of me, but I have all of these other expectations as well, particularly when I find out you're a nurse. Let's be real. 

Tiffany: 

Yes, absolutely. 

Joni: 

So the trust huddles, that's new to me. So I'm definitely going to look some things up after that. And this is not like an overnight thing. This is a long-term vision, but I love that you said it's like a citizenship entry into Ochsner.

Tiffany:

Well, think we have four generations, almost five generations of people working right now in nursing and growing up in all different types. And so you have the social media era, you have the work till you pass out era, all these different people. And so their purposes are different. 

Joni: 

Absolutely. 

Tiffany: 

And then the whole behavioral piece is really different from people who have been in nursing for a long time versus now. I mean, the nurses coming out demand respect, which I love. I'm like, come on. But how do we do it in a kind way and how do we bring people along with us and the other professions that we work with? So it's going to be a journey, but I think that's the next level of our profession from a high reliability standpoint.

Joni: 

Yeah. Yeah. Tiffany, you are really propelling Ochsner nurses in some incredible ways. So kudos to you and the Ochsner Health team for doing this and everyone who works at Ochsner because this, I mean, that is a huge culture shift, so wow. Bravo to you guys. 

Well, Tiffany, thank you. Yes, absolutely. I love talking with leaders who are just stretching the way that we think about certain aspects, and you are definitely one of those leaders. And so when I find these people, I kind of just hang on to them in my life. So congratulations. We're connected forever. 

Tiffany: 

Works for me. Perfect. 

Joni: 

But I also, I just have this curious nature in me to try and figure out what drives these leaders, what are they learning? What are they doing, how do great leaders sharpen themselves to be even better tomorrow or next week or next year? So I'm curious, what are you reading or learning about or doing these days to nourish your mind or your soul? I know you mentioned that you're a mom to kiddos, and so that might look a little bit different in different seasons, but what are you doing right now to sharpen yourself to care for yourself and others?

Tiffany: 

Yeah, I mean, there's a very limited amount of time for that, but actually one of the things that I do is look outside of the industry, look outside of healthcare and see what other leaders are doing. I try to read all types of just publications from news on all different sides, but really not limited to healthcare. Also, just trying to speak to people outside. So really the community members getting involved in different aspects. So I know this sounds ridiculous, but even joining my, I've said yes to being the room mom for my kids school, connecting with my kids on a different level, but showing, I got an email from a nurse the other day yesterday that was talking to me about you doing that shows me that it's okay to be a mom and to continue to still try to be the nursing leader that I want to be.

And so I think that I fill my cup with reading about less healthcare industry stuff, but some healthcare industry. So Sg2 has a ton of information that I look at from a community standard. Becker's has some, I just look at what's going on in the industry, but from a book I'm reading, UNICORN Leader is excellent. So just filling my cup with as much knowledge and public health is really important to me. So what's going on in our community health assessments from a mental health standpoint, from a health equity standpoint, I still read a lot about that as well. So I think that's it. But my family time probably fills me up the most.

Joni: 

That's great. I love that you role model these things, Tiffany, for others, and whether you realize it or not, right, I mean, how amazing. I had little tears well up in my eyes for a nurse leader to be able to see that somebody else can be a nurse executive and a mom. It doesn't mean it's always easy, but to be a role model for other people. I mean, it just shapes the way that people view themselves and what they view as possible. And I love too that you certainly have aspects of adaptive leadership. So you mentioned you're always scanning the healthcare environment and scanning and watching all of the trends and reading these pieces, but you are clearly a boundary spanner into other industries. And so you become a bridge into these adaptive spaces. So it's all clicking to me and making sense why Ochsner nursing is kind of propelling forward in these ways because wow, what beautiful, complex adaptive leadership does Ochsner Health have in you, Tiffany, that's incredible. Thank you. 

Tiffany: 

Yes, definitely. 

Joni: 

Well, again, lots of things that we've covered today. And so ultimately, what would you like to hand off to nurse leaders at all levels and in every setting today?

Tiffany: 

What I would say is that we are a profession and we have so much more to show the world in regards to how we can change it. We are going to do incredible things. I keep telling people, this is the nursing era of reminding people that healthcare systems need us. We are revenue generators, we are quality game changers. We are operators at every step of the way. And so I'm really looking forward to seeing what nursing looks like in five years, because just in the past year, it's been mind blowing what we do. Just don't quit and find someone to remind you about your purpose. It’s exciting times for us.

Joni:

Absolutely. Beautiful, Tiffany.

Tiffany: 

Thanks.

Joni:

I love that. So lastly, where can people follow or connect with you to find more of your work or to continue conversations? Because I know they will after this podcast.

Tiffany: 

Absolutely. So I need to be better at social media, but I'm a big LinkedIn user, so come follow me and reach out to me on LinkedIn and I would be more than happy. You can always look on the Ochsner website and my email and all of that's there. It's TiffanyMurdock@ochsner.org. I would love for you to reach out to me and connect. I'm like, you are now a part of my permanent network.

Joni: 

Love it. I'm here for it. I'm here for it, Tiffany.

Tiffany: 

Good. 

Joni: 

Well everyone, be sure to find Dr. Tiffany Murdock, connect with her via email or through LinkedIn. Tiffany, thank you so much for this energetic time today. Thank you for sharing your energy, your expertise and passion with us today to propel healthcare and nursing forward. It's been a delight having you on The Handoff. 

Tiffany: 

Thank you so much for having me. I will forever remember this. This is wonderful. Thank you.