1 00:00:00,405 --> 00:00:02,855 - This is Laura Dero with the Becker's Healthcare Podcast. 2 00:00:03,475 --> 00:00:05,535 I'm thrilled today to be joined by Trish Solano, 3 00:00:05,535 --> 00:00:06,855 who's a Chief Nurse Executive 4 00:00:06,855 --> 00:00:09,615 and associate Chief Clinical Officer at Advent Health. 5 00:00:10,145 --> 00:00:12,135 Trish, it's a pleasure to have you on the podcast today. 6 00:00:12,765 --> 00:00:14,665 - Thanks so much, Laura. I'm happy to be here. 7 00:00:15,295 --> 00:00:17,875 - Now we're gonna talk a lot about, um, a strategy 8 00:00:17,985 --> 00:00:20,035 that you have at Advent Health, 9 00:00:20,095 --> 00:00:22,355 and one that we have included in an article 10 00:00:22,355 --> 00:00:25,755 with Becker's talking about use less, lose less, 11 00:00:25,775 --> 00:00:30,435 and hire more inside the strategy that Advent Health used 12 00:00:30,455 --> 00:00:31,715 to cut nurse turnover. 13 00:00:32,095 --> 00:00:34,355 Um, and so I'm excited to dig deeper into that, 14 00:00:34,495 --> 00:00:35,555 um, specifics there. 15 00:00:35,575 --> 00:00:37,835 But before we do, can you tell us a little bit more 16 00:00:38,075 --> 00:00:39,235 about yourself and your background? 17 00:00:40,065 --> 00:00:42,915 - Sure. Um, well, I'm just coming into my 30th year 18 00:00:43,015 --> 00:00:46,115 as a nurse and, um, started in critical care 19 00:00:46,695 --> 00:00:49,875 and in my, in my background, I was a CNO 20 00:00:50,375 --> 00:00:51,875 for our Children's hospital 21 00:00:51,975 --> 00:00:56,315 and a CNO for our flagship Orlando campus, as well 22 00:00:56,315 --> 00:00:58,715 as a Chief Clinical Officer for one of our markets, 23 00:00:59,255 --> 00:01:01,955 and have been in the chief nurse exec role 24 00:01:02,095 --> 00:01:03,395 for about four years here. 25 00:01:03,895 --> 00:01:06,915 Uh, you know, we're located here in central Florida, uh, 26 00:01:06,915 --> 00:01:10,315 but have, uh, 51 hospitals across the US in nine states. 27 00:01:12,645 --> 00:01:14,605 - Absolutely. And that's, you know, a huge undertaking 28 00:01:14,705 --> 00:01:17,525 to be able to oversee the nursing workforce 29 00:01:17,825 --> 00:01:20,765 for such a large system crossing, as you mentioned, 30 00:01:21,005 --> 00:01:23,245 multiple states in several different facilities. 31 00:01:23,345 --> 00:01:25,525 So, you know, I, I'm excited to dive in 32 00:01:25,525 --> 00:01:27,405 and see how you're able to manage all those things. 33 00:01:27,985 --> 00:01:31,085 Um, and in particular, you talked about, um, with us 34 00:01:31,085 --> 00:01:35,245 for our article, how the useless strategy, um, 35 00:01:35,385 --> 00:01:38,045 has played into reducing their turnover at Advent Health. 36 00:01:38,135 --> 00:01:40,365 Could you expand upon that a little bit, a bit? 37 00:01:40,825 --> 00:01:42,165 Um, what does that really mean to you 38 00:01:42,265 --> 00:01:44,685 and how do you see that playing out on a regular basis? 39 00:01:45,835 --> 00:01:48,125 - Sure. You know, I think, uh, for us, um, 40 00:01:48,955 --> 00:01:52,805 what the use less element of useless, lose less, hire more, 41 00:01:52,865 --> 00:01:55,685 it was not about, uh, decreasing staffing, which is 42 00:01:55,685 --> 00:01:58,045 what people automatically kind of think. 43 00:01:58,435 --> 00:02:02,285 It's really about using less RNs where, uh, 44 00:02:02,335 --> 00:02:04,685 where you don't necessarily need to have an rn. 45 00:02:05,025 --> 00:02:06,925 So, you know, there's a certain amount of the work 46 00:02:06,925 --> 00:02:09,725 that nurses do that can be managed 47 00:02:09,985 --> 00:02:12,525 by other licensed personnel keeping 48 00:02:13,065 --> 00:02:14,525 RNs at the top of their license. 49 00:02:15,185 --> 00:02:18,965 So, you know, some of the feeding, walking clothing, um, 50 00:02:20,395 --> 00:02:23,725 bathing and other elements don't necessarily need 51 00:02:23,725 --> 00:02:24,805 to be done by an rn. 52 00:02:25,145 --> 00:02:28,005 So our useless strategy was really around appropriately 53 00:02:28,675 --> 00:02:31,925 elevating the RN to the top of their license 54 00:02:32,145 --> 00:02:35,645 and making sure that we had enough of the other, uh, 55 00:02:36,045 --> 00:02:39,885 providers to care for patients, whether that's drawing blood 56 00:02:40,105 --> 00:02:42,205 or transporting them off of the unit. 57 00:02:42,315 --> 00:02:43,765 There's a variety of different things. 58 00:02:43,885 --> 00:02:46,485 I think over the course of, um, the last two 59 00:02:46,545 --> 00:02:49,805 or three decades, many organizations have pulled those 60 00:02:50,085 --> 00:02:53,165 resources away from nursing, which ended up, um, 61 00:02:53,555 --> 00:02:56,845 just leading the RN to provide a whole bunch of things that, 62 00:02:56,865 --> 00:03:00,805 you know, perhaps, uh, were not necessary, uh, for them 63 00:03:00,805 --> 00:03:02,005 with their licensure. 64 00:03:02,585 --> 00:03:05,365 So the lu the useless element, uh, 65 00:03:05,725 --> 00:03:08,325 involved us bringing on additional patient care techs 66 00:03:09,085 --> 00:03:11,585 as well as in some markets launching LPN models, 67 00:03:11,925 --> 00:03:13,545 but bringing on patient care techs 68 00:03:13,545 --> 00:03:16,745 and others to provide care according to their license 69 00:03:17,435 --> 00:03:20,065 helps keep their RN focused at the top of their license 70 00:03:20,205 --> 00:03:22,225 and just improves the care that's delivered. 71 00:03:25,975 --> 00:03:26,985 - That makes a lot of sense. 72 00:03:27,005 --> 00:03:29,305 You know, it really seems like it would be beneficial 73 00:03:29,305 --> 00:03:31,865 overall for the RN to have the opportunity 74 00:03:31,885 --> 00:03:34,265 and ability to focus more on patient care 75 00:03:34,285 --> 00:03:35,425 and as you said, the things 76 00:03:35,425 --> 00:03:37,865 that they're trained most highly to do. 77 00:03:38,045 --> 00:03:40,185 Um, and, and does that mean, you know, then some 78 00:03:40,185 --> 00:03:44,905 of the other, uh, work is, is either, um, done by people 79 00:03:44,905 --> 00:03:46,785 with other experience levels 80 00:03:47,005 --> 00:03:49,225 or in some ways, I'm sure automated? 81 00:03:49,285 --> 00:03:50,825 Um, how does that really show up for you? 82 00:03:51,295 --> 00:03:53,425 - Yeah, well, you know, for us it's really about bringing 83 00:03:53,425 --> 00:03:56,985 back those individuals who have that skillset who we, 84 00:03:57,245 --> 00:03:59,945 you know, perhaps over the course of the last two decades, 85 00:04:00,085 --> 00:04:03,545 health systems said we actually don't need to have those, 86 00:04:03,765 --> 00:04:06,305 um, those individuals working in the hospital. 87 00:04:06,405 --> 00:04:09,105 You know, labor is the largest, um, one 88 00:04:09,105 --> 00:04:10,745 of the largest costs for any hospital. 89 00:04:10,925 --> 00:04:15,385 So over, over the course of, um, over the last few decades, 90 00:04:15,615 --> 00:04:18,505 many health systems have removed, uh, 91 00:04:18,605 --> 00:04:21,105 or at least decreased the support from transportation, 92 00:04:21,575 --> 00:04:23,985 from phlebotomy, from nutritional services, 93 00:04:24,405 --> 00:04:25,825 and then from patient care techs. 94 00:04:26,245 --> 00:04:28,185 So, you know, for us here at Advent Health, 95 00:04:28,725 --> 00:04:31,065 our market's looking across where they currently were 96 00:04:31,085 --> 00:04:35,105 and how they could better right size the, the people 97 00:04:35,105 --> 00:04:37,185 that they needed to help support the rn. 98 00:04:37,205 --> 00:04:39,905 So the RN who is obviously, you know, 99 00:04:39,905 --> 00:04:41,265 the most highly paid out of 100 00:04:41,265 --> 00:04:43,305 that whole group can focus on the work 101 00:04:43,305 --> 00:04:44,545 that they need to focus on. 102 00:04:44,765 --> 00:04:47,225 So not only, uh, you know, are we using less RNs, 103 00:04:47,225 --> 00:04:51,595 which are a really, um, uh, a difficult commodity to get, 104 00:04:51,775 --> 00:04:54,115 but we're using them appropriately at the top 105 00:04:54,115 --> 00:04:57,195 of their license, and we're making sure that that also, um, 106 00:04:57,195 --> 00:04:59,435 helps to address any workforce burnout. 107 00:04:59,655 --> 00:05:01,995 If they have to do everything well, how are they going 108 00:05:01,995 --> 00:05:04,515 to do the one thing that they need to do well, really well. 109 00:05:06,965 --> 00:05:09,205 - Absolutely. That's really an extra excellent point. 110 00:05:09,425 --> 00:05:12,085 And, you know, I'm wondering too if you could share some 111 00:05:12,325 --> 00:05:14,405 specific examples of changes that you've made 112 00:05:14,405 --> 00:05:16,525 that have positively impacted nurse retention. 113 00:05:17,075 --> 00:05:19,685 - Sure, sure. Yeah, we've had, um, just some great, 114 00:05:20,055 --> 00:05:22,965 great wins in retention of our, um, 115 00:05:23,115 --> 00:05:25,685 bedside nurses over the last 24 months, 116 00:05:26,225 --> 00:05:29,685 and we're really, really excited about where that has gone 117 00:05:29,785 --> 00:05:31,365 for us as a company and, 118 00:05:31,505 --> 00:05:34,485 and what it means to our communities across the country. 119 00:05:35,505 --> 00:05:38,165 Our, um, nursing leaders, um, 120 00:05:38,745 --> 00:05:40,965 our nursing leaders had an opportunity 121 00:05:41,185 --> 00:05:43,165 to really have additional support 122 00:05:43,265 --> 00:05:45,445 and education preparing them to lead. 123 00:05:46,065 --> 00:05:48,805 Now here you have, uh, an assistant nurse manager 124 00:05:48,825 --> 00:05:53,365 and a nurse manager who are running operations 24 for 24 7, 125 00:05:53,865 --> 00:05:55,965 and we realized that we had an opportunity 126 00:05:56,025 --> 00:05:58,405 to better prepare them for that role. 127 00:05:59,025 --> 00:06:01,445 So, uh, 24 months ago we developed 128 00:06:01,445 --> 00:06:05,005 and launched nursing leadership development content 129 00:06:05,155 --> 00:06:06,805 that was very tactical 130 00:06:07,655 --> 00:06:11,275 and very practical, uh, for our nurse leaders so 131 00:06:11,275 --> 00:06:14,035 that they understood what it meant to 132 00:06:14,715 --> 00:06:16,355 actually develop staffing 133 00:06:16,355 --> 00:06:18,435 and manage staffing throughout the day. 134 00:06:18,855 --> 00:06:22,875 Um, things like unit huddles, uh, a variety of different, 135 00:06:23,055 --> 00:06:25,515 um, educational topics that a and s 136 00:06:25,515 --> 00:06:28,595 and nurse managers now would learn in a, 137 00:06:28,595 --> 00:06:30,275 in a pretty tactical clear, 138 00:06:30,375 --> 00:06:33,515 but prescriptive format as they transition to their roles. 139 00:06:34,255 --> 00:06:36,915 We also launched a professional excellence program kind 140 00:06:36,915 --> 00:06:38,275 of commonly known across the country 141 00:06:38,295 --> 00:06:39,835 as the clinical ladder for nursing. 142 00:06:40,495 --> 00:06:42,475 Big, big, uh, win for us. 143 00:06:42,615 --> 00:06:47,075 And, you know, nurses are looking for a standard way to, um, 144 00:06:48,065 --> 00:06:49,765 to develop in their career. 145 00:06:50,225 --> 00:06:52,165 And that doesn't have to mean, you know, 146 00:06:52,165 --> 00:06:53,445 if you're a bedside nurse 147 00:06:53,445 --> 00:06:54,445 and you wanna continue to 148 00:06:54,445 --> 00:06:55,565 develop, you have to leave the bedside. 149 00:06:56,065 --> 00:06:58,205 You know, we wanted to kind of flip the script on that, 150 00:06:58,235 --> 00:07:00,405 that we really value our nurses 151 00:07:00,665 --> 00:07:03,645 who have 10, 15, 20 years experience. 152 00:07:03,705 --> 00:07:05,725 So how do, how can we recognize that 153 00:07:06,145 --> 00:07:07,285 and how can they be 154 00:07:07,845 --> 00:07:09,085 recognized for what they bring to the bedside? 155 00:07:10,105 --> 00:07:12,365 The third one was our competitive market pay. 156 00:07:12,465 --> 00:07:16,985 You know, we, um, post pandemic market pay changed 157 00:07:17,125 --> 00:07:18,345 so quickly across the country. 158 00:07:18,885 --> 00:07:22,345 So, you know, we went from evaluating market pay to, 159 00:07:22,525 --> 00:07:25,425 to every other year, a few years back to every year, 160 00:07:25,845 --> 00:07:26,905 to every six months. 161 00:07:27,445 --> 00:07:29,305 And over the course of the last three years, 162 00:07:29,525 --> 00:07:32,985 we evaluated it, uh, quarterly to really make sure 163 00:07:32,985 --> 00:07:35,585 that we had a pulse on what was, um, 164 00:07:35,935 --> 00:07:37,705 happening in our local markets. 165 00:07:38,065 --> 00:07:41,465 'cause it's easy to get out of, um, out of line with 166 00:07:41,465 --> 00:07:44,065 where compensation is going, when there is a pandemic 167 00:07:44,165 --> 00:07:45,505 and a national nursing shortage. 168 00:07:45,885 --> 00:07:49,825 So our focus on making sure that we maintained compensation 169 00:07:49,935 --> 00:07:51,585 that was competitive for our nurses. 170 00:07:51,935 --> 00:07:54,185 Also, another, another strategy. 171 00:07:54,365 --> 00:07:56,985 The third of really four strategies that we use. 172 00:07:56,985 --> 00:07:58,945 Fourth one being, um, career pathways 173 00:07:59,405 --> 00:08:00,945 and, you know, tuition reimbursement, 174 00:08:00,945 --> 00:08:05,515 student loan repayment, all of these things, um, nursing 175 00:08:05,575 --> 00:08:08,475 and Advent Health, a really competitive that nurses 176 00:08:09,035 --> 00:08:13,705 recognize that we were here to provide for them a pathway 177 00:08:13,805 --> 00:08:15,265 to develop, and that we were also able 178 00:08:15,285 --> 00:08:16,665 and willing to resource that. 179 00:08:18,685 --> 00:08:21,335 - Certainly. And, you know, I I think that's such a strong 180 00:08:21,335 --> 00:08:23,215 and powerful message, as you mentioned, um, 181 00:08:23,355 --> 00:08:26,575 to really put the resources behind those efforts and, 182 00:08:26,575 --> 00:08:29,975 and making sure that no matter what the nurse chooses and, 183 00:08:29,975 --> 00:08:32,855 and feels like is their best path forward for them, um, 184 00:08:32,965 --> 00:08:34,415 that they're valued and supported. 185 00:08:34,655 --> 00:08:37,295 I, I love that. I think that's such a remarkable way to, 186 00:08:37,435 --> 00:08:39,935 you know, develop a culture within the organization. 187 00:08:40,355 --> 00:08:43,415 - Yep, absolutely. You know, they'll, the whole idea behind, 188 00:08:43,635 --> 00:08:46,055 um, magnet hospitals, if you, 189 00:08:46,155 --> 00:08:49,375 if you recall when they first launched was, was how, 190 00:08:49,645 --> 00:08:51,615 what are the elements that will make a 191 00:08:51,775 --> 00:08:53,015 hospital a magnet for nurses? 192 00:08:53,115 --> 00:08:56,045 It will draw nurses to that facility. 193 00:08:56,135 --> 00:08:59,525 Those things haven't changed in, in, in 20 years. 194 00:08:59,785 --> 00:09:03,085 Um, not, not really, not much . 195 00:09:05,035 --> 00:09:06,845 - Yeah, absolutely. Absolutely. 196 00:09:07,205 --> 00:09:09,005 , that's so, you know, such a great point. 197 00:09:09,185 --> 00:09:11,485 And you know, the other thing I was wondering is 198 00:09:11,485 --> 00:09:14,245 that the article mentions strategic overlaps 199 00:09:14,245 --> 00:09:16,165 between the use less and lose less. 200 00:09:16,705 --> 00:09:19,085 Can you explain how these improvements contribute 201 00:09:19,085 --> 00:09:21,965 to the overall success of the nurse staffing strategy? 202 00:09:22,985 --> 00:09:26,475 - Sure, absolutely. So, you know, in order to, uh, 203 00:09:26,495 --> 00:09:30,395 the use less, which is using, um, other, other providers 204 00:09:30,395 --> 00:09:34,555 outside of just RNs to provide a real, um, kind of model 205 00:09:34,735 --> 00:09:37,395 for care, um, in order to do that, 206 00:09:37,395 --> 00:09:39,435 we had a couple things we had to do right, uh, 207 00:09:39,815 --> 00:09:42,795 namely leadership development so that our nurses, 208 00:09:43,575 --> 00:09:47,435 our assistant nurse managers who run operations 24 7 as well 209 00:09:47,435 --> 00:09:51,275 as our nurse managers had that they were prepared to, 210 00:09:51,375 --> 00:09:52,595 to effectively staff. 211 00:09:52,595 --> 00:09:54,355 They needed to understand what that meant 212 00:09:54,975 --> 00:09:57,595 and all of the variables involved in that. 213 00:09:58,135 --> 00:10:01,835 Um, when, when assignments are being made for nurses, 214 00:10:01,985 --> 00:10:04,875 it's not just a, a ratio of a number of patients as it seems 215 00:10:04,875 --> 00:10:09,035 to be kind of, uh, dumbed down in, um, in the press. 216 00:10:09,575 --> 00:10:11,195 It, it's much more than a ratio. 217 00:10:11,305 --> 00:10:15,235 It's actually the nursing, um, not only the complexity 218 00:10:15,235 --> 00:10:18,235 of the patient, but the experience level of the nurse 219 00:10:18,495 --> 00:10:20,115 and the intensity of the work. 220 00:10:20,415 --> 00:10:22,955 So it's the acuity, the intensity, as well as 221 00:10:23,305 --> 00:10:24,635 that nurse's experience. 222 00:10:24,805 --> 00:10:29,155 Those three things work together in conjunction to determine 223 00:10:29,225 --> 00:10:32,275 what an appropriate, um, assignment is for a nurse. 224 00:10:32,295 --> 00:10:33,395 So we needed to go back 225 00:10:33,395 --> 00:10:37,335 and just do some level settings, nursing staffing principles 226 00:10:37,335 --> 00:10:40,455 and practices that that class for our nurse leaders, 227 00:10:40,675 --> 00:10:42,895 you know, really helped to get everybody on the same page. 228 00:10:43,595 --> 00:10:46,395 And then, uh, things like leading effective unit huddles, 229 00:10:46,655 --> 00:10:48,835 if, um, there's a good way to do it, a way 230 00:10:48,835 --> 00:10:51,355 that is actually useful, that is, is helpful 231 00:10:51,495 --> 00:10:53,555 to both the staff as well as the leaders 232 00:10:54,595 --> 00:10:57,035 communicating effectively with physicians and providers. 233 00:10:57,495 --> 00:11:00,555 Um, you know, we, um, brought on 234 00:11:00,575 --> 00:11:03,595 as many hospitals did across the country, uh, 235 00:11:03,795 --> 00:11:06,315 a significant number of graduate nurses, uh, 236 00:11:06,345 --> 00:11:07,915 over the last 24 months. 237 00:11:08,415 --> 00:11:11,475 And we needed to make sure that they were transitioned 238 00:11:11,475 --> 00:11:13,675 to practice in a way that they felt good about, 239 00:11:13,705 --> 00:11:16,475 that they weren't just thrown in to these units. 240 00:11:17,095 --> 00:11:19,795 Um, and having to suddenly communicate and, 241 00:11:20,335 --> 00:11:23,155 and develop, you know, really working relationships 242 00:11:23,795 --> 00:11:26,195 with physicians, uh, that they didn't know 243 00:11:26,195 --> 00:11:27,315 and weren't comfortable with. 244 00:11:27,375 --> 00:11:30,235 And there is a, there are nuances to those relationships, 245 00:11:31,055 --> 00:11:34,315 um, and then, you know, principals of onboarding, 246 00:11:34,445 --> 00:11:37,195 staff nurses, it, it can be challenging 247 00:11:37,215 --> 00:11:41,155 for a 26-year-old assistant nurse manager to be managing 22 248 00:11:41,335 --> 00:11:43,235 and 21-year-old nurses. 249 00:11:43,455 --> 00:11:45,715 So, you know, do they understand how 250 00:11:45,715 --> 00:11:48,515 to appropriately onboard those new nurses and what they need 251 00:11:48,575 --> 00:11:51,675 and, and how a GN can make a smooth transition 252 00:11:52,095 --> 00:11:53,345 to practice practice. 253 00:11:53,345 --> 00:11:55,505 So the fundamentals about that, we outlined that 254 00:11:55,525 --> 00:11:57,825 and then made sure that, uh, everybody participated 255 00:11:57,825 --> 00:12:02,225 and really raise a bar for our nursing leadership relative 256 00:12:02,245 --> 00:12:04,305 to, um, their ability to lead. 257 00:12:08,055 --> 00:12:09,515 - You know, that's so interesting to hear, 258 00:12:09,515 --> 00:12:12,355 and especially, um, that last point you made, you know, 259 00:12:12,425 --> 00:12:16,155 with, um, new leaders emerging and coming in 260 00:12:16,155 --> 00:12:18,915 and then all of a sudden having to manage large teams, 261 00:12:19,655 --> 00:12:21,675 you know, it, it, it's a, a skill 262 00:12:21,695 --> 00:12:24,955 and especially as, um, you know, the, the workforce changes 263 00:12:25,135 --> 00:12:29,155 and kind of the dynamics, um, within, you know, the, 264 00:12:29,295 --> 00:12:31,595 the whole, um, department I can imagine 265 00:12:31,655 --> 00:12:33,595 or the whole hospital are changing as well. 266 00:12:34,215 --> 00:12:36,275 And, you know, is there anything that you've noticed, 267 00:12:36,435 --> 00:12:38,595 I guess, compared to whether it's pre pandemic 268 00:12:38,655 --> 00:12:40,875 or just how things used to be that, you know, 269 00:12:40,875 --> 00:12:43,955 you really see it as being, um, super helpful 270 00:12:43,975 --> 00:12:46,795 and beneficial within some of these trainings so that, um, 271 00:12:46,925 --> 00:12:49,035 going forward, you know, the, the hospitals 272 00:12:49,035 --> 00:12:51,635 and the nursing departments in particular, um, are, 273 00:12:51,695 --> 00:12:53,795 are really becoming those places, as you mentioned 274 00:12:53,795 --> 00:12:56,035 before, that people are, are really wanting to work at 275 00:12:56,035 --> 00:12:57,555 and wanting to be at in strong teams 276 00:12:57,695 --> 00:13:00,835 and not engendering some of the, um, challenging aspects 277 00:13:00,835 --> 00:13:02,835 of culture that we've seen previously. 278 00:13:03,425 --> 00:13:05,555 - Yeah, you know, I think probably one 279 00:13:05,555 --> 00:13:07,835 of the most important things is that the, um, 280 00:13:08,415 --> 00:13:11,115 the leader who's leading operations on that unit for 281 00:13:11,115 --> 00:13:13,755 that shift, there's always someone 24 7 for us, 282 00:13:13,865 --> 00:13:16,395 it's an assistant nurse manager or a charge nurse. 283 00:13:16,935 --> 00:13:20,395 Um, they really have to, uh, number one, 284 00:13:20,815 --> 00:13:22,715 be in the position to be able 285 00:13:22,715 --> 00:13:25,755 to evaluate what's happening on the unit at any given time. 286 00:13:26,545 --> 00:13:30,075 That means, you know, we need those, those unit leaders 287 00:13:30,655 --> 00:13:33,395 to not have an assignment to actually be free so 288 00:13:33,395 --> 00:13:38,275 that they are, they are continually evaluating the workload 289 00:13:38,335 --> 00:13:39,475 of the bedside nurses. 290 00:13:39,745 --> 00:13:41,275 Sometimes a graduate nurse 291 00:13:41,335 --> 00:13:44,195 or a nurse, you know, a novice nurse who's got less than two 292 00:13:44,195 --> 00:13:47,315 years experience, that nurse might not, um, 293 00:13:47,665 --> 00:13:50,435 realize when they are starting to get into trouble, 294 00:13:50,505 --> 00:13:53,955 when perhaps they're not able to keep up with, um, and, 295 00:13:54,055 --> 00:13:56,475 and appropriately assess and evaluate their patients. 296 00:13:56,505 --> 00:13:57,995 They feel stressed, 297 00:13:58,095 --> 00:14:01,075 but they, they need help sometimes to identify, you know, 298 00:14:01,075 --> 00:14:03,075 what, the workload of this assignment is actually 299 00:14:03,655 --> 00:14:05,715 not appropriate, you know, 300 00:14:05,735 --> 00:14:08,595 and a way that, you know, we have focused on doing that is 301 00:14:08,595 --> 00:14:11,515 to have, uh, nursing leaders who actually are assessing 302 00:14:11,515 --> 00:14:13,755 that along with the bedside nurses. 303 00:14:14,495 --> 00:14:17,435 Um, you know, high intensity leads to burnout, 304 00:14:17,615 --> 00:14:19,155 and burnout leads to turnover 305 00:14:19,295 --> 00:14:22,035 and leads to bad patient outcomes when you don't have enough 306 00:14:22,255 --> 00:14:23,555 nurses to provide care. 307 00:14:24,055 --> 00:14:25,795 So, you know, preparing our leaders 308 00:14:25,975 --> 00:14:28,195 to manage operations 24 7 309 00:14:29,015 --> 00:14:32,125 and um, to more effectively make 310 00:14:32,145 --> 00:14:35,645 and manage staffing assignments has really been fundamental 311 00:14:36,185 --> 00:14:39,165 in supporting the improvements in our nurses' perception 312 00:14:39,165 --> 00:14:40,205 of staffing adequacy. 313 00:14:40,785 --> 00:14:43,765 Um, you know, I say perception of staffing adequacy, 314 00:14:43,765 --> 00:14:45,325 because every nurse, regardless of 315 00:14:45,355 --> 00:14:46,925 what the staffing level looks like, 316 00:14:46,925 --> 00:14:48,325 they have their own perception of 317 00:14:48,325 --> 00:14:49,965 how they feel on that given shift. 318 00:14:50,345 --> 00:14:52,685 You know, we measure staffing adequacy in our annual 319 00:14:52,685 --> 00:14:54,005 nursing engagement survey. 320 00:14:54,425 --> 00:14:57,445 So the N-D-N-Q-I survey asks tho, you know, 321 00:14:57,445 --> 00:14:59,285 those really important questions, 322 00:14:59,825 --> 00:15:02,645 do we have enough registered nurses to provide quality care? 323 00:15:03,345 --> 00:15:05,085 How do nurses, do nurses have enough time 324 00:15:05,105 --> 00:15:08,005 to discuss patient care problems with other nurses? 325 00:15:08,665 --> 00:15:10,525 Do we have enough staff to get the work done? 326 00:15:10,985 --> 00:15:13,365 Are there adequate support services to allow me 327 00:15:13,365 --> 00:15:14,485 to spend time with my patients? 328 00:15:14,485 --> 00:15:18,685 Those four questions really give you a great pulse of, of 329 00:15:18,905 --> 00:15:20,845 how those nurses on that unit feel. 330 00:15:21,505 --> 00:15:25,485 You know, we had a just significant increase in staffing, 331 00:15:25,805 --> 00:15:28,365 adequacy perception from our nurses last year, 332 00:15:28,445 --> 00:15:29,685 a 14% increase. 333 00:15:30,185 --> 00:15:32,845 And, um, and I, uh, all 334 00:15:32,845 --> 00:15:34,525 of our nursing leaders in our markets 335 00:15:34,665 --> 00:15:37,565 and divisions all, all accredit that 336 00:15:37,585 --> 00:15:40,965 to an increased awareness, not only the education of how 337 00:15:40,965 --> 00:15:43,925 to step, but awareness of the frontline nurse leaders that 338 00:15:43,925 --> 00:15:46,405 that is their responsibility, you know, to, 339 00:15:46,825 --> 00:15:49,445 to be making sure that those bedside nurses have 340 00:15:49,445 --> 00:15:52,085 what they need, and if not, that assignments are changed 341 00:15:52,145 --> 00:15:53,845 and redistributed more appropriately. 342 00:15:55,365 --> 00:15:57,245 I think that was probably one of the biggest. 343 00:15:57,345 --> 00:15:59,485 And you, you hear about that a lot in the, um, 344 00:16:00,445 --> 00:16:01,545 in the news when you, 345 00:16:01,545 --> 00:16:04,345 when you hear about nursing dissatisfaction, uh, 346 00:16:04,615 --> 00:16:07,305 very frequently, it's around that, that we don't have, 347 00:16:07,565 --> 00:16:09,225 you'll hear them call it a charge nurse 348 00:16:09,225 --> 00:16:11,585 or our charge nurse has an assignment, you know, 349 00:16:11,605 --> 00:16:14,065 and when that happens, who is, um, 350 00:16:14,755 --> 00:16:16,665 who's got their eye on what's happening on that unit? 351 00:16:20,565 --> 00:16:21,785 - And it's such an excellent point 352 00:16:21,785 --> 00:16:24,345 and certainly a situation that is less than ideal 353 00:16:24,405 --> 00:16:27,425 and hospitals don't wanna get into that situation. 354 00:16:27,425 --> 00:16:28,545 For sure. Um, 355 00:16:28,725 --> 00:16:29,825 before we wrap up here, 356 00:16:29,945 --> 00:16:32,425 I was wondering if you could tell me more about some 357 00:16:32,425 --> 00:16:34,465 of the results that you've seen from the recruitment 358 00:16:34,465 --> 00:16:36,025 and retention strategies you mentioned, 359 00:16:36,175 --> 00:16:38,065 including your partnership with the schools 360 00:16:38,125 --> 00:16:39,865 and your Clinical Leader Ladders program. 361 00:16:41,425 --> 00:16:44,395 - Sure. Um, well, yeah, our results, you know, 362 00:16:44,395 --> 00:16:46,235 we've been very, very pleased. 363 00:16:46,455 --> 00:16:49,485 We, we exceeded our hiring targets. 364 00:16:49,485 --> 00:16:52,645 You know, we had a, um, hiring target of about 5,000 nurses. 365 00:16:52,705 --> 00:16:53,765 We hired 7,000. 366 00:16:54,025 --> 00:16:56,965 So we beat that goal by, by, um, 2000 367 00:16:57,265 --> 00:17:00,165 or turnover, significant increase in 24 months from, 368 00:17:00,395 --> 00:17:03,765 from over 31% to, uh, just under 19 369 00:17:05,905 --> 00:17:08,115 nursing agencies, uh, post pandemic, 370 00:17:08,185 --> 00:17:10,675 many health systems brought on agency nursing. 371 00:17:10,815 --> 00:17:13,795 You know, we, at the height of the pandemic, uh, 372 00:17:13,795 --> 00:17:17,515 we're at about a 13% of our, uh, work hours agency. 373 00:17:17,525 --> 00:17:22,355 We're down to 1% now. So, uh, nursing engagement improved. 374 00:17:22,575 --> 00:17:26,475 The N-D-N-Q-I, uh, annual nursing engagement survey, which, 375 00:17:26,495 --> 00:17:30,195 you know, probably the survey most hospitals take across the 376 00:17:30,195 --> 00:17:33,515 country, we saw improvement in all eight domains. 377 00:17:33,735 --> 00:17:37,675 Really, really pleased with that. Um, and the turnover. 378 00:17:37,855 --> 00:17:41,275 So we launched a clinical ladder across the company, um, 379 00:17:41,605 --> 00:17:44,995 about 18 months ago across the entire company. 380 00:17:45,295 --> 00:17:47,595 And the nurses who participate in that clinical ladder, 381 00:17:47,595 --> 00:17:49,325 their turnover was less than 5%. 382 00:17:50,435 --> 00:17:51,735 So, you know, that's really a, 383 00:17:51,805 --> 00:17:53,415 that was a game changer for us. 384 00:17:53,475 --> 00:17:56,455 The latter turnover we're engaging nurses and, um, 385 00:17:57,275 --> 00:17:59,445 and they're staying, you know, 386 00:17:59,445 --> 00:18:01,405 and relative to academic partnerships, 387 00:18:01,425 --> 00:18:02,565 you asked about that as well. 388 00:18:02,625 --> 00:18:05,605 You know, that was a, a big, uh, big deal for us, 389 00:18:05,825 --> 00:18:09,205 really connecting with all of our feeder nursing schools, 390 00:18:09,785 --> 00:18:11,205 uh, making sure that we're there. 391 00:18:11,215 --> 00:18:12,285 We're connecting with faculty 392 00:18:12,465 --> 00:18:14,965 and students opening up positions on our 393 00:18:14,965 --> 00:18:16,085 end for nursing students. 394 00:18:16,185 --> 00:18:18,485 So our nurse tech positions, allowing them to work, 395 00:18:19,025 --> 00:18:22,365 you know, a, a one, perhaps it's one shift every other week 396 00:18:22,385 --> 00:18:24,925 so they can kind of get to know us and we get to know them 397 00:18:25,025 --> 00:18:26,845 and, and they can figure out 398 00:18:26,855 --> 00:18:28,645 where at Advent Health they wanna land 399 00:18:28,645 --> 00:18:30,765 where they wanna make their home after graduation. 400 00:18:31,875 --> 00:18:35,655 We also launched a number of dedicated education units, uh, 401 00:18:35,805 --> 00:18:37,775 with local colleges of nursing, 402 00:18:37,915 --> 00:18:40,415 really strengthening those academic partnerships. 403 00:18:40,875 --> 00:18:43,615 We expanded our practicums, our clinical rotations. 404 00:18:44,645 --> 00:18:48,265 We have our, um, team members working as adjunct faculty to, 405 00:18:48,325 --> 00:18:51,265 to help support those colleges of nursing so that they have 406 00:18:51,845 --> 00:18:55,425 the, um, academic leaders that they need while they continue 407 00:18:55,425 --> 00:18:57,905 to also, uh, develop and expand their pool. 408 00:18:58,965 --> 00:19:01,185 Our graduate nurse residencies we're all, um, 409 00:19:02,225 --> 00:19:04,905 standardized across the company, really making sure 410 00:19:04,935 --> 00:19:07,385 that they were evidence-based and that they 411 00:19:07,745 --> 00:19:11,025 provided a, a solid education with a, 412 00:19:11,135 --> 00:19:14,905 with evaluation throughout the graduate nurse residency so 413 00:19:14,935 --> 00:19:17,145 that those residents were prepared 414 00:19:17,285 --> 00:19:19,065 and transitioned well practice. 415 00:19:19,605 --> 00:19:21,765 We also did the same thing for our preceptor. 416 00:19:21,905 --> 00:19:25,485 So, you know, every graduate nurse residency is led 417 00:19:25,505 --> 00:19:27,325 by preceptors bedside nurses. 418 00:19:27,905 --> 00:19:30,765 Uh, we realized that we had an opportunity there 419 00:19:30,785 --> 00:19:33,885 to help standardize their approach to the preceptor role. 420 00:19:34,145 --> 00:19:36,125 Did they understand, you know, what it meant to be 421 00:19:36,145 --> 00:19:39,485 and adult learning, um, strategies so 422 00:19:39,485 --> 00:19:42,365 that our preceptors were functioning at a very high level 423 00:19:42,425 --> 00:19:47,245 and able to really transition those GNS in a way 424 00:19:47,245 --> 00:19:49,965 that was, uh, good for everyone, the gn as well 425 00:19:49,965 --> 00:19:52,315 as the organization, and then a number 426 00:19:52,315 --> 00:19:54,115 of nursing mentor programs as well. 427 00:19:54,755 --> 00:19:57,275 I think our relationship with our colleges of nursing 428 00:19:57,535 --> 00:20:00,755 and then our own Advent Health University College of Nursing 429 00:20:00,855 --> 00:20:05,275 as well, um, has really strengthened in the last 24 months. 430 00:20:05,895 --> 00:20:07,565 We've become very, very good partners. 431 00:20:09,035 --> 00:20:10,085 - Well, that's great to hear, 432 00:20:10,265 --> 00:20:12,925 and certainly inspiring just everything you've put together, 433 00:20:13,105 --> 00:20:15,765 um, or, and resources that you put towards the nursing 434 00:20:15,825 --> 00:20:16,925 and and development program. 435 00:20:17,305 --> 00:20:20,085 Um, this really great to hear, Trish, thank you so much 436 00:20:20,125 --> 00:20:22,405 for joining us on the podcast today to really expand 437 00:20:22,405 --> 00:20:24,485 and dig deeper into what you're doing at Advent Health. 438 00:20:24,825 --> 00:20:26,045 Um, I really appreciate it, 439 00:20:26,045 --> 00:20:27,885 and I look forward to connecting with you again soon. 440 00:20:28,385 --> 00:20:30,645 - Hey, thanks so much, Laura. 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