1 00:00:00,240 --> 00:00:02,799 Hi, everyone. Thank you so much for tuning 2 00:00:02,799 --> 00:00:05,200 in to this episode of the Becker's health 3 00:00:05,200 --> 00:00:06,019 care podcast. 4 00:00:06,559 --> 00:00:09,359 I'm Erica Carbajal, an editor with Becker's, and 5 00:00:09,359 --> 00:00:11,859 I'm excited today to be joined by Andrea 6 00:00:11,919 --> 00:00:12,419 Highfill. 7 00:00:12,974 --> 00:00:15,955 Andrea is the CNO at Carson Valley Health. 8 00:00:16,414 --> 00:00:18,254 Andrea, thank you so much. A pleasure to 9 00:00:18,254 --> 00:00:19,314 have you on today. 10 00:00:19,855 --> 00:00:20,835 Thank you, Erica. 11 00:00:21,294 --> 00:00:23,934 Nice to be here. Yeah. Well, to start 12 00:00:23,934 --> 00:00:25,614 us off, do you mind just sharing a 13 00:00:25,614 --> 00:00:27,375 bit about your role, the scope of your 14 00:00:27,375 --> 00:00:29,349 work at Carson Valley to help set the 15 00:00:29,349 --> 00:00:30,410 stage for attendees? 16 00:00:31,429 --> 00:00:33,829 Sure. Sure. Yeah. So I've actually been at 17 00:00:33,829 --> 00:00:35,909 Carson Valley Health in our hospital here, 18 00:00:36,469 --> 00:00:38,390 for 15 years now. I've been a nurse 19 00:00:38,390 --> 00:00:39,369 for about 25. 20 00:00:40,229 --> 00:00:42,674 And, started out as a staff nurse on 21 00:00:42,674 --> 00:00:43,335 the floor 22 00:00:44,994 --> 00:00:47,395 and then became went into leadership a few 23 00:00:47,395 --> 00:00:48,854 years after that, managing 24 00:00:49,634 --> 00:00:52,914 a mental health department and then becoming the 25 00:00:52,914 --> 00:00:53,975 senior manager 26 00:00:54,500 --> 00:00:55,960 of ancillary services, 27 00:00:56,659 --> 00:00:59,059 and then followed by my current role as 28 00:00:59,059 --> 00:01:00,359 the chief nursing officer. 29 00:01:00,820 --> 00:01:02,500 So in my current role, I'm over the 30 00:01:02,500 --> 00:01:03,000 nursing 31 00:01:03,460 --> 00:01:05,799 departments, which are med surg, ICU, 32 00:01:06,099 --> 00:01:08,599 emergency department, the surgery department, 33 00:01:09,155 --> 00:01:09,974 and then also, 34 00:01:10,914 --> 00:01:12,774 our infusion department, respiratory 35 00:01:14,114 --> 00:01:14,614 therapy, 36 00:01:15,075 --> 00:01:15,894 and pharmacy. 37 00:01:16,274 --> 00:01:19,715 So I oversee all those, in leadership and 38 00:01:19,715 --> 00:01:20,215 operations 39 00:01:21,479 --> 00:01:23,500 of the departments, the finances, 40 00:01:23,879 --> 00:01:24,939 quality metrics, 41 00:01:25,319 --> 00:01:26,219 and also, 42 00:01:27,000 --> 00:01:27,979 just kind of, 43 00:01:28,280 --> 00:01:31,239 the managers all report to me on on 44 00:01:31,239 --> 00:01:32,299 their day to days. 45 00:01:33,575 --> 00:01:36,534 Thanks, Andrea. Yeah. 25 years. Wow. I'm sure 46 00:01:36,534 --> 00:01:38,295 you've seen a lot of, you know, different 47 00:01:38,295 --> 00:01:38,795 iterations 48 00:01:39,334 --> 00:01:41,494 of nursing in such an, a time of 49 00:01:41,494 --> 00:01:42,875 change right now. 50 00:01:43,655 --> 00:01:45,174 So I guess I'll, I'll start there. If 51 00:01:45,174 --> 00:01:46,534 you could just tell us a little bit 52 00:01:46,534 --> 00:01:47,034 about 53 00:01:47,519 --> 00:01:50,000 over the past year kind of changes you've 54 00:01:50,000 --> 00:01:51,540 seen with the nursing workforce. 55 00:01:52,079 --> 00:01:53,219 I think we've really seen 56 00:01:53,599 --> 00:01:56,319 national reports over the past year suggesting that 57 00:01:56,319 --> 00:01:57,540 there's some more stabilization 58 00:01:58,000 --> 00:02:00,500 happening within the nursing workforce. So 59 00:02:01,015 --> 00:02:02,855 what are your reactions to that, you know, 60 00:02:02,855 --> 00:02:04,935 living living it on the ground? Does that 61 00:02:04,935 --> 00:02:07,094 resonate with your experience? What some of these 62 00:02:07,094 --> 00:02:09,915 data reports say? And what if any improvements 63 00:02:10,055 --> 00:02:11,115 are you seeing if 64 00:02:11,974 --> 00:02:15,175 so? Yes. That definitely resonates, Erica. I took 65 00:02:15,175 --> 00:02:17,300 this job in December of 2019 66 00:02:17,599 --> 00:02:19,699 as the Chief Nursing Officer. And so, 67 00:02:21,039 --> 00:02:21,539 this 68 00:02:22,879 --> 00:02:25,680 is the biggest change that I've ever seen 69 00:02:25,680 --> 00:02:26,500 in nursing, 70 00:02:27,199 --> 00:02:30,000 going having started at the very beginning of 71 00:02:30,000 --> 00:02:32,135 COVID and then going through COVID, and now 72 00:02:32,135 --> 00:02:33,754 I'm just now we've 73 00:02:34,055 --> 00:02:37,355 kind of we're moving past the post COVID 74 00:02:37,415 --> 00:02:39,735 recovery now, and that means a lot to 75 00:02:39,735 --> 00:02:41,495 us in the hospital. It means a lot 76 00:02:41,495 --> 00:02:42,635 to us in staffing. 77 00:02:44,215 --> 00:02:45,034 We have 78 00:02:45,335 --> 00:02:46,555 learned to innovate 79 00:02:47,860 --> 00:02:50,099 and not just do what we've always done 80 00:02:50,099 --> 00:02:52,740 because that's what, you know, has been in 81 00:02:52,740 --> 00:02:53,400 our box 82 00:02:53,780 --> 00:02:55,879 of nursing, you know, 83 00:02:56,180 --> 00:02:57,480 policies and procedures, 84 00:02:58,099 --> 00:03:00,500 innovate and work with what we have, and 85 00:03:00,500 --> 00:03:01,844 then also not 86 00:03:02,724 --> 00:03:03,224 fear 87 00:03:03,604 --> 00:03:04,745 of looking past 88 00:03:05,245 --> 00:03:05,745 and 89 00:03:06,245 --> 00:03:08,165 just working in different ways than we ever 90 00:03:08,165 --> 00:03:08,665 have. 91 00:03:09,205 --> 00:03:11,705 And so with that and with the recovery, 92 00:03:12,645 --> 00:03:15,145 I think that the new graduates now, 93 00:03:15,620 --> 00:03:17,079 you know, have been through 94 00:03:17,699 --> 00:03:21,159 the nursing school during the times where 95 00:03:21,780 --> 00:03:24,659 COVID was still a little bit fresh and 96 00:03:24,659 --> 00:03:25,879 they were still being 97 00:03:26,419 --> 00:03:28,215 taught a lot of the lessons and stuff. 98 00:03:28,215 --> 00:03:30,055 And so now coming out into the real 99 00:03:30,055 --> 00:03:32,935 world as new graduate nurses and still some 100 00:03:32,935 --> 00:03:33,435 students, 101 00:03:34,215 --> 00:03:36,294 it's probably a little bit more refreshing once 102 00:03:36,294 --> 00:03:37,675 they get their 103 00:03:38,375 --> 00:03:40,694 feet wet and see that it's not so 104 00:03:40,694 --> 00:03:41,594 scary anymore. 105 00:03:41,974 --> 00:03:45,169 And so we have been able to retain 106 00:03:45,310 --> 00:03:47,229 a lot more nurses and hire a lot 107 00:03:47,229 --> 00:03:49,310 more nurses. People are coming back into the 108 00:03:49,310 --> 00:03:50,530 field, I think, now. 109 00:03:51,229 --> 00:03:53,889 We went from half of our nursing force 110 00:03:54,030 --> 00:03:54,849 as travelers, 111 00:03:55,389 --> 00:03:57,490 and we're paying up to $160, 112 00:03:57,949 --> 00:03:58,449 $180 113 00:03:58,830 --> 00:04:00,884 an hour for all these travelers during 114 00:04:01,264 --> 00:04:03,205 COVID. So now we only have 1 traveler 115 00:04:03,264 --> 00:04:04,405 in our system, 116 00:04:05,185 --> 00:04:07,284 and that's only at $80 an hour. 117 00:04:07,985 --> 00:04:10,145 And so it's really a breath of fresh 118 00:04:10,145 --> 00:04:10,965 air really 119 00:04:11,824 --> 00:04:13,349 coming back to 120 00:04:13,650 --> 00:04:16,069 what we can focus on now with our 121 00:04:16,689 --> 00:04:20,050 improving the patient experience and continuing to improve 122 00:04:20,050 --> 00:04:22,310 our quality metrics and the way we practice 123 00:04:22,610 --> 00:04:24,449 and being able to focus on that and 124 00:04:24,449 --> 00:04:26,785 not just looking around and wondering when we're 125 00:04:26,785 --> 00:04:28,785 gonna get the next nurse to for the 126 00:04:28,785 --> 00:04:29,685 night shift tonight, 127 00:04:30,464 --> 00:04:33,205 for example. So it's it's a big improvement. 128 00:04:34,785 --> 00:04:37,665 Yeah. Really interesting to hear just how many 129 00:04:37,665 --> 00:04:39,045 nurses have come back 130 00:04:39,379 --> 00:04:42,339 after having left from traveling and and coming 131 00:04:42,339 --> 00:04:43,800 back to really a different, 132 00:04:44,100 --> 00:04:46,740 you know, changes with technology and new care 133 00:04:46,740 --> 00:04:49,860 delivery models, than they may have been used 134 00:04:49,860 --> 00:04:52,360 to, you know, had they before they left 135 00:04:52,819 --> 00:04:54,120 throughout the pandemic. 136 00:04:55,154 --> 00:04:56,854 For this next question here, 137 00:04:57,235 --> 00:04:59,555 do you mind sharing a bit about your 138 00:04:59,555 --> 00:05:01,334 top initiative that you're prioritizing 139 00:05:01,714 --> 00:05:03,414 to strengthen and elevate 140 00:05:03,954 --> 00:05:06,454 Carson Valley Health's nursing workforce in 2025? 141 00:05:07,074 --> 00:05:09,620 And how might this effort affect patient outcomes 142 00:05:09,680 --> 00:05:10,980 and and staff satisfaction? 143 00:05:12,960 --> 00:05:14,900 So I think our top initiative, 144 00:05:16,000 --> 00:05:18,879 to strengthen our our nursing workforce and just 145 00:05:18,879 --> 00:05:20,180 to continue to 146 00:05:20,639 --> 00:05:23,520 elevate our practice in general is, our nurse 147 00:05:23,520 --> 00:05:26,634 apprentice program and new graduate nurse program. 148 00:05:27,654 --> 00:05:29,834 Right now, we are a 25 149 00:05:30,454 --> 00:05:32,314 bed critical access hospital, 150 00:05:33,175 --> 00:05:33,675 with 151 00:05:34,375 --> 00:05:36,074 a 14 bed ER, 152 00:05:36,615 --> 00:05:39,115 and we have 3 ORs in our surgery 153 00:05:39,175 --> 00:05:39,675 department. 154 00:05:40,349 --> 00:05:42,050 So we're a little bit smaller, 155 00:05:42,669 --> 00:05:45,009 on the outskirts of Reno and Lake Tahoe. 156 00:05:45,550 --> 00:05:48,449 So I think that actually helps us with 157 00:05:48,669 --> 00:05:51,649 the nurse apprentice and new graduate nurses because 158 00:05:51,949 --> 00:05:53,404 they're not shuffled into 159 00:05:54,024 --> 00:05:54,685 a huge 160 00:05:55,224 --> 00:05:57,064 system of getting lost. There's a lot of 161 00:05:57,064 --> 00:05:57,964 1 on 1 162 00:05:58,824 --> 00:05:59,324 attention 163 00:05:59,625 --> 00:06:01,644 and training for the nurse apprentices. 164 00:06:02,745 --> 00:06:05,485 And so starting with that program, we 165 00:06:06,899 --> 00:06:08,279 hire nursing students 166 00:06:09,060 --> 00:06:11,080 usually in their last year 167 00:06:11,620 --> 00:06:14,839 of nursing school because once they 168 00:06:15,459 --> 00:06:18,420 have been checked off in school for doing 169 00:06:18,420 --> 00:06:20,980 different procedures and things like that, then they 170 00:06:20,980 --> 00:06:21,720 can actually 171 00:06:29,835 --> 00:06:32,735 apprentice's salaries and so we're able to really, 172 00:06:33,835 --> 00:06:36,634 really hire as many as our staff can 173 00:06:36,634 --> 00:06:37,134 handle 174 00:06:37,629 --> 00:06:40,310 in order to, have a nice pipeline for, 175 00:06:40,310 --> 00:06:42,910 you know, kind of try before you buy 176 00:06:42,910 --> 00:06:44,910 for both of us, if the nurse thinks 177 00:06:44,910 --> 00:06:46,350 it's a good fit to work here, the 178 00:06:46,350 --> 00:06:47,089 nurse apprentice, 179 00:06:47,389 --> 00:06:48,829 and then if we think they're a good 180 00:06:48,829 --> 00:06:50,895 cultural fit and able to be trained here 181 00:06:50,895 --> 00:06:52,975 in the hospital. So that's a really strong 182 00:06:52,975 --> 00:06:54,274 program we have going. 183 00:06:54,735 --> 00:06:57,535 And the new graduate program isn't one that 184 00:06:57,535 --> 00:06:58,035 we 185 00:06:58,975 --> 00:06:59,475 can 186 00:07:00,095 --> 00:07:03,235 say it's just like the larger hospitals because 187 00:07:03,970 --> 00:07:05,430 it's really not. We 188 00:07:06,290 --> 00:07:08,930 have the new graduate nurses more on a 189 00:07:08,930 --> 00:07:10,930 1 on 1 basis and not like a 190 00:07:10,930 --> 00:07:13,269 huge cohort of 50 or 100 191 00:07:13,889 --> 00:07:15,110 new graduate nurses. 192 00:07:15,569 --> 00:07:17,104 And so these nurses, 193 00:07:17,564 --> 00:07:19,485 will be paired up with a preceptor on 194 00:07:19,485 --> 00:07:20,625 day or night shift, 195 00:07:21,245 --> 00:07:24,285 in any of our nursing departments. And then, 196 00:07:24,685 --> 00:07:27,324 they take they have an online course that 197 00:07:27,324 --> 00:07:30,464 they take throughout the 1st 12 weeks. 198 00:07:31,209 --> 00:07:34,029 And it actually is enhanced with AI, 199 00:07:34,649 --> 00:07:35,709 and the AI 200 00:07:36,250 --> 00:07:38,409 can tell through all the test questions and 201 00:07:38,409 --> 00:07:41,129 things like that what they are struggling with 202 00:07:41,129 --> 00:07:42,189 and what their 203 00:07:42,649 --> 00:07:43,629 biggest opportunities 204 00:07:44,409 --> 00:07:46,954 in their clinical work and then also in 205 00:07:47,574 --> 00:07:49,115 their knowledge base, 206 00:07:49,574 --> 00:07:51,514 are for us to help 207 00:07:52,055 --> 00:07:56,074 really cater to an independent and individualized learning 208 00:07:56,935 --> 00:07:59,060 for them. So those are our 2, really 209 00:07:59,060 --> 00:08:02,519 big programs that hopefully will help us retain 210 00:08:03,379 --> 00:08:04,919 nurses and then also 211 00:08:05,300 --> 00:08:07,699 improve our patient outcomes as they become a 212 00:08:07,699 --> 00:08:09,860 part of our team with still a lot 213 00:08:09,860 --> 00:08:10,680 of oversight 214 00:08:11,620 --> 00:08:12,919 during that first period. 215 00:08:14,394 --> 00:08:16,555 Yeah. Thanks for sharing those too. With the 216 00:08:16,555 --> 00:08:18,095 nurse apprenticeship program, 217 00:08:18,555 --> 00:08:19,615 you said it was like 218 00:08:20,154 --> 00:08:22,394 a robust program. How long has that one 219 00:08:22,394 --> 00:08:24,014 been in place? I know we've seen, 220 00:08:24,475 --> 00:08:26,975 some reports about health systems kind of reintroducing 221 00:08:27,354 --> 00:08:30,589 nurse externship programs, which has been interesting, 222 00:08:31,290 --> 00:08:33,370 as kind of kind of a reemerging trend. 223 00:08:33,370 --> 00:08:34,889 But I just wanted to see how how 224 00:08:34,889 --> 00:08:36,110 long that's been in place. 225 00:08:37,450 --> 00:08:40,089 We've had the nurse apprentice program in place 226 00:08:40,089 --> 00:08:40,909 for probably 227 00:08:41,289 --> 00:08:42,509 7 years now. 228 00:08:43,049 --> 00:08:44,429 You know, there's there's 229 00:08:45,044 --> 00:08:47,605 been some slow years of it. And I 230 00:08:47,605 --> 00:08:49,684 think when we talk about nurses coming back 231 00:08:49,684 --> 00:08:50,585 into the workforce, 232 00:08:51,764 --> 00:08:54,164 some of it is that I think that 233 00:08:54,164 --> 00:08:57,044 they're coming back to school too. I I 234 00:08:57,044 --> 00:08:59,924 haven't actually looked at the entrance numbers for 235 00:08:59,924 --> 00:09:00,585 our local 236 00:09:01,019 --> 00:09:02,240 nursing schools here, 237 00:09:02,700 --> 00:09:05,759 but it seems like those also dropped during 238 00:09:05,980 --> 00:09:08,300 COVID and kind of that post COVID area. 239 00:09:08,300 --> 00:09:11,100 So our nurse apprentice program wasn't as strong 240 00:09:11,100 --> 00:09:12,399 during that time either. 241 00:09:13,100 --> 00:09:14,460 And so now it's pretty 242 00:09:15,845 --> 00:09:18,804 it's getting to be very competitive. And we 243 00:09:18,804 --> 00:09:20,904 have, you know, for our small 244 00:09:21,684 --> 00:09:24,825 space, we probably have 5 or 6 spots, 245 00:09:24,884 --> 00:09:26,985 and we definitely have more than double 246 00:09:27,445 --> 00:09:27,945 applicants. 247 00:09:29,110 --> 00:09:31,049 Yeah. Sure, Chris. I see that that interest. 248 00:09:31,830 --> 00:09:33,830 By and large, nurses still have a lot 249 00:09:33,830 --> 00:09:36,710 of questions surrounding what AI means for patient 250 00:09:36,710 --> 00:09:37,210 care. 251 00:09:37,669 --> 00:09:39,429 What role do you believe it will play 252 00:09:39,429 --> 00:09:41,529 in care delivery in the coming years? 253 00:09:43,034 --> 00:09:43,855 Sure. So 254 00:09:44,235 --> 00:09:46,634 I think there's a role for AI in 255 00:09:46,634 --> 00:09:47,134 nursing. 256 00:09:47,754 --> 00:09:50,095 I think that when you look at AI 257 00:09:50,154 --> 00:09:52,254 becoming developed, the limitation 258 00:09:52,634 --> 00:09:53,855 of it and 259 00:09:54,554 --> 00:09:55,054 is 260 00:09:55,549 --> 00:09:56,370 is really 261 00:09:56,909 --> 00:10:00,189 anything with human interaction, any anything that requires 262 00:10:00,189 --> 00:10:01,009 human interaction 263 00:10:02,350 --> 00:10:05,870 and relationship building is not gonna be enhanced 264 00:10:05,870 --> 00:10:07,169 with AI necessarily, 265 00:10:07,789 --> 00:10:09,709 or it's not going to be replaced by 266 00:10:09,709 --> 00:10:10,209 AI 267 00:10:10,565 --> 00:10:12,264 is probably a better way to say it. 268 00:10:12,804 --> 00:10:14,424 And so I think with nursing, 269 00:10:15,684 --> 00:10:18,904 we currently are not doing any piloting 270 00:10:19,284 --> 00:10:21,924 of AI in our bedside nursing or our 271 00:10:21,924 --> 00:10:24,964 nursing departments. We are piloting AI in our 272 00:10:24,964 --> 00:10:26,105 behavioral health 273 00:10:26,779 --> 00:10:27,279 outpatient 274 00:10:27,740 --> 00:10:29,840 department as a part of therapy 275 00:10:31,259 --> 00:10:33,840 and where the therapists are able to 276 00:10:34,460 --> 00:10:35,840 use AI to 277 00:10:36,700 --> 00:10:38,940 pick out the most common words and the 278 00:10:38,940 --> 00:10:39,679 most common 279 00:10:43,134 --> 00:10:45,235 patient's therapy session and things like that 280 00:10:45,535 --> 00:10:48,479 to more accurately diagnose and treat the patients. 281 00:10:48,479 --> 00:10:49,715 So I think that's 282 00:10:50,254 --> 00:10:52,654 a really good first step. In the future, 283 00:10:52,654 --> 00:10:54,835 though, for bedside nursing, 284 00:10:55,375 --> 00:10:55,934 I think that, 285 00:10:56,740 --> 00:10:59,220 it's going to be able to help AI 286 00:10:59,220 --> 00:11:00,740 is going to be able to just play 287 00:11:00,740 --> 00:11:02,919 more of a supportive role with nurses 288 00:11:03,539 --> 00:11:04,199 in improving 289 00:11:04,579 --> 00:11:05,720 things like efficiencies 290 00:11:06,740 --> 00:11:09,379 and reducing workload and some of the things 291 00:11:09,379 --> 00:11:10,904 that nurses do every day, like 292 00:11:11,465 --> 00:11:11,965 documentation 293 00:11:12,585 --> 00:11:15,404 and medication and administration. And then, 294 00:11:16,345 --> 00:11:18,345 I'm sure that it will be really useful 295 00:11:18,345 --> 00:11:21,545 in the analysis of the patient monitoring systems 296 00:11:21,545 --> 00:11:24,365 as well, telemetry and recognizing rhythms, 297 00:11:25,509 --> 00:11:29,029 much easier than sometimes if there's artifact on 298 00:11:29,029 --> 00:11:31,830 the telemetry monitor, it's hard to tell if 299 00:11:31,830 --> 00:11:33,210 the patient's in a specific, 300 00:11:34,149 --> 00:11:36,710 rhythm. And then if they go into anything 301 00:11:36,710 --> 00:11:37,450 that could 302 00:11:37,975 --> 00:11:40,695 start down a life threatening rhythm, then, 303 00:11:41,254 --> 00:11:43,835 I think AI would be useful in 304 00:11:44,375 --> 00:11:47,095 detecting that earlier than possibly a human eye 305 00:11:47,095 --> 00:11:50,054 could, or possibly a consistent human eye could, 306 00:11:50,054 --> 00:11:50,554 right? 307 00:11:51,250 --> 00:11:52,710 So I think there's some 308 00:11:53,170 --> 00:11:55,889 real impacts that that could have on our 309 00:11:55,889 --> 00:11:56,389 profession. 310 00:11:57,009 --> 00:11:58,790 And then when you look at the staffing 311 00:11:59,330 --> 00:12:02,930 and patient ratios, you know, if AI does 312 00:12:02,930 --> 00:12:05,649 support the nurses so much more, then will 313 00:12:05,649 --> 00:12:08,605 their jobs be easier and our staffing ratios 314 00:12:08,745 --> 00:12:09,245 change, 315 00:12:10,264 --> 00:12:12,424 so that nurses can take care of more 316 00:12:12,424 --> 00:12:12,924 patients 317 00:12:13,304 --> 00:12:14,044 with that. 318 00:12:14,745 --> 00:12:18,284 Andrea, just around financial pressures, obviously, the industry 319 00:12:18,424 --> 00:12:19,084 is navigating 320 00:12:19,704 --> 00:12:21,565 those across the board. So 321 00:12:22,160 --> 00:12:24,559 during this, how is Carson Valley really trying 322 00:12:24,559 --> 00:12:27,679 to balance cost management with investments in the 323 00:12:27,679 --> 00:12:29,299 nursing workforce and development 324 00:12:29,840 --> 00:12:31,700 and patient care improvements? 325 00:12:33,040 --> 00:12:34,100 Well, I think 326 00:12:34,445 --> 00:12:37,725 what happens we do play a balancing sort 327 00:12:37,725 --> 00:12:38,225 of 328 00:12:38,524 --> 00:12:39,024 dance 329 00:12:39,884 --> 00:12:40,384 and, 330 00:12:41,004 --> 00:12:41,745 I think 331 00:12:42,205 --> 00:12:44,284 it was about 10 or 15 years ago 332 00:12:44,284 --> 00:12:45,264 when there was 333 00:12:45,804 --> 00:12:47,164 a freeze on any capital items and it 334 00:12:47,164 --> 00:12:47,965 was during, like, a recession period. There was 335 00:12:47,965 --> 00:12:49,970 a freeze any capital items and it was 336 00:12:49,970 --> 00:12:52,210 during like a recession period. There was a 337 00:12:52,210 --> 00:12:54,450 freeze on capital items. There was a freeze 338 00:12:54,450 --> 00:12:54,950 on, 339 00:12:56,370 --> 00:12:57,269 wage increases 340 00:12:57,970 --> 00:13:00,950 and this lasted like only about 2 years. 341 00:13:01,649 --> 00:13:02,629 But recovering 342 00:13:03,009 --> 00:13:03,830 from that, 343 00:13:04,424 --> 00:13:07,625 we were so far behind that we had 344 00:13:07,625 --> 00:13:08,125 to 345 00:13:08,584 --> 00:13:09,084 budget 346 00:13:09,384 --> 00:13:10,365 so aggressively 347 00:13:10,825 --> 00:13:13,245 to catch up even to the rest of 348 00:13:13,384 --> 00:13:15,004 the hospitals in our area 349 00:13:15,384 --> 00:13:17,464 just to be able to compete that we 350 00:13:17,464 --> 00:13:18,845 just can't get behind 351 00:13:19,379 --> 00:13:23,240 on the latest technology and paying people fairly 352 00:13:23,779 --> 00:13:26,340 and making sure everyone has what they need 353 00:13:26,340 --> 00:13:28,360 to take care of patients. 354 00:13:29,540 --> 00:13:31,860 And so that's sort of the spending piece 355 00:13:31,860 --> 00:13:32,519 of it. 356 00:13:32,964 --> 00:13:35,524 And then the responsibility piece of it. So 357 00:13:35,524 --> 00:13:36,745 we don't want to be irresponsible 358 00:13:38,404 --> 00:13:38,985 in fiscally 359 00:13:39,764 --> 00:13:40,345 in that, 360 00:13:40,725 --> 00:13:42,825 but we also don't want to fall behind 361 00:13:43,445 --> 00:13:45,865 benchmarks and we don't want to fall behind 362 00:13:46,740 --> 00:13:49,220 in technology. We want to have the latest 363 00:13:49,220 --> 00:13:50,040 and the greatest 364 00:13:50,660 --> 00:13:52,340 to be able to safely take care of 365 00:13:52,340 --> 00:13:53,000 our patients. 366 00:13:53,779 --> 00:13:54,440 And then 367 00:13:55,379 --> 00:13:56,660 what we do on a day to day 368 00:13:56,660 --> 00:13:57,799 basis that we're 369 00:13:58,259 --> 00:13:58,759 more 370 00:13:59,335 --> 00:14:01,095 in control of is, 371 00:14:02,615 --> 00:14:04,154 always staffing to our volumes 372 00:14:04,934 --> 00:14:07,254 and always looking at how we can be 373 00:14:07,254 --> 00:14:07,995 more efficient 374 00:14:08,375 --> 00:14:08,875 in 375 00:14:09,654 --> 00:14:11,735 how we schedule our patients and then how 376 00:14:11,735 --> 00:14:12,955 we staff our patients. 377 00:14:13,429 --> 00:14:15,029 So staffing is one of the number one 378 00:14:15,029 --> 00:14:16,809 expenses in the hospital setting. 379 00:14:17,909 --> 00:14:18,569 And so 380 00:14:19,110 --> 00:14:21,350 that's something we are always looking at. And 381 00:14:21,350 --> 00:14:24,250 then also, obviously, supplies and costs, 382 00:14:24,789 --> 00:14:26,329 just being very mindful 383 00:14:27,154 --> 00:14:29,654 of those. And then we hold our managers 384 00:14:29,715 --> 00:14:30,215 accountable. 385 00:14:31,235 --> 00:14:33,794 In our health system, we create our own 386 00:14:33,794 --> 00:14:35,875 budget. We're not given a budget and said, 387 00:14:35,875 --> 00:14:38,595 hey. And like a lot of for profit 388 00:14:38,595 --> 00:14:41,174 hospitals are given budgets from above, 389 00:14:41,990 --> 00:14:44,870 But we actually have to work with I 390 00:14:44,870 --> 00:14:47,269 work with my managers and my department leaders 391 00:14:47,269 --> 00:14:49,850 to create the budget and then justify it 392 00:14:50,389 --> 00:14:52,809 to our CEO and to our CFO 393 00:14:53,795 --> 00:14:54,455 so that 394 00:14:54,995 --> 00:14:58,055 we're responsible and accountable and we know every 395 00:14:58,434 --> 00:15:00,754 line item that's in that budget. And every 396 00:15:00,754 --> 00:15:02,434 month when we look at it, we say, 397 00:15:02,434 --> 00:15:04,434 oh, gosh, we either did a really good 398 00:15:04,434 --> 00:15:06,355 job of sticking to what we thought we 399 00:15:06,355 --> 00:15:09,154 would have or we there's a little bit 400 00:15:09,154 --> 00:15:11,129 of a variance based on this and that. 401 00:15:11,129 --> 00:15:11,629 So 402 00:15:12,169 --> 00:15:12,830 the more 403 00:15:14,250 --> 00:15:16,090 we are we include our managers in that 404 00:15:16,090 --> 00:15:19,049 and we're aware of what every line item 405 00:15:19,049 --> 00:15:20,429 is, the more accountable 406 00:15:21,049 --> 00:15:22,110 they are. And 407 00:15:23,049 --> 00:15:25,149 we can continue to grow 408 00:15:25,634 --> 00:15:27,554 each year with that and say, okay, what 409 00:15:27,554 --> 00:15:29,394 did we do wrong last year? Let's improve 410 00:15:29,394 --> 00:15:30,295 that this year. 411 00:15:30,835 --> 00:15:33,554 And how can we educate the staff on 412 00:15:33,554 --> 00:15:36,434 the reasons behind this, you know, instead of 413 00:15:36,434 --> 00:15:37,315 sometimes the staff 414 00:15:38,019 --> 00:15:40,600 think that the only thing that administration 415 00:15:41,139 --> 00:15:43,139 cares about is money and the bottom line, 416 00:15:43,139 --> 00:15:45,620 but that's not the case. The case is 417 00:15:45,620 --> 00:15:47,220 we really want to take care of patients, 418 00:15:47,220 --> 00:15:48,419 and we can't do it if we go 419 00:15:48,419 --> 00:15:49,159 out of business. 420 00:15:49,700 --> 00:15:50,144 So 421 00:15:50,705 --> 00:15:53,425 there's there's both sides of the coin there. 422 00:15:53,425 --> 00:15:53,925 So 423 00:15:55,024 --> 00:15:57,345 Yeah. Andrea, and I think your point just 424 00:15:57,345 --> 00:15:57,845 about 425 00:15:58,465 --> 00:15:58,965 prioritizing 426 00:15:59,825 --> 00:16:02,144 what to invest in when it comes to, 427 00:16:02,144 --> 00:16:03,764 you know, the latest technology 428 00:16:04,529 --> 00:16:07,269 and, you know, not wanting to be irresponsible 429 00:16:07,329 --> 00:16:09,570 with spending, but also not wanting to fall 430 00:16:09,570 --> 00:16:10,629 behind there with, 431 00:16:11,409 --> 00:16:11,909 integrating, 432 00:16:13,009 --> 00:16:15,429 new technology that could could make an organization 433 00:16:16,209 --> 00:16:18,764 remain competitive. I think it's such a sentiment 434 00:16:18,764 --> 00:16:20,684 that we hear from leaders and and trying 435 00:16:20,684 --> 00:16:22,924 to navigate that. So do you have any 436 00:16:22,924 --> 00:16:24,384 thoughts or advice on 437 00:16:25,324 --> 00:16:27,964 how you go about actually doing so? How 438 00:16:27,964 --> 00:16:29,424 you go about actually prioritizing 439 00:16:30,204 --> 00:16:30,944 what to 440 00:16:31,320 --> 00:16:33,160 invest in and move forward with, 441 00:16:33,720 --> 00:16:35,740 given tight budget constraints? 442 00:16:37,480 --> 00:16:39,559 Yeah. That's a that's a really good question. 443 00:16:39,559 --> 00:16:40,059 So, 444 00:16:40,920 --> 00:16:43,634 the very first thing is we establish the 445 00:16:43,634 --> 00:16:45,235 demand for it. And I can give you 446 00:16:45,235 --> 00:16:46,455 an example of 447 00:16:46,915 --> 00:16:50,434 our Mako orthopedic robot. So this is a 448 00:16:50,434 --> 00:16:52,774 very expensive piece of machinery. It's, 449 00:16:53,554 --> 00:16:55,575 you know, probably over $1,000,000 450 00:16:56,355 --> 00:16:57,575 for this piece of equipment. 451 00:16:58,379 --> 00:16:58,879 So 452 00:17:00,220 --> 00:17:02,379 we started just hearing surgeons say, hey, we 453 00:17:02,379 --> 00:17:03,980 really want the Mako. Hey, we're going to 454 00:17:03,980 --> 00:17:05,519 take our patients down the road 455 00:17:05,900 --> 00:17:07,980 to the other hospital that has the Mako 456 00:17:07,980 --> 00:17:09,820 because you guys don't have it. Hey, we're 457 00:17:09,820 --> 00:17:12,275 starting to give our patients the choice. So 458 00:17:12,275 --> 00:17:14,674 the doctors in their offices say, Hey, I 459 00:17:14,674 --> 00:17:15,174 can 460 00:17:15,634 --> 00:17:16,134 I 461 00:17:16,595 --> 00:17:17,815 can operate at 462 00:17:18,755 --> 00:17:21,075 2 different hospitals? 1 has the Mako and 463 00:17:21,075 --> 00:17:23,234 one doesn't. And these are the benefits of 464 00:17:23,234 --> 00:17:24,994 the Mako. Because a lot of the surgeons 465 00:17:24,994 --> 00:17:27,174 these days, the orthopedic surgeons, are 466 00:17:28,380 --> 00:17:30,619 are training in the Mako and see the 467 00:17:30,619 --> 00:17:33,580 better outcomes and see the reduced sentinel events 468 00:17:33,580 --> 00:17:34,640 and things like that. 469 00:17:35,420 --> 00:17:36,160 And so 470 00:17:36,860 --> 00:17:39,279 once we kind of started hearing this buzz 471 00:17:39,580 --> 00:17:41,600 that it was a high demand, 472 00:17:42,015 --> 00:17:43,474 we wanted to 473 00:17:44,255 --> 00:17:47,055 capture that in data, like how many patients 474 00:17:47,055 --> 00:17:48,894 are we seeing, how many patients are being 475 00:17:48,894 --> 00:17:49,714 sent away. 476 00:17:50,494 --> 00:17:53,134 And so we tried the best we could 477 00:17:53,134 --> 00:17:53,634 to 478 00:17:53,934 --> 00:17:55,490 capture the data through 479 00:17:56,509 --> 00:17:58,450 the vendors that work with us, 480 00:17:58,750 --> 00:18:00,289 because the Mako vendors 481 00:18:00,750 --> 00:18:01,250 also 482 00:18:01,549 --> 00:18:02,049 work 483 00:18:02,509 --> 00:18:05,150 in a tight area here and are able 484 00:18:05,150 --> 00:18:07,355 to say, hey, this is the amount of 485 00:18:07,355 --> 00:18:09,434 patients that we generally see at these other 486 00:18:09,434 --> 00:18:11,934 hospitals using the robotic equipment. 487 00:18:12,634 --> 00:18:13,535 And then also, 488 00:18:14,634 --> 00:18:18,255 getting like using part of our strategic plan 489 00:18:18,795 --> 00:18:22,240 to navigate where our community has seen a 490 00:18:22,240 --> 00:18:23,220 need in orthopedics 491 00:18:23,920 --> 00:18:24,420 and 492 00:18:24,799 --> 00:18:26,880 when are the peaks of these and just 493 00:18:26,880 --> 00:18:29,039 collecting all of this data and then putting 494 00:18:29,039 --> 00:18:29,779 it into 495 00:18:30,559 --> 00:18:32,960 a pro form a, like a business case 496 00:18:32,960 --> 00:18:34,259 and return on investment 497 00:18:35,119 --> 00:18:35,779 and then 498 00:18:36,384 --> 00:18:37,765 being like, okay, how 499 00:18:38,304 --> 00:18:39,044 many Mako 500 00:18:39,505 --> 00:18:41,184 surgery cases is it going to take to 501 00:18:41,184 --> 00:18:43,105 pay this thing off? How many do we 502 00:18:43,105 --> 00:18:44,944 need to do in a month? How many 503 00:18:44,944 --> 00:18:46,404 can we do in a month? 504 00:18:46,785 --> 00:18:49,904 And what's our capability on our side? And 505 00:18:49,904 --> 00:18:52,829 then, how expensive would it be to continue 506 00:18:52,829 --> 00:18:54,289 to take care of this thing. 507 00:18:54,829 --> 00:18:55,569 And so 508 00:18:56,190 --> 00:18:58,210 that's kind of one of the things that 509 00:18:58,910 --> 00:19:00,769 that's a really good example of 510 00:19:01,309 --> 00:19:03,329 the latest technology that 511 00:19:04,029 --> 00:19:04,605 we also 512 00:19:05,164 --> 00:19:06,684 would be losing out on a lot of 513 00:19:06,684 --> 00:19:09,244 business. That's the other case of the that's 514 00:19:09,244 --> 00:19:10,304 the other part of 515 00:19:10,605 --> 00:19:12,605 the business case is what kind of business 516 00:19:12,605 --> 00:19:14,365 would we be losing out on if we 517 00:19:14,365 --> 00:19:15,345 didn't get it. 518 00:19:15,804 --> 00:19:17,105 So at the end of the day, 519 00:19:18,044 --> 00:19:18,704 we did 520 00:19:20,339 --> 00:19:20,839 data 521 00:19:21,140 --> 00:19:22,419 did show that we would be losing quite 522 00:19:22,419 --> 00:19:23,079 a bit. 523 00:19:23,539 --> 00:19:24,740 And if we didn't keep up with this 524 00:19:24,740 --> 00:19:25,240 technology 525 00:19:26,099 --> 00:19:26,420 and, 526 00:19:27,460 --> 00:19:28,359 would be gaining 527 00:19:29,059 --> 00:19:30,740 quite a bit if we if we did 528 00:19:30,740 --> 00:19:31,539 acquire it. So 529 00:19:33,085 --> 00:19:35,565 Yeah. Andrea, thanks for walking through that example. 530 00:19:35,565 --> 00:19:37,664 I think it's interesting to hear just 531 00:19:38,045 --> 00:19:38,545 how, 532 00:19:38,845 --> 00:19:40,845 you know, you and your peers really did 533 00:19:40,845 --> 00:19:42,845 the leg work on on building that that 534 00:19:42,845 --> 00:19:43,825 business case. 535 00:19:44,285 --> 00:19:46,065 You have to be able to speak to 536 00:19:46,440 --> 00:19:49,179 the actual board who approves it, and and 537 00:19:49,319 --> 00:19:51,559 they they may or may not understand just, 538 00:19:51,559 --> 00:19:53,500 hey. Can we have $2,000,000 539 00:19:53,960 --> 00:19:56,119 for a piece of equipment? They're gonna wanna 540 00:19:56,119 --> 00:19:58,139 know a little more than that. So Sure. 541 00:19:58,839 --> 00:19:59,339 Yeah. 542 00:19:59,894 --> 00:20:02,455 Andrea, before we close out here, just wanted 543 00:20:02,455 --> 00:20:04,215 to end with a piece of advice if 544 00:20:04,215 --> 00:20:06,934 you could share for the next generation of 545 00:20:06,934 --> 00:20:08,795 nurse leaders who may be listening. 546 00:20:10,615 --> 00:20:13,169 Well, I think I think my number one 547 00:20:13,169 --> 00:20:15,750 piece of advice is probably something that I 548 00:20:16,210 --> 00:20:17,829 can pride myself in, 549 00:20:18,529 --> 00:20:21,490 and that is always hiring the the best 550 00:20:21,490 --> 00:20:23,669 people, always hiring the best managers, 551 00:20:24,244 --> 00:20:26,325 people who I think are smarter than me, 552 00:20:26,325 --> 00:20:27,545 especially at their 553 00:20:28,244 --> 00:20:29,305 specific jobs. 554 00:20:29,684 --> 00:20:32,244 If I hire the best and sometimes I 555 00:20:32,244 --> 00:20:35,384 have left positions, manager positions open for 556 00:20:36,085 --> 00:20:38,210 6, 8 months even sometimes, 557 00:20:38,910 --> 00:20:41,410 because I just don't have the right fit. 558 00:20:41,549 --> 00:20:43,410 I never hired just for a pulse, 559 00:20:43,789 --> 00:20:45,950 because that will make my life much harder. 560 00:20:45,950 --> 00:20:48,190 I'd rather manage it myself until I can 561 00:20:48,190 --> 00:20:49,250 find the best fit. 562 00:20:49,625 --> 00:20:51,785 And so that's my, that's my one piece 563 00:20:51,785 --> 00:20:52,445 of advice. 564 00:20:53,225 --> 00:20:54,045 Great advice. 565 00:20:55,065 --> 00:20:57,225 Andrea, thank you so much for joining me. 566 00:20:57,225 --> 00:20:59,404 It's been a pleasure chatting with you today. 567 00:20:59,865 --> 00:21:00,845 Thank you, Erica. 568 00:21:01,225 --> 00:21:04,309 And listeners, you can tune into additional episodes 569 00:21:04,369 --> 00:21:07,329 of the Becker's Healthcare podcast by visiting the 570 00:21:07,329 --> 00:21:08,390 podcast page 571 00:21:08,690 --> 00:21:10,069 webpage on our website. 572 00:21:10,369 --> 00:21:11,670 Thank you all so much.