Hi, everyone. Thank you so much for tuning
in to this episode of the Becker's health
care podcast.
I'm Erica Carbajal, an editor with Becker's, and
I'm excited today to be joined by Andrea
Highfill.
Andrea is the CNO at Carson Valley Health.
Andrea, thank you so much. A pleasure to
have you on today.
Thank you, Erica.
Nice to be here. Yeah. Well, to start
us off, do you mind just sharing a
bit about your role, the scope of your
work at Carson Valley to help set the
stage for attendees?
Sure. Sure. Yeah. So I've actually been at
Carson Valley Health in our hospital here,
for 15 years now. I've been a nurse
for about 25.
And, started out as a staff nurse on
the floor
and then became went into leadership a few
years after that, managing
a mental health department and then becoming the
senior manager
of ancillary services,
and then followed by my current role as
the chief nursing officer.
So in my current role, I'm over the
nursing
departments, which are med surg, ICU,
emergency department, the surgery department,
and then also,
our infusion department, respiratory
therapy,
and pharmacy.
So I oversee all those, in leadership and
operations
of the departments, the finances,
quality metrics,
and also,
just kind of,
the managers all report to me on on
their day to days.
Thanks, Andrea. Yeah. 25 years. Wow. I'm sure
you've seen a lot of, you know, different
iterations
of nursing in such an, a time of
change right now.
So I guess I'll, I'll start there. If
you could just tell us a little bit
about
over the past year kind of changes you've
seen with the nursing workforce.
I think we've really seen
national reports over the past year suggesting that
there's some more stabilization
happening within the nursing workforce. So
what are your reactions to that, you know,
living living it on the ground? Does that
resonate with your experience? What some of these
data reports say? And what if any improvements
are you seeing if
so? Yes. That definitely resonates, Erica. I took
this job in December of 2019
as the Chief Nursing Officer. And so,
this
is the biggest change that I've ever seen
in nursing,
going having started at the very beginning of
COVID and then going through COVID, and now
I'm just now we've
kind of we're moving past the post COVID
recovery now, and that means a lot to
us in the hospital. It means a lot
to us in staffing.
We have
learned to innovate
and not just do what we've always done
because that's what, you know, has been in
our box
of nursing, you know,
policies and procedures,
innovate and work with what we have, and
then also not
fear
of looking past
and
just working in different ways than we ever
have.
And so with that and with the recovery,
I think that the new graduates now,
you know, have been through
the nursing school during the times where
COVID was still a little bit fresh and
they were still being
taught a lot of the lessons and stuff.
And so now coming out into the real
world as new graduate nurses and still some
students,
it's probably a little bit more refreshing once
they get their
feet wet and see that it's not so
scary anymore.
And so we have been able to retain
a lot more nurses and hire a lot
more nurses. People are coming back into the
field, I think, now.
We went from half of our nursing force
as travelers,
and we're paying up to $160,
$180
an hour for all these travelers during
COVID. So now we only have 1 traveler
in our system,
and that's only at $80 an hour.
And so it's really a breath of fresh
air really
coming back to
what we can focus on now with our
improving the patient experience and continuing to improve
our quality metrics and the way we practice
and being able to focus on that and
not just looking around and wondering when we're
gonna get the next nurse to for the
night shift tonight,
for example. So it's it's a big improvement.
Yeah. Really interesting to hear just how many
nurses have come back
after having left from traveling and and coming
back to really a different,
you know, changes with technology and new care
delivery models, than they may have been used
to, you know, had they before they left
throughout the pandemic.
For this next question here,
do you mind sharing a bit about your
top initiative that you're prioritizing
to strengthen and elevate
Carson Valley Health's nursing workforce in 2025?
And how might this effort affect patient outcomes
and and staff satisfaction?
So I think our top initiative,
to strengthen our our nursing workforce and just
to continue to
elevate our practice in general is, our nurse
apprentice program and new graduate nurse program.
Right now, we are a 25
bed critical access hospital,
with
a 14 bed ER,
and we have 3 ORs in our surgery
department.
So we're a little bit smaller,
on the outskirts of Reno and Lake Tahoe.
So I think that actually helps us with
the nurse apprentice and new graduate nurses because
they're not shuffled into
a huge
system of getting lost. There's a lot of
1 on 1
attention
and training for the nurse apprentices.
And so starting with that program, we
hire nursing students
usually in their last year
of nursing school because once they
have been checked off in school for doing
different procedures and things like that, then they
can actually
apprentice's salaries and so we're able to really,
really hire as many as our staff can
handle
in order to, have a nice pipeline for,
you know, kind of try before you buy
for both of us, if the nurse thinks
it's a good fit to work here, the
nurse apprentice,
and then if we think they're a good
cultural fit and able to be trained here
in the hospital. So that's a really strong
program we have going.
And the new graduate program isn't one that
we
can
say it's just like the larger hospitals because
it's really not. We
have the new graduate nurses more on a
1 on 1 basis and not like a
huge cohort of 50 or 100
new graduate nurses.
And so these nurses,
will be paired up with a preceptor on
day or night shift,
in any of our nursing departments. And then,
they take they have an online course that
they take throughout the 1st 12 weeks.
And it actually is enhanced with AI,
and the AI
can tell through all the test questions and
things like that what they are struggling with
and what their
biggest opportunities
in their clinical work and then also in
their knowledge base,
are for us to help
really cater to an independent and individualized learning
for them. So those are our 2, really
big programs that hopefully will help us retain
nurses and then also
improve our patient outcomes as they become a
part of our team with still a lot
of oversight
during that first period.
Yeah. Thanks for sharing those too. With the
nurse apprenticeship program,
you said it was like
a robust program. How long has that one
been in place? I know we've seen,
some reports about health systems kind of reintroducing
nurse externship programs, which has been interesting,
as kind of kind of a reemerging trend.
But I just wanted to see how how
long that's been in place.
We've had the nurse apprentice program in place
for probably
7 years now.
You know, there's there's
been some slow years of it. And I
think when we talk about nurses coming back
into the workforce,
some of it is that I think that
they're coming back to school too. I I
haven't actually looked at the entrance numbers for
our local
nursing schools here,
but it seems like those also dropped during
COVID and kind of that post COVID area.
So our nurse apprentice program wasn't as strong
during that time either.
And so now it's pretty
it's getting to be very competitive. And we
have, you know, for our small
space, we probably have 5 or 6 spots,
and we definitely have more than double
applicants.
Yeah. Sure, Chris. I see that that interest.
By and large, nurses still have a lot
of questions surrounding what AI means for patient
care.
What role do you believe it will play
in care delivery in the coming years?
Sure. So
I think there's a role for AI in
nursing.
I think that when you look at AI
becoming developed, the limitation
of it and
is
is really
anything with human interaction, any anything that requires
human interaction
and relationship building is not gonna be enhanced
with AI necessarily,
or it's not going to be replaced by
AI
is probably a better way to say it.
And so I think with nursing,
we currently are not doing any piloting
of AI in our bedside nursing or our
nursing departments. We are piloting AI in our
behavioral health
outpatient
department as a part of therapy
and where the therapists are able to
use AI to
pick out the most common words and the
most common
patient's therapy session and things like that
to more accurately diagnose and treat the patients.
So I think that's
a really good first step. In the future,
though, for bedside nursing,
I think that,
it's going to be able to help AI
is going to be able to just play
more of a supportive role with nurses
in improving
things like efficiencies
and reducing workload and some of the things
that nurses do every day, like
documentation
and medication and administration. And then,
I'm sure that it will be really useful
in the analysis of the patient monitoring systems
as well, telemetry and recognizing rhythms,
much easier than sometimes if there's artifact on
the telemetry monitor, it's hard to tell if
the patient's in a specific,
rhythm. And then if they go into anything
that could
start down a life threatening rhythm, then,
I think AI would be useful in
detecting that earlier than possibly a human eye
could, or possibly a consistent human eye could,
right?
So I think there's some
real impacts that that could have on our
profession.
And then when you look at the staffing
and patient ratios, you know, if AI does
support the nurses so much more, then will
their jobs be easier and our staffing ratios
change,
so that nurses can take care of more
patients
with that.
Andrea, just around financial pressures, obviously, the industry
is navigating
those across the board. So
during this, how is Carson Valley really trying
to balance cost management with investments in the
nursing workforce and development
and patient care improvements?
Well, I think
what happens we do play a balancing sort
of
dance
and,
I think
it was about 10 or 15 years ago
when there was
a freeze on any capital items and it
was during, like, a recession period. There was
a freeze any capital items and it was
during like a recession period. There was a
freeze on capital items. There was a freeze
on,
wage increases
and this lasted like only about 2 years.
But recovering
from that,
we were so far behind that we had
to
budget
so aggressively
to catch up even to the rest of
the hospitals in our area
just to be able to compete that we
just can't get behind
on the latest technology and paying people fairly
and making sure everyone has what they need
to take care of patients.
And so that's sort of the spending piece
of it.
And then the responsibility piece of it. So
we don't want to be irresponsible
in fiscally
in that,
but we also don't want to fall behind
benchmarks and we don't want to fall behind
in technology. We want to have the latest
and the greatest
to be able to safely take care of
our patients.
And then
what we do on a day to day
basis that we're
more
in control of is,
always staffing to our volumes
and always looking at how we can be
more efficient
in
how we schedule our patients and then how
we staff our patients.
So staffing is one of the number one
expenses in the hospital setting.
And so
that's something we are always looking at. And
then also, obviously, supplies and costs,
just being very mindful
of those. And then we hold our managers
accountable.
In our health system, we create our own
budget. We're not given a budget and said,
hey. And like a lot of for profit
hospitals are given budgets from above,
But we actually have to work with I
work with my managers and my department leaders
to create the budget and then justify it
to our CEO and to our CFO
so that
we're responsible and accountable and we know every
line item that's in that budget. And every
month when we look at it, we say,
oh, gosh, we either did a really good
job of sticking to what we thought we
would have or we there's a little bit
of a variance based on this and that.
So
the more
we are we include our managers in that
and we're aware of what every line item
is, the more accountable
they are. And
we can continue to grow
each year with that and say, okay, what
did we do wrong last year? Let's improve
that this year.
And how can we educate the staff on
the reasons behind this, you know, instead of
sometimes the staff
think that the only thing that administration
cares about is money and the bottom line,
but that's not the case. The case is
we really want to take care of patients,
and we can't do it if we go
out of business.
So
there's there's both sides of the coin there.
So
Yeah. Andrea, and I think your point just
about
prioritizing
what to invest in when it comes to,
you know, the latest technology
and, you know, not wanting to be irresponsible
with spending, but also not wanting to fall
behind there with,
integrating,
new technology that could could make an organization
remain competitive. I think it's such a sentiment
that we hear from leaders and and trying
to navigate that. So do you have any
thoughts or advice on
how you go about actually doing so? How
you go about actually prioritizing
what to
invest in and move forward with,
given tight budget constraints?
Yeah. That's a that's a really good question.
So,
the very first thing is we establish the
demand for it. And I can give you
an example of
our Mako orthopedic robot. So this is a
very expensive piece of machinery. It's,
you know, probably over $1,000,000
for this piece of equipment.
So
we started just hearing surgeons say, hey, we
really want the Mako. Hey, we're going to
take our patients down the road
to the other hospital that has the Mako
because you guys don't have it. Hey, we're
starting to give our patients the choice. So
the doctors in their offices say, Hey, I
can
I
can operate at
2 different hospitals? 1 has the Mako and
one doesn't. And these are the benefits of
the Mako. Because a lot of the surgeons
these days, the orthopedic surgeons, are
are training in the Mako and see the
better outcomes and see the reduced sentinel events
and things like that.
And so
once we kind of started hearing this buzz
that it was a high demand,
we wanted to
capture that in data, like how many patients
are we seeing, how many patients are being
sent away.
And so we tried the best we could
to
capture the data through
the vendors that work with us,
because the Mako vendors
also
work
in a tight area here and are able
to say, hey, this is the amount of
patients that we generally see at these other
hospitals using the robotic equipment.
And then also,
getting like using part of our strategic plan
to navigate where our community has seen a
need in orthopedics
and
when are the peaks of these and just
collecting all of this data and then putting
it into
a pro form a, like a business case
and return on investment
and then
being like, okay, how
many Mako
surgery cases is it going to take to
pay this thing off? How many do we
need to do in a month? How many
can we do in a month?
And what's our capability on our side? And
then, how expensive would it be to continue
to take care of this thing.
And so
that's kind of one of the things that
that's a really good example of
the latest technology that
we also
would be losing out on a lot of
business. That's the other case of the that's
the other part of
the business case is what kind of business
would we be losing out on if we
didn't get it.
So at the end of the day,
we did
data
did show that we would be losing quite
a bit.
And if we didn't keep up with this
technology
and,
would be gaining
quite a bit if we if we did
acquire it. So
Yeah. Andrea, thanks for walking through that example.
I think it's interesting to hear just
how,
you know, you and your peers really did
the leg work on on building that that
business case.
You have to be able to speak to
the actual board who approves it, and and
they they may or may not understand just,
hey. Can we have $2,000,000
for a piece of equipment? They're gonna wanna
know a little more than that. So Sure.
Yeah.
Andrea, before we close out here, just wanted
to end with a piece of advice if
you could share for the next generation of
nurse leaders who may be listening.
Well, I think I think my number one
piece of advice is probably something that I
can pride myself in,
and that is always hiring the the best
people, always hiring the best managers,
people who I think are smarter than me,
especially at their
specific jobs.
If I hire the best and sometimes I
have left positions, manager positions open for
6, 8 months even sometimes,
because I just don't have the right fit.
I never hired just for a pulse,
because that will make my life much harder.
I'd rather manage it myself until I can
find the best fit.
And so that's my, that's my one piece
of advice.
Great advice.
Andrea, thank you so much for joining me.
It's been a pleasure chatting with you today.
Thank you, Erica.
And listeners, you can tune into additional episodes
of the Becker's Healthcare podcast by visiting the
podcast page
webpage on our website.
Thank you all so much.