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Hi, everyone. This is Erica Carbajal with the
Becker's Healthcare podcast.
Thank you so much for tuning in to
this episode where we're joined by Meredith Fox,
chief nursing officer at Cleveland Clinic.
We're gonna be talking about how the system
is tackling nurse retention, improving access to care,
and more.
Meredith, welcome. Thank you so much for being
here today.
Thank you. I'm so excited to talk nursing
with you. Yeah. We're thrilled to have you.
So much going on.
Meredith, can you start by sharing one initiative
that the clinic has implemented in the past
year or so that has had a measurable
effect on nurse retention and well-being,
something other systems might learn from?
Absolutely. So when I think back on my
career here at the Cleveland Clinic in terms
of,
whether I was in leadership or at the
bedside, we've always had a strong focus on
retention. We had to strengthen those efforts,
extensively
during the pandemic and then post the pandemic,
based on some of our health care challenges
with workforce. And what has really been successful
is having our what we call part of
our shared governance
structure and having retention councils at not only
the local hospital level, but also at the
organizational enterprise level, where we are talking to
our own nurses around
why they stay at the Cleveland Clinic, why
they stay at the bedside, why they became
nurses, and then trying to pepper that throughout
the organization.
One particular best practice and we believe that
has been really influential
is we've done a lot with peer retention
stay interviews. It started with one of our
hospitals who has pretty strong retention, and they
started doing peer to peer stay interviews with
particularly
new hires as well as new graduate nurses
and talking to them around
why they chose Cleveland Clinic, what's going well,
what would they consider doing differently, and, you
know, what is the one thing that potentially
might,
convince them to leave. And then taking that
information and drafting our strategies around that as
a nursing leadership and Cleveland Clinic organization and
understanding what really they wanna focus on in
terms of what keeps them, here at the
Cleveland Clinic. And so that's been great because
not only can it be local efforts at
the hospital level with local leadership teams, but
then also taking some themes and focusing our,
retention council work and offerings at the enterprise
level.
As for well-being,
I think one of the benefits that our
organization is
seeing on retention side of this is we
have tremendous resources within our caregiver office
and within the organization supporting that. So not
only is it our total rewards, but different
resources around,
well-being,
wellness,
balance,
resources around caring for yourself, caring for others.
We have mental first aid. We have different,
resources that caregivers can take advantage and leaders
can take advantage. The The other last thing
I would say about well-being is we have
had a very,
focused effort around
safety in the workplace for our caregivers, in
particular, our nursing caregivers and a focus on,
preventing safety issues for them to happen. And
that is not only at the nursing level,
but the caregiver office level. And our CEO
had a focus on caregiver safety, particularly with
workplace violence. We know that is on the
rise, not only within our organization, but within
society. And so how we can,
ensure that our caregivers wanna come back to
work and that they feel safe working here.
Yeah. Thanks for sharing all that, Meredith. Interesting
to hear the
retention council's structure and how those are implemented
at the local level, but then also at
the enterprise level so that some of the
the things that are really working can be
streamlined
across the health system.
With those peer retention
stay interviews,
you know, you had mentioned it started at
one of the one of the hospitals that
had really strong retention.
When were those is that more recent, or
has that been in place for a few
years now?
So it came from the caregivers themselves. So
it came from the nurses at that hospital
themselves that they wanted to talk to their
peers that had just started at the hospital
or had been there for a short amount
of time.
And it started several years ago, and it
built up over time and is now a
consistent practice for them. And we have now,
we are now working it across our other
organization
our our other hospitals within the organization to,
for other caregivers to learn from the other
nurses to learn from that process and then
also make it a little bit their own.
So not only doing it with the bedside
nurses, but also doing it with our nursing
assistants.
And then some of the groups have even
done it with, some of the nurse leaders
just to understand why people are staying in
their roles.
So I would say it was homegrown
at a unit level
with the nurses at the bedside who had
been there for some time wanting to understand
why their teams,
team members had joined and why they were
staying. It then went to the hospital level,
and now we're,
exploring it across the entire Cleveland Clinic system.
Oh, yeah. And it definitely sounds like something
that can be, you know, useful for an
a variety of roles too beyond nursing.
It's been great because they have standard questions
they ask,
so it's consistent. So we have strong data
around it to say, okay. You know, what
are the action items we can do from
this? What's going well? And we also use
it as a way to recognize and, you
know, celebrate what's going well in places.
Well, Meredith, Cleveland Clinic, like many systems, is
focused on improving access to care and exploring
innovative models of care. You know, this is
a really big focus across the board for
health systems across the country.
Can you share a bit about what role
nurses specifically play in system wide efforts to
expand access?
Sure. So we are definitely on this journey,
and we've been trying different care delivery models
as well as been involved in a lot
of different efforts to expand access.
I'd like to talk about our first, our
care delivery models. So we looked at our
particularly inpatient setting, our hospital setting, and looked
at the teams that support,
the care that's provided, particularly the nursing care.
So we've been exploring some different ways of
doing those,
models of care delivery a little bit differently.
And it's not one size fits all because
we have different makeups of how nursing units
as as simple as how many beds are
in a unit or what is the current
team makeup. So that's been in process for
several years already at many locations. And what
I push with those teams around creating team
models using different licensed personnel is really being
agile and being willing to take risks and
trying to do things differently and getting the
nursing caregivers and team members,
feedback and involving them in the creation of
these care delivery models. So that's been really
successful at quite a few of our hospitals.
Some have been, early adopters. Some have a
little bit more been, at the end of
adopting due to some speculation or concerns of
how it would go. But I'm happy to
report that most of our hospitals are exploring
some way differently to deliver care in the
inpatient
setting. When I look at how other roles
that nurses have played in terms of improving
access, we have a very robust hospital at
home program,
which is in our Florida market, which is
very exciting. It expanded pretty quickly and has
been
well received, not only by the teams, but
the patients that end up in that program,
and we are looking to explore it now
into Ohio.
That was a model that started,
mid to late pandemic and started at different,
locations. And our Florida market really took it
and ran with it. And the nurses are,
you know, really happy in those roles. It
is providing direct patient care through a virtual
model, and it's really exciting to see how
much that's,
gone well, as well as getting from the
nursing caregivers
the innovative spirit and so how they can
make changes to making that successful.
And the last one I would, share is
we have done a lot around our emergency
room access and involving the nurses in care
in different places of our emergency rooms.
It's not, it's not news to anyone in
the health care world. There's been a high
demand for emergency room care. You know, you
can read almost any day to hear about
the the access points there. And the teams
have really come together
to explore virtual care there, different ways of
monitoring patients in the emergency room, as well
as, ensuring that they have the same level
of care,
at that level as they would possibly in
the hospital and working with their physician and
APP colleagues,
whether it's to use a virtual
provider and triage model, some different monitoring capabilities.
So I would say that, you know, they're
really diving into how we can care for
the patients that are coming into our doors.
Yeah. Thanks for touching on all that. Definitely
a ton of innovative
ways, that technology is coming in to streamline
emergency department operations at health system. It's been
interesting to see.
Mhmm.
Meredith, what's one strategic goal you have for
Cleveland Clinic's nursing operations this year? When you
look back at the end of twenty twenty
five, where do you hope to have made
some measurable progress?
So I'm really excited about this. At the,
all throughout 2024,
the nursing executive team with other leaders as
stakeholders,
we really looked at what the nursing strategic
themes were for our organization based on our
Cleveland Clinic four care priorities and the Cleveland
Clinic strategic themes and how we align with
them.
We launched those strategic themes at our annual
nursing leadership summit at the end of twenty
twenty four, and we're now really focused on
how we're going to deliver on operationalizing what
those themes and goals were. We also set
a new vision, which was very exciting for
nursing.
In true form, we wanted to support the
Cleveland Clinic mission of caring for life, researching
for health, and educating those who serve. And
we know that's what we do every day.
But then how do we operationally do that?
So when I look back at the end
of twenty twenty five, what I'm really hoping
to have made measurable progress on is the,
safe patient care
as well as our,
recruitment and retention efforts, not only of our
bedside nurses, but our nursing assistants and our
nursing support roles. So I'd like to look
back at the end and say that we've
been able to fill a lot of roles
again. We have great our turnover is great,
but we still have some vacancy. And then
really looking at being able to say we
are, a safe place to get care not
only excuse me. I should say, not only
to receive care, but also to be a
caregiver at.
Yeah. Meredith, quickly too. When when you talk
about, like, recruitment and retention,
not just for bedside nurses, but also for
those support roles, nursing assistants,
patient care assistants, etcetera,
is there any way that comes to mind
that recruitment looks different
for those roles versus a bedside nurse?
So I would say yes, and no. But
what I would say we're doing a little
bit differently is we are really looking at
it as
a pipeline. Right? This is your career entry.
So we have spent a lot of time
on,
focus on what we call our center for
nursing career exploration. So anybody who has an
interest in patient care in the nursing realm
can start to explore,
what opportunities the Cleveland Clinic has. And so
that could be their entry point, whether they
are a nursing student or not a nursing
student
into patient care. We've also created some different
job opportunities and job types that allow for,
entry level exposure to patient care to see
if that's really what an individual's,
you know, in interests are. We know it
takes a team effort, and there are other
roles that provide patient care that's a little
bit different than nursing. So if it's not
meant to be somebody to be a registered
nurse, that we sustain them in our organization,
possibly with another career progression. But really looking
at the pipeline, ensuring that those entry folks
know what the opportunities lie within the Cleveland
Clinic, and is nursing the career path they
want to pursue as well, or are there
other opportunities outside of nursing that are patient
care focused? I'm also really proud that we
are supporting
our nursing support caregivers. We call the majority
of them patient care nursing assistants, and we've
done some, focused work with them to develop
them at the bedside and develop their role.
We had a great leadership ex brunch experiential
program
that originally was only for registered nurses that
we now offer to our, patient care nursing
assistant programs. And the feedback from that has
been wonderful, and it's allowing them to grow
in that role. Many of them wanna stay
in that role, and then it's also allowing
them to explore, wow, I can be a
nurse. And then with supporting them with our
great,
total rewards to consider future careers.
Yeah. Meredith, staying on on the topic of
workforce, the APP workforce is growing rapidly. We've
we've done a lot of coverage around this
over the last year. Nurse practitioner employment alone
is expected to grow 46%
by 2031.
Can you tell us a bit about any
strategic adjustments the clinic is making to hire,
integrate,
and support this workforce?
So near and dear to my heart, I
started out as a leader in advanced practice,
particularly for our advanced practice registered nurse group.
And it's been amazing to see the support
and growth, not only of advanced practice registered
nurses, but all APPs,
not only in the Cleveland Clinic, but nationally.
I mean, those statistics are out there that
it's both nurse practitioners and physician's assistants are
some of the fastest growing roles.
What I believe at Cleveland Clinic, what we've
done strategically was a a big shift in
the end of twenty twenty four. We created
the first vice president of, advanced practice providers.
So we are bringing all advanced practice providers
under one leader for the entire enterprise.
This started and was homegrown,
over ten years ago where myself and my,
physician's assistant leader colleague, we had started the
development of leadership roles for advanced practice providers.
And it's been amazing to see the growth
and now have it all come under one
structure,
for one enterprise role with all the advanced
practice, folks being together and caregivers being together
as one unified team, whether it's within their
hospital, within their clinical specialty.
It's really important to think about them as
a part of the workforce,
but not just lumped into all the providers.
There's different licensure requirements. There's different standards of
expectations of practice.
We want to treat them at being able
to walk to work to top of license,
top of scope, but they also want leadership
opportunities and want to be developed within the
organization. So I'm really excited about that not
only have we been able to sustain and
maintain a leadership structure
for our advanced practice providers, but that it's
growing and that, you know, if I can
think back to when I started in advanced
practice nursing as a leader, I think we
had around 450 to 500 advanced practice registered
nurses.
We are over 3,000 now advanced practice providers
in just over a decade. So pretty exciting
stuff here.
And I'm I think to be able to
hire and to integrate the their roles across
the enterprise to have one leader
that all of the other leaders are reporting
up to is gonna be lead us to
success for the future.
Yeah. That's such rapid growth when you talk
about 500 to now over 3,000 in just
the last ten years. And over the past
year even,
we've seen I think Cleveland Clinic was one
of the first that we reported on and
then saw a handful of of health systems
that had created,
a c suite role to oversee their advanced
practitioner
provider workforce, so definitely a growing trend.
Meredith, to close us out, what do you
see as the biggest challenge chief nursing officers
will face in the next several years? What
should they be thinking about or doing now
to prepare?
Well, I think we know that the workforce
has been changing not only from the time
the pandemic started, but probably even pre pandemic.
And how do we
have a workforce that stays engaged about their
profession and understands their why of becoming
a nurse? And so
myself
with the Cleveland Clinic nursing leaders at this,
we talk a lot about that is, like,
what is the why and what is the
passion, and what is the purpose for being
a nurse here, not only as your profession,
but also at the Cleveland Clinic. And how
do we continue to foster that professional growth?
I'm a firm believer that,
the professional the what you put into your
profession is what you get out of your
profession, and so the contributions there will only
pay it forward. And that's what really where
you find the value there. And if we
can instill that into
all different generations of our workforce, we're gonna
set us up for strong success in terms
of,
having a pipeline and a future workforce that
can take care of our populations.
Thank you so much for joining us today,
Meredith. It's been a pleasure.
Yeah. Thank you. Thanks for having me. Yeah.
And to our listeners, you can tune in
to additional episodes of the podcast by visiting
the podcast page on our website at beckershospitalreview.com.
Thanks, everyone.