1 00:00:01,120 --> 00:00:03,279 The Becker's team is excited to announce the 2 00:00:03,279 --> 00:00:06,160 launch of our new CFO and Revenue Cycle 3 00:00:06,160 --> 00:00:06,660 podcast. 4 00:00:07,440 --> 00:00:10,240 Tune in for conversations with finance experts from 5 00:00:10,240 --> 00:00:13,119 the top hospitals and health systems. We'll discuss 6 00:00:13,119 --> 00:00:15,679 key trends and ideas to drive meaningful change 7 00:00:15,679 --> 00:00:18,855 in the industry. Look for Becker's CFO and 8 00:00:18,855 --> 00:00:21,995 Revenue Cycle podcast wherever you listen to episodes. 9 00:00:24,614 --> 00:00:27,335 Hi, everyone. This is Erica Carbajal with the 10 00:00:27,335 --> 00:00:28,954 Becker's Healthcare podcast. 11 00:00:29,769 --> 00:00:31,449 Thank you so much for tuning in to 12 00:00:31,449 --> 00:00:34,329 this episode where we're joined by Meredith Fox, 13 00:00:34,329 --> 00:00:36,750 chief nursing officer at Cleveland Clinic. 14 00:00:37,130 --> 00:00:39,130 We're gonna be talking about how the system 15 00:00:39,130 --> 00:00:42,429 is tackling nurse retention, improving access to care, 16 00:00:42,570 --> 00:00:43,310 and more. 17 00:00:43,704 --> 00:00:46,104 Meredith, welcome. Thank you so much for being 18 00:00:46,104 --> 00:00:46,684 here today. 19 00:00:47,545 --> 00:00:49,704 Thank you. I'm so excited to talk nursing 20 00:00:49,704 --> 00:00:51,864 with you. Yeah. We're thrilled to have you. 21 00:00:51,864 --> 00:00:53,085 So much going on. 22 00:00:54,024 --> 00:00:56,765 Meredith, can you start by sharing one initiative 23 00:00:56,905 --> 00:00:59,480 that the clinic has implemented in the past 24 00:00:59,480 --> 00:01:01,740 year or so that has had a measurable 25 00:01:01,800 --> 00:01:04,060 effect on nurse retention and well-being, 26 00:01:04,520 --> 00:01:06,700 something other systems might learn from? 27 00:01:07,640 --> 00:01:09,719 Absolutely. So when I think back on my 28 00:01:09,719 --> 00:01:11,640 career here at the Cleveland Clinic in terms 29 00:01:11,640 --> 00:01:11,799 of, 30 00:01:12,825 --> 00:01:14,424 whether I was in leadership or at the 31 00:01:14,424 --> 00:01:16,584 bedside, we've always had a strong focus on 32 00:01:16,584 --> 00:01:18,844 retention. We had to strengthen those efforts, 33 00:01:19,465 --> 00:01:19,965 extensively 34 00:01:20,504 --> 00:01:22,765 during the pandemic and then post the pandemic, 35 00:01:23,545 --> 00:01:25,465 based on some of our health care challenges 36 00:01:25,465 --> 00:01:28,640 with workforce. And what has really been successful 37 00:01:28,780 --> 00:01:31,020 is having our what we call part of 38 00:01:31,020 --> 00:01:31,920 our shared governance 39 00:01:32,299 --> 00:01:34,939 structure and having retention councils at not only 40 00:01:34,939 --> 00:01:37,420 the local hospital level, but also at the 41 00:01:37,420 --> 00:01:40,299 organizational enterprise level, where we are talking to 42 00:01:40,299 --> 00:01:42,000 our own nurses around 43 00:01:42,694 --> 00:01:44,855 why they stay at the Cleveland Clinic, why 44 00:01:44,855 --> 00:01:46,855 they stay at the bedside, why they became 45 00:01:46,855 --> 00:01:49,254 nurses, and then trying to pepper that throughout 46 00:01:49,254 --> 00:01:49,915 the organization. 47 00:01:50,534 --> 00:01:53,094 One particular best practice and we believe that 48 00:01:53,094 --> 00:01:54,394 has been really influential 49 00:01:55,015 --> 00:01:57,560 is we've done a lot with peer retention 50 00:01:57,700 --> 00:01:59,859 stay interviews. It started with one of our 51 00:01:59,859 --> 00:02:03,219 hospitals who has pretty strong retention, and they 52 00:02:03,219 --> 00:02:05,780 started doing peer to peer stay interviews with 53 00:02:05,780 --> 00:02:06,280 particularly 54 00:02:06,579 --> 00:02:09,080 new hires as well as new graduate nurses 55 00:02:09,379 --> 00:02:10,919 and talking to them around 56 00:02:11,254 --> 00:02:13,594 why they chose Cleveland Clinic, what's going well, 57 00:02:13,895 --> 00:02:16,375 what would they consider doing differently, and, you 58 00:02:16,375 --> 00:02:18,155 know, what is the one thing that potentially 59 00:02:18,215 --> 00:02:18,715 might, 60 00:02:19,415 --> 00:02:21,495 convince them to leave. And then taking that 61 00:02:21,495 --> 00:02:24,375 information and drafting our strategies around that as 62 00:02:24,375 --> 00:02:27,930 a nursing leadership and Cleveland Clinic organization and 63 00:02:27,930 --> 00:02:30,490 understanding what really they wanna focus on in 64 00:02:30,490 --> 00:02:32,169 terms of what keeps them, here at the 65 00:02:32,169 --> 00:02:34,330 Cleveland Clinic. And so that's been great because 66 00:02:34,330 --> 00:02:35,930 not only can it be local efforts at 67 00:02:35,930 --> 00:02:38,169 the hospital level with local leadership teams, but 68 00:02:38,169 --> 00:02:41,435 then also taking some themes and focusing our, 69 00:02:41,675 --> 00:02:44,555 retention council work and offerings at the enterprise 70 00:02:44,555 --> 00:02:45,055 level. 71 00:02:45,514 --> 00:02:46,655 As for well-being, 72 00:02:46,955 --> 00:02:49,034 I think one of the benefits that our 73 00:02:49,034 --> 00:02:50,254 organization is 74 00:02:50,634 --> 00:02:52,875 seeing on retention side of this is we 75 00:02:52,875 --> 00:02:56,629 have tremendous resources within our caregiver office 76 00:02:57,250 --> 00:02:59,969 and within the organization supporting that. So not 77 00:02:59,969 --> 00:03:02,849 only is it our total rewards, but different 78 00:03:02,849 --> 00:03:03,990 resources around, 79 00:03:04,930 --> 00:03:05,430 well-being, 80 00:03:06,370 --> 00:03:06,870 wellness, 81 00:03:07,875 --> 00:03:08,375 balance, 82 00:03:09,395 --> 00:03:13,014 resources around caring for yourself, caring for others. 83 00:03:13,395 --> 00:03:16,534 We have mental first aid. We have different, 84 00:03:17,314 --> 00:03:19,794 resources that caregivers can take advantage and leaders 85 00:03:19,794 --> 00:03:21,669 can take advantage. The The other last thing 86 00:03:21,669 --> 00:03:23,349 I would say about well-being is we have 87 00:03:23,349 --> 00:03:24,389 had a very, 88 00:03:24,789 --> 00:03:26,090 focused effort around 89 00:03:26,469 --> 00:03:28,469 safety in the workplace for our caregivers, in 90 00:03:28,469 --> 00:03:30,789 particular, our nursing caregivers and a focus on, 91 00:03:31,110 --> 00:03:33,844 preventing safety issues for them to happen. And 92 00:03:33,844 --> 00:03:35,685 that is not only at the nursing level, 93 00:03:35,685 --> 00:03:38,164 but the caregiver office level. And our CEO 94 00:03:38,164 --> 00:03:40,724 had a focus on caregiver safety, particularly with 95 00:03:40,724 --> 00:03:43,044 workplace violence. We know that is on the 96 00:03:43,044 --> 00:03:45,364 rise, not only within our organization, but within 97 00:03:45,364 --> 00:03:47,064 society. And so how we can, 98 00:03:47,510 --> 00:03:49,590 ensure that our caregivers wanna come back to 99 00:03:49,590 --> 00:03:51,689 work and that they feel safe working here. 100 00:03:53,030 --> 00:03:55,510 Yeah. Thanks for sharing all that, Meredith. Interesting 101 00:03:55,510 --> 00:03:56,490 to hear the 102 00:03:56,790 --> 00:04:00,534 retention council's structure and how those are implemented 103 00:04:00,534 --> 00:04:02,375 at the local level, but then also at 104 00:04:02,375 --> 00:04:04,455 the enterprise level so that some of the 105 00:04:04,455 --> 00:04:06,635 the things that are really working can be 106 00:04:06,855 --> 00:04:07,355 streamlined 107 00:04:08,455 --> 00:04:09,835 across the health system. 108 00:04:10,135 --> 00:04:11,435 With those peer retention 109 00:04:11,735 --> 00:04:12,555 stay interviews, 110 00:04:13,094 --> 00:04:14,909 you know, you had mentioned it started at 111 00:04:14,990 --> 00:04:16,589 one of the one of the hospitals that 112 00:04:16,589 --> 00:04:17,970 had really strong retention. 113 00:04:18,509 --> 00:04:20,430 When were those is that more recent, or 114 00:04:20,430 --> 00:04:22,029 has that been in place for a few 115 00:04:22,029 --> 00:04:22,850 years now? 116 00:04:24,110 --> 00:04:26,189 So it came from the caregivers themselves. So 117 00:04:26,189 --> 00:04:27,870 it came from the nurses at that hospital 118 00:04:27,870 --> 00:04:29,754 themselves that they wanted to talk to their 119 00:04:29,754 --> 00:04:32,574 peers that had just started at the hospital 120 00:04:32,634 --> 00:04:34,314 or had been there for a short amount 121 00:04:34,314 --> 00:04:34,975 of time. 122 00:04:35,275 --> 00:04:37,675 And it started several years ago, and it 123 00:04:37,675 --> 00:04:39,355 built up over time and is now a 124 00:04:39,355 --> 00:04:41,355 consistent practice for them. And we have now, 125 00:04:42,740 --> 00:04:44,500 we are now working it across our other 126 00:04:44,500 --> 00:04:45,000 organization 127 00:04:45,379 --> 00:04:48,040 our our other hospitals within the organization to, 128 00:04:48,660 --> 00:04:50,420 for other caregivers to learn from the other 129 00:04:50,420 --> 00:04:52,899 nurses to learn from that process and then 130 00:04:52,899 --> 00:04:54,500 also make it a little bit their own. 131 00:04:54,500 --> 00:04:56,524 So not only doing it with the bedside 132 00:04:56,524 --> 00:04:58,285 nurses, but also doing it with our nursing 133 00:04:58,285 --> 00:04:58,785 assistants. 134 00:04:59,245 --> 00:05:00,605 And then some of the groups have even 135 00:05:00,605 --> 00:05:02,605 done it with, some of the nurse leaders 136 00:05:02,605 --> 00:05:04,285 just to understand why people are staying in 137 00:05:04,285 --> 00:05:05,024 their roles. 138 00:05:05,485 --> 00:05:06,865 So I would say it was homegrown 139 00:05:07,165 --> 00:05:08,464 at a unit level 140 00:05:09,290 --> 00:05:11,370 with the nurses at the bedside who had 141 00:05:11,370 --> 00:05:13,310 been there for some time wanting to understand 142 00:05:13,610 --> 00:05:14,589 why their teams, 143 00:05:15,129 --> 00:05:16,649 team members had joined and why they were 144 00:05:16,649 --> 00:05:18,810 staying. It then went to the hospital level, 145 00:05:18,810 --> 00:05:19,610 and now we're, 146 00:05:20,009 --> 00:05:22,589 exploring it across the entire Cleveland Clinic system. 147 00:05:23,894 --> 00:05:26,375 Oh, yeah. And it definitely sounds like something 148 00:05:26,375 --> 00:05:29,214 that can be, you know, useful for an 149 00:05:29,334 --> 00:05:31,435 a variety of roles too beyond nursing. 150 00:05:31,814 --> 00:05:33,814 It's been great because they have standard questions 151 00:05:33,814 --> 00:05:34,555 they ask, 152 00:05:35,014 --> 00:05:37,680 so it's consistent. So we have strong data 153 00:05:37,680 --> 00:05:40,000 around it to say, okay. You know, what 154 00:05:40,000 --> 00:05:41,839 are the action items we can do from 155 00:05:41,839 --> 00:05:43,839 this? What's going well? And we also use 156 00:05:43,839 --> 00:05:45,919 it as a way to recognize and, you 157 00:05:45,919 --> 00:05:48,259 know, celebrate what's going well in places. 158 00:05:49,455 --> 00:05:52,895 Well, Meredith, Cleveland Clinic, like many systems, is 159 00:05:52,895 --> 00:05:55,795 focused on improving access to care and exploring 160 00:05:55,855 --> 00:05:58,014 innovative models of care. You know, this is 161 00:05:58,014 --> 00:06:00,254 a really big focus across the board for 162 00:06:00,254 --> 00:06:01,875 health systems across the country. 163 00:06:02,279 --> 00:06:03,960 Can you share a bit about what role 164 00:06:03,960 --> 00:06:07,000 nurses specifically play in system wide efforts to 165 00:06:07,000 --> 00:06:07,899 expand access? 166 00:06:08,920 --> 00:06:11,240 Sure. So we are definitely on this journey, 167 00:06:11,240 --> 00:06:13,800 and we've been trying different care delivery models 168 00:06:13,800 --> 00:06:15,560 as well as been involved in a lot 169 00:06:15,560 --> 00:06:18,134 of different efforts to expand access. 170 00:06:18,514 --> 00:06:20,595 I'd like to talk about our first, our 171 00:06:20,595 --> 00:06:22,915 care delivery models. So we looked at our 172 00:06:22,915 --> 00:06:26,035 particularly inpatient setting, our hospital setting, and looked 173 00:06:26,035 --> 00:06:27,495 at the teams that support, 174 00:06:28,275 --> 00:06:30,720 the care that's provided, particularly the nursing care. 175 00:06:30,720 --> 00:06:32,639 So we've been exploring some different ways of 176 00:06:32,639 --> 00:06:33,379 doing those, 177 00:06:34,000 --> 00:06:36,019 models of care delivery a little bit differently. 178 00:06:36,079 --> 00:06:38,399 And it's not one size fits all because 179 00:06:38,399 --> 00:06:41,459 we have different makeups of how nursing units 180 00:06:41,919 --> 00:06:43,245 as as simple as how many beds are 181 00:06:43,245 --> 00:06:44,925 in a unit or what is the current 182 00:06:44,925 --> 00:06:47,165 team makeup. So that's been in process for 183 00:06:47,165 --> 00:06:49,965 several years already at many locations. And what 184 00:06:49,965 --> 00:06:52,525 I push with those teams around creating team 185 00:06:52,525 --> 00:06:55,725 models using different licensed personnel is really being 186 00:06:55,725 --> 00:06:58,270 agile and being willing to take risks and 187 00:06:58,270 --> 00:07:01,009 trying to do things differently and getting the 188 00:07:01,310 --> 00:07:03,149 nursing caregivers and team members, 189 00:07:03,709 --> 00:07:06,189 feedback and involving them in the creation of 190 00:07:06,189 --> 00:07:08,670 these care delivery models. So that's been really 191 00:07:08,670 --> 00:07:10,574 successful at quite a few of our hospitals. 192 00:07:11,055 --> 00:07:13,775 Some have been, early adopters. Some have a 193 00:07:13,775 --> 00:07:15,694 little bit more been, at the end of 194 00:07:15,694 --> 00:07:18,654 adopting due to some speculation or concerns of 195 00:07:18,654 --> 00:07:20,814 how it would go. But I'm happy to 196 00:07:20,814 --> 00:07:23,154 report that most of our hospitals are exploring 197 00:07:23,215 --> 00:07:25,535 some way differently to deliver care in the 198 00:07:25,535 --> 00:07:26,035 inpatient 199 00:07:26,670 --> 00:07:29,149 setting. When I look at how other roles 200 00:07:29,149 --> 00:07:31,810 that nurses have played in terms of improving 201 00:07:31,870 --> 00:07:34,990 access, we have a very robust hospital at 202 00:07:34,990 --> 00:07:35,810 home program, 203 00:07:36,269 --> 00:07:38,509 which is in our Florida market, which is 204 00:07:38,509 --> 00:07:41,149 very exciting. It expanded pretty quickly and has 205 00:07:41,149 --> 00:07:41,649 been 206 00:07:41,954 --> 00:07:44,675 well received, not only by the teams, but 207 00:07:44,675 --> 00:07:46,435 the patients that end up in that program, 208 00:07:46,435 --> 00:07:48,035 and we are looking to explore it now 209 00:07:48,035 --> 00:07:48,935 into Ohio. 210 00:07:49,394 --> 00:07:51,254 That was a model that started, 211 00:07:51,794 --> 00:07:54,214 mid to late pandemic and started at different, 212 00:07:54,675 --> 00:07:57,639 locations. And our Florida market really took it 213 00:07:57,639 --> 00:07:59,979 and ran with it. And the nurses are, 214 00:08:00,039 --> 00:08:02,599 you know, really happy in those roles. It 215 00:08:02,599 --> 00:08:05,639 is providing direct patient care through a virtual 216 00:08:05,639 --> 00:08:08,379 model, and it's really exciting to see how 217 00:08:08,925 --> 00:08:09,665 much that's, 218 00:08:10,205 --> 00:08:12,285 gone well, as well as getting from the 219 00:08:12,285 --> 00:08:13,185 nursing caregivers 220 00:08:13,485 --> 00:08:15,645 the innovative spirit and so how they can 221 00:08:15,645 --> 00:08:17,345 make changes to making that successful. 222 00:08:17,725 --> 00:08:19,725 And the last one I would, share is 223 00:08:19,725 --> 00:08:22,079 we have done a lot around our emergency 224 00:08:22,220 --> 00:08:25,100 room access and involving the nurses in care 225 00:08:25,100 --> 00:08:27,279 in different places of our emergency rooms. 226 00:08:27,979 --> 00:08:29,740 It's not, it's not news to anyone in 227 00:08:29,740 --> 00:08:31,500 the health care world. There's been a high 228 00:08:31,500 --> 00:08:34,139 demand for emergency room care. You know, you 229 00:08:34,139 --> 00:08:36,434 can read almost any day to hear about 230 00:08:36,894 --> 00:08:38,735 the the access points there. And the teams 231 00:08:38,735 --> 00:08:39,794 have really come together 232 00:08:40,174 --> 00:08:42,495 to explore virtual care there, different ways of 233 00:08:42,495 --> 00:08:45,294 monitoring patients in the emergency room, as well 234 00:08:45,294 --> 00:08:47,855 as, ensuring that they have the same level 235 00:08:47,855 --> 00:08:48,514 of care, 236 00:08:49,340 --> 00:08:51,019 at that level as they would possibly in 237 00:08:51,019 --> 00:08:53,340 the hospital and working with their physician and 238 00:08:53,340 --> 00:08:54,160 APP colleagues, 239 00:08:54,700 --> 00:08:56,320 whether it's to use a virtual 240 00:08:56,620 --> 00:08:59,840 provider and triage model, some different monitoring capabilities. 241 00:09:00,060 --> 00:09:01,575 So I would say that, you know, they're 242 00:09:01,894 --> 00:09:03,654 really diving into how we can care for 243 00:09:03,654 --> 00:09:05,835 the patients that are coming into our doors. 244 00:09:06,934 --> 00:09:09,195 Yeah. Thanks for touching on all that. Definitely 245 00:09:09,335 --> 00:09:10,315 a ton of innovative 246 00:09:11,014 --> 00:09:13,835 ways, that technology is coming in to streamline 247 00:09:13,975 --> 00:09:16,535 emergency department operations at health system. It's been 248 00:09:16,535 --> 00:09:17,549 interesting to see. 249 00:09:17,950 --> 00:09:18,450 Mhmm. 250 00:09:19,470 --> 00:09:22,110 Meredith, what's one strategic goal you have for 251 00:09:22,110 --> 00:09:25,070 Cleveland Clinic's nursing operations this year? When you 252 00:09:25,070 --> 00:09:26,990 look back at the end of twenty twenty 253 00:09:26,990 --> 00:09:28,750 five, where do you hope to have made 254 00:09:28,750 --> 00:09:29,970 some measurable progress? 255 00:09:31,115 --> 00:09:33,034 So I'm really excited about this. At the, 256 00:09:33,595 --> 00:09:35,034 all throughout 2024, 257 00:09:35,034 --> 00:09:38,154 the nursing executive team with other leaders as 258 00:09:38,154 --> 00:09:38,654 stakeholders, 259 00:09:39,274 --> 00:09:41,695 we really looked at what the nursing strategic 260 00:09:41,835 --> 00:09:44,235 themes were for our organization based on our 261 00:09:44,235 --> 00:09:46,970 Cleveland Clinic four care priorities and the Cleveland 262 00:09:46,970 --> 00:09:49,050 Clinic strategic themes and how we align with 263 00:09:49,050 --> 00:09:49,550 them. 264 00:09:49,929 --> 00:09:52,730 We launched those strategic themes at our annual 265 00:09:52,730 --> 00:09:54,730 nursing leadership summit at the end of twenty 266 00:09:54,730 --> 00:09:57,290 twenty four, and we're now really focused on 267 00:09:57,290 --> 00:09:59,955 how we're going to deliver on operationalizing what 268 00:09:59,955 --> 00:10:02,514 those themes and goals were. We also set 269 00:10:02,514 --> 00:10:04,674 a new vision, which was very exciting for 270 00:10:04,674 --> 00:10:05,174 nursing. 271 00:10:06,274 --> 00:10:08,595 In true form, we wanted to support the 272 00:10:08,595 --> 00:10:11,174 Cleveland Clinic mission of caring for life, researching 273 00:10:11,235 --> 00:10:13,759 for health, and educating those who serve. And 274 00:10:13,759 --> 00:10:15,519 we know that's what we do every day. 275 00:10:15,519 --> 00:10:17,919 But then how do we operationally do that? 276 00:10:17,919 --> 00:10:19,600 So when I look back at the end 277 00:10:19,600 --> 00:10:22,000 of twenty twenty five, what I'm really hoping 278 00:10:22,000 --> 00:10:24,559 to have made measurable progress on is the, 279 00:10:25,695 --> 00:10:26,915 safe patient care 280 00:10:27,455 --> 00:10:29,134 as well as our, 281 00:10:29,695 --> 00:10:31,934 recruitment and retention efforts, not only of our 282 00:10:31,934 --> 00:10:34,335 bedside nurses, but our nursing assistants and our 283 00:10:34,335 --> 00:10:36,815 nursing support roles. So I'd like to look 284 00:10:36,815 --> 00:10:38,674 back at the end and say that we've 285 00:10:38,809 --> 00:10:40,169 been able to fill a lot of roles 286 00:10:40,169 --> 00:10:42,490 again. We have great our turnover is great, 287 00:10:42,490 --> 00:10:44,509 but we still have some vacancy. And then 288 00:10:44,570 --> 00:10:46,649 really looking at being able to say we 289 00:10:46,649 --> 00:10:49,129 are, a safe place to get care not 290 00:10:49,129 --> 00:10:50,889 only excuse me. I should say, not only 291 00:10:50,889 --> 00:10:52,329 to receive care, but also to be a 292 00:10:52,329 --> 00:10:53,389 caregiver at. 293 00:10:54,345 --> 00:10:56,585 Yeah. Meredith, quickly too. When when you talk 294 00:10:56,585 --> 00:10:58,605 about, like, recruitment and retention, 295 00:10:59,225 --> 00:11:01,465 not just for bedside nurses, but also for 296 00:11:01,465 --> 00:11:03,884 those support roles, nursing assistants, 297 00:11:04,264 --> 00:11:05,804 patient care assistants, etcetera, 298 00:11:06,504 --> 00:11:08,549 is there any way that comes to mind 299 00:11:08,549 --> 00:11:10,409 that recruitment looks different 300 00:11:10,870 --> 00:11:14,009 for those roles versus a bedside nurse? 301 00:11:15,350 --> 00:11:18,549 So I would say yes, and no. But 302 00:11:18,549 --> 00:11:19,990 what I would say we're doing a little 303 00:11:19,990 --> 00:11:21,909 bit differently is we are really looking at 304 00:11:21,909 --> 00:11:22,889 it as 305 00:11:23,264 --> 00:11:25,904 a pipeline. Right? This is your career entry. 306 00:11:25,904 --> 00:11:27,585 So we have spent a lot of time 307 00:11:27,585 --> 00:11:28,085 on, 308 00:11:28,545 --> 00:11:30,225 focus on what we call our center for 309 00:11:30,225 --> 00:11:33,024 nursing career exploration. So anybody who has an 310 00:11:33,024 --> 00:11:35,524 interest in patient care in the nursing realm 311 00:11:35,665 --> 00:11:36,705 can start to explore, 312 00:11:37,460 --> 00:11:39,700 what opportunities the Cleveland Clinic has. And so 313 00:11:39,700 --> 00:11:41,460 that could be their entry point, whether they 314 00:11:41,460 --> 00:11:43,379 are a nursing student or not a nursing 315 00:11:43,379 --> 00:11:43,879 student 316 00:11:44,340 --> 00:11:47,220 into patient care. We've also created some different 317 00:11:47,220 --> 00:11:50,355 job opportunities and job types that allow for, 318 00:11:50,675 --> 00:11:52,675 entry level exposure to patient care to see 319 00:11:52,675 --> 00:11:54,615 if that's really what an individual's, 320 00:11:55,394 --> 00:11:57,554 you know, in interests are. We know it 321 00:11:57,554 --> 00:11:59,235 takes a team effort, and there are other 322 00:11:59,235 --> 00:12:01,154 roles that provide patient care that's a little 323 00:12:01,154 --> 00:12:03,040 bit different than nursing. So if it's not 324 00:12:03,040 --> 00:12:05,200 meant to be somebody to be a registered 325 00:12:05,200 --> 00:12:07,700 nurse, that we sustain them in our organization, 326 00:12:08,080 --> 00:12:10,960 possibly with another career progression. But really looking 327 00:12:10,960 --> 00:12:14,160 at the pipeline, ensuring that those entry folks 328 00:12:14,160 --> 00:12:16,845 know what the opportunities lie within the Cleveland 329 00:12:16,845 --> 00:12:19,164 Clinic, and is nursing the career path they 330 00:12:19,164 --> 00:12:21,164 want to pursue as well, or are there 331 00:12:21,164 --> 00:12:23,485 other opportunities outside of nursing that are patient 332 00:12:23,485 --> 00:12:26,044 care focused? I'm also really proud that we 333 00:12:26,044 --> 00:12:26,945 are supporting 334 00:12:27,325 --> 00:12:30,289 our nursing support caregivers. We call the majority 335 00:12:30,289 --> 00:12:32,690 of them patient care nursing assistants, and we've 336 00:12:32,690 --> 00:12:35,490 done some, focused work with them to develop 337 00:12:35,490 --> 00:12:37,889 them at the bedside and develop their role. 338 00:12:38,129 --> 00:12:40,950 We had a great leadership ex brunch experiential 339 00:12:41,250 --> 00:12:41,750 program 340 00:12:42,084 --> 00:12:44,164 that originally was only for registered nurses that 341 00:12:44,164 --> 00:12:46,644 we now offer to our, patient care nursing 342 00:12:46,644 --> 00:12:49,125 assistant programs. And the feedback from that has 343 00:12:49,125 --> 00:12:51,764 been wonderful, and it's allowing them to grow 344 00:12:51,764 --> 00:12:53,845 in that role. Many of them wanna stay 345 00:12:53,845 --> 00:12:55,445 in that role, and then it's also allowing 346 00:12:55,445 --> 00:12:57,500 them to explore, wow, I can be a 347 00:12:57,500 --> 00:12:59,660 nurse. And then with supporting them with our 348 00:12:59,660 --> 00:13:00,139 great, 349 00:13:00,860 --> 00:13:03,200 total rewards to consider future careers. 350 00:13:04,220 --> 00:13:06,620 Yeah. Meredith, staying on on the topic of 351 00:13:06,620 --> 00:13:10,304 workforce, the APP workforce is growing rapidly. We've 352 00:13:10,304 --> 00:13:12,144 we've done a lot of coverage around this 353 00:13:12,144 --> 00:13:15,424 over the last year. Nurse practitioner employment alone 354 00:13:15,424 --> 00:13:17,664 is expected to grow 46% 355 00:13:17,664 --> 00:13:18,964 by 2031. 356 00:13:19,105 --> 00:13:20,544 Can you tell us a bit about any 357 00:13:20,544 --> 00:13:23,745 strategic adjustments the clinic is making to hire, 358 00:13:23,745 --> 00:13:24,245 integrate, 359 00:13:24,649 --> 00:13:26,269 and support this workforce? 360 00:13:27,769 --> 00:13:29,289 So near and dear to my heart, I 361 00:13:29,289 --> 00:13:31,529 started out as a leader in advanced practice, 362 00:13:31,850 --> 00:13:34,330 particularly for our advanced practice registered nurse group. 363 00:13:34,330 --> 00:13:36,649 And it's been amazing to see the support 364 00:13:36,649 --> 00:13:38,970 and growth, not only of advanced practice registered 365 00:13:38,970 --> 00:13:40,269 nurses, but all APPs, 366 00:13:40,584 --> 00:13:42,584 not only in the Cleveland Clinic, but nationally. 367 00:13:42,584 --> 00:13:44,424 I mean, those statistics are out there that 368 00:13:44,424 --> 00:13:47,625 it's both nurse practitioners and physician's assistants are 369 00:13:47,625 --> 00:13:49,245 some of the fastest growing roles. 370 00:13:50,024 --> 00:13:51,784 What I believe at Cleveland Clinic, what we've 371 00:13:51,784 --> 00:13:54,240 done strategically was a a big shift in 372 00:13:54,240 --> 00:13:56,320 the end of twenty twenty four. We created 373 00:13:56,320 --> 00:13:59,940 the first vice president of, advanced practice providers. 374 00:14:00,080 --> 00:14:02,399 So we are bringing all advanced practice providers 375 00:14:02,399 --> 00:14:04,820 under one leader for the entire enterprise. 376 00:14:06,014 --> 00:14:07,555 This started and was homegrown, 377 00:14:08,014 --> 00:14:10,335 over ten years ago where myself and my, 378 00:14:10,575 --> 00:14:13,535 physician's assistant leader colleague, we had started the 379 00:14:13,535 --> 00:14:16,514 development of leadership roles for advanced practice providers. 380 00:14:16,975 --> 00:14:18,975 And it's been amazing to see the growth 381 00:14:18,975 --> 00:14:20,815 and now have it all come under one 382 00:14:20,815 --> 00:14:21,315 structure, 383 00:14:21,860 --> 00:14:24,339 for one enterprise role with all the advanced 384 00:14:24,339 --> 00:14:27,539 practice, folks being together and caregivers being together 385 00:14:27,539 --> 00:14:29,860 as one unified team, whether it's within their 386 00:14:29,860 --> 00:14:31,799 hospital, within their clinical specialty. 387 00:14:32,500 --> 00:14:34,419 It's really important to think about them as 388 00:14:34,419 --> 00:14:35,480 a part of the workforce, 389 00:14:36,019 --> 00:14:38,245 but not just lumped into all the providers. 390 00:14:38,305 --> 00:14:41,585 There's different licensure requirements. There's different standards of 391 00:14:41,585 --> 00:14:42,805 expectations of practice. 392 00:14:43,264 --> 00:14:45,825 We want to treat them at being able 393 00:14:45,825 --> 00:14:47,985 to walk to work to top of license, 394 00:14:47,985 --> 00:14:50,065 top of scope, but they also want leadership 395 00:14:50,065 --> 00:14:52,850 opportunities and want to be developed within the 396 00:14:52,850 --> 00:14:55,649 organization. So I'm really excited about that not 397 00:14:55,649 --> 00:14:57,330 only have we been able to sustain and 398 00:14:57,330 --> 00:14:58,870 maintain a leadership structure 399 00:14:59,250 --> 00:15:01,409 for our advanced practice providers, but that it's 400 00:15:01,409 --> 00:15:04,210 growing and that, you know, if I can 401 00:15:04,210 --> 00:15:05,970 think back to when I started in advanced 402 00:15:05,970 --> 00:15:08,264 practice nursing as a leader, I think we 403 00:15:08,264 --> 00:15:11,384 had around 450 to 500 advanced practice registered 404 00:15:11,384 --> 00:15:11,884 nurses. 405 00:15:12,264 --> 00:15:15,304 We are over 3,000 now advanced practice providers 406 00:15:15,304 --> 00:15:17,704 in just over a decade. So pretty exciting 407 00:15:17,704 --> 00:15:18,444 stuff here. 408 00:15:18,824 --> 00:15:20,664 And I'm I think to be able to 409 00:15:20,664 --> 00:15:22,950 hire and to integrate the their roles across 410 00:15:23,029 --> 00:15:24,889 the enterprise to have one leader 411 00:15:25,269 --> 00:15:27,029 that all of the other leaders are reporting 412 00:15:27,029 --> 00:15:29,590 up to is gonna be lead us to 413 00:15:29,590 --> 00:15:30,649 success for the future. 414 00:15:32,309 --> 00:15:34,790 Yeah. That's such rapid growth when you talk 415 00:15:34,790 --> 00:15:37,684 about 500 to now over 3,000 in just 416 00:15:37,684 --> 00:15:40,485 the last ten years. And over the past 417 00:15:40,485 --> 00:15:41,304 year even, 418 00:15:42,085 --> 00:15:44,085 we've seen I think Cleveland Clinic was one 419 00:15:44,085 --> 00:15:45,605 of the first that we reported on and 420 00:15:45,605 --> 00:15:47,605 then saw a handful of of health systems 421 00:15:47,605 --> 00:15:48,665 that had created, 422 00:15:49,285 --> 00:15:52,330 a c suite role to oversee their advanced 423 00:15:52,330 --> 00:15:52,830 practitioner 424 00:15:53,209 --> 00:15:56,110 provider workforce, so definitely a growing trend. 425 00:15:58,169 --> 00:16:00,250 Meredith, to close us out, what do you 426 00:16:00,250 --> 00:16:02,990 see as the biggest challenge chief nursing officers 427 00:16:03,129 --> 00:16:05,504 will face in the next several years? What 428 00:16:05,504 --> 00:16:07,345 should they be thinking about or doing now 429 00:16:07,345 --> 00:16:08,004 to prepare? 430 00:16:09,184 --> 00:16:11,924 Well, I think we know that the workforce 431 00:16:12,065 --> 00:16:14,785 has been changing not only from the time 432 00:16:14,785 --> 00:16:17,445 the pandemic started, but probably even pre pandemic. 433 00:16:17,504 --> 00:16:18,965 And how do we 434 00:16:19,309 --> 00:16:21,789 have a workforce that stays engaged about their 435 00:16:21,789 --> 00:16:24,449 profession and understands their why of becoming 436 00:16:24,909 --> 00:16:26,209 a nurse? And so 437 00:16:26,669 --> 00:16:27,169 myself 438 00:16:27,949 --> 00:16:30,429 with the Cleveland Clinic nursing leaders at this, 439 00:16:30,429 --> 00:16:31,870 we talk a lot about that is, like, 440 00:16:31,870 --> 00:16:33,404 what is the why and what is the 441 00:16:33,485 --> 00:16:35,245 passion, and what is the purpose for being 442 00:16:35,245 --> 00:16:37,665 a nurse here, not only as your profession, 443 00:16:37,805 --> 00:16:39,965 but also at the Cleveland Clinic. And how 444 00:16:39,965 --> 00:16:42,365 do we continue to foster that professional growth? 445 00:16:42,365 --> 00:16:43,904 I'm a firm believer that, 446 00:16:44,605 --> 00:16:46,800 the professional the what you put into your 447 00:16:46,800 --> 00:16:48,240 profession is what you get out of your 448 00:16:48,240 --> 00:16:50,559 profession, and so the contributions there will only 449 00:16:50,559 --> 00:16:52,720 pay it forward. And that's what really where 450 00:16:52,720 --> 00:16:54,639 you find the value there. And if we 451 00:16:54,639 --> 00:16:56,180 can instill that into 452 00:16:56,720 --> 00:16:59,120 all different generations of our workforce, we're gonna 453 00:16:59,120 --> 00:17:01,715 set us up for strong success in terms 454 00:17:01,715 --> 00:17:02,215 of, 455 00:17:02,835 --> 00:17:05,075 having a pipeline and a future workforce that 456 00:17:05,075 --> 00:17:06,615 can take care of our populations. 457 00:17:08,115 --> 00:17:10,355 Thank you so much for joining us today, 458 00:17:10,355 --> 00:17:11,974 Meredith. It's been a pleasure. 459 00:17:12,369 --> 00:17:14,690 Yeah. Thank you. Thanks for having me. Yeah. 460 00:17:14,690 --> 00:17:16,609 And to our listeners, you can tune in 461 00:17:16,609 --> 00:17:19,649 to additional episodes of the podcast by visiting 462 00:17:19,649 --> 00:17:23,909 the podcast page on our website at beckershospitalreview.com. 463 00:17:24,049 --> 00:17:24,869 Thanks, everyone.