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Hi, everyone. You're listening to the Becker's Healthcare
podcast.
Thank you so much for tuning in to
this episode.
I'm Eric Carbajal, an editor with Becker's Hospital
Review.
And today, we're honored to be joined by
John Rich Levine, chief nursing officer of Reeves
Regional Health in Texas.
John Rich, thank you for joining us today.
Thank you, Erica. Good morning to you, and,
thank you for having me today.
Yeah. Good morning. Pleasure to have you on.
Can you start by talking about an issue
that is perhaps taking up most of your
time and energy as CNO right now and
how you're navigating that?
Yes. Of course.
Right now, most significant
focus for us in in our place is
workforce stability,
because we want to
be able to stabilize our workforce while building
long term
nursing infrastructure in a rural environment. So
the Reeves Regional Health is a small hospital.
It is an important
hub
for patient care in the area because we
are located,
in a geographical
location where we are the only hospital within
100 mile
radius. And so in that context,
one vacancy can shift the entire operational rhythm
for us. So every staffing decision that we
make, it carries financial,
crucial, and even clinical impact, and they they
happen almost at the same time.
And at this point, I'm navigating it by
shifting from
reactive
staffing management
to a structural
design approach that we've tried to
figure out. We are strengthening charge nurse leadership.
We have a charge nurse leadership program that
we just launched. And then we are tightening
onboarding processes,
and we're also aligning our staffing models
with patient acuity rather than on the tradition
that we've been used to for years and
years. As you can tell, probably
a lot of our listeners have can tell
that, the Reeves Regional Health has been in
existence for over sixty five years.
I also spend a great deal of time
on visibility.
When teams see leadership, I understand
that when leaders
listen
and make decisions with clarity and
and, all of that kind of thing,
stability
for the workforce
follows. And I really believe in that because
I see that in rural health care, culture
drives retention more
than compensation
alone.
We cannot compete with bigger citizen, bigger medical
centers in terms of probably
compensation, but we can at least work on
the culture that drives our retention.
Yeah. Absolutely, John Rajan. I know you mentioned
streamlining and tightening those onboarding processes. I think
that's something we tend to hear a lot
about right now from chief nursing officers. Can
you share a little bit more about why
that's so important right now and how that,
you know, factors into
retention, especially among earlier career nurses?
We know that earlier
career nurses, they
they move a lot. It's a different kind
of generation. It's a generation that we welcome,
but it's also the a generation that we
wanna learn so that we know how to
lead them.
And,
the most
obvious
characteristic
is movement.
And so we've been moving a while back,
And now that we have this kinds of
workforce,
we want to even
capitalize on movement.
There is always something that,
help me recall when people will say about
why do we need to train them? They
are going to go away anyway.
And the deeper question for me is
if we
we train them
and they stay,
That is the most stupid thing we can
do to ourselves. It's like a punishment to
ourselves.
And if we train them and they leave,
then it is better for them that we
set them up for success in their next
phases. So,
there's always a movement, but what what we
have, not everyone is designed to be in
a certain place at a certain time,
only those who are designed for that. Because
if we force it, then we're really creating
a barrier for them to move forward. So
that's my,
idea about those movements and newer nurses and
how to lead them in this health care
setting at this time.
Yeah. Certainly. And I know you mentioned just
the challenges with,
you know,
staffing stability
across the board, but even more so felt
in rural areas and how one shift can
can really affect the operational
rhythm as you put it. So
what do you feel like has been a
true differentiator
for Reeves Regional when it comes
to attracting and retaining nurses in in the
rural environment? I know you pointed to culture.
Can you expand a little bit about, you
know, the specific components
of that and what seems to really resonate
with the nursing staff?
Yeah. So, what I meant by that is
that,
our differentiator
is our ownership.
In rural hospitals well, I come from a
big, big hospital before I came here, and
so there's a big shift for me. But
I'm
doing my homework and understanding what rural hospital
is. And in that context,
nurses see the full continuum of care in
rural hospitals.
They know their patients personally. They shop with
them. They meet them in the aisles. They
go to church with them. They influence
operational decisions directly.
And to me, that level of voice and
impact is very powerful.
They own their own patients.
So in that context, we focus on three
things. First, we want to establish leadership with
accessibility.
Nurses can walk into my office. They can
just go in there. There's no need for
them to set up an appointment or that
they could do that, and they see decision
making in action.
The second part is the skill expansion.
The rural nurses develop broad competencies
weekly, so we can't,
compartmentalize
them and specialize them too much because their
growth is accelerated
because of their, ability to expand.
The other one is
cultural clarity, which ties up to what I
said before. We are intentional about accountability
and respect. We address issues early. We celebrate
performance openly because it's just us
around our community.
And, to me,
even if rural nursing is demanding,
it does help deeply
ingrain to us meaning into what we do,
and that's what we lean in, meaning and
ownership
to what we do. It is us. It
is ours, and no one will come in
come here to save us but us.
Yeah. And and I love what you mentioned
just about the
being so close to the decision making and
and being able to having such close
access to leaders in rural settings is something
that really stands out,
especially in the context of just seeing so
many reports
and surveys, data
that speak to how nurses want to be
involved directly in the decisions that affect their
practice, and it sounds like that can be
something that is, you know, a true differentiator
in in rural hospitals.
Well, Don Rich, I wanted to ask you
as well just about a topic we've been
obviously covering a lot of in the news,
which is how hospitals are anticipating seeing a
rise in in uncompensated
care with the lapse of ACA premium tax
credits
and looming cuts to Medicaid spending. So Yeah.
How are you preparing for the possibility of
caring for more uninsured or underinsured patients from
a nursing and care delivery standpoint? You know,
we cover a lot about this from the
financial lens, but curious, you know, from that
clinical and operational standpoint, what this looks like.
Yeah. The it's funny that you asked me
that question because yesterday, we had a a
in person meeting with
a congressman in our area, and we asked
those questions. And there are people who ask
similar questions as well. And I can feel
that he has a hard time
creating a generic answer to those different questions
that mean only one. And but to me,
preparation begins with operational
efficiency, if you know what I mean. We
are standardizing our workflows. We are strengthening
documentation accuracy. We are improving throughput by reducing
waste of supplies and materials and even time.
Every minute we save supports our sustainability
because we depend largely
on being sustainable
by utilizing the limited resources that we have.
The second is we are strengthening case management
integration.
Early discharge planning,
we we wanna be more aware of that.
We are want to be more aware or
increase our awareness on social determinants of health
to reduce readmissions
and avoidable,
utilization of our swing bed program, for example.
Third, we are focusing on cross training. I
just launched it last week. A flexible nursing
workforce, I believe, allows us to absorb volume
fluctuations
within different units without compromising our safety. So
we cross train are you from the ER?
Cross train the medsurg, ICU, OB, different areas
that are just versatile.
And then,
because we know that financial pressures are real,
and we can feel it in our area,
The response must be to us disciplined operations
paired with compassionate care.
And sometimes we feel like, no. They don't
one can exist, but not the other. And
the challenge that we're facing is to make
both coexist
for the disciplined operations and being
owning it and being a steward of it,
but also
displaying or deliver delivering
compassionate care.
Yeah. Certainly. I think,
Neemai here with us, especially when chatting with
clinical leaders is, you know, the environment that
hospitals are operating now has just made it
has just elevated the importance of the operational
efficiency and the ability to provide the best
care possible, if anything. So it's been interesting
to follow this.
John Rich, what is one policy shift or
perhaps workforce trend that you believe might have
the biggest effect on the nursing workforce in
rural America
in the next few years? What should leaders
maybe be paying some closer attention to right
now?
I would think that is the
the shift towards nurse workforce regulation
without operational new ones
that could, significantly impact rural hospitals.
We are,
for example,
us, for example, particularly, because we are in
the middle of what what you call nowhere.
The people that are coming to us can
come and go,
you know, and and then pretty much there
will be no more coming,
and therefore, we are stuck. And so we
wanna be able to
to regulate our workforce
without
so much of those new ones like immigration,
you know, visa processing for international hires,
for out of state that what what do
they need in order to come to us?
It's very expensive.
But what we're looking is that mandated ratios
or, broad federal staffing models, They may work
differently in urban tertiary centers,
but ours is a 25 bed rural facility,
and it may not apply. So what I'm
saying is that there's no such thing to
us as copy and paste because what works
in others may not work for us. We
can create our own models.
And in that context, leaders should pay close
attention to flexibility.
As rural health care depends on adaptable
staffing models,
we should be able to align with census
fluctuations, and that shouldn't scare us, but a
welcome
change in the dynamics of day to day
operations. And at the same time,
work workforce expectations,
they are evolving. As you can tell, we
have different,
generations in one team. Nurses are seeking also
career progressions. They ask me if they how
how so soon can they become manager
at the day they are interviewed, and it's
just amazing that people think that way. Back
in the days, it would take two, five
years to be able to to manage. Now
we have a six month old
nurse, six months in terms of their experience,
and they are ready to become charged nurses.
So
autonomy,
work life alignment,
system that integrate leadership development, and transparent career
pathways will attract
and, I believe, will retain talent more effectively
than those relying solely on pay incentives.
That's what I thought it was.
Yeah, John Rich. And I think that just
speaks to, again, a lot of what we're
hearing about is nurses coming in and wanting
to see that clear
career progression very quickly when they wanna be
able to envision exactly what that could potentially
look like.
Well, John Rich, to close us out here,
can you share
a leadership practice or mindset that has been
most important to your success in your career,
a piece of advice that you'd offer to
aspiring nurse leaders?
Yes. Of course, Erica. The the the thing
that I could say about this is
that my experience has taught me clarity
under pressure.
As a leader in health care,
I can tell that complexity is almost
always the constant.
My team look for steadiness.
They always watch how I respond when the
stakes are high. So, for those leaders out
there that are similarly situated,
my advice would be operational
fluency.
You wanna understand
finance. You wanna understand quality metrics and how
they work. You wanna understand
workforce analytics. Some people call that predictive analytics,
but you wanna understand what it is about.
Clinical expertise alone does not sustain an executive
leader.
Second thing I want to, make mention is
to
invest in relationships
because relationships
matter before crisis moments arrive. You
wanna establish trust.
You wanna build trust early on, and it
becomes your currency
in dealing with difficult decisions. And finally,
I would
say stay close to the bedside.
Leadership credibility grows when teens know that you
yourself understand
their reality, and sometimes I jump in there
and ask to give me a patient that
I can take care of just to know
to make to make them see and know
that I understand
them fully, and here I am doing the
same things that they're doing.
John read some great closing remarks there. Thank
you very much for carving some time out
of your schedule to join us on the
podcast.
Look forward to continuing to follow the work
that you're leading at Reeves Regional.
Thank you. Thank you, Erica, for having me.
Have a great day.