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This is where health care leadership comes together.

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Becker's sixteenth annual meeting brings more than 3,500

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hospital and health system executives and nearly 800

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speakers to Chicago

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April.

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This series event includes keynote conversations with Dallas

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Cowboys legend Troy Aikman and former president George

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w Bush. For the agenda and event details,

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visit beckershospitalreview.com

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and click on the events tab in the

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upper right. We're looking forward to hosting you

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in Chicago.

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Hi, everyone. You're listening to the Becker's Healthcare

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podcast.

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Thank you so much for tuning in to

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this episode.

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I'm Eric Carbajal, an editor with Becker's Hospital

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Review.

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And today, we're honored to be joined by

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John Rich Levine, chief nursing officer of Reeves

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Regional Health in Texas.

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John Rich, thank you for joining us today.

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Thank you, Erica. Good morning to you, and,

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thank you for having me today.

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Yeah. Good morning. Pleasure to have you on.

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Can you start by talking about an issue

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that is perhaps taking up most of your

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time and energy as CNO right now and

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how you're navigating that?

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Yes. Of course.

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Right now, most significant

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focus for us in in our place is

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workforce stability,

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because we want to

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be able to stabilize our workforce while building

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long term

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nursing infrastructure in a rural environment. So

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the Reeves Regional Health is a small hospital.

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It is an important

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hub

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for patient care in the area because we

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are located,

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in a geographical

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location where we are the only hospital within

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100 mile

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radius. And so in that context,

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one vacancy can shift the entire operational rhythm

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for us. So every staffing decision that we

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make, it carries financial,

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crucial, and even clinical impact, and they they

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happen almost at the same time.

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And at this point, I'm navigating it by

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shifting from

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reactive

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staffing management

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to a structural

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design approach that we've tried to

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figure out. We are strengthening charge nurse leadership.

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We have a charge nurse leadership program that

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we just launched. And then we are tightening

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onboarding processes,

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and we're also aligning our staffing models

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with patient acuity rather than on the tradition

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that we've been used to for years and

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years. As you can tell, probably

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a lot of our listeners have can tell

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that, the Reeves Regional Health has been in

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existence for over sixty five years.

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I also spend a great deal of time

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on visibility.

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When teams see leadership, I understand

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that when leaders

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listen

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and make decisions with clarity and

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and, all of that kind of thing,

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stability

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for the workforce

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follows. And I really believe in that because

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I see that in rural health care, culture

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drives retention more

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than compensation

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alone.

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We cannot compete with bigger citizen, bigger medical

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centers in terms of probably

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compensation, but we can at least work on

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the culture that drives our retention.

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Yeah. Absolutely, John Rajan. I know you mentioned

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streamlining and tightening those onboarding processes. I think

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that's something we tend to hear a lot

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about right now from chief nursing officers. Can

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you share a little bit more about why

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that's so important right now and how that,

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you know, factors into

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retention, especially among earlier career nurses?

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We know that earlier

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career nurses, they

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they move a lot. It's a different kind

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of generation. It's a generation that we welcome,

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but it's also the a generation that we

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wanna learn so that we know how to

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lead them.

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And,

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the most

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obvious

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characteristic

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is movement.

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And so we've been moving a while back,

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And now that we have this kinds of

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workforce,

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we want to even

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capitalize on movement.

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There is always something that,

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help me recall when people will say about

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why do we need to train them? They

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are going to go away anyway.

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And the deeper question for me is

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if we

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we train them

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and they stay,

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That is the most stupid thing we can

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do to ourselves. It's like a punishment to

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ourselves.

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And if we train them and they leave,

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then it is better for them that we

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set them up for success in their next

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phases. So,

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there's always a movement, but what what we

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have, not everyone is designed to be in

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a certain place at a certain time,

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only those who are designed for that. Because

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if we force it, then we're really creating

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a barrier for them to move forward. So

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that's my,

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idea about those movements and newer nurses and

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how to lead them in this health care

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setting at this time.

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Yeah. Certainly. And I know you mentioned just

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the challenges with,

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you know,

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staffing stability

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across the board, but even more so felt

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in rural areas and how one shift can

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can really affect the operational

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rhythm as you put it. So

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what do you feel like has been a

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true differentiator

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for Reeves Regional when it comes

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to attracting and retaining nurses in in the

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rural environment? I know you pointed to culture.

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Can you expand a little bit about, you

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know, the specific components

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of that and what seems to really resonate

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with the nursing staff?

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Yeah. So, what I meant by that is

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that,

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our differentiator

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is our ownership.

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In rural hospitals well, I come from a

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big, big hospital before I came here, and

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so there's a big shift for me. But

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I'm

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doing my homework and understanding what rural hospital

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is. And in that context,

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nurses see the full continuum of care in

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rural hospitals.

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They know their patients personally. They shop with

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them. They meet them in the aisles. They

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go to church with them. They influence

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operational decisions directly.

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And to me, that level of voice and

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impact is very powerful.

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They own their own patients.

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So in that context, we focus on three

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things. First, we want to establish leadership with

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accessibility.

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Nurses can walk into my office. They can

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just go in there. There's no need for

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them to set up an appointment or that

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they could do that, and they see decision

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making in action.

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The second part is the skill expansion.

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The rural nurses develop broad competencies

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weekly, so we can't,

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compartmentalize

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them and specialize them too much because their

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growth is accelerated

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because of their, ability to expand.

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The other one is

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cultural clarity, which ties up to what I

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said before. We are intentional about accountability

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and respect. We address issues early. We celebrate

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performance openly because it's just us

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around our community.

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And, to me,

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even if rural nursing is demanding,

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it does help deeply

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ingrain to us meaning into what we do,

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and that's what we lean in, meaning and

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ownership

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to what we do. It is us. It

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is ours, and no one will come in

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come here to save us but us.

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Yeah. And and I love what you mentioned

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just about the

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being so close to the decision making and

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and being able to having such close

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access to leaders in rural settings is something

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that really stands out,

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especially in the context of just seeing so

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many reports

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and surveys, data

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that speak to how nurses want to be

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involved directly in the decisions that affect their

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practice, and it sounds like that can be

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something that is, you know, a true differentiator

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in in rural hospitals.

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Well, Don Rich, I wanted to ask you

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as well just about a topic we've been

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obviously covering a lot of in the news,

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which is how hospitals are anticipating seeing a

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rise in in uncompensated

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care with the lapse of ACA premium tax

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credits

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and looming cuts to Medicaid spending. So Yeah.

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How are you preparing for the possibility of

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caring for more uninsured or underinsured patients from

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a nursing and care delivery standpoint? You know,

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we cover a lot about this from the

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financial lens, but curious, you know, from that

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clinical and operational standpoint, what this looks like.

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Yeah. The it's funny that you asked me

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that question because yesterday, we had a a

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in person meeting with

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a congressman in our area, and we asked

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those questions. And there are people who ask

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similar questions as well. And I can feel

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that he has a hard time

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creating a generic answer to those different questions

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that mean only one. And but to me,

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preparation begins with operational

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efficiency, if you know what I mean. We

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are standardizing our workflows. We are strengthening

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documentation accuracy. We are improving throughput by reducing

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waste of supplies and materials and even time.

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Every minute we save supports our sustainability

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because we depend largely

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on being sustainable

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by utilizing the limited resources that we have.

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The second is we are strengthening case management

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integration.

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Early discharge planning,

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we we wanna be more aware of that.

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We are want to be more aware or

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increase our awareness on social determinants of health

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to reduce readmissions

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and avoidable,

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utilization of our swing bed program, for example.

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Third, we are focusing on cross training. I

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just launched it last week. A flexible nursing

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workforce, I believe, allows us to absorb volume

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fluctuations

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within different units without compromising our safety. So

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we cross train are you from the ER?

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Cross train the medsurg, ICU, OB, different areas

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that are just versatile.

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And then,

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because we know that financial pressures are real,

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and we can feel it in our area,

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The response must be to us disciplined operations

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paired with compassionate care.

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And sometimes we feel like, no. They don't

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one can exist, but not the other. And

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the challenge that we're facing is to make

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both coexist

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for the disciplined operations and being

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owning it and being a steward of it,

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but also

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displaying or deliver delivering

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compassionate care.

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Yeah. Certainly. I think,

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Neemai here with us, especially when chatting with

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clinical leaders is, you know, the environment that

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hospitals are operating now has just made it

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has just elevated the importance of the operational

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efficiency and the ability to provide the best

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care possible, if anything. So it's been interesting

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to follow this.

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John Rich, what is one policy shift or

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perhaps workforce trend that you believe might have

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the biggest effect on the nursing workforce in

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rural America

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in the next few years? What should leaders

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maybe be paying some closer attention to right

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now?

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I would think that is the

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the shift towards nurse workforce regulation

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without operational new ones

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that could, significantly impact rural hospitals.

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We are,

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for example,

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us, for example, particularly, because we are in

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the middle of what what you call nowhere.

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The people that are coming to us can

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come and go,

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you know, and and then pretty much there

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will be no more coming,

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and therefore, we are stuck. And so we

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wanna be able to

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to regulate our workforce

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without

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so much of those new ones like immigration,

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you know, visa processing for international hires,

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for out of state that what what do

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they need in order to come to us?

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It's very expensive.

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But what we're looking is that mandated ratios

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or, broad federal staffing models, They may work

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differently in urban tertiary centers,

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but ours is a 25 bed rural facility,

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and it may not apply. So what I'm

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saying is that there's no such thing to

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us as copy and paste because what works

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in others may not work for us. We

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can create our own models.

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And in that context, leaders should pay close

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attention to flexibility.

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As rural health care depends on adaptable

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staffing models,

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we should be able to align with census

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fluctuations, and that shouldn't scare us, but a

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welcome

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change in the dynamics of day to day

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operations. And at the same time,

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work workforce expectations,

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they are evolving. As you can tell, we

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have different,

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generations in one team. Nurses are seeking also

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career progressions. They ask me if they how

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how so soon can they become manager

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at the day they are interviewed, and it's

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just amazing that people think that way. Back

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in the days, it would take two, five

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years to be able to to manage. Now

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we have a six month old

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nurse, six months in terms of their experience,

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and they are ready to become charged nurses.

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So

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autonomy,

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work life alignment,

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system that integrate leadership development, and transparent career

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pathways will attract

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and, I believe, will retain talent more effectively

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than those relying solely on pay incentives.

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That's what I thought it was.

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Yeah, John Rich. And I think that just

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speaks to, again, a lot of what we're

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hearing about is nurses coming in and wanting

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to see that clear

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career progression very quickly when they wanna be

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able to envision exactly what that could potentially

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look like.

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Well, John Rich, to close us out here,

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can you share

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a leadership practice or mindset that has been

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most important to your success in your career,

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a piece of advice that you'd offer to

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aspiring nurse leaders?

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Yes. Of course, Erica. The the the thing

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that I could say about this is

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that my experience has taught me clarity

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under pressure.

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As a leader in health care,

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I can tell that complexity is almost

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always the constant.

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My team look for steadiness.

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They always watch how I respond when the

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stakes are high. So, for those leaders out

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there that are similarly situated,

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my advice would be operational

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fluency.

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You wanna understand

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finance. You wanna understand quality metrics and how

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they work. You wanna understand

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workforce analytics. Some people call that predictive analytics,

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but you wanna understand what it is about.

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Clinical expertise alone does not sustain an executive

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leader.

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Second thing I want to, make mention is

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to

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invest in relationships

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because relationships

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matter before crisis moments arrive. You

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wanna establish trust.

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You wanna build trust early on, and it

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becomes your currency

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in dealing with difficult decisions. And finally,

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I would

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say stay close to the bedside.

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Leadership credibility grows when teens know that you

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yourself understand

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their reality, and sometimes I jump in there

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and ask to give me a patient that

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I can take care of just to know

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to make to make them see and know

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that I understand

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them fully, and here I am doing the

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same things that they're doing.

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John read some great closing remarks there. Thank

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you very much for carving some time out

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of your schedule to join us on the

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podcast.

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Look forward to continuing to follow the work

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that you're leading at Reeves Regional.

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Thank you. Thank you, Erica, for having me.

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Have a great day.