Hi, everyone. This is Erica Carbajal with Becker's
Hospital Review. Thank you so much for tuning
in to this episode of the Becker's Healthcare
Podcast.
Today, we're joined by Frankie Hamilton,
vice president of nursing operations
at My Minaitis Medical Center in New York.
Frankie, welcome. Welcome. Thank you so much for
taking the time.
Thank you. Thank you for having me, Erica.
I appreciate it. Yeah. Pleasure to have you
on today. Do you wanna start by sharing
a little bit about
your role, your organization, and the scope of
your work?
Sure.
So I joined the Maimonides
team about almost a year ago in March
2025.
I came here, in the role of vice
president of nursing operations, which is a title
that was, I think, newer to the organization.
And in my role, I oversee
nine medicine units
as well as our dialysis unit, which only
covers
inpatients. We don't have,
outpatient services for Dallas at the moment.
I also cover the nursing administration office, which
houses our float pools
as well as our nursing administrative directors who
keep the hospital running on the evening, night,
and weekend shifts.
And I also
sort of am in charge of special nursing
projects and initiatives that come up throughout
the course of our daily operations.
And,
so that includes, like, working with some vendors
and bringing new products. And, of course, that's
in collaboration with all of our other nursing
departments, quality department,
nursing practice and innovation, nursing education.
So my job is definitely not siloed for
sure.
And then I also will be in charge
of our ANCC
magnet
designation application
project
slash initiative, which we will be applying
for magnet designation
soon,
possibly within the the next year or two.
And, I will be that will be under
my book of work as well. So we'll
be hiring
a magnet program director,
and
I'll be working on our entire magnet journey
alongside
whoever is chosen for that for that role.
Yeah. Thanks, Frankie. Well, congrats on on almost
a year here.
I I know you you oversee a lot,
and I know you mentioned your role isn't
siloed, and it certainly sounds that way. And
I know magnet designation is is no small
feat. There's so much work that that goes
into
applying for those and achieving that that designee.
So thank you for sharing that helpful context.
Frankie, I know you you mentioned you are
coming up on a year. So what was
maybe the most important initiative you've led since
you've joined?
What what was it, and what were some
of the results?
Sure.
So
for me, I guess, I have worked night
shift for a lot of my nursing career.
I've worked night shift many years as a
clinical bedside nurse
and then also
when I have held roles in nursing administration
as an assistant director
for nursing or nursing administrator
where I covered the hospital on the night
shift. And since that team reports up through
me,
I noticed that there were some areas of
opportunity that we could really work on improving
and streamlining communication
between
the different departments on the night shift. So,
you know, after really kind of learning the
ways of the land here at Maimonides and
understanding where there were areas of growth, I
realized that there was opportunity to implement
a night shift safety huddle.
So there was already a safety huddle in
place for the day shift,
and that takes place every morning with all
the the department leadership
from all the different disciplines,
ancillary departments,
nursing, physicians.
And, you know, the whole point
of that safety huddle is to escalate any
concerns that might need to be addressed immediately
throughout that day to make sure that there
are safety measures in place and to make
sure that things that are, you know, barriers
or challenges
are taken care of and remediated as expeditiously
as possible.
So we were missing that on the night
shift. So when I spoke with our CNO,
he was 100%
behind
initiating the same type of Huddl and mirror
mirroring that for the night shift. So I
think that's one of the initiatives that I'm
most proud of is bringing that sort of
communication platform
to the night shift so that we have
a similar type of structure and process in
place
where the interdisciplinary teams can come together,
the nursing teams, you know, nursing leaders who
work at night
as well as engineering and environmental services and
biomed,
where they can come together and report out
on their areas any barriers or challenges they
might be experiencing
that are gonna impact patient care or patient
flow or or operations.
So, you know, from that, I think there
has been better engagement from the night shift,
and
I think the night shift have
appreciated the better communication
coming from those different departments because sometimes,
you know, as a night shift a former
night shift nurse myself,
sometimes night shift can feel left out. And
so I think this 09:30PM
Huddl brings people together,
establishes
relationships,
which is really important for the night shift
when there are less people around. You wanna
know the people who are there and the
players that are gonna be able to help
you out in the different departments.
So I think I've seen a lot of
success and heard anecdotally from the nursing administrative
directors who cover the night shift as nurse
leaders as well as the different team members
who are part of the Huddl that this
new platform
has helped to streamline communication,
to enhance,
you know, throughput, and to just bring awareness
to the current state of affairs of things
happening on the night shift that are possibly
gonna impact
the the the workflows for the staff. So
it's been really successful, and we are gonna
continue that. It happens on the weekends as
well on Saturday and Sunday morning and night.
So there's continuity
of communication
throughout all shifts. And I think that's really
you know, as we know in health care,
most errors are
caused by lack of communication or miscommunication.
So in this case, this platform has
served to,
you know, really try to enhance
the dialogue between teams. So I'm really proud
of it, and, looking forward to its continued
success as we continue on.
Yeah. Frank, you, what a great initiative. I
mean, see safety held, I know, are so
important. So it's great to hear that they've
been in place on night shift too and
that it is improving engagement
among the night shift staff, and I imagine
just
improving overall, like,
communication in terms of shift changes. I know
that's another area of
concern, and that can be a challenge. So
I imagine being able to just have that
space and time to talk through
what's happening, have more awareness on challenges that
might need to be addressed just trickles into
the whole rest of the
shift and the following people who are gonna
be coming in and taking over after those
shifts too.
Absolutely.
And even anything happening, oh, we're gonna have
be shutting down the tube station, you know,
at this time or during this day. Just
those types of informational things are important for
the night shift, so they also feel connected
and they know what's happening.
Yeah. Definitely has a big impact on continuity.
Well, Frankie, looking ahead, what is maybe a
big priority or a headwind that you're encountering
or planning expecting to encounter this year?
So for for us,
for for nursing,
one area that we're doing really well on
is nurse retention. You know, as a nurse
leader, there's these buckets that you're always focused
on.
One of them is always staffing to make
sure that we have the right staff in
place to serve the needs of our community.
You know, at Maimonides, we are outperforming
the nation in terms of nurse retention, and
we're doing really well with that, which is
phenomenal.
And we're really excited and proud of that
as well. So that's one thing that we
don't need to focus on as much. You
know, we
are, of course, working on always improving nurse
engagement,
and that's one of the areas that I
always like to focus on. And that includes
just for all shifts, so day and night
shift. And and, again, not to be
I'm not biased, but as a former night
shift nurse, you know, I I do recognize
the challenges of some night shift staff feeling
disconnected.
So I do prioritize making sure
that the night shift do feel like they
are part of the team and that they
are feeling valued and seen and appreciated in
addition to the day shift. So engagement is
definitely one of the areas I'm gonna be
focusing on for this next year. And, again,
it's gonna be focusing on all areas and
departments within nursing, including night shift. So, for
example, we had a Valentine's Day nighttime celebration,
last week with, cookies and karaoke, which was
super fun, and it was a huge turnout.
And it was just really great to see
the night shift show up and show out
and really have a good time. And that's
an area that I wanna make sure I
continue to look at because
you need to bring joy into the workplace,
and health care is just such a dynamic
and ever evolving and quite honestly challenging environment
to work in. So without having those fun
things incorporated, you know, it can become really
burdensome. So,
trying to encourage staff to get involved,
to join our professional governance councils, to have
their voices heard, to really increase nursing's sense
of autonomy
and engagement and belonging. And so that's one
area that we're definitely gonna be looking at.
The other area, of course, is nursing quality,
and we continue
to focus on the standard nursing quality metrics,
our hospital acquired pressure injuries,
our catheter associated UTIs,
our central line associated bloodstream infections,
and our patient falls. So we have really
made
wonderful strides in our quality metrics,
but the work is never done, and it's
always it's continuous process improvement.
So we are gonna be continuing to focus
on our quality goals as we continue on
this,
this new year
and make sure that we are doing even
better than we did last year, and there's
always room for improvement. So, you know, making
sure the nurses you know, we're gonna look
at implementing champion models so that we have
our falls champions and we have our CLABSI
champions and make sure that the nurses
are feeling empowered and, also engaged
in the work that they're doing to prevent
hospital acquired infections.
And then the third area that I would
say we're really gonna be looking at is
our patient experience.
So we, you know, we are doing pretty
well with patient experience metrics
in relation to the Brooklyn hospitals,
but we wanna make sure that we're still
striving to improve.
So with that, we're gonna be looking at
enhancing nurse leader rounding
on both the day shift and the night
shift, which we're hoping will identify
barriers or things that are
impacting patient satisfaction
early in their stay so we can remedy
those and take care of them immediately
and prevent that from showing up on the
survey at the end when they're discharged and
it's too late to intervene.
So, you know, I think those are the
three buckets that we're definitely gonna be putting
a lot of our energy towards to improve
our patients'
happiness and satisfaction with our hospital experience
as well as their their quality outcomes.
Yeah. Frankie, three really important areas. And I
think what you mentioned about nurse engagement,
it's interesting because it feels like that piece
really runs through all the rest. Like, being
able to, you know, move the needle on
patient experience and quality all really kind of
bolts back to to nurse engagement in the
first place. So I thought that that was
just interesting.
And I know
nurse engagement and just participation on committees and
governance councils can can be a challenge in
certain areas, especially
when it comes to night nurses too and,
hospitals and health systems kind of looking at
different
ways to to structure things and give folks
more flexibility to participate in some of these
things. So I was curious if you could
follow-up on that just in terms of
are you looking at any
specific ways
to get night nurses more involved on certain
things, especially,
you know, governance
councils?
Oh, absolutely. Yeah. So, you know, we do
have some nurse leaders who are in charge
of the professional governance councils, and there are
two that are in charge of the night
shift council specifically.
And they hold them via Webex
to allow
staff to log in from home, or if
they're on the unit, they can log in
from the unit. So trying to offer
that that hybrid, you know, in person Webex
platform,
really
enhances participation
because people can either log in and listen
passively,
or they can log in and be active
participants
either from, you know, the nurses' station or
from home. So that was one of the
suggestions from the night from the night shift
staff themselves
to allow
the Webex option so that people would attend
if they wanted to and if they happen
to not be working that
night. And, also just offering people opportunity to
to join these meetings if it's extra time.
So, you know, maybe they can book a
shift, and they'll work the night shift. But
if the council is meeting, maybe they'll be
nonproductive, and they'll be part of the meeting.
And then the rest of their shift, they
can help do chart audits, or they can
do chart reviews and
do some teaching to their colleagues or things
of that nature. So trying to be flexible
and creative in the way that
we schedule our staff so that we do
have maximum participation,
for the for the night shift specifically,
but the same applies for the day shift.
So if people wanna come in for the
day shift on days when we have meetings,
they can participate in whatever councils they are
a part of, and then they can do
ad hoc things like chart reviews or, you
know, patient rounding or whatever creative ideas our
nurse leaders can come up with to make
them be,
active part of the team for that day
and not necessarily taking a patient assignment so
that they're able to focus on the meetings
and really be part of the
their the voice that they're wanting to share
for those council meetings as well as be
helpful to their teams at large.
Yeah. Sure. That's great. Thanks, Frankie.
Well, I wanted to ask you too just
about something we've been following a lot of
in the news, which is
the lapse of ACA
premium tax credits
and looming cuts to Medicaid with both of
those, and be hearing from a lot of
hospital leaders about how they're anticipating a rise
in uninsured patients and potentially more strain on
their emergency departments.
So I was curious to hear from you
on how MyEminities
is preparing to care for a spike in
uninsured and underinsured patients from a clinical or
operational standpoint.
Sure. So, yeah, that's definitely
a challenge that we're all bracing for.
And,
a lot of the work that we're
that we're doing is really focused on throughput.
So we know that, you know, with more
uninsured
patients, they're usually gonna delay coming to the
hospital for as long as they possibly can.
Unfortunately, that means when they get to the
hospital, if they really need to get seen
and treated, they're probably gonna arrive sicker, and
they're probably gonna require admission. Right? So there's
a few things that we're working on that
we've been doing to try to enhance throughput.
Our ED is already busy as it is,
and, you know, we just survived the strike,
obviously, as you're aware of in New York
City. We were expecting to get some overflow
of patients from other hospitals locally.
However, that did not really impact our operations
too much,
but we did just have a really tough
flu season. So we did just have extreme
surges in patient volume in the EV that
we're still navigating actively.
But part of our book of work in
addressing EV volumes, which, again, we're gonna probably
see increased due to
more uninsured patients
or and, you know, it's it's really we're
gonna be working on getting patients out of
the hospital
as soon as possible
when it's safe,
and to make sure that they were continuing
their care outside so that they don't get
readmitted. So if we can get patients out
of a hospital sooner who don't need to
be here any longer, then we can get
those patients up from the ED to those
beds.
And then if we can keep those patients
who've been discharged out of the hospital and
keep them safe at home, then, of course,
we're hopefully not gonna see them be readmitted,
and then that should hopefully,
you know, reduce our ED volumes ultimately in
the long run.
So we do have tasks for us on
length of stay.
I personally am part of a nursing strategic,
group work group related to length of stay
with one of my other VPs of cardiology,
And so we are implementing
some nurse driven checklists
to be able to,
enhance our awareness of what are the outstanding
or pending
things needed for someone to be discharged So
that our bed expediters and I'm not sure
if you're familiar with that term, but we
have,
bed expediters for each division, and they're pretty
much in charge of rounding on all the
units within their area
to see who's planned for discharge and to
try to make sure that they get all
of their milestones checked off so they can
actually be discharged for that day. So we're
gonna be working with them to implement a
new
nurse driven checklist that they will be in
charge of, and that will have all of
the elements that are required for discharge,
and they'll be able to check off for
most patients who are leaving that day and
engage with teams who
need to
be escalated to. So if they're pending an
X-ray before discharge or if they're pending an
echo, like, they'll be able to escalate to
those areas to get that done so we
can really streamline the discharge process.
So there's a lot of nursing related work
being done to improve earlier discharges. You know,
our our industry standard is discharged before noon.
We do decently well with that, but I
think with our new nursing,
strategic initiatives, we're gonna be seeing more DBNs
as they are abbreviated,
and then that will hopefully help throughput from
the ED.
And then on the
other end of it, we are partnering with
outside organizations.
One of them is called MyLaurel,
and they are helpful in
they do follow-up care. So when the patients
are discharged,
this company, you know, has a nurse follow
them at home
and ensure that the patients are, you know,
asymptomatic
or taking their medications,
complying with their treatment regimens,
and the goal
for them is to prevent readmission.
And that, again, trickles back to us to
prevent unnecessary ED visits, which will hopefully
allow there to be more space for the
increased volume of patients that we might see
due to the higher,
rates of uninsured patients in the community. So
I think those are some of the initiatives
that we're working.
Yeah. No. Definitely. It sounds like if anything,
you know, any additional
ED strain,
that comes through, you know, potentially more patients
is just has really elevated
length of stay work and and up throughput
operational efficiency work. So it's interesting to hear
logistics of how all of that connects.
Yeah. And there's just one more thing that
I do wanna mention regarding our staff.
So I think, you know,
again, with uninsured patients who might be coming
to the hospital late, who might be getting
diagnosed with illnesses that they may have been
ignoring for some time, there's a chance that
we are we're gonna be seeing sicker patients
and with that, more complex
needs.
And so for our staff, we need to
make sure that they are prepared
for the potential of you know, there's always
the
the possibility of moral distress. So when we
feel like
we have patients that we're we really wanna
help and get what they need, but there
are systemic
barriers related to insurance or placement issues
or or social determinants of health and things
of that nature. Our staff can sometimes feel
a little bit defeated. So I think one
of our other areas we can't forget about
is our workforce and making sure that they're
prepared for, you know, compassion fatigue and for
the feeling that maybe they're they're not seeing
the outcomes that they would like to see
for all of their patients
and making sure we have really good debriefing
structures set up. So if there's a difficult
case in the hospital where maybe ethics is
involved, that we have that platform available for
the staff to come together and debrief and
talk about their feelings. We do have team
Lavender here, which is a phenomenal support
structure that's led by our HR department.
And, you know, we actually just called one
yesterday
for our staff that went through a challenging
patient situation.
So I think I I would be remiss
if I didn't also say that one of
our areas of focus will be on our
on our nursing staff and our frontline staff
to make sure that they are prepared for
the challenges that might be coming down the
pike.
Yeah. No. Such an important to point to,
especially as with the potential for seeing patients
who are higher acuity coming in. Well, Frankie,
thank you so much for your time today.
It was a pleasure to connect and hear
about some of the work you're leading at
My Monites.