Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. The Baldrige Foundation and ABOUT Healthcare welcome you to LeaderDialogue Radio where leaders glean valuable insights and practical takeaways to help navigate effectively through these challenging times. The show airs the 1st and 3rd Tuesdays of every month at 1:00 pm (ET) on Business RadioX.
Chief Nurse Officers (CNOs), Gay Landstrom Ph.D., RN, NEA-BC, FACHE – SVP and CNO of Trinity Health, and Kim Maguire RN, BSN, MBA/HCM, CENP – EVP and CNO at Northwest Community Hospital (NCH) in Chicago, will be joining the Leader Dialogue co-hosts for this timely and relevant 2/15/22 podcast.
The podcast topic for this 2/15/22 podcast is Operating as one: Employee empowerment and seamless handoffs. Gay and Kim will share their personal experiences and insights on this important topic, providing insights that can be applied immediately.
Listen to the podcast here
Operating As One: Employee Empowerment And Seamless Handoffs With Gay Landstrom And Kim Maguire
I’m glad you’ve read another episode with some of the most fascinating leaders in healthcare and other fields. Before we get started, I want to thank the Malcolm Baldrige Foundation for making this show possible and also to give a shout-out to our sponsor ABOUT Healthcare. I’m joined by my good friends and colleagues, Ben Sawyer and Dr. Darin Vercillo. These guys are both executives at ABOUT and you are going to appreciate them as I have their real insight, keen ideas and thoughts about healthcare and some of the challenges that we’re facing. This conversation is going to be both interesting and helpful. Our guests are two of my very favorite nurses. I’ve had the privilege of working with both of them in my career.
We’re going to talk about systemness and operating as one system, employee empowerment and some seamless handoffs. One of my two favorite nurses is Kim Maguire who is the Executive Vice President and CNO at Northwest Community Healthcare in Arlington Heights, Illinois. It’s a magnet-recognized designated system. Kim is fairly new in her position there but we’ve had the opportunity to work together at Mercy Health and Trinity for many years. She’s one of my favorite, not just nurses, people. We’ve had a great time working together. Kim was the successor. Her predecessor in her job several years ago was Dr. Gay Landstrom.
Gay didn’t have enough initials after her name like a lot of nurse executives. She needed PhD so she left us and went to the University of Michigan to get her Doctorate. She has since done some amazing things. She’s worked with Dartmouth Hitchcock health system, Ascension St. John and was at Trinity before. Now, she’s back at Trinity Healthcare. Trinity is one of the largest health systems in the country. She is the Senior Vice President and Chief Nursing Officer for Trinity Health. Some interesting fun facts, there are 34,000 RNs at Trinity and 13,000 staff beds, about 100 hospitals and continuing care sites. Gay, you must be exhausted with all of that. Kim and Gay, it is so much fun to have you on the program with us. Thank you so much.
It’s great to be with you.
I’m glad to introduce you to my friends, Darin and Ben. We’re going to have a great conversation about these very important topics, systemness and seamless care and handoffs. We were talking about some of the challenges that you as healthcare leaders are facing. We don’t want to slide into that thing where everybody’s talking about the pandemic and they get stuck. I know for a fact that the two of you are fully aware of the challenges but you’re not satisfied with just sitting and admiring the problem. You will get to work and try to make solutions for this problem.
You’ve both been doing that prior to the pandemic. Some things were put on hold and in some things you’re saying, “This isn’t going to last forever. We got to get busy.” Let me go to Kim first. You’re on the front lines doing this every day. You’ve got to keep your staff engaged. You can tell us, if you want, how many openings you have. What is your greatest challenge in a community health system as a chief nurse exec?
First of all, I wanted to thank all the healthcare workers out there that are reading for the last couple of years, especially. We don’t want to dwell on it but it’s been a rough couple of years at healthcare as everybody knows. I want to acknowledge everybody in healthcare and thank them for the hard work that they’ve put in over the last couple of years. The biggest challenge and the stage where I am, probably not unlike any other healthcare system in the country, is staffing.
We’re still struggling with our staffing. We have a fairly substantial vacancy rate here both for our RNs, as well as for our nursing assistants. That switches into other disciplines as well, such as respiratory therapy and surgical technologists. Our nurses are tired. They’re weary. They’re still engaged and committed but they’re tired and had been tempted by some of the agency dollars that are out there. That’s why we’ve seen a little bit of a turnover here at NCH.
We’ve been working on different things that we can do here in Chicago to help them stay in their organization and place and stay engaged. We’ve had some success with a couple of tactics we’ve put in place but that’s our biggest issue. Our patients are sick. These are the sickest patients that I’ve seen in my entire career as a CNO and as a nurse. Patients that we used to see in the ICU were seen on the med surge, which is very normal. We’re dealing with high acuity and very tired staff.
Thank you for what you’re doing. We do have an appreciation but I want everyone to have an appreciation for what your challenges are and what you’re doing. Gay, through your system, Trinity has been working in some ways. This takes what Kim’s situation is. It multiplies that across about 100 other facilities. What’s your RN vacancy rate?
Everything that Kim said is true in the 25 states where I have facilities. Our vacancy rate is approaching in many of our ministries 20%. That matches the numbers that we’ve been seeing across the country. 1 in 5 healthcare workers have left the bedside and they’re doing something different. We had some vacancies before this pandemic hit but it’s clear that the pandemic shifted things for a lot of clinical staff. We’re just seeing that what we were becoming aware of prior to the pandemic accelerated. A good year before the pandemic, we had been doing quite a bit of work trying to listen to staff, nurses, respiratory therapists and a lot of those caregivers that are part of the interprofessional team at the bedside in an inpatient area.
What we were seeing was that what they needed and wanted in life was changing. What they needed and wanted all accelerated during the pandemic. My point is it started before that. It might’ve been more subtle. Some of my colleagues that I talked to across the country resisted the thought that it was shifting. I described the shift that our nurses, respiratory therapists and others were wanting to have more control over their schedules and lives.
It wasn’t just the young, newer generations. It was a bit more mixed than you might assume. They didn’t want to beg provocation or have to wait until they’d been there for twenty years and have seniority to get what they desired and take that family vacation or always have to work half of the holidays, working every 2 or 3 weekends. They were willing to work very hard and bring their expertise to patient care but they needed more control.
Our historic roles, those full-time or part-time FTE roles, weren’t giving them a lot of flexibility and needed more flexibility. We needed to be responding to that. The pandemic hits and what all are talking about is the value proposition, what kind of money can they make for this dangerous, hard work they’re doing and what kind of flexibility could they enjoy? Suddenly, it is right at the forefront.We really have to pay attention to not only attraction, but to reasons for people to stay. Click To Tweet
We began developing a national internal agency to give a place for clinical staff to be able to bring their skills and experience to patient care but they could control their schedule and be compensated well for it. You don’t get many benefits but you’re making a good salary similar to travel agencies. When the pandemic hit, we also launched a national traveler program. We had both regional and national ways for staff to work for our company, care for our patients and align with our mission and vision. They didn’t have to always go to an outside firm to get what they needed.
Darin, I’m sure that you’ve got a lot of thoughts and comments about this as a practicing hospitalist. You’ve seen some of the impacts of this. Share with us what your thoughts are.
First of all, to see all the nodding heads here in the background as Kim and Gay have been talking about the things that they’ve been sharing, we’re all in violent agreement on everything that they’ve been talking about here. Thank you for sharing and for all you’re doing. In my experience, we’ve been seeing the same thing like Gay where I practice and see some of the statistics, the 20% Great Resignation rate or the move-on rate, the tenure process it’s going to take to replace all of these and the increase in ER boarding and transferring patient because we don’t have staff. Making these decisions to put ICU patients on telepatients in a medical ward is reaching the radio limits of your wireless telemetry so you can take care of these patients and all these things that we’re dealing with.
You have to adapt. It’s adapt or fail. Some of the things you’ve talked about implementing are probably of great interest to many organizations around the country. I wanted to pose a question to you. One thing as a hospitalist is it’s always been extremely gratifying and reassuring working with the nurses that are either in the ICU, stepping down or med surge. It’s their ability to be critical thinkers, analyze situations, think outside the box and not just do but to think and go one step beyond. How do you take your nursing staff? They’re weary. It’s tough. How do you keep them critically thinking about what’s going on and reward them for that so they continue to do that and we raised the bar of how they’re in their practice?
One of the things that I did in a previous role or organization, especially early in the pandemic, is we took nurses in our med surge areas that showed some interest in critical care but could never crack into critical care because there were never any openings. We created a tiered system. We had tiers 1 through 4. If you were considered to your four, we could put you in the ICU on a team with an ICU RN but with that came additional educational opportunities. We would tear them up. That’s how we stretch our RN and the resources that we had during the early part of the pandemic.
What we ended up with pleasantly is that when we did have openings, we had a slew of med surge nurses that were ready to go into the critical care area because they had been working alongside very experienced critical care nurses and physicians. They had a safety net of learning. That honed critical care and thinking. We maintain that going forward to help. Something we’re looking at doing here at NCH as well is having these additional educational opportunities to help our nurses grow in their ability to take care of the sicker population.
I’m glad you shared that and that idea of nurses being able to graduate up through those higher acuity patients. Not to be equated solely with critical care but that critical thinking capability on any level of care raises the quality of care. Thanks, Kim. I appreciate that.
One of our themes in this conversation is systemness. One of the things that we did within Trinity Health started before the pandemic, which I was grateful for. We knew that we needed to increase the development of our nurses and create some opportunities for them even before they might move into a specialty area to be able to gain some greater knowledge and think through complex care because frankly, there are no simple patients that have a single condition. They’re not going to spend a single night in the hospital. If you look at some of the Medicare data, these patients got 4, 5, 6, 7 or 8 comorbidities and that takes some serious planning. Nurses need to be able to think critically and creatively and put together plans of care in that context.
We began developing what we called an academy program. If a nurse was thinking about career-wise wanting to become a critical care nurse, care manager, move into surgery, the emergency department or any other specialty area they could be a part of a 6 to 9-month academy program where we set it up virtually and they could learn from experienced nurses, gain some of that knowledge and bring that to their patient care, the unit that they’re on, even if it’s a med surge unit, we could increase the ability of nurses to think about complex care. We had started that and we’re continuing to expand it. We offer it to our nurses across all of Trinity.
It’d be more challenging for an individual hospital to develop it alone. We leveraged it across our system. I will make one other note that is an emerging challenge for us. I know this because we’ve been doing a piece of research, interviewing brand new nurses and students ready to graduate from nursing school. Their education has been very disrupted over the last couple of years. For many of them, they were missing a lot of their clinical experience and learning from experienced nurses. Some weren’t even able to get into simulation labs for many months.
This impacted other clinician education programs as well. We have some young clinical people coming out of their programs with very different experiences and development. That is causing health systems to need to augment that, recognize where they are and help to develop them into the clinicians that we need but it’s not the same product coming out of programs at least over the last couple of years. It’s another challenge and one that we’re all embracing and figuring out.
Gay makes a good point and I want to expand on that a little bit because we’ve been seeing the same thing here at NCH. The expansion of residency programs for nursing is very important. We talk about what you want your CEO to know. We need to expand our residency programs by incorporating simulation into those programs because we’re experiencing it as well versus just not getting the same training during the pandemic.
I was going to jump in there and ask, maybe this is a simplistic question or it doesn’t have a simple answer. What about the age cohorts? Are you seeing more of your resignations or people leaving the field? Is it the seasoned nurses that have the most experience or is it across the board? The other thing is, are you seeing younger nurses choosing this as a profession or did the numbers drop because of how crazy things are?
We’re seeing a mix.There are no simple patients that have a single condition. Nurses need to be able to think critically and creatively in putting together plans of care. Click To Tweet
Here’s the other part of this and Darin, you know this to be very true. Gay, when you talk about the disruption that occurs in nurses’ training, some young people who are in medical school or had been in medical school were disrupted. They think, “They’re nice people but I hope I never have to rely on them as a physician. I don’t know what their training is like.” You compound it because who’s your best friend as a brand new doctor or as a resident? It’s the experienced nurse. If they’re not there, we have lots of challenges.
I have a daughter and a son-in-law both in medical school who are experiencing that exact thing, the lack of being able to get the clinical experience and are having to travel all over the country to find those experiences. Apart from my clinical work with ABOUT Healthcare or something that we work extensively with are transfer centers and access centers. The best model there is to staff them with experienced nurses so they can interact with those providers as they’re calling in.
One of the things that came to mind was as you see people shifting around to different areas, whether they’re on the wards or have other opportunities to go into something that maybe isn’t bedside intensive like being in an access center and then working with care traffic control in that environment, I see such great experienced nurses getting into those environments and providing services within organizations where they keep getting more added on to the work that they’re doing in these access and transfer centers. They are so capable, have so much experience and can help create systemness. They can help a load balance across the organization. Have you been leveraging that within your organizations to do those alternative services as well?
We have been doing a lot of work looking at what our care model needs to be in the future, recognizing that the country is short of registered nurses, LPMs and nursing assistants. Everyone’s vying for nursing assistants. Even McDonald’s is competition. It’s crazy. The competition for that entry-level worker is compounding. We have to pay attention to not the only attraction but reasons for people to stay in those professions.
To your point, we’ve been looking at how do we create roles for those nurses who are retiring early? We saw that during the last years. That’s one of the groups that we were losing, not only all that experience and knowledge but those are the ones who also mentor our newer minted nurses. Losing that component causes a lot of issues.
One of the things that we’ve focused on is how can we create roles where we can encourage those nurses to stretch out their careers a few more years? We need them to stay in nursing longer. If that’s not at the bedside hiking up and down hallways, how can we bring them into patient care so they can help with complex care, mentor those young nurses and can be a vital part of the tea? How do you make a role and a value proposition that will entice them?
I’ve been talking to nurses that retired in the last couple of years about, “If you could be a virtual nurse, part of the care team and you’re not on that floor, that inpatient unit but you can be a part of working with the patient, helping with assessments, complex care planning and mentoring a young nurse, would you do it?” I have yet to have one of those nurses tell me no. They’re interested. We’re doing a lot of work in that direction. I am convinced that there will be virtual roles for probably nurses, pharmacists, case managers and lots of different roles. It’s our future.
You’re talking about maybe creating programs. Kim, I don’t know if you’re doing the same thing but it’s a gradual off-ramp rather than getting to the frustration level and saying “I can’t take it anymore,” which is horrible. We haven’t touched on behavioral health, mental health challenges and issues. We should do that for another show. Can you create an off-ramp where you stretch it out a little bit more? Don’t send them into retirement used up, overusing alcohol, drugs and stuff because they had to cope with it but a nice, easy off-ramp where they’re contributing to the day that they leave in a very positive way? Have you seen that? Have you been able to utilize that system?
I have not but I’m calling Gay after this conversation. I have her cell number. The only other thing I wanted to mention was the other thing we have to hone in on is academic partners with apprenticeship programs and releasing some of our senior nurses to teach because we have a problem in nursing with having enough instructors. We’re trying to do more of that. Back home I did that and I’m praying to do more of that here as well but another opportunity for us in healthcare is to have stronger partnerships with our academic partners.
Some of those are combined roles for a nurse who is an active clinician but frankly, the patients are very acute. It can be difficult for them to stay in that work if they have a blended role where they might also be teaching in a program that gives them respite and allows them to go back to the bedside with some renewal. It contributes to resiliency. Those blended roles are brilliant.
I remember some of the things that we worked on, saving physicians and nurses from burnout, this was before the pandemic. We had no idea what was coming but some of those things went by the wayside because it’s the tyranny of the urgent. You’re in the moment trying to survive. Hopefully, we’ll get back to some of those things in the near future and some of those more proactive measures.
I do think the challenges of the workforce we’ve got years of working on this but we need to keep our eye on that long-range plan, not just digging out of this challenging hole but where we need to go beyond that.
We have been so fortunate to have the two of you on this show. Thank you so much. For our audience, we have a webinar coming up and we’ve also twisted those arms to get you to be on our webinar to have this roundtable discussion to further this very important discussion. Ben, could you tell our audience a little bit about how they can get involved in that?
There is a webinar titled Systemness: Operating as One that Gay was referring to. It is on February 22, 2022, at Noon Central. People can sign up through the Baldrige LeaderDialogue program. The registration link is on there. It’s at www.LeaderDialogue.com. You can find that on the event page and sign up for that. We’ll continue this conversation, which was fantastic.
Gay and Kim, we appreciate it. The thing that stuck out to me in the conversation was a lot of these trends were happening before the pandemic hit and it accelerated it. Also, the comment you made Kim, which is, “You have to respond at the moment but the goal is to be able to look at the horizon and say, ‘How can we make changes?’” Healthcare has changed permanently. How do we make changes that can get us in the right place going forward in the future for our patients?
We’ve come to the end of our time. If you’ve been taking notes, I hope you have, you can go back and reread this episode. You’ve known some innovative solutions to some difficult challenges. We want to thank both Kim and Gay for the leadership that you’re showing in this important time and for your work. Darin, thanks for your questions and comments. Ben, there are lots of shows and we’re grateful you decided to tune into this one. We hope that you got some creative solutions. Join us on our webinar. We’d love to have an opportunity to submit some questions to our panelists at our roundtable. Thanks so much for reading. Thank you to our guests. Keep leading in this very difficult time. We need you. Your patients need you. Thank you so much. We’ll see you next time.