Latest / Becker’s Healthcare Podcast / Tim Plante, Region Chief Nursing Officer at CommonSpirit Health

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Tim Plante, Region Chief Nursing Officer at CommonSpirit Health · Becker’s Healthcare Podcast

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Hi, everyone. You are listening to the Becker's
0:40
HealthCare podcast.
0:42
I'm Erica Carbajal with Becker's Hospital Review.
0:45
Thank you so much for tuning in to
0:46
this episode, or we are joined by Tim
0:49
Plante, chief nursing officer of the Central Region
0:52
at CommonSpirit Health. We're excited to welcome you
0:55
to the podcast, Tim. Thanks for being here.
0:57
Oh, glad to be here. Thank you.
0:59
Yeah. Well, let me hand it over to
1:01
you to get us started. Can you share
1:03
a bit about your background in health care
1:05
and and give our audience a sense of
1:07
the scope of your work at CommonSpirit?
1:09
Yeah. Absolutely. So,
1:11
well, hello, everybody. Glad to be here.
1:14
I,
1:15
am, like you said, the the chief nursing
1:17
officer for the central region of CommonSpirit Health.
1:20
And if you're not familiar with CommonSpirit Health,
1:22
we're organized
1:23
into five
1:24
regions overall,
1:26
as a company,
1:28
nationwide.
1:28
We're,
1:30
about a 150
1:32
hospitals,
1:33
across the country from everything from,
1:36
critical access all the way up to coronary
1:38
centers in some of our larger cities.
1:41
And,
1:42
and I, like I said, I'm I'm over
1:44
the Central region. And so,
1:46
this region is six states, North Dakota, Minnesota,
1:50
Nebraska, Iowa,
1:51
Nevada,
1:53
and Arizona. I'm home based,
1:55
just a little bit well, well, I live,
1:56
just a little bit west of Omaha, Nebraska.
1:59
I have a little farm out there in
2:01
Wahoo, Nebraska,
2:03
and,
2:04
and it's been a really good company. So
2:06
I,
2:07
have actually,
2:08
for 99%
2:09
of my career,
2:11
worked,
2:11
in Catholic health care for CHI, which then,
2:14
of course, merged with Dignity Health,
2:17
and we became,
2:18
CommonSpirit Health. So started my career out on
2:21
the West Coast in the Tacoma,
2:23
Washington area,
2:25
worked for the Franciscan Health System,
2:28
sort of grew up there. I was an
2:29
ICU nurse,
2:31
during my clinical time,
2:33
and eventually became
2:35
the manager of the, critical care area. And
2:39
then I was an emergency department director before
2:42
becoming,
2:44
the,
2:44
chief nurse of that hospital.
2:47
And then about ten years ago,
2:49
I made the leap, moved to Nebraska
2:52
to be the president of a small,
2:54
critical access hospital
2:56
about thirty minutes well, forty minutes north of,
3:00
Omaha.
3:01
And then from there, I was went back
3:03
into the nursing leadership
3:05
area at Saint Elizabeth in Lincoln, Nebraska
3:09
before being in a
3:12
corporate role,
3:13
within Omaha and now over,
3:16
you know,
3:17
serving the entire Central Region.
3:20
So it's been,
3:21
it's it's a it's been a really good,
3:24
experience within CommonSpirit,
3:26
very supportive company,
3:28
with lots of different opportunities.
3:31
Yeah. Thanks, Dan. Sounds like you're really familiar
3:33
with the with the Midwest there. Major way
3:35
around. That's right. Yep. Yeah. Well, thanks for
3:37
sharing. It's interesting to hear just the pathway
3:40
up to up to the chief nursing officer
3:42
role that you're in now.
3:44
What has been maybe the most important initiative
3:46
that you led in the last year?
3:49
What was it, and what were some of
3:50
the results?
3:51
Yeah. Well, with within an organization,
3:55
of our size and as,
3:58
centralized,
3:59
as this organization is,
4:01
we have a lot of centralized functions to,
4:03
you know, really gain the economy of scale
4:05
and efficiency
4:07
of our, company health care company.
4:10
We,
4:11
have been on a journey within this company
4:13
and within the region,
4:15
to implement
4:16
virtual nursing. We call it virtually integrated care
4:19
or VIC for short,
4:21
and we're, about three years into this journey.
4:24
It's really the the the vision of our,
4:27
national,
4:28
chief nursing officer, Kathy Sanford.
4:31
And she's been working on virtual nursing,
4:34
for
4:35
for years, for actually decades.
4:38
And we we really had that vision,
4:40
very early on about, you know, the need
4:43
to incorporate technology
4:45
into nursing care with the,
4:48
shortages that we have experienced in the past
4:50
and and and really probably the the most
4:53
significant shortage that that that is upcoming and
4:56
how can we leverage our experienced nurses,
4:59
across a continuum of care,
5:01
but especially in the acute care environment where
5:04
the patients are are the sickest. And so
5:07
we have, been going,
5:09
hospital by hospital,
5:11
in our med surg, our intermediate care, in
5:14
our intermediate care areas to implement,
5:17
virtual nursing. So what this looks like is,
5:20
you know, every room, on a unit is
5:22
outfitted with, of course, a camera and speakers
5:24
and,
5:25
to allow for two way conversation between,
5:28
the patient and the virtual nurse. And and
5:31
these are all experienced nurses,
5:34
that actually work from home,
5:36
and they they assist with care. And so
5:39
on a particular
5:40
unit,
5:42
and this isn't like an inclusive list, but
5:44
a virtual nurse may
5:47
complete admission paperwork for or the the admission
5:51
history,
5:52
for,
5:53
for a patient.
5:55
They they do things like the medication reconciliation,
5:58
which takes a lot of time and a
6:00
lot of extra effort to do it correctly.
6:03
They they can discharge patients. They can answer
6:06
call lights that you you know, where you
6:07
don't need an actual in,
6:10
live nurse to come and ambulate you to
6:11
the bathroom or or or to give a
6:14
medication. And we find a you know, a
6:16
pretty good percentage of calls,
6:18
just are,
6:20
are not that, but but some are.
6:23
And and through this process, we've also,
6:26
you know,
6:27
implemented a lot of different quality,
6:30
audits
6:30
and and and measures.
6:33
And and and like I said, this is
6:35
med surge in on intermediate care, which I
6:38
believe
6:39
is the hardest place to practice nursing. When
6:41
you're managing
6:42
five to six patients on a med surge
6:44
or four very sick intermediate care patients. Doing
6:47
that,
6:49
requires
6:50
a lot of good time management, but but
6:51
you are running all shift. And so as
6:54
we've added in this resource,
6:56
it's really, really changed the way nurses in
6:58
our organization are viewing these,
7:01
these work assignments. So,
7:03
our,
7:05
our retention on these units is,
7:07
is near ninety percent.
7:09
We we have improved,
7:12
every,
7:13
every health care acquired condition,
7:15
that that we track, including pressure ulcers, including,
7:19
infections, health care required convention. So that's your
7:22
CAUTI and CLABSI.
7:24
So so from across the continuum, just about
7:27
every
7:28
measure
7:29
has improved.
7:31
But probably most important to me is is,
7:33
you know, talking to the nurses that experienced
7:35
this. And I hear things like, you know,
7:37
please don't ever take this away. I I
7:39
wouldn't, but but that's what the nurses say
7:42
and and and and that we've made med
7:44
surg a place that is fun to work
7:46
or that people are enjoying practicing nursing where
7:49
you're not,
7:50
so stressed out all the time because you're,
7:52
you know, chronically running behind just because of
7:55
the list of everything that you have to
7:57
get done
7:58
with these very, very ill patients. It's it's
8:00
made it a lot more palatable,
8:01
to our nurses, and so we're seeing better
8:03
retention rates.
8:05
We are able to hire new grads into
8:07
these roles with confidence,
8:10
meaning
8:11
our virtual nurses mentor,
8:13
and are available for questions and,
8:16
maybe to help talk through a patient situation
8:19
to make the best possible
8:21
nursing decision.
8:23
And so we have this,
8:26
at five of our hospitals here in Omaha.
8:28
We're, we have it at Saint Joseph's, which
8:31
is in Phoenix at our Cortinary Center there.
8:34
They've taken it to another level where they
8:36
have a discharge lounge,
8:38
where our, VIC team,
8:41
is installed and and they process discharges in
8:43
a different location because they're,
8:47
under bedded. Right? They they are always holding
8:49
patients and trying to move things along,
8:52
and and that's worked out fantastically.
8:56
And and they just have a good leadership
8:57
team, out there that's embraced and has innovated.
9:01
So, you know, we've had a really good
9:03
experience. It's not perfect. There's always opportunities for
9:06
improvements,
9:07
when you're talking about virtual care. Patients seem
9:10
to like it. That that really hasn't been
9:12
an issue. That was a big, concern at
9:14
first is that certain patients won't won't appreciate
9:17
this this person on a video screen. They
9:19
want an in person, which they have in
9:22
person people. Right? But we have added this
9:23
extra resource,
9:25
that that can move things along quicker.
9:28
Yeah. Thanks for sharing that, Tim. It's interesting
9:31
to hear just
9:32
the perspective of med surg nurses and and
9:35
how much this seems to just help support
9:38
their workflows,
9:40
because I know that's been such an area
9:42
where, you know, even over the last few
9:43
years as as some of the national, you
9:45
like, we've seen data of nursing shortages
9:48
stabilizing a bit, but med surge continuing to
9:51
be an area where where health systems see
9:53
see some pain points still.
9:56
When you mentioned that, you know, this is
9:58
a process to to implement and kind of
10:00
going around, like, hospital by hospital, obviously, implementing
10:03
the actual tech is a big part of
10:05
this. Mhmm. How long, like just to give
10:08
leaders a sense of
10:10
the lift in in implementing this in in
10:12
a larger system,
10:13
Is that pros has that process taken to
10:16
outfit
10:17
units with all the technology and and get
10:19
it up and running?
10:21
Yeah. And and, you know, there there are
10:22
a lot of steps here. So I you
10:24
know, I'm I'm gonna simplify it a little
10:26
bit. But but if your technology,
10:28
foundation is in place, meaning you have,
10:32
the bandwidth
10:33
and, you know, Wi Fi capabilities and all
10:35
those technical things that I'm not an expert
10:38
on,
10:39
and and and really the the electrical needs
10:41
too because
10:42
we've tried to install in some of our
10:44
hospitals that are maxed out on power. Right?
10:47
They're they've got medical office buildings and,
10:50
a certain number of, you know,
10:52
you know, amps they can use up for
10:54
for for electrical, and this would have pushed
10:56
it over the edge. So there's a big
10:58
list of things that you gotta look at.
10:59
But once that is done and the install
11:02
of the equipment, the cameras, the microphones,
11:06
you know, the the screens,
11:09
from a clinical perspective, you're you're looking at
11:12
about a ninety day,
11:13
go live. And and, you know, it also
11:15
has to to it depends on how quickly
11:18
you can hire nurses into these roles.
11:21
In in some of our locations like Phoenix,
11:24
Arizona, well, that's a pretty large population,
11:28
and and it's not as difficult as it
11:31
would be, say, for,
11:32
you you know, somewhere in in,
11:35
Nebraska Lincoln, Nebraska to attract talent. There just
11:38
isn't as many people there. Right? And so
11:41
and so so that's a piece. But,
11:44
what what we do is we bring the
11:45
bedside staff to the table in a Kaizen
11:48
event, and we go through the process and
11:51
and and and we work through with the
11:53
staff what's important to them,
11:55
and help them to determine
11:57
what their workflows are based on their unit.
11:59
You know, we have some standardized workflows as
12:01
well,
12:02
because there there are a lot of similarities
12:05
in our units, but,
12:06
but but not everywhere,
12:08
is the same. And so
12:10
the staff come to the table, and they
12:12
talk through the work and and and just
12:15
how you know, what the process is gonna
12:18
be to introduce the patient to the VIC,
12:20
what, you know, what they can expect from
12:22
the VIC nurses to to do during a
12:25
shift, what they won't do, you know, what
12:27
what's better done by an in person
12:29
resource,
12:31
and and and that takes about ninety days.
12:33
And then you have your go live, and
12:34
and it's definitely a ramp up to get,
12:37
you you you know, to get used to
12:38
it and to to make sure that you're
12:39
using it to its fullest extent.
12:42
And then after about six months, then comes
12:44
the innovation. Like, we could could use it
12:46
in our discharge lounge. You know? Can we
12:48
use it to make, you know, calls to
12:50
the patients after they have arrived home?
12:53
And
12:54
it it really does stimulate a lot of
12:55
that innovation.
12:57
Yeah. Definitely. Sounds like you're critical to have
12:59
a really comprehensive
13:01
process to to engage nurses and what the
13:03
new workflow will look like too. Right. Well,
13:06
Tim, I wanna talk about just a little
13:08
bit about
13:09
nurse recruitment and retention
13:11
retention trends. I think we've touched on it
13:13
a little bit, but
13:15
what I've seen, like, health systems have made
13:17
progress in nurse recruitment and retention over the
13:20
past few years. But one of the things
13:22
that continues to come up when chatting with
13:24
health care leaders is the engagement of early
13:28
career nurses in particular. So
13:30
in your experience, what do you feel has
13:32
worked well to build a sense of loyalty
13:35
and connection early on among
13:37
newer folks entering the workforce? And are there
13:40
any strategies or shifts you're planning to help
13:43
support retention among younger nurses in the year
13:46
ahead?
13:47
Yeah.
13:48
You know, the pandemic, the COVID pandemic was
13:51
sort of a, a turning point in in
13:54
how we train our nurses. And and I
13:56
would say not not for the good because
13:58
we abandon a lot of our
14:01
processes and, you know,
14:03
times that we
14:04
commit to for
14:05
for training,
14:07
with the sole purpose of getting nurses out
14:09
on the floors because out of sheer necessity.
14:12
Right? It it and and so a lot
14:14
of organizations, I think, we, you know, kinda
14:16
shorten those times up,
14:18
for for training and,
14:20
and that that and that led to turnover,
14:23
because if a if a nurse doesn't feel
14:25
engaged,
14:26
with their coworkers, if a nurse doesn't feel
14:28
like they,
14:30
can come in and do a good job
14:31
every day,
14:33
or if they have
14:34
a really strong sense of collegiality and teamwork,
14:38
especially our Gen z nurses,
14:40
that are coming out of nursing school and
14:42
starting their careers,
14:44
you're gonna end up with, you you know,
14:47
a a turnover rate of, you know, 15
14:49
to to 20%
14:50
or higher
14:51
based on the, different specialties,
14:54
like med surg. We, you know, we had
14:56
some of our med surg units as high
14:57
as thirty percent
14:58
first year nursing turnover.
15:01
And so knowing all this, our organization
15:04
looked at all the evidence,
15:06
for new grad training
15:08
and developed a, nurse residency. And this, again,
15:12
is a collaboration
15:13
with our national,
15:15
team,
15:16
but,
15:17
you know, locally driven, but but really supported
15:20
nationally.
15:21
And it's it's a it was a brand
15:23
new nursing residency program. And so looking at
15:26
all the evidence,
15:27
and then really taking time with our new
15:29
grads,
15:31
developed
15:32
a a residency that that has been just
15:35
fantastically successful.
15:37
And some of the main differences are the
15:39
amount of time a nurse is in the
15:41
residency,
15:42
you know, up up up to a year
15:44
in in some cases. That doesn't mean that
15:46
they're,
15:47
you know, in orientation or in one on
15:49
one training
15:50
for for that long, but but they have
15:52
that support system within the residency,
15:56
for for a year,
15:58
and that's proved,
15:59
to be very effective.
16:01
And and then, you know, committing to,
16:05
how we train our preceptors
16:06
to make sure that we have really a
16:08
good fit with the specific new grad, but
16:10
that we are not asking people,
16:12
and nurses who maybe don't want to be
16:15
a preceptor. Maybe it's just not something they're
16:17
comfortable with or or, you know, frankly, something
16:20
that they're good at,
16:22
educating and and training somebody and being patient
16:25
and taking the time to teach.
16:27
And and so we we we require
16:29
training for our preceptors,
16:32
and and we certify them.
16:34
And then we we we commit to not,
16:37
shifting around who's training
16:40
these nurses.
16:42
Meaning, you know, when when I was coming
16:44
up,
16:45
you know, through the ranks and and I
16:47
was a new grad, I I probably had
16:49
five or six different nurses that that trained
16:52
me, and it basically was, you know, you
16:55
you arrive I would arrive to the ICU
16:57
and they'd be like, okay. Who wants them
16:58
tonight?
16:59
That kind of thing. Well well, that's not
17:01
a way to welcome somebody, and it's not
17:02
a way to build rapport, and it's not
17:04
a good way to build confidence,
17:08
because if you're constantly changing that, then you're
17:10
starting all over in this dynamic from learner
17:13
to teacher. Right? And so we do everything
17:16
we can,
17:17
to to just have a one on one
17:20
type of situation,
17:21
with our with our nurses and their preceptors.
17:25
There's always vacations and sick calls and all
17:27
those types of things, and so it's not
17:28
a 100%.
17:30
But but for the most part,
17:32
they're they're just training with one nurse. And
17:35
then, of course, they have classes and they
17:37
have time as a group along with
17:39
experienced nurse mentorship that is completely separate from
17:43
all of the residency,
17:44
you know, educators and teachers and,
17:47
people on their unit. They have another person
17:49
who is just gonna be their buddy. Right?
17:51
Just going to help mentor them, meet with
17:53
them, maybe grab coffee, go to breakfast, those
17:56
types of things so so that they can
17:57
talk through some of the anxieties that they
17:59
have. They can talk through some of the
18:02
challenges,
18:03
maybe unit die dynamics,
18:06
and and then how how to proceed forward.
18:10
We we're over 90%
18:12
with our first year turnover,
18:15
which is a giant,
18:17
improvement to where we were just just post
18:19
COVID.
18:21
And that's that's just on just about every
18:23
unit, you know, whether it be women's
18:25
or med surg,
18:27
or
18:27
intermediate care. It's it's been very, very effective.
18:32
Yeah. Thanks for sharing, Tim. I feel like
18:34
you just can't understate, like, how valuable that
18:36
that mentorship and confidence building piece is. I
18:39
feel like there's just so much literature that
18:42
points to nurses really craving that and then
18:44
how how that funnels into directly what you
18:47
mentioned of just satisfaction
18:50
and and retention.
18:52
Yeah. You know, I I think we're changing
18:54
the
18:55
this, you know, this this saying that nurses
18:58
eat their young, which is which is not
19:00
a good thing. Right? It's not a badge
19:01
of honor. It's it's actually not good at
19:03
all, and we're we're doing everything we can
19:05
to to change this,
19:08
this this culture that's, you know, that used
19:10
to be very pervasive
19:12
within nursing,
19:14
that, you know well, I was treated this
19:16
way and that way when I was a
19:18
new grad. Therefore, I'm going to treat new
19:20
grads like that too because it's like a
19:22
rite of acid. Right? Well, that doesn't work,
19:25
and that doesn't lead to patient,
19:27
you know, good patient outcomes and and safe
19:30
patient care. That leads to anxiety and not
19:32
speaking up.
19:34
So,
19:35
it's been a process, to get that changed,
19:37
but but I feel like we've taken the
19:38
right steps. Yeah. Certainly.
19:41
Well, lastly here, I want to ask you
19:44
about just the rise in uninsured patients that
19:47
Hall Systems are preparing for with the expiration
19:50
of ACA premiums,
19:52
subsidies, and the looming cuts to Medicaid.
19:55
Can you share a bit about how
19:58
you, your team leaders are thinking about
20:01
caring for a spike in uninsured and underinsured
20:04
patients from from a clinical standpoint, clinical and
20:07
operational standpoint? I think,
20:09
you know, there's so much reporting and and
20:11
hearing a lot from finance leaders on this,
20:14
but curious to hear how clinical leaders are
20:17
are thinking about this as well. Yeah.
20:19
Couple things on this. Yeah. You you know,
20:21
within,
20:23
our system, within common spirit, we
20:25
are quite often in almost every circumstance,
20:29
the safety net for our communities.
20:31
And and that is something that we actually
20:33
set out to do. Right? We were founded,
20:36
by by, in most cases, women religious
20:39
that came out,
20:40
with a need on gathering donations to start
20:43
hospitals, and and that really is is is
20:46
who we are still. And and and so
20:48
we we do take care of the uninsured.
20:50
We do take care of, you know, marginalized
20:53
populations,
20:54
and I think we do it quite well.
20:55
Now
20:57
I would be remiss to say that we're
20:59
not worried about some of the changes that
21:01
have come, you know, with the new, with
21:03
the latest legislation.
21:05
And in fact, I was just in a
21:06
meeting today where we were we're estimating out,
21:09
you know, what what we think might be
21:12
affected
21:13
if everything goes into,
21:15
place the way the way we think it
21:17
will within the next few years.
21:19
And so, you you know, we have a
21:21
whole team of advocacy folks that work with,
21:24
state and federal governments
21:26
to to help,
21:29
make sure that our legislators,
21:31
like I said, both at the state and
21:33
federal level, understand the impact this is gonna
21:35
have on us as a not for profit
21:38
not for profit faith based organization,
21:41
who are often taking care of,
21:43
you know, people who can't afford their care.
21:46
And and
21:47
it's it's quite a bit. It's a quite
21:49
a bit of of,
21:51
of of of money that that that we
21:54
think might might might be affected. And so,
21:57
we have time to ramp up to this,
21:59
but, you you know, where I'm gonna focus
22:01
as a clinical leader is to make sure
22:03
that we we provide the best care we
22:06
can,
22:07
even through
22:08
any,
22:09
challenges we have with under insured populations,
22:14
and to treat everybody
22:16
the same,
22:17
and to make sure that that that we're
22:19
giving competent care.
22:21
We have a lot of changes in front
22:23
of us. We got a lot to work
22:24
through.
22:25
We're you know, we gotta make care more
22:27
efficient. We have to reduce our costs
22:30
too on the clinical side. And so that's
22:31
what we're doing, as as as we build
22:34
towards it. But, honestly, it's it's it's a,
22:37
it's an evolving situation.
22:39
But,
22:40
but, you know, as a clinical leader, we're
22:42
gonna make sure that that consistent safe care
22:44
keeps keeps happening.
22:47
Yeah. Definitely. I mean, and arguably, I mean,
22:49
it's never been more of an important time
22:51
than now to double down on that and
22:54
and and the operational efficiency piece efficiency piece
22:56
too. Right. Well, Tim,
22:58
lastly here,
23:00
maybe if you can share one of the
23:01
best opportunities you see for organizational growth or
23:04
something you're focusing on in that on that
23:07
front.
23:08
Yeah.
23:10
You know, we we spend a lot of
23:12
time,
23:13
focusing on our throughput and,
23:15
different metrics around our, length of stay,
23:19
and,
23:20
and and making sure that we're as efficient
23:22
as we can be.
23:24
And that does help to drive,
23:26
growth. Right? So that you're,
23:28
able able to provide access,
23:31
to people who are seeking
23:33
your seeking,
23:34
care in the community so that you can
23:37
compete,
23:38
and that and that you're actually, you know,
23:41
creating space. We have a lot of facilities
23:43
that
23:44
regularly hold, you you know, many patients over
23:47
their capacity,
23:50
and,
23:51
and that can be difficult at times. And
23:52
so it's really focusing on that backdoor and
23:55
making sure that we're, you know,
23:58
executing the best practices that that we know
24:01
everything from multidisciplinary
24:03
rounds to,
24:05
you know, geographic rounding, all all these things
24:08
that we know drive
24:09
drive our length of stay. You know, we
24:11
don't wanna push anybody out too early because,
24:14
that creates readmissions, which we don't we don't
24:15
want that either because that's not good safe
24:17
care.
24:19
But we know that we have opportunities there.
24:22
We we have some really awesome strategy folks,
24:25
that that are working on our organic growth
24:28
as a system.
24:30
But but, you you know, for for for
24:33
my world and and what I'm doing with
24:35
with nursing, it's it's it's mainly focused on
24:38
being efficient and,
24:40
making sure that, you know, we're reducing costs
24:43
where we can.
24:45
Yeah. Absolutely. You know, a lot of
24:47
folks are focused on that
24:49
length of stay, ED boarding, all those sorts
24:51
of of metrics to open up capacity
24:54
this year. Well, Tim, thank you so much
24:57
for your time. It's a pleasure to have
24:58
you on today.
24:59
Yeah. Absolutely. Thanks for having me.