Latest / Becker’s Healthcare - Clinical Leadership Podcast / Trish Celano, Chief Nursing Officer for AdventHealth

Transcript

Trish Celano, Chief Nursing Officer for AdventHealth · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - This is Laura Dero with the Becker's Healthcare Podcast.
• 0:03
  I'm thrilled today to be joined by Trish Solano,
• 0:05
  who's a Chief Nurse Executive
• 0:06
  and associate Chief Clinical Officer at Advent Health.
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  Trish, it's a pleasure to have you on the podcast today.
• 0:12
  - Thanks so much, Laura. I'm happy to be here.
• 0:15
  - Now we're gonna talk a lot about, um, a strategy
• 0:17
  that you have at Advent Health,
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  and one that we have included in an article
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  with Becker's talking about use less, lose less,
• 0:25
  and hire more inside the strategy that Advent Health used
• 0:30
  to cut nurse turnover.
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  Um, and so I'm excited to dig deeper into that,
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  um, specifics there.
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  But before we do, can you tell us a little bit more
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  about yourself and your background?
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  - Sure. Um, well, I'm just coming into my 30th year
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  as a nurse and, um, started in critical care
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  and in my, in my background, I was a CNO
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  for our Children's hospital
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  and a CNO for our flagship Orlando campus, as well
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  as a Chief Clinical Officer for one of our markets,
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  and have been in the chief nurse exec role
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  for about four years here.
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  Uh, you know, we're located here in central Florida, uh,
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  but have, uh, 51 hospitals across the US in nine states.
• 1:12
  - Absolutely. And that's, you know, a huge undertaking
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  to be able to oversee the nursing workforce
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  for such a large system crossing, as you mentioned,
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  multiple states in several different facilities.
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  So, you know, I, I'm excited to dive in
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  and see how you're able to manage all those things.
• 1:27
  Um, and in particular, you talked about, um, with us
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  for our article, how the useless strategy, um,
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  has played into reducing their turnover at Advent Health.
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  Could you expand upon that a little bit, a bit?
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  Um, what does that really mean to you
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  and how do you see that playing out on a regular basis?
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  - Sure. You know, I think, uh, for us, um,
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  what the use less element of useless, lose less, hire more,
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  it was not about, uh, decreasing staffing, which is
• 1:55
  what people automatically kind of think.
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  It's really about using less RNs where, uh,
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  where you don't necessarily need to have an rn.
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  So, you know, there's a certain amount of the work
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  that nurses do that can be managed
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  by other licensed personnel keeping
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  RNs at the top of their license.
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  So, you know, some of the feeding, walking clothing, um,
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  bathing and other elements don't necessarily need
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  to be done by an rn.
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  So our useless strategy was really around appropriately
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  elevating the RN to the top of their license
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  and making sure that we had enough of the other, uh,
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  providers to care for patients, whether that's drawing blood
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  or transporting them off of the unit.
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  There's a variety of different things.
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  I think over the course of, um, the last two
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  or three decades, many organizations have pulled those
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  resources away from nursing, which ended up, um,
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  just leading the RN to provide a whole bunch of things that,
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  you know, perhaps, uh, were not necessary, uh, for them
• 3:00
  with their licensure.
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  So the lu the useless element, uh,
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  involved us bringing on additional patient care techs
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  as well as in some markets launching LPN models,
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  but bringing on patient care techs
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  and others to provide care according to their license
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  helps keep their RN focused at the top of their license
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  and just improves the care that's delivered.
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  - That makes a lot of sense.
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  You know, it really seems like it would be beneficial
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  overall for the RN to have the opportunity
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  and ability to focus more on patient care
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  and as you said, the things
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  that they're trained most highly to do.
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  Um, and, and does that mean, you know, then some
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  of the other, uh, work is, is either, um, done by people
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  with other experience levels
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  or in some ways, I'm sure automated?
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  Um, how does that really show up for you?
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  - Yeah, well, you know, for us it's really about bringing
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  back those individuals who have that skillset who we,
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  you know, perhaps over the course of the last two decades,
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  health systems said we actually don't need to have those,
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  um, those individuals working in the hospital.
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  You know, labor is the largest, um, one
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  of the largest costs for any hospital.
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  So over, over the course of, um, over the last few decades,
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  many health systems have removed, uh,
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  or at least decreased the support from transportation,
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  from phlebotomy, from nutritional services,
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  and then from patient care techs.
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  So, you know, for us here at Advent Health,
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  our market's looking across where they currently were
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  and how they could better right size the, the people
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  that they needed to help support the rn.
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  So the RN who is obviously, you know,
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  the most highly paid out of
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  that whole group can focus on the work
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  that they need to focus on.
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  So not only, uh, you know, are we using less RNs,
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  which are a really, um, uh, a difficult commodity to get,
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  but we're using them appropriately at the top
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  of their license, and we're making sure that that also, um,
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  helps to address any workforce burnout.
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  If they have to do everything well, how are they going
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  to do the one thing that they need to do well, really well.
• 5:06
  - Absolutely. That's really an extra excellent point.
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  And, you know, I'm wondering too if you could share some
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  specific examples of changes that you've made
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  that have positively impacted nurse retention.
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  - Sure, sure. Yeah, we've had, um, just some great,
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  great wins in retention of our, um,
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  bedside nurses over the last 24 months,
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  and we're really, really excited about where that has gone
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  for us as a company and,
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  and what it means to our communities across the country.
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  Our, um, nursing leaders, um,
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  our nursing leaders had an opportunity
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  to really have additional support
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  and education preparing them to lead.
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  Now here you have, uh, an assistant nurse manager
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  and a nurse manager who are running operations 24 for 24 7,
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  and we realized that we had an opportunity
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  to better prepare them for that role.
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  So, uh, 24 months ago we developed
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  and launched nursing leadership development content
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  that was very tactical
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  and very practical, uh, for our nurse leaders so
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  that they understood what it meant to
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  actually develop staffing
• 6:16
  and manage staffing throughout the day.
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  Um, things like unit huddles, uh, a variety of different,
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  um, educational topics that a and s
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  and nurse managers now would learn in a,
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  in a pretty tactical clear,
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  but prescriptive format as they transition to their roles.
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  We also launched a professional excellence program kind
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  of commonly known across the country
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  as the clinical ladder for nursing.
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  Big, big, uh, win for us.
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  And, you know, nurses are looking for a standard way to, um,
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  to develop in their career.
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  And that doesn't have to mean, you know,
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  if you're a bedside nurse
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  and you wanna continue to
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  develop, you have to leave the bedside.
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  You know, we wanted to kind of flip the script on that,
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  that we really value our nurses
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  who have 10, 15, 20 years experience.
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  So how do, how can we recognize that
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  and how can they be
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  recognized for what they bring to the bedside?
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  The third one was our competitive market pay.
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  You know, we, um, post pandemic market pay changed
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  so quickly across the country.
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  So, you know, we went from evaluating market pay to,
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  to every other year, a few years back to every year,
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  to every six months.
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  And over the course of the last three years,
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  we evaluated it, uh, quarterly to really make sure
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  that we had a pulse on what was, um,
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  happening in our local markets.
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  'cause it's easy to get out of, um, out of line with
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  where compensation is going, when there is a pandemic
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  and a national nursing shortage.
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  So our focus on making sure that we maintained compensation
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  that was competitive for our nurses.
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  Also, another, another strategy.
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  The third of really four strategies that we use.
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  Fourth one being, um, career pathways
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  and, you know, tuition reimbursement,
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  student loan repayment, all of these things, um, nursing
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  and Advent Health, a really competitive that nurses
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  recognize that we were here to provide for them a pathway
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  to develop, and that we were also able
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  and willing to resource that.
• 8:18
  - Certainly. And, you know, I I think that's such a strong
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  and powerful message, as you mentioned, um,
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  to really put the resources behind those efforts and,
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  and making sure that no matter what the nurse chooses and,
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  and feels like is their best path forward for them, um,
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  that they're valued and supported.
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  I, I love that. I think that's such a remarkable way to,
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  you know, develop a culture within the organization.
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  - Yep, absolutely. You know, they'll, the whole idea behind,
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  um, magnet hospitals, if you,
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  if you recall when they first launched was, was how,
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  what are the elements that will make a
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  hospital a magnet for nurses?
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  It will draw nurses to that facility.
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  Those things haven't changed in, in, in 20 years.
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  Um, not, not really, not much .
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  - Yeah, absolutely. Absolutely.
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  , that's so, you know, such a great point.
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  And you know, the other thing I was wondering is
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  that the article mentions strategic overlaps
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  between the use less and lose less.
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  Can you explain how these improvements contribute
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  to the overall success of the nurse staffing strategy?
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  - Sure, absolutely. So, you know, in order to, uh,
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  the use less, which is using, um, other, other providers
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  outside of just RNs to provide a real, um, kind of model
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  for care, um, in order to do that,
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  we had a couple things we had to do right, uh,
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  namely leadership development so that our nurses,
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  our assistant nurse managers who run operations 24 7 as well
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  as our nurse managers had that they were prepared to,
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  to effectively staff.
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  They needed to understand what that meant
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  and all of the variables involved in that.
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  Um, when, when assignments are being made for nurses,
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  it's not just a, a ratio of a number of patients as it seems
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  to be kind of, uh, dumbed down in, um, in the press.
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  It, it's much more than a ratio.
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  It's actually the nursing, um, not only the complexity
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  of the patient, but the experience level of the nurse
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  and the intensity of the work.
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  So it's the acuity, the intensity, as well as
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  that nurse's experience.
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  Those three things work together in conjunction to determine
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  what an appropriate, um, assignment is for a nurse.
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  So we needed to go back
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  and just do some level settings, nursing staffing principles
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  and practices that that class for our nurse leaders,
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  you know, really helped to get everybody on the same page.
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  And then, uh, things like leading effective unit huddles,
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  if, um, there's a good way to do it, a way
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  that is actually useful, that is, is helpful
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  to both the staff as well as the leaders
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  communicating effectively with physicians and providers.
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  Um, you know, we, um, brought on
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  as many hospitals did across the country, uh,
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  a significant number of graduate nurses, uh,
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  over the last 24 months.
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  And we needed to make sure that they were transitioned
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  to practice in a way that they felt good about,
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  that they weren't just thrown in to these units.
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  Um, and having to suddenly communicate and,
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  and develop, you know, really working relationships
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  with physicians, uh, that they didn't know
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  and weren't comfortable with.
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  And there is a, there are nuances to those relationships,
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  um, and then, you know, principals of onboarding,
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  staff nurses, it, it can be challenging
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  for a 26-year-old assistant nurse manager to be managing 22
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  and 21-year-old nurses.
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  So, you know, do they understand how
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  to appropriately onboard those new nurses and what they need
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  and, and how a GN can make a smooth transition
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  to practice practice.
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  So the fundamentals about that, we outlined that
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  and then made sure that, uh, everybody participated
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  and really raise a bar for our nursing leadership relative
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  to, um, their ability to lead.
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  - You know, that's so interesting to hear,
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  and especially, um, that last point you made, you know,
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  with, um, new leaders emerging and coming in
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  and then all of a sudden having to manage large teams,
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  you know, it, it, it's a, a skill
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  and especially as, um, you know, the, the workforce changes
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  and kind of the dynamics, um, within, you know, the,
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  the whole, um, department I can imagine
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  or the whole hospital are changing as well.
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  And, you know, is there anything that you've noticed,
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  I guess, compared to whether it's pre pandemic
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  or just how things used to be that, you know,
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  you really see it as being, um, super helpful
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  and beneficial within some of these trainings so that, um,
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  going forward, you know, the, the hospitals
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  and the nursing departments in particular, um, are,
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  are really becoming those places, as you mentioned
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  before, that people are, are really wanting to work at
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  and wanting to be at in strong teams
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  and not engendering some of the, um, challenging aspects
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  of culture that we've seen previously.
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  - Yeah, you know, I think probably one
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  of the most important things is that the, um,
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  the leader who's leading operations on that unit for
• 13:11
  that shift, there's always someone 24 7 for us,
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  it's an assistant nurse manager or a charge nurse.
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  Um, they really have to, uh, number one,
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  be in the position to be able
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  to evaluate what's happening on the unit at any given time.
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  That means, you know, we need those, those unit leaders
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  to not have an assignment to actually be free so
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  that they are, they are continually evaluating the workload
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  of the bedside nurses.
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  Sometimes a graduate nurse
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  or a nurse, you know, a novice nurse who's got less than two
• 13:44
  years experience, that nurse might not, um,
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  realize when they are starting to get into trouble,
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  when perhaps they're not able to keep up with, um, and,
• 13:54
  and appropriately assess and evaluate their patients.
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  They feel stressed,
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  but they, they need help sometimes to identify, you know,
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  what, the workload of this assignment is actually
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  not appropriate, you know,
• 14:05
  and a way that, you know, we have focused on doing that is
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  to have, uh, nursing leaders who actually are assessing
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  that along with the bedside nurses.
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  Um, you know, high intensity leads to burnout,
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  and burnout leads to turnover
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  and leads to bad patient outcomes when you don't have enough
• 14:22
  nurses to provide care.
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  So, you know, preparing our leaders
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  to manage operations 24 7
• 14:29
  and um, to more effectively make
• 14:32
  and manage staffing assignments has really been fundamental
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  in supporting the improvements in our nurses' perception
• 14:39
  of staffing adequacy.
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  Um, you know, I say perception of staffing adequacy,
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  because every nurse, regardless of
• 14:45
  what the staffing level looks like,
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  they have their own perception of
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  how they feel on that given shift.
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  You know, we measure staffing adequacy in our annual
• 14:52
  nursing engagement survey.
• 14:54
  So the N-D-N-Q-I survey asks tho, you know,
• 14:57
  those really important questions,
• 14:59
  do we have enough registered nurses to provide quality care?
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  How do nurses, do nurses have enough time
• 15:05
  to discuss patient care problems with other nurses?
• 15:08
  Do we have enough staff to get the work done?
• 15:10
  Are there adequate support services to allow me
• 15:13
  to spend time with my patients?
• 15:14
  Those four questions really give you a great pulse of, of
• 15:18
  how those nurses on that unit feel.
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  You know, we had a just significant increase in staffing,
• 15:25
  adequacy perception from our nurses last year,
• 15:28
  a 14% increase.
• 15:30
  And, um, and I, uh, all
• 15:32
  of our nursing leaders in our markets
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  and divisions all, all accredit that
• 15:37
  to an increased awareness, not only the education of how
• 15:40
  to step, but awareness of the frontline nurse leaders that
• 15:43
  that is their responsibility, you know, to,
• 15:46
  to be making sure that those bedside nurses have
• 15:49
  what they need, and if not, that assignments are changed
• 15:52
  and redistributed more appropriately.
• 15:55
  I think that was probably one of the biggest.
• 15:57
  And you, you hear about that a lot in the, um,
• 16:00
  in the news when you,
• 16:01
  when you hear about nursing dissatisfaction, uh,
• 16:04
  very frequently, it's around that, that we don't have,
• 16:07
  you'll hear them call it a charge nurse
• 16:09
  or our charge nurse has an assignment, you know,
• 16:11
  and when that happens, who is, um,
• 16:14
  who's got their eye on what's happening on that unit?
• 16:20
  - And it's such an excellent point
• 16:21
  and certainly a situation that is less than ideal
• 16:24
  and hospitals don't wanna get into that situation.
• 16:27
  For sure. Um,
• 16:28
  before we wrap up here,
• 16:29
  I was wondering if you could tell me more about some
• 16:32
  of the results that you've seen from the recruitment
• 16:34
  and retention strategies you mentioned,
• 16:36
  including your partnership with the schools
• 16:38
  and your Clinical Leader Ladders program.
• 16:41
  - Sure. Um, well, yeah, our results, you know,
• 16:44
  we've been very, very pleased.
• 16:46
  We, we exceeded our hiring targets.
• 16:49
  You know, we had a, um, hiring target of about 5,000 nurses.
• 16:52
  We hired 7,000.
• 16:54
  So we beat that goal by, by, um, 2000
• 16:57
  or turnover, significant increase in 24 months from,
• 17:00
  from over 31% to, uh, just under 19
• 17:05
  nursing agencies, uh, post pandemic,
• 17:08
  many health systems brought on agency nursing.
• 17:10
  You know, we, at the height of the pandemic, uh,
• 17:13
  we're at about a 13% of our, uh, work hours agency.
• 17:17
  We're down to 1% now. So, uh, nursing engagement improved.
• 17:22
  The N-D-N-Q-I, uh, annual nursing engagement survey, which,
• 17:26
  you know, probably the survey most hospitals take across the
• 17:30
  country, we saw improvement in all eight domains.
• 17:33
  Really, really pleased with that. Um, and the turnover.
• 17:37
  So we launched a clinical ladder across the company, um,
• 17:41
  about 18 months ago across the entire company.
• 17:45
  And the nurses who participate in that clinical ladder,
• 17:47
  their turnover was less than 5%.
• 17:50
  So, you know, that's really a,
• 17:51
  that was a game changer for us.
• 17:53
  The latter turnover we're engaging nurses and, um,
• 17:57
  and they're staying, you know,
• 17:59
  and relative to academic partnerships,
• 18:01
  you asked about that as well.
• 18:02
  You know, that was a, a big, uh, big deal for us,
• 18:05
  really connecting with all of our feeder nursing schools,
• 18:09
  uh, making sure that we're there.
• 18:11
  We're connecting with faculty
• 18:12
  and students opening up positions on our
• 18:14
  end for nursing students.
• 18:16
  So our nurse tech positions, allowing them to work,
• 18:19
  you know, a, a one, perhaps it's one shift every other week
• 18:22
  so they can kind of get to know us and we get to know them
• 18:25
  and, and they can figure out
• 18:26
  where at Advent Health they wanna land
• 18:28
  where they wanna make their home after graduation.
• 18:31
  We also launched a number of dedicated education units, uh,
• 18:35
  with local colleges of nursing,
• 18:37
  really strengthening those academic partnerships.
• 18:40
  We expanded our practicums, our clinical rotations.
• 18:44
  We have our, um, team members working as adjunct faculty to,
• 18:48
  to help support those colleges of nursing so that they have
• 18:51
  the, um, academic leaders that they need while they continue
• 18:55
  to also, uh, develop and expand their pool.
• 18:58
  Our graduate nurse residencies we're all, um,
• 19:02
  standardized across the company, really making sure
• 19:04
  that they were evidence-based and that they
• 19:07
  provided a, a solid education with a,
• 19:11
  with evaluation throughout the graduate nurse residency so
• 19:14
  that those residents were prepared
• 19:17
  and transitioned well practice.
• 19:19
  We also did the same thing for our preceptor.
• 19:21
  So, you know, every graduate nurse residency is led
• 19:25
  by preceptors bedside nurses.
• 19:27
  Uh, we realized that we had an opportunity there
• 19:30
  to help standardize their approach to the preceptor role.
• 19:34
  Did they understand, you know, what it meant to be
• 19:36
  and adult learning, um, strategies so
• 19:39
  that our preceptors were functioning at a very high level
• 19:42
  and able to really transition those GNS in a way
• 19:47
  that was, uh, good for everyone, the gn as well
• 19:49
  as the organization, and then a number
• 19:52
  of nursing mentor programs as well.
• 19:54
  I think our relationship with our colleges of nursing
• 19:57
  and then our own Advent Health University College of Nursing
• 20:00
  as well, um, has really strengthened in the last 24 months.
• 20:05
  We've become very, very good partners.
• 20:09
  - Well, that's great to hear,
• 20:10
  and certainly inspiring just everything you've put together,
• 20:13
  um, or, and resources that you put towards the nursing
• 20:15
  and and development program.
• 20:17
  Um, this really great to hear, Trish, thank you so much
• 20:20
  for joining us on the podcast today to really expand
• 20:22
  and dig deeper into what you're doing at Advent Health.
• 20:24
  Um, I really appreciate it,
• 20:26
  and I look forward to connecting with you again soon.
• 20:28
  - Hey, thanks so much, Laura. Uh, I enjoyed it.
• 20:30
  Have a great day.
• 20:33
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• 20:35
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• 20:39
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• 20:43
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• 20:58
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