Latest / Becker’s Healthcare Podcast / Building a Resilient Nursing Workforce in Rural Texas with JohnRich Levine

Transcript

Building a Resilient Nursing Workforce in Rural Texas with JohnRich Levine · Becker’s Healthcare Podcast

0:01
This is where health care leadership comes together.
0:04
Becker's sixteenth annual meeting brings more than 3,500
0:07
hospital and health system executives and nearly 800
0:10
speakers to Chicago
0:12
April.
0:14
This series event includes keynote conversations with Dallas
0:17
Cowboys legend Troy Aikman and former president George
0:20
w Bush. For the agenda and event details,
0:22
visit beckershospitalreview.com
0:25
and click on the events tab in the
0:26
upper right. We're looking forward to hosting you
0:29
in Chicago.
0:31
Hi, everyone. You're listening to the Becker's Healthcare
0:34
podcast.
0:35
Thank you so much for tuning in to
0:37
this episode.
0:38
I'm Eric Carbajal, an editor with Becker's Hospital
0:41
Review.
0:42
And today, we're honored to be joined by
0:44
John Rich Levine, chief nursing officer of Reeves
0:47
Regional Health in Texas.
0:49
John Rich, thank you for joining us today.
0:52
Thank you, Erica. Good morning to you, and,
0:54
thank you for having me today.
0:56
Yeah. Good morning. Pleasure to have you on.
0:59
Can you start by talking about an issue
1:02
that is perhaps taking up most of your
1:05
time and energy as CNO right now and
1:07
how you're navigating that?
1:10
Yes. Of course.
1:11
Right now, most significant
1:14
focus for us in in our place is
1:17
workforce stability,
1:20
because we want to
1:22
be able to stabilize our workforce while building
1:25
long term
1:26
nursing infrastructure in a rural environment. So
1:30
the Reeves Regional Health is a small hospital.
1:33
It is an important,
1:36
hub
1:37
for patient care in the area because we
1:40
are located,
1:41
in a geographical
1:43
location where we are the only hospital within
1:46
100 mile
1:47
radius. And so in that context,
1:50
one vacancy can shift the entire operational rhythm
1:54
for us. So every staffing decision that we
1:56
make, it carries financial,
1:59
crucial, and even clinical impact, and they they
2:02
happen almost at the same time.
2:05
And at this point, I'm navigating it by
2:08
shifting from
2:09
reactive
2:10
staffing management
2:11
to a structural
2:12
design approach that we've tried to
2:15
figure out. We are strengthening charge nurse leadership.
2:19
We have a charge nurse leadership program that
2:21
we just launched. And then we are tightening
2:24
onboarding processes,
2:26
and we're also aligning our staffing models
2:29
with patient acuity rather than on the tradition
2:32
that we've been used to for years and
2:34
years. As you can tell, probably
2:37
a lot of our listeners have can tell
2:39
that, the Reeves Regional Health has been in
2:41
existence for over sixty five years.
2:44
I also spend a great deal of time
2:46
on visibility.
2:48
When teams see leadership, I understand
2:51
that when leaders
2:52
listen
2:53
and make decisions with clarity and
2:57
and, all of that kind of thing,
2:59
stability
3:00
for the workforce
3:02
follows. And I really believe in that because
3:05
I see that in rural health care, culture
3:07
drives retention more
3:09
than compensation
3:11
alone.
3:11
We cannot compete with bigger citizen, bigger medical
3:14
centers in terms of probably
3:17
compensation, but we can at least work on
3:19
the culture that drives our retention.
3:22
Yeah. Absolutely, John Rajan. I know you mentioned
3:25
streamlining and tightening those onboarding processes. I think
3:28
that's something we tend to hear a lot
3:31
about right now from chief nursing officers. Can
3:33
you share a little bit more about why
3:36
that's so important right now and how that,
3:38
you know, factors into
3:40
retention, especially among earlier career nurses?
3:44
We know that earlier
3:46
career nurses, they
3:48
they move a lot. It's a different kind
3:50
of generation. It's a generation that we welcome,
3:53
but it's also the a generation that we
3:55
wanna learn so that we know how to
3:57
lead them.
3:58
And,
4:00
the most
4:01
obvious
4:02
characteristic
4:03
is movement.
4:04
And so we've been moving a while back,
4:07
And now that we have this kinds of
4:10
workforce,
4:11
we want to even
4:12
capitalize on movement.
4:14
There is always something that,
4:18
help me recall when people will say about
4:22
why do we need to train them? They
4:23
are going to go away anyway.
4:26
And the deeper question for me is
4:29
if we
4:30
we train them
4:32
and they stay,
4:34
That is the most stupid thing we can
4:35
do to ourselves. It's like a punishment to
4:38
ourselves.
4:39
And if we train them and they leave,
4:41
then it is better for them that we
4:43
set them up for success in their next
4:45
phases. So,
4:47
there's always a movement, but what what we
4:50
have, not everyone is designed to be in
4:52
a certain place at a certain time,
4:54
only those who are designed for that. Because
4:57
if we force it, then we're really creating
4:59
a barrier for them to move forward. So
5:03
that's my,
5:04
idea about those movements and newer nurses and
5:08
how to lead them in this health care
5:10
setting at this time.
5:12
Yeah. Certainly. And I know you mentioned just
5:14
the challenges with,
5:16
you know,
5:18
staffing stability
5:19
across the board, but even more so felt
5:21
in rural areas and how one shift can
5:24
can really affect the operational
5:26
rhythm as you put it. So
5:28
what do you feel like has been a
5:30
true differentiator
5:31
for Reeves Regional when it comes
5:34
to attracting and retaining nurses in in the
5:36
rural environment? I know you pointed to culture.
5:39
Can you expand a little bit about, you
5:41
know, the specific components
5:43
of that and what seems to really resonate
5:45
with the nursing staff?
5:47
Yeah. So, what I meant by that is
5:50
that,
5:51
our differentiator
5:52
is our ownership.
5:55
In rural hospitals well, I come from a
5:58
big, big hospital before I came here, and
6:02
so there's a big shift for me. But
6:04
I'm
6:05
doing my homework and understanding what rural hospital
6:08
is. And in that context,
6:10
nurses see the full continuum of care in
6:13
rural hospitals.
6:14
They know their patients personally. They shop with
6:17
them. They meet them in the aisles. They
6:19
go to church with them. They influence
6:21
operational decisions directly.
6:24
And to me, that level of voice and
6:26
impact is very powerful.
6:29
They own their own patients.
6:31
So in that context, we focus on three
6:33
things. First, we want to establish leadership with
6:37
accessibility.
6:38
Nurses can walk into my office. They can
6:40
just go in there. There's no need for
6:42
them to set up an appointment or that
6:44
they could do that, and they see decision
6:46
making in action.
6:48
The second part is the skill expansion.
6:51
The rural nurses develop broad competencies
6:54
weekly, so we can't,
6:57
compartmentalize
6:58
them and specialize them too much because their
7:02
growth is accelerated
7:04
because of their, ability to expand.
7:07
The other one is
7:09
cultural clarity, which ties up to what I
7:11
said before. We are intentional about accountability
7:15
and respect. We address issues early. We celebrate
7:18
performance openly because it's just us
7:21
around our community.
7:23
And, to me,
7:25
even if rural nursing is demanding,
7:28
it does help deeply
7:30
ingrain to us meaning into what we do,
7:33
and that's what we lean in, meaning and
7:36
ownership
7:37
to what we do. It is us. It
7:39
is ours, and no one will come in
7:41
come here to save us but us.
7:44
Yeah. And and I love what you mentioned
7:47
just about the
7:49
being so close to the decision making and
7:51
and being able to having such close
7:54
access to leaders in rural settings is something
7:56
that really stands out,
7:59
especially in the context of just seeing so
8:01
many reports
8:02
and surveys, data
8:04
that speak to how nurses want to be
8:06
involved directly in the decisions that affect their
8:08
practice, and it sounds like that can be
8:10
something that is, you know, a true differentiator
8:12
in in rural hospitals.
8:14
Well, Don Rich, I wanted to ask you
8:16
as well just about a topic we've been
8:18
obviously covering a lot of in the news,
8:20
which is how hospitals are anticipating seeing a
8:23
rise in in uncompensated
8:25
care with the lapse of ACA premium tax
8:27
credits
8:28
and looming cuts to Medicaid spending. So Yeah.
8:31
How are you preparing for the possibility of
8:35
caring for more uninsured or underinsured patients from
8:38
a nursing and care delivery standpoint? You know,
8:41
we cover a lot about this from the
8:43
financial lens, but curious, you know, from that
8:44
clinical and operational standpoint, what this looks like.
8:49
Yeah. The it's funny that you asked me
8:50
that question because yesterday, we had a a
8:53
in person meeting with
8:55
a congressman in our area, and we asked
8:57
those questions. And there are people who ask
8:59
similar questions as well. And I can feel
9:02
that he has a hard time
9:04
creating a generic answer to those different questions
9:08
that mean only one. And but to me,
9:11
preparation begins with operational
9:14
efficiency, if you know what I mean. We
9:16
are standardizing our workflows. We are strengthening
9:20
documentation accuracy. We are improving throughput by reducing
9:25
waste of supplies and materials and even time.
9:29
Every minute we save supports our sustainability
9:32
because we depend largely
9:35
on being sustainable
9:37
by utilizing the limited resources that we have.
9:40
The second is we are strengthening case management
9:43
integration.
9:44
Early discharge planning,
9:46
we we wanna be more aware of that.
9:49
We are want to be more aware or
9:52
increase our awareness on social determinants of health
9:56
to reduce readmissions
9:58
and avoidable,
10:00
utilization of our swing bed program, for example.
10:03
Third, we are focusing on cross training. I
10:06
just launched it last week. A flexible nursing
10:09
workforce, I believe, allows us to absorb volume
10:12
fluctuations
10:13
within different units without compromising our safety. So
10:17
we cross train are you from the ER?
10:19
Cross train the medsurg, ICU, OB, different areas
10:23
that are just versatile.
10:25
And then,
10:26
because we know that financial pressures are real,
10:29
and we can feel it in our area,
10:31
The response must be to us disciplined operations
10:35
paired with compassionate care.
10:37
And sometimes we feel like, no. They don't
10:40
one can exist, but not the other. And
10:42
the challenge that we're facing is to make
10:44
both coexist
10:46
for the disciplined operations and being
10:49
owning it and being a steward of it,
10:52
but also
10:53
displaying or deliver delivering
10:56
compassionate care.
10:58
Yeah. Certainly. I think,
11:00
Neemai here with us, especially when chatting with
11:03
clinical leaders is, you know, the environment that
11:05
hospitals are operating now has just made it
11:07
has just elevated the importance of the operational
11:10
efficiency and the ability to provide the best
11:13
care possible, if anything. So it's been interesting
11:15
to follow this.
11:17
John Rich, what is one policy shift or
11:20
perhaps workforce trend that you believe might have
11:23
the biggest effect on the nursing workforce in
11:26
rural America
11:27
in the next few years? What should leaders
11:30
maybe be paying some closer attention to right
11:32
now?
11:34
I would think that is the
11:36
the shift towards nurse workforce regulation
11:40
without operational new ones
11:43
that could, significantly impact rural hospitals.
11:47
We are,
11:48
for example,
11:49
us, for example, particularly, because we are in
11:52
the middle of what what you call nowhere.
11:55
The people that are coming to us can
11:56
come and go,
11:58
you know, and and then pretty much there
12:00
will be no more coming,
12:02
and therefore, we are stuck. And so we
12:04
wanna be able to
12:07
to regulate our workforce
12:10
without
12:11
so much of those new ones like immigration,
12:15
you know, visa processing for international hires,
12:19
for out of state that what what do
12:21
they need in order to come to us?
12:23
It's very expensive.
12:24
But what we're looking is that mandated ratios
12:27
or, broad federal staffing models, They may work
12:31
differently in urban tertiary centers,
12:34
but ours is a 25 bed rural facility,
12:37
and it may not apply. So what I'm
12:38
saying is that there's no such thing to
12:41
us as copy and paste because what works
12:44
in others may not work for us. We
12:46
can create our own models.
12:49
And in that context, leaders should pay close
12:51
attention to flexibility.
12:53
As rural health care depends on adaptable
12:57
staffing models,
12:58
we should be able to align with census
13:01
fluctuations, and that shouldn't scare us, but a
13:04
welcome
13:05
change in the dynamics of day to day
13:08
operations. And at the same time,
13:10
work workforce expectations,
13:13
they are evolving. As you can tell, we
13:15
have different,
13:16
generations in one team. Nurses are seeking also
13:20
career progressions. They ask me if they how
13:24
how so soon can they become manager
13:27
at the day they are interviewed, and it's
13:30
just amazing that people think that way. Back
13:33
in the days, it would take two, five
13:35
years to be able to to manage. Now
13:37
we have a six month old
13:40
nurse, six months in terms of their experience,
13:43
and they are ready to become charged nurses.
13:45
So
13:46
autonomy,
13:46
work life alignment,
13:48
system that integrate leadership development, and transparent career
13:52
pathways will attract
13:54
and, I believe, will retain talent more effectively
13:56
than those relying solely on pay incentives.
14:00
That's what I thought it was.
14:02
Yeah, John Rich. And I think that just
14:04
speaks to, again, a lot of what we're
14:06
hearing about is nurses coming in and wanting
14:09
to see that clear
14:11
career progression very quickly when they wanna be
14:13
able to envision exactly what that could potentially
14:17
look like.
14:18
Well, John Rich, to close us out here,
14:20
can you share
14:21
a leadership practice or mindset that has been
14:24
most important to your success in your career,
14:27
a piece of advice that you'd offer to
14:29
aspiring nurse leaders?
14:31
Yes. Of course, Erica. The the the thing
14:34
that I could say about this is
14:36
that my experience has taught me clarity
14:39
under pressure.
14:42
As a leader in health care,
14:44
I can tell that complexity is almost
14:47
always the constant.
14:50
My team look for steadiness.
14:52
They always watch how I respond when the
14:55
stakes are high. So, for those leaders out
14:58
there that are similarly situated,
15:00
my advice would be operational
15:03
fluency.
15:04
You wanna understand
15:06
finance. You wanna understand quality metrics and how
15:09
they work. You wanna understand
15:11
workforce analytics. Some people call that predictive analytics,
15:15
but you wanna understand what it is about.
15:17
Clinical expertise alone does not sustain an executive
15:20
leader.
15:21
Second thing I want to, make mention is
15:24
to
15:25
invest in relationships
15:27
because relationships
15:29
matter before crisis moments arrive. You
15:32
wanna establish trust.
15:34
You wanna build trust early on, and it
15:37
becomes your currency
15:39
in dealing with difficult decisions. And finally,
15:43
I would
15:44
say stay close to the bedside.
15:47
Leadership credibility grows when teens know that you
15:51
yourself understand
15:52
their reality, and sometimes I jump in there
15:55
and ask to give me a patient that
15:58
I can take care of just to know
16:00
to make to make them see and know
16:02
that I understand
16:03
them fully, and here I am doing the
16:05
same things that they're doing.
16:08
John read some great closing remarks there. Thank
16:11
you very much for carving some time out
16:13
of your schedule to join us on the
16:16
podcast.
16:17
Look forward to continuing to follow the work
16:19
that you're leading at Reeves Regional.
16:22
Thank you. Thank you, Erica, for having me.
16:23
Have a great day.