Latest / Becker’s Healthcare Podcast / Kathleen Sanford on Nurse Retention, Virtual Care and Workforce Transformation

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Kathleen Sanford on Nurse Retention, Virtual Care and Workforce Transformation · Becker’s Healthcare Podcast

• 0:02
  - The strategic agenda facing hospital and health system
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  - Hi, everyone, and welcome to the Becker's Healthcare
• 1:00
  - Clinical Leadership podcast.
• 1:02
  - I'm Mackenzie Bean, associate vice president and managing
• 1:06
  - editor of Becker's Hospital Review.
• 1:08
  - Today, I'm so thrilled to be joined by
• 1:10
  - Doctor. Kathleen Sanford, who is senior executive vice
• 1:13
  - president and chief nursing officer of CommonSpirit Health.
• 1:17
  - Doctor Sanford, thank you so much for joining
• 1:19
  - us on the podcast today. How are you
• 1:20
  - doing?
• 1:22
  - I'm doing great and I'm very glad to
• 1:23
  - be here. Thanks for the invitation.
• 1:26
  - We're glad to have you, and I'm excited
• 1:28
  - to dive into more of the work that
• 1:30
  - you've been doing at CommonSpirit
• 1:31
  - this year. But before we do that, I'd
• 1:33
  - love to turn the floor over to you
• 1:34
  - just to share a little bit more about
• 1:36
  - your role for our listeners.
• 1:39
  - Well, I am privileged to be the chief
• 1:42
  - nursing officer for CommonSpirit Health.
• 1:45
  - Previous to that, I was in one of
• 1:47
  - the two,
• 1:48
  - companies that came together to make CommonSpirit Health
• 1:51
  - in 2019.
• 1:52
  - And so I've been with the company since
• 1:54
  - 2006.
• 1:56
  - As the chief nursing officer, I serve on
• 1:58
  - the executive leadership team for the for the
• 2:00
  - entire company, and I have the privilege again
• 2:03
  - of leading all nursing across the system, including
• 2:06
  - informatics,
• 2:08
  - including
• 2:09
  - quality and safety in the nursing areas and
• 2:11
  - and,
• 2:13
  - patient experience for the entire company.
• 2:15
  - It's a pretty big job, but it's what
• 2:18
  - nurses do. Right? That's what nurse leaders do.
• 2:20
  - They they do all kinds of things that
• 2:21
  - have to do with taking care of patients
• 2:23
  - and making sure that we're giving the people
• 2:25
  - who we serve the very very best and
• 2:27
  - excellent care.
• 2:29
  - Exactly. You are you're shaping
• 2:32
  - care and the care that patients receive in
• 2:34
  - so many important ways in your role which
• 2:37
  - I really admire.
• 2:38
  - As you said you're really leading across such
• 2:41
  - a large
• 2:42
  - footprint and workforce. I'd love to zoom in
• 2:45
  - on the workforce.
• 2:46
  - Nurse vacancy turnover rates
• 2:49
  - are obviously a huge focus for nursing executives
• 2:52
  - today. Can you talk about,
• 2:54
  - where CommonSpirit is sitting right now with those
• 2:57
  - focuses compared to last year?
• 3:01
  - I can and thank you for asking because
• 3:03
  - we're pretty happy with what's been happening.
• 3:05
  - We have about 50,000
• 3:07
  - nurses across the entire system. So there there
• 3:10
  - is a there is turnover that just happens.
• 3:12
  - Right? But we've done a lot of things
• 3:14
  - to try to make sure that we could
• 3:16
  - mitigate that as much as possible and that
• 3:18
  - we could keep nurses working for us because
• 3:21
  - we want them to be happy working for
• 3:22
  - us and wanting to work for us and
• 3:24
  - wanting to
• 3:25
  - to be a part of CommonSpirit Health. So
• 3:28
  - we've seen a measurable improvement in vacancy and
• 3:31
  - turnover rates,
• 3:32
  - across our hospitals and across our clinics. We
• 3:34
  - keep track of that very carefully. So in
• 3:37
  - the last year,
• 3:38
  - our
• 3:39
  - RN turnover rate has been reduced by 14%.
• 3:44
  - Our resignation rate has been,
• 3:46
  - reduced 11%,
• 3:49
  - and we've had an 81%
• 3:51
  - increase
• 3:52
  - in new hire retention rate.
• 3:55
  - So, we get a lot of feedback from
• 3:57
  - nurses about why that has been happening, and
• 4:00
  - they talked about
• 4:02
  - they have been telling us and talked about
• 4:04
  - the fact that they like it, that nurses
• 4:05
  - have a voice at all levels in our
• 4:08
  - organization.
• 4:09
  - So,
• 4:10
  - we have a voice all the way from
• 4:12
  - the front line to the CEO. We have
• 4:14
  - shared governance on the floors,
• 4:16
  - and we have,
• 4:18
  - shared governance at our nursing executive council, which
• 4:21
  - is for for at the national level. And
• 4:25
  - our chief nursing officer,
• 4:27
  - serves at, as I said, at the executive
• 4:29
  - leadership team at the very highest level. That
• 4:31
  - sends a message to nurses, and I think
• 4:33
  - that's one reason one of the reasons that
• 4:36
  - we've been fortunate to have decreased so much
• 4:38
  - in our vacancy and turnover.
• 4:41
  - Yeah. Those
• 4:42
  - are very significant
• 4:43
  - results. You said overall
• 4:45
  - turnover rate of 14%. I'm curious as you're
• 4:49
  - thinking through all of the strategies that you've
• 4:51
  - initiated over the past year plus,
• 4:53
  - what do you think has truly moved the
• 4:55
  - needle most on retention? You mentioned the shared
• 4:57
  - governance and nurses really feeling like their voices
• 5:00
  - is heard, but if you I'd love to
• 5:01
  - have you expand on that one bit more.
• 5:04
  - Well, I have a theory that you don't
• 5:06
  - just do one or two things to try
• 5:08
  - to make the world of nursing better and,
• 5:12
  - more fulfilling for the individuals
• 5:14
  - and for the whole groups of nurses.
• 5:17
  - So we have,
• 5:18
  - a strategic plan.
• 5:20
  - We we started our first strategic plan to
• 5:22
  - help us support retention and to ensure that
• 5:25
  - nurses have a voice,
• 5:27
  - and that's helped us focus on the variety
• 5:29
  - of things that, have worked. However, I believe
• 5:32
  - that you can't just look at one piece.
• 5:35
  - You have to look at the total package.
• 5:37
  - And so the things that we've been doing
• 5:39
  - the last five years in our first strategic
• 5:41
  - plan included virtual care,
• 5:44
  - a brand new nursing residency,
• 5:46
  - and a variety of other practices that we
• 5:49
  - think make nursing a better job.
• 5:52
  - It's it's a rewarding job anyway, but even
• 5:55
  - more
• 5:56
  - rewarding job.
• 5:57
  - So,
• 5:58
  - when we determine our strategic priorities, we make
• 6:01
  - sure that the nurses have a part in
• 6:03
  - it. And like I said, we just finished
• 6:05
  - our first five year plan in which we
• 6:08
  - developed our first strategic plan, and we're in
• 6:10
  - the process right now of doing our second
• 6:13
  - plan.
• 6:14
  - We've been fortunate because we had 30,000
• 6:17
  - of our nurses
• 6:19
  - respond to a survey
• 6:21
  - where they ranked the 11 priorities
• 6:24
  - that they thought would be the next best
• 6:27
  - strategic plan to meet our goal, which is
• 6:30
  - to be the employer of choice for nurses
• 6:33
  - in an organization
• 6:34
  - that is known for outstanding care. And I
• 6:36
  - know a lot of other systems have similar
• 6:38
  - similar
• 6:39
  - goals,
• 6:40
  - but that's our goal.
• 6:42
  - And the ones that so if I had
• 6:44
  - to talk about just a few of those
• 6:46
  - that have worked, the first one would be
• 6:47
  - my virtually hour, virtually integrated care
• 6:51
  - that is one of our most meaningful
• 6:53
  - retention levers. We have a virtual model where
• 6:56
  - experienced nurses provide remote support for admissions, discharges,
• 7:01
  - medication reconciliation,
• 7:02
  - real time
• 7:03
  - consultation with the nurses
• 7:05
  - and with the medical staff,
• 7:07
  - and that's just transformed
• 7:09
  - our work our workload equation at the bedside.
• 7:12
  - What we've been hearing, which makes me believe
• 7:15
  - this is one of the most
• 7:17
  - most important
• 7:19
  - changes that we made in our strategic plan,
• 7:22
  - is that the nurses tell us they feel
• 7:23
  - less alone, they feel more supported, and they
• 7:26
  - have a virtual nurses part of the team.
• 7:29
  - And those who go into the virtual programs
• 7:33
  - to be virtual nurses
• 7:35
  - see it as a pathway to stay in
• 7:37
  - clinical practice
• 7:39
  - when they've gotten
• 7:41
  - a little bit tired of the physical demands
• 7:43
  - of the bedside.
• 7:44
  - It's also,
• 7:45
  - been proven to be a safety net for
• 7:47
  - us for our newer nurses,
• 7:49
  - which really helps with our new grad experience.
• 7:52
  - The other one that I think has really
• 7:54
  - helped is our nurse residency program. It's been
• 7:57
  - transformative for retention. I mentioned that the the
• 8:00
  - biggest change in our retention is in our
• 8:02
  - first year
• 8:03
  - nurses
• 8:04
  - right out of school,
• 8:06
  - and we have a structured residency program. It's
• 8:10
  - worked on it's, put together with evidence based
• 8:13
  - frameworks.
• 8:14
  - It gives new graduates a supported
• 8:16
  - transition rather than just throwing them into the
• 8:18
  - deep end. I think some of the people
• 8:20
  - listening may remember when they started in nursing
• 8:23
  - and you just kinda got out of school
• 8:25
  - and you went on the floor and you
• 8:26
  - were supposed to know what to do and
• 8:29
  - figure it out. But we've learned that by
• 8:31
  - having a one year long residency
• 8:34
  - program
• 8:35
  - with
• 8:36
  - better trained
• 8:38
  - nurses that are specially trained to take care
• 8:41
  - of
• 8:42
  - the new grads in every way, take care
• 8:45
  - of their learning, but also in the emotional
• 8:47
  - needs that they have when they come into
• 8:48
  - a new job like this.
• 8:50
  - We believe that this has been,
• 8:53
  - exactly what we've needed to get this done,
• 8:55
  - and our data tells us it is. The
• 8:57
  - nurses who complete the residency have significantly
• 9:00
  - higher rates of, retention in the first year,
• 9:03
  - but also in the second year. So, we're
• 9:06
  - very happy with those two things. But, again,
• 9:08
  - I wanna repeat,
• 9:10
  - you have to look at everything together, the
• 9:12
  - entire picture of what you're doing to make
• 9:15
  - the nursing environment,
• 9:18
  - a better place to work. And you can't
• 9:20
  - just
• 9:21
  - signal single out
• 9:23
  - one or two things because they all work
• 9:26
  - together.
• 9:26
  - Mhmm. Is that what you're asking? Yeah. That
• 9:29
  - makes sense. Sounds like virtual integrated care and
• 9:32
  - the nurse residency programs were two major levers
• 9:35
  - in supporting retention,
• 9:38
  - but as you said really those when you
• 9:40
  - zoom out are two pieces of a much
• 9:41
  - larger puzzle and there's so many important factors
• 9:44
  - that go into that.
• 9:46
  - I'm curious with the nurse residency program. You
• 9:48
  - mentioned that 81% increase over the past year
• 9:51
  - in terms of new hire retention rate. Did
• 9:54
  - you change anything in the nurse residency program
• 9:56
  - on this iteration of the strategic plan to
• 9:59
  - help achieve that?
• 10:02
  - Yes. We did. We made it longer. We
• 10:03
  - made it a full year, number one. We
• 10:06
  - hired a coach for first year
• 10:10
  - for their careers so that they could,
• 10:12
  - have someone to go to just to talk
• 10:14
  - about what they might wanna do long term.
• 10:16
  - We're just just coaching them and just talking
• 10:18
  - to them about it. Something like you had
• 10:20
  - in high school when you had counselors that
• 10:23
  - tried to help you figure out what you
• 10:25
  - wanted to do. We we try to help
• 10:27
  - the nurses figure out what they wanna do
• 10:28
  - with their careers.
• 10:29
  - We also use virtual nurses and virtual
• 10:33
  - preceptors
• 10:34
  - so that a nurse on any shift has
• 10:36
  - someone that they can get a hold of
• 10:38
  - virtually if they have questions during that first
• 10:41
  - year or any time in their career actually,
• 10:43
  - but it's especially important to the to the
• 10:45
  - new,
• 10:46
  - graduates.
• 10:47
  - So those were two major changes. One, having
• 10:50
  - a coach
• 10:51
  - three major changes. A longer period of time
• 10:53
  - in a residency program, having a coach, and
• 10:56
  - having virtual availability
• 10:58
  - to more experienced nurses.
• 11:01
  - Mhmm. I've heard from so many
• 11:04
  - nursing executives of how crucial support is in
• 11:08
  - the first year for new nurse graduates and
• 11:10
  - really how creating that psychologically
• 11:12
  - safe environment for them to speak up when
• 11:14
  - they might need more training or have questions
• 11:17
  - can go such a long way to, you
• 11:19
  - know, having them want to stay. That's great
• 11:23
  - to hear.
• 11:24
  - I'm curious what advice would you
• 11:27
  - give to a nurse who's just starting out
• 11:29
  - in 2026? What do you wish you could
• 11:31
  - tell them?
• 11:32
  - Well, the first thing I'd like to tell
• 11:34
  - them is that they're coming into
• 11:36
  - nursing at a time of genuine transformation. If
• 11:37
  - they come from a family of nurses and
• 11:37
  - their parents or their mother,
• 11:40
  - nurses and their parents or their mother or
• 11:42
  - their father tell them what nursing was like
• 11:44
  - when they graduated, it's not gonna be the
• 11:46
  - same.
• 11:47
  - It's a challenging time. It's an extraordinary time,
• 11:50
  - and I think that the profession is changing
• 11:53
  - faster than any point in my fairly long
• 11:56
  - career.
• 11:57
  - So,
• 11:58
  - lots of change.
• 12:00
  - I I would also tell them as they
• 12:02
  - look for that first job,
• 12:04
  - they should look for an organization that does
• 12:06
  - have a structured nurse residency program
• 12:09
  - because that first year is going to define
• 12:12
  - their early career trajectory,
• 12:14
  - and it's also going to help them decide
• 12:16
  - to stay in nursing.
• 12:18
  - Because if you've got the support at the
• 12:20
  - beginning, that has given you a transition that
• 12:23
  - makes your entire career, become more rewarding.
• 12:27
  - Mhmm. I'd also tell them, and I don't
• 12:29
  - know that I have to tell them grads
• 12:30
  - just because they may have figured it out.
• 12:32
  - Technology is going to be their partner, not
• 12:34
  - their replacement. They're going to be learning new
• 12:37
  - tools that are designed to give them more
• 12:39
  - capacity Because
• 12:41
  - when
• 12:42
  - you
• 12:43
  - make
• 12:44
  - changes
• 12:44
  - and
• 12:45
  - you
• 12:46
  - bring
• 12:47
  - in
• 12:48
  - technology,
• 12:49
  - sometimes
• 12:50
  - it
• 12:51
  - doesn't work. Because when you make changes and
• 12:54
  - you bring in technology, sometimes it doesn't work.
• 12:56
  - So I'd like the new grads as well
• 12:58
  - as all nurses to tell us what's working
• 13:00
  - and what's not.
• 13:03
  - I will
• 13:04
  - tell them it's important to find their own
• 13:06
  - community early because your best support are the
• 13:09
  - nurses around you. It's a team. It's teamwork.
• 13:13
  - And those relationships that they they they make
• 13:16
  - in their very first year is going to
• 13:19
  - sustain them on on the times when sometimes
• 13:21
  - nursing is hard because we have to admit
• 13:23
  - it is a hard job.
• 13:26
  - It's physically
• 13:27
  - demanding and it is also emotionally demanding.
• 13:30
  - So find a community early, find people to
• 13:33
  - support you, find people who you can talk
• 13:35
  - to.
• 13:36
  - I also wanna tell them to ask for
• 13:38
  - help when they need it. When you come
• 13:40
  - out of school, you really are not you
• 13:42
  - are not ready to do everything all by
• 13:44
  - yourself. And throughout your career, you need to
• 13:47
  - speak up when you think something's unsafe.
• 13:50
  - You need to talk to,
• 13:53
  - other nurses about,
• 13:55
  - help that you need and go to people
• 13:57
  - when you don't know something and get the
• 13:58
  - support that you'll need.
• 14:00
  - And then I wanna really, really remind them
• 14:03
  - that people choose nursing, and the new grads
• 14:05
  - are choosing nursing
• 14:07
  - because it matters.
• 14:09
  - You're coming into
• 14:11
  - a profession that takes care of people at
• 14:14
  - their most vulnerable times in their lives.
• 14:17
  - And those vulnerable people
• 14:20
  - are why you will want to stay with
• 14:23
  - this career because you're going to make a
• 14:25
  - difference
• 14:26
  - to thousands and thousands of people and,
• 14:29
  - communities
• 14:31
  - in a way that will change their lives
• 14:34
  - for the better.
• 14:36
  - I,
• 14:37
  - also would like to say, because sometimes when
• 14:39
  - people come into nursing, they think that, oh,
• 14:41
  - I'm going to be a bedside nurse forever.
• 14:43
  - And I had the privilege of being, an
• 14:46
  - editor of a nursing journal years ago. And
• 14:48
  - in my last last
• 14:50
  - journal,
• 14:51
  - I had a a topical
• 14:54
  - a topical,
• 14:56
  - edition where I talked about how nurses are
• 14:58
  - always a nurse. I called it,
• 15:01
  - always a nurse, frankly. And
• 15:04
  - nurses don't realize that what they're learning about
• 15:06
  - how they work with people, how they organize,
• 15:09
  - how they adjust to new technology,
• 15:12
  - how they are able to be team players
• 15:16
  - will work for all kinds of professions if
• 15:19
  - they choose to do something different.
• 15:22
  - The the chapter the each chapter that I
• 15:25
  - did in that one journal was by a
• 15:27
  - different nurse who was a nurse CEO, a
• 15:30
  - nurse lawyer, a nurse who was a mayor,
• 15:32
  - a nurse who was a,
• 15:34
  - who went into mission,
• 15:36
  - a variety of things that nurses can do
• 15:38
  - because of what they learn and what they
• 15:40
  - do for other people.
• 15:42
  - It will it translates. It translates
• 15:45
  - in being really well organized,
• 15:47
  - solving problems, and most of all, caring for
• 15:50
  - people, which is what everybody needs in every
• 15:52
  - job.
• 15:54
  - Yeah. It's so clear that
• 15:56
  - not only is nursing such
• 15:58
  - incredibly meaningful work, but there really is so
• 16:01
  - much more diversity and possibility in what a
• 16:04
  - career in nursing
• 16:05
  - can do for someone
• 16:07
  - in this day and age.
• 16:10
  - Yes. So, of course, as a chief nurse
• 16:12
  - executive, I would love it if they if
• 16:14
  - each one of them wanted to forever touch
• 16:17
  - patients and be in in health care. I
• 16:20
  - just want them to understand that they have
• 16:22
  - the variety, and it's a it's a wonderful,
• 16:24
  - wonderful career they've chosen, a wonderful profession.
• 16:27
  - And I think your virtual integrated care program
• 16:29
  - is a good example of of that as
• 16:32
  - well. And it's just clear from speaking with
• 16:34
  - you that
• 16:36
  - CommonSpirit truly is creating
• 16:38
  - a space where nurses do wanna stay and
• 16:40
  - can grow and thrive. So I just appreciate
• 16:43
  - you taking the time to share some of
• 16:44
  - your thoughts around this, doctor Sanford.
• 16:47
  - Well, thank you for asking.