Latest / Becker’s Healthcare - Clinical Leadership Podcast / Strengthening the Nursing Workforce Through Education and Innovation with Melanie Heuston, DNP, RN

Transcript

Strengthening the Nursing Workforce Through Education and Innovation with Melanie Heuston, DNP, RN · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - Hello, everyone, and welcome to the Becker's Healthcare
• 0:02
  - Clinical Leadership podcast.
• 0:04
  - I'm Mackenzie Bean, assistant vice president and managing
• 0:07
  - editor of Becker's Hospital Review.
• 0:09
  - Today, I am very thrilled to be joined
• 0:11
  - by doctor Melanie Houston, who is the inaugural
• 0:14
  - chief nurse executive at WVU
• 0:16
  - Medicine.
• 0:17
  - We're also very honored to have Melanie as
• 0:19
  - a member of our nurse executive advisory board.
• 0:22
  - Melanie, thanks for joining us on the podcast.
• 0:24
  - How are you doing today?
• 0:26
  - I'm great. Excited to talk with you about
• 0:28
  - nursing and how Beckers can work together.
• 0:32
  - Yeah. I'm I'm very excited for the conversation
• 0:34
  - both today and on going through our board.
• 0:37
  - I'm hoping you can just start off before
• 0:40
  - we dive into really the conversation around a
• 0:42
  - lot of the innovative work you're doing around,
• 0:45
  - nursing workforce and more of really just sharing
• 0:48
  - a little bit more about yourself and your
• 0:49
  - role at WVU Medicine for the listeners.
• 0:53
  - Well, I started at WVU Medicine four years
• 0:56
  - ago as the inaugural chief nursing executive for
• 0:59
  - the health system.
• 1:00
  - And
• 1:01
  - my role at the health system is really
• 1:03
  - to look at the innovative work that we
• 1:06
  - can do as a health system
• 1:07
  - that each individual hospital could not really do
• 1:10
  - on their own because they're busy running an
• 1:12
  - organization.
• 1:13
  - I try and bring us together
• 1:15
  - to have systemness with individual autonomy.
• 1:18
  - I've been a nurse for over forty years,
• 1:21
  - and I have been in nursing leadership roles
• 1:24
  - for over twenty years. And the focus of
• 1:26
  - my career and not exactly by design, but
• 1:29
  - by interest and love and passion has always
• 1:33
  - been workforce development.
• 1:34
  - I've loved working in hospitals
• 1:36
  - and leading clinical disciplines and leading organization,
• 1:40
  - but inevitably in my career and almost every
• 1:43
  - aspect, workforce development has stood out as something
• 1:46
  - that's a passion of mine.
• 1:48
  - Well, so let's zoom into that exact piece
• 1:51
  - on workforce development.
• 1:53
  - Can you talk through how you're thinking about
• 1:54
  - that at WVU Medicine? What are some of
• 1:57
  - the more innovative ways that you are working
• 1:59
  - to increase the supply of nurses coming to
• 2:01
  - the health system?
• 2:03
  - The shortage of nurses is not going away.
• 2:06
  - We know that there's more nurses coming out
• 2:09
  - than there had been in the past.
• 2:11
  - There is really a big uptick in nurses
• 2:14
  - going to nursing school. That's the good news.
• 2:17
  - The bad news is is there's fewer nurses
• 2:20
  - going into bedside nursing care because there are
• 2:22
  - so many options for nursing, which is wonderful.
• 2:24
  - Please don't get me wrong.
• 2:26
  - I love that for our profession.
• 2:29
  - But as we look at the increase in,
• 2:31
  - nursing school enrollments,
• 2:33
  - we need to continue to be focused on
• 2:35
  - creating bedside nursing roles that are appealing
• 2:39
  - because that's where our need is, is bedside
• 2:41
  - nursing care. As our patients get sicker and
• 2:43
  - sicker, every hospital that I talk to, our
• 2:47
  - WVU Medicine and all our colleagues across the
• 2:50
  - country
• 2:50
  - are facing shortages,
• 2:52
  - EDs that are very busy,
• 2:55
  - filling all their units. And the one thing
• 2:57
  - we all have in common is vacancies in
• 2:59
  - bedside caregivers.
• 3:01
  - So,
• 3:02
  - the philosophy of WVU Medicine is really, like,
• 3:05
  - let's try and think out of the box.
• 3:07
  - Some of the same solutions that's been working...
• 3:09
  - That haven't been working for the past ten
• 3:11
  - years aren't gonna be working now. And so
• 3:13
  - we've created some innovative programs that I'm really
• 3:16
  - excited about. We ready for me to share
• 3:18
  - that? Please. I would love to hear about
• 3:20
  - them.
• 3:21
  - I could talk about it for a long
• 3:23
  - time, but I will give you the, like,
• 3:25
  - couple minute version
• 3:26
  - of the two programs we've put together that
• 3:29
  - I think are innovative.
• 3:31
  - The Aspiring Nurse Program,
• 3:33
  - we started
• 3:34
  - about three years ago, and we pair academic
• 3:37
  - organizations
• 3:38
  - up with one
• 3:40
  - with one hospital and really strengthen that relationship.
• 3:44
  - But we have also,
• 3:45
  - as we have looked at barriers for students
• 3:48
  - finishing school
• 3:49
  - or entering nursing school are similar to the
• 3:52
  - social determinants of health as the patients that
• 3:54
  - we see.
• 3:55
  - Potentially,
• 3:57
  - funding for tuition or could be housing
• 4:00
  - security, or it could be I need to
• 4:02
  - pay childcare.
• 4:03
  - So what we've done is we've created a
• 4:06
  - program where the nurses agree to work for
• 4:08
  - us for three years. We give them $5,000
• 4:11
  - each semester
• 4:13
  - to spend on whatever they need to help
• 4:15
  - them through nursing school.
• 4:17
  - And then they get $5,000
• 4:18
  - when they start. But outside of the money,
• 4:21
  - we've created what I call a human centered
• 4:23
  - design program where they have a connection
• 4:26
  - every month with somebody in the organization who
• 4:28
  - checks in on them, helps them look at
• 4:30
  - barriers.
• 4:31
  - They do most of their clinicals in our
• 4:32
  - hospital, so they really become part of our
• 4:34
  - team
• 4:35
  - before they even walk in the door.
• 4:38
  - So there's a lot about that program I
• 4:40
  - would love to share, but that's the meat
• 4:42
  - and potatoes of the program.
• 4:43
  - Today, we have a thousand nurses in this
• 4:45
  - program.
• 4:47
  - We're increasing nursing school enrollment across the health
• 4:49
  - system and across our state.
• 4:52
  - So, really exciting continuing to work. Of course,
• 4:55
  - it is something that is
• 4:58
  - not inexpensive,
• 5:00
  - but we've definitely found an ROI
• 5:02
  - on this program. Mhmm. So that's number one.
• 5:06
  - The second program is a little harder to,
• 5:09
  - get off the ground because it really takes
• 5:11
  - a lot of funding And a little bit
• 5:12
  - controversial, we've created our own diploma school of
• 5:15
  - nursing called the Center for Nursing Education.
• 5:18
  - And it is a nursing,
• 5:21
  - diploma program,
• 5:23
  - but I I would call it, like, with
• 5:24
  - an innovative twist. It's today's program. It's not
• 5:27
  - a program of old. It's contemporary.
• 5:30
  - It's being taught to what nurses are expected
• 5:33
  - today.
• 5:34
  - It is really an amazing program with academic
• 5:37
  - rigor. I mean, this is not a program
• 5:40
  - that I would say is for the faint
• 5:42
  - of heart, but it is really amazing, and
• 5:45
  - it's meant to create bedside caregivers. This is
• 5:47
  - provided free of charge, a 100%.
• 5:50
  - Uniform, stethoscope,
• 5:52
  - laptop,
• 5:53
  - and,
• 5:54
  - we have had, as an example,
• 5:56
  - our first program,
• 5:58
  - which will be graduating May of next year,
• 6:00
  - we had 600
• 6:01
  - applicants for 24 slots. So the interest is
• 6:05
  - there.
• 6:06
  - That's very significant. Clearly, huge, huge
• 6:10
  - demand.
• 6:11
  - What are your plans to grow or expand
• 6:14
  - that program?
• 6:15
  - Well, Mackenzie, that's...
• 6:17
  - Thanks for asking. It is growing quickly.
• 6:19
  - So we started with 24. We've become accredited,
• 6:23
  - and we have been fully accredited by the
• 6:26
  - state board and our our regulatory bodies. We
• 6:29
  - are now going to 48 twice a year
• 6:31
  - in Morgantown. And next year...
• 6:34
  - Well, actually, we're starting right now, we opened
• 6:36
  - up a satellite or an additional instructional site
• 6:39
  - in,
• 6:40
  - Wheeling
• 6:41
  - in West Virginia and Berkeley, which is up
• 6:44
  - east of,
• 6:45
  - the state.
• 6:46
  - We've also seen an overwhelming amount of applicants
• 6:49
  - for that program,
• 6:51
  - and that will be starting next August, but
• 6:53
  - we're taking applications now. So at any point
• 6:56
  - in time, we're gonna have over 200 in
• 6:58
  - our program.
• 6:59
  - So really exciting, and they are all being
• 7:02
  - provided the opportunity to quickly go on and
• 7:04
  - get their bachelor's degree.
• 7:06
  - So that's the expansion. You asked the right
• 7:09
  - question.
• 7:10
  - Yeah.
• 7:11
  - Very exciting. And, you know, you mentioned this
• 7:14
  - is today's program. It's innovative. It's teaching nurses
• 7:17
  - the skills they're gonna need today to thrive,
• 7:19
  - which I think is
• 7:21
  - increasingly being
• 7:22
  - recognized across the country as leaders are seeing
• 7:25
  - nurses come into their first day on the
• 7:27
  - job and maybe don't have that clinical
• 7:30
  - readiness or the critical thinking that's really needed
• 7:32
  - to jump in to practice. Can you talk
• 7:34
  - a bit more about how are new nurse
• 7:36
  - graduates landing at WVU Medicine,
• 7:39
  - and then how are you thinking about retaining
• 7:41
  - them in that critical first year and beyond?
• 7:45
  - So I think it's not a secret that,
• 7:47
  - you know, we, as CNEs across the country
• 7:50
  - and CNOs,
• 7:52
  - do have some concern as health care is
• 7:54
  - so rapidly changing, it's hard for the academic
• 7:57
  - partners to keep up with the pace of
• 7:59
  - change.
• 8:00
  - And so we value our partnerships,
• 8:03
  - but there's a lot of readiness that the
• 8:05
  - health systems
• 8:06
  - have to fill in the gaps
• 8:08
  - because of virtual cares coming and,
• 8:11
  - you know,
• 8:12
  - the change in how patients are coming to
• 8:14
  - us. So we are spending a lot more
• 8:16
  - time with readiness. And that's one of the
• 8:19
  - things our school of nursing,
• 8:21
  - immersion. They know our hospitals. They know our
• 8:23
  - programs.
• 8:24
  - And so,
• 8:25
  - I feel like they're coming out with some
• 8:28
  - gaps in clinical readiness,
• 8:30
  - lots of good education, and wonderful clinical
• 8:34
  - practitioners.
• 8:35
  - We have lots of programs for the first
• 8:36
  - year transition to practice.
• 8:39
  - Many of our hospitals have that year long
• 8:41
  - program. And what we're seeing, Mackenzie, is something
• 8:43
  - a little different. And I think, again, I'm
• 8:45
  - talking to my colleagues across the country. The
• 8:48
  - first year we're keeping people. We've got the
• 8:50
  - transition of practice. They're getting support.
• 8:53
  - It's that two to four year cliff I'm
• 8:54
  - worried about. You know, when those programs change
• 8:58
  - and,
• 8:59
  - they're kind of then two years. And so
• 9:03
  - we are trying right now to design programs
• 9:06
  - to look at that two to four year
• 9:07
  - cliff. What is making them wanna leave? You
• 9:09
  - know, instead of just desperately trying to hang
• 9:11
  - on to them, which we need them, but
• 9:13
  - we need to figure out what makes them
• 9:15
  - wanna stay. Is it an investment in their
• 9:18
  - professional
• 9:18
  - development?
• 9:19
  - Is career,
• 9:20
  - you know, advice and support?
• 9:23
  - Or is it engagement
• 9:24
  - in,
• 9:25
  - you know, leading units? Even though one year,
• 9:28
  - they're not ready to lead a unit, but
• 9:30
  - they've got valuable input. They've got to feel
• 9:32
  - part of the team. They've got to feel
• 9:33
  - acknowledged.
• 9:34
  - So we're right now really trying to what
• 9:36
  - we're calling the two to four year cliff.
• 9:39
  - And can you give any high level insights
• 9:41
  - on
• 9:42
  - what what are some of the motivating factors
• 9:44
  - you've identified as potentially driving them to leave,
• 9:46
  - or what is motivating them to stay in
• 9:49
  - that cliff period?
• 9:51
  - Well, we're still studying it right now.
• 9:53
  - We're trying to learn from other organizations
• 9:56
  - and have those conversations
• 9:58
  - more broadly.
• 9:59
  - Like, we have our, you know, Becker's Nurse
• 10:01
  - Advisory Council that... Those groups are where we
• 10:04
  - all come together.
• 10:06
  - We're really trying to study it right now,
• 10:08
  - but one of our beliefs is nurses at
• 10:11
  - that point in time wanna understand what their
• 10:13
  - next, you know, goals in their career are.
• 10:16
  - Nurses like myself, we weren't thinking about that
• 10:18
  - in two years. We've gotta adjust to think
• 10:21
  - about
• 10:21
  - what opportunities and exposures can they see within
• 10:25
  - our health system that will be within their
• 10:27
  - reach.
• 10:28
  - So they don't automatically think that they need
• 10:30
  - to leave for something greener or immediately go
• 10:32
  - back to school, which, again, we want people
• 10:34
  - to go back to school and get advanced
• 10:36
  - degrees, but we wanna make bedside nursing appealing.
• 10:39
  - We also have to do our role in
• 10:40
  - retention and making sure that care delivery
• 10:43
  - and work environments
• 10:45
  - are what they need. And a lot of,
• 10:47
  - you know, wellness
• 10:48
  - around studying of nursing is really to look
• 10:51
  - at staffing. And so it's kind of a
• 10:53
  - chicken and egg, and that's why focusing on
• 10:55
  - workforce,
• 10:56
  - getting enough nurses to create the right environment.
• 10:59
  - So
• 11:00
  - it's really looking at all those things. But
• 11:02
  - one of our focuses really is looking at
• 11:04
  - that two to four year lift and how
• 11:05
  - we can make it an appealing place to
• 11:07
  - work.
• 11:09
  - That makes sense. We're really thinking through what
• 11:11
  - are all of the factors that are coming
• 11:13
  - in at play here. And you mentioned that
• 11:15
  - peer learning piece is so key to all
• 11:17
  - of this too because many health systems across
• 11:19
  - across the country are going through the same
• 11:21
  - thing right now. Yeah.
• 11:23
  - I wanna talk a little bit about how
• 11:25
  - virtual nursing is showing up in some of
• 11:26
  - your workforce strategy. I know for many health
• 11:29
  - systems, that can be an effective way to
• 11:32
  - retain nurses who maybe don't necessarily still want
• 11:34
  - to be at the bedside, but, you know,
• 11:36
  - are still passionate about practicing.
• 11:39
  - How has virtual nursing
• 11:41
  - really earned its keypad WVU Medicine, and where
• 11:44
  - do you see it going in the future?
• 11:46
  - So that's a bunch of questions.
• 11:48
  - So I'll start with back to the newer
• 11:50
  - nurses. I think virtual care, they're excited about
• 11:53
  - helping getting them involved in design, getting them
• 11:56
  - at the early part of thinking,
• 11:59
  - and really helping it to,
• 12:01
  - alleviate some of the stress of their practice.
• 12:04
  - We, right now, have one of our hospitals
• 12:04
  - that is fully, ready for
• 12:09
  - implementation of virtual care.
• 12:11
  - They have gone unit by unit, and they
• 12:13
  - have one unit that is, like, started... Has
• 12:16
  - started in... Going forward.
• 12:18
  - So across our health system, we're committed to
• 12:20
  - virtual care, which our health systems grow very,
• 12:23
  - very quickly. As of today, it's 30 hospitals.
• 12:26
  - But we are we are prepared to roll
• 12:28
  - it out methodically.
• 12:31
  - Virtual care in my... This is my philosophy.
• 12:35
  - Thinking ahead is I do think it's gonna
• 12:37
  - just be part of our care team and,
• 12:38
  - you know, when we talk about redesigning care
• 12:40
  - delivery, which a lot of people talk about,
• 12:43
  - virtual care is going to be a big
• 12:45
  - piece of our virtual care redesign.
• 12:47
  - It's not just simply doing admissions and discharges,
• 12:50
  - which a lot of people are doing now.
• 12:52
  - They have a virtual nurse doing admissions and
• 12:54
  - discharges, which is really important.
• 12:56
  - We're investing in that.
• 12:57
  - But I also think there's gonna be so
• 12:59
  - much with virtual care that is really going
• 13:02
  - to help care be... Increase the quality.
• 13:05
  - It's gonna increase our satisfaction.
• 13:07
  - And so in our unit that we have
• 13:09
  - virtual whiteboards, and you can actually document into
• 13:12
  - the whiteboard, and it goes right into the
• 13:14
  - EMR.
• 13:15
  - So
• 13:16
  - there's just so much that can be done.
• 13:18
  - And I think the key to tying both
• 13:20
  - things together, getting the newer nurses involved with
• 13:23
  - that and helping them to design it. And
• 13:26
  - at first, I was nervous like, well, how
• 13:29
  - are the new nurses gonna keep all their
• 13:30
  - skills? Right? Because if they're not doing admissions
• 13:33
  - and discharges...
• 13:34
  - And I said to myself, wait a minute.
• 13:36
  - This is the care delivery model of the
• 13:38
  - future.
• 13:39
  - Just like when we had an electronic health
• 13:41
  - record at the beginning, it wasn't part of
• 13:43
  - everything we do, and now we can't live
• 13:44
  - without it. I believe the virtual nursing is
• 13:47
  - gonna be that same piece. We are gonna
• 13:50
  - need it. We're not gonna be able to
• 13:51
  - live without it. It's gonna be our tool
• 13:53
  - and our toolkit.
• 13:55
  - That's really interesting. I think
• 13:57
  - the quick advent of AI technology is starting
• 14:00
  - a lot of those conversations about concerns about
• 14:02
  - skill atrophy and, you know, what does need
• 14:04
  - to stay with the clinician and what is
• 14:06
  - the new way of working. And virtual nursing
• 14:08
  - is no is no different. But I think
• 14:09
  - you make a great point there.
• 14:12
  - I also wanna talk about as we're thinking
• 14:13
  - about the nursing workforce and retention,
• 14:17
  - creating a a safe environment for them, we
• 14:19
  - know, is obviously another huge huge
• 14:22
  - priority. Can you talk through some of the
• 14:24
  - work that WVU Medicine is doing around,
• 14:28
  - protecting staff against workplace violence?
• 14:31
  - I'm happy to talk about it because it
• 14:33
  - is definitely something that I lose sleep over,
• 14:36
  - you know,
• 14:37
  - and part of the role that I see
• 14:38
  - myself in is really... I always call myself
• 14:41
  - an interpreter to people that don't understand exactly
• 14:43
  - what it's like to be a bedside caregiver.
• 14:46
  - And even though I haven't taken care of
• 14:47
  - patients myself
• 14:49
  - on a regular basis, I make sure I
• 14:51
  - am out
• 14:52
  - working side by side with folks as often
• 14:54
  - as I can to understand
• 14:56
  - this. Because when I started as a nurse,
• 14:58
  - workplace violence was not
• 15:00
  - not at all prevalent. I didn't go into
• 15:02
  - work worrying about my safety.
• 15:04
  - With all that being said,
• 15:06
  - my role with the president and CEO is
• 15:08
  - to really talk about that as our health
• 15:11
  - system.
• 15:12
  - And the first thing that we have done
• 15:14
  - is we have implemented... We have a whole
• 15:16
  - workplace violence committee like most hospitals.
• 15:18
  - We've implemented orange banners in our health record
• 15:22
  - that alert the whole care team when there's
• 15:24
  - somebody at risk. We have a whole process
• 15:27
  - of when they're applied and when they're removed
• 15:29
  - and how people are notified, which has done
• 15:32
  - very, very well. We are in the process
• 15:35
  - of implementing staff safety buttons,
• 15:37
  - which I believe should be a standard in
• 15:39
  - health care,
• 15:41
  - and that is something that I think that,
• 15:43
  - is gonna go ahead. It's already gone a
• 15:45
  - long way. We've implemented it in five to
• 15:47
  - six of our hospitals. There's a plan by
• 15:50
  - the end of the year to implement it
• 15:52
  - in every one of them. And simply, it's
• 15:54
  - a button that you press when you feel
• 15:56
  - afraid,
• 15:58
  - threatened,
• 15:59
  - and any way that you feel like you
• 16:00
  - need some support. It's not
• 16:02
  - dictated exactly. We don't wanna wait until it's
• 16:05
  - happened. And a lot of times people know
• 16:07
  - it's coming. Not... Sometimes you don't.
• 16:10
  - There's a vibration. You hit the button. It
• 16:12
  - goes to whoever in that, you know, who
• 16:15
  - we deem in that organization because we have
• 16:16
  - small hospitals, we have large hospitals, and the
• 16:19
  - nurse gets a vibration that helps on the
• 16:21
  - way
• 16:22
  - from that. So it's gone very well. We're
• 16:25
  - tracking our data. And,
• 16:28
  - unfortunately,
• 16:29
  - it's been utilized a fair amount.
• 16:31
  - But the staff feel like it's one more
• 16:33
  - tool in their toolkit
• 16:35
  - in the... In our fight for workplace violence.
• 16:38
  - Mhmm. It's just another protective measure, and it's
• 16:41
  - like someone has their back, which is so
• 16:43
  - powerful.
• 16:44
  - It doesn't solve all the problems. It's just
• 16:46
  - a piece. Right? And so with the whole,
• 16:49
  - like, de escalation training,
• 16:51
  - a whole toolkit that lots of people are
• 16:54
  - doing. And so I just think we gotta
• 16:56
  - keep focusing on it. You know, it's one
• 16:58
  - piece. We can't take our foot off the
• 16:59
  - gas pedal. And so,
• 17:02
  - yeah, it's something that really is a worry
• 17:05
  - and a concern, but action is needed now.
• 17:09
  - Mhmm.
• 17:09
  - And it's clear WVU Medicine is making that
• 17:12
  - core investment in it.
• 17:14
  - Doctor Houston or Melanie, I wanna be Please
• 17:17
  - call me back.
• 17:19
  - I know you all work very hard for
• 17:21
  - those, degrees, so I always defer to doctor,
• 17:23
  - but I appreciate that.
• 17:25
  - I wanna make sure that we are, cognizant
• 17:27
  - of our time here.
• 17:29
  - Thank you so much for joining us on
• 17:31
  - the podcast and diving deeper into your workforce
• 17:34
  - and your pipeline strategy. I think our,
• 17:37
  - listeners are gonna find it very valuable. So
• 17:39
  - appreciate your time.
• 17:40
  - Mackenzie, thanks for asking me. Yeah. As you
• 17:42
  - can tell, I'm very excited about these initiatives,
• 17:45
  - and I have such executive support because it
• 17:47
  - doesn't happen without
• 17:49
  - the team around the table of executives
• 17:51
  - to listen to the nurses and the nurse
• 17:53
  - leaders. And I think that's a lot what
• 17:55
  - we're talking about is having that voice to
• 17:58
  - talk about the clinical issues is... Has been
• 18:01
  - really important. I feel grateful.
• 18:03
  - Yeah. Well, we are just as grateful. So
• 18:05
  - thank you again, Melanie.
• 18:07
  - Thanks, Mackenzie.