Latest / Becker’s Healthcare Podcast / Restoring the Nursing Workforce at Penn State Health, Milton S. Hershey Medical Center with Michele Szkolnicki

Transcript

Restoring the Nursing Workforce at Penn State Health, Milton S. Hershey Medical Center with Michele Szkolnicki · 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 year's 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
  Hello, everyone, and welcome to Becker's Healthcare podcast.
• 0:34
  I'm Scott King. Thrilled today to be joined
• 0:36
  by a very special guest, Michelle Skolnicki, senior
• 0:38
  vice president and chief nursing officer over at
• 0:41
  Penn State Health Milton s Hershey Medical Center.
• 0:44
  Michelle, Michelle, how are you doing? Thanks so
• 0:45
  much for joining us today.
• 0:47
  I'm doing great. Thank you. And I so
• 0:49
  appreciate the invitation to join you today. Appreciate
• 0:52
  you joining us. We have a lot of,
• 0:53
  you know, big topics in in health care
• 0:55
  and what's going on, right now to get
• 0:56
  to. But before doing that, I I just
• 0:58
  wonder if you could please share a little
• 1:00
  bit about your background and your career. Well,
• 1:02
  as you said, I'm currently the chief nursing
• 1:04
  officer here at Hershey Medical Center, part of
• 1:07
  Penn State Health. We are the academic medical
• 1:10
  center of the Penn State Health System.
• 1:12
  I have been here as the CNO for
• 1:14
  the last four and a half years.
• 1:16
  Just a little plug. I'm happy to say
• 1:18
  that we just put in our application for
• 1:20
  our fifth magnet reaccreditation.
• 1:22
  So so happy about that.
• 1:25
  The Hershey Medical Center has,
• 1:27
  471
• 1:28
  beds in its adult hospital and, a 160
• 1:31
  beds in its in our children's hospital. And
• 1:33
  we are part of a,
• 1:35
  seven hospital system. And,
• 1:38
  we also, have, about a 180 physician practices,
• 1:42
  about 22,000
• 1:44
  employees, and,
• 1:45
  we also are a learning organization. We are
• 1:48
  on the campus here at Hershey Medical Center
• 1:50
  of the Penn State University
• 1:53
  College of Medicine.
• 1:55
  Well, that's excellent, Michelle. Thanks so much for
• 1:56
  that background info and all that other info
• 1:58
  about your your system.
• 2:00
  The first topic I want to get to
• 2:03
  is what was the most important initiative
• 2:05
  you led in the last year? You know,
• 2:07
  what what did you do for that initiative,
• 2:08
  and what were the results?
• 2:11
  So I have to say for the last
• 2:13
  year or maybe the last several years culminating
• 2:16
  in this, last year was restoring the workforce.
• 2:19
  You know, COVID
• 2:21
  really
• 2:22
  hit us and hit all of,
• 2:24
  hospitals across the nation as far as needing
• 2:27
  to replenish the nursing staff
• 2:29
  as well as other staff that care for
• 2:31
  patients within the hospital.
• 2:33
  And, we started off with a high vacancy
• 2:35
  rate, a high turnover rate,
• 2:37
  and just a lot of,
• 2:39
  nursing repair work as far as the emotional
• 2:42
  strain
• 2:43
  of COVID as well. So we put
• 2:45
  we had a several year initiative,
• 2:47
  and put a lot of things in place.
• 2:49
  I am not a person who believes in
• 2:51
  this silver bullet theory. There's a lot of
• 2:54
  things you need to do in tandem in
• 2:55
  order to restore nursing workforce.
• 2:57
  Everything from how we reach need to retool
• 3:01
  our different units so that, nurses who are
• 3:03
  graduating,
• 3:05
  are are enticed by what we offer in
• 3:07
  each of our floors because, nurses come out
• 3:10
  choosing, you know, with an idea of the
• 3:12
  kinds of specialties that they wanna be in.
• 3:14
  How do we look at other ways to
• 3:16
  get,
• 3:17
  nursing staff interested in us such as
• 3:20
  international
• 3:21
  nurses.
• 3:22
  We have started with that program.
• 3:24
  Those international nurses didn't come in during COVID
• 3:27
  because of
• 3:28
  some of the busy requirements and timelines that
• 3:30
  are involved, but they have started coming in
• 3:32
  now. And they have turned into kind of
• 3:35
  a replenishment
• 3:36
  plan for us too. And we are just
• 3:38
  so happy to have,
• 3:40
  those nurses here, and they really
• 3:42
  inspire us in different ways with the different
• 3:44
  types of experiences that they come with from
• 3:46
  all over the world.
• 3:48
  We also,
• 3:50
  involved our nurses.
• 3:51
  We have nurses that we call RN ambassadors
• 3:54
  that go to, nursing schools and other recruitment
• 3:57
  fairs and things like that, and they speak
• 3:59
  from their own heart as far as what
• 4:01
  it is like to work here. And that
• 4:03
  has been one of our most successful
• 4:06
  initiatives as far as the our actual nurses
• 4:09
  talking about their excitement in being here. We
• 4:12
  have showcased all of the things that we
• 4:14
  do for nurses to grow nursing.
• 4:16
  We have very strong certification programs and RN
• 4:19
  to BSN programs, which we just highlighted in
• 4:22
  our recent magnet submission.
• 4:24
  And the results of it have been great.
• 4:27
  You know, we
• 4:28
  have under a 9%
• 4:30
  turnover rate that we have sustained for the
• 4:32
  last thirteen months
• 4:34
  combined. You know?
• 4:36
  Our, vacancy rate measured as of last as
• 4:40
  of December is 2.65.
• 4:43
  Our continue our quality continues to grow
• 4:46
  and be better and better. And we recently
• 4:49
  got the results of our staff engagement store
• 4:51
  that shows that our staff are also more
• 4:53
  engaged and happier. So restabilizing
• 4:55
  that workforce
• 4:57
  and preparing for the headwinds for what to
• 4:59
  come next
• 5:00
  is, has been so vital. And I think
• 5:03
  we are now in a very good position,
• 5:06
  in which to do that and have put
• 5:08
  a lot of processes in place that will
• 5:10
  help to continue to sustain us.
• 5:13
  And, a lot of our focus has been
• 5:15
  not to continue to ride that up and
• 5:17
  down roller coasters. You're well staffed. You're not
• 5:19
  well staffed, but to really put things in
• 5:21
  place at work and to work at sustaining
• 5:23
  those things.
• 5:25
  Yeah. I appreciate you sharing that, Michelle, because,
• 5:27
  you know, obviously, a lot of systems nationwide
• 5:30
  are still
• 5:31
  dealing with workforce shortages. So yeah. You know?
• 5:34
  And I I think you just touched on
• 5:36
  it, but but could you kind of,
• 5:38
  tell us what you think was the biggest
• 5:41
  step in in restoring your workforce?
• 5:44
  I I'm not sure we have a biggest
• 5:45
  step, but I'll I'll give you an example
• 5:47
  or two. So Sure. One, I think that
• 5:50
  there is a lot of
• 5:52
  a lot of hospitals have hardship with staffing
• 5:55
  medical surgical units for an exam for example.
• 5:59
  A lot of nurses are graduating nursing school,
• 6:01
  and they want the,
• 6:03
  the flash. You know? They want the, critical
• 6:05
  care units. They want the emergency department,
• 6:07
  for which we have wonderful programs in order
• 6:10
  to help those nursing students be successful.
• 6:12
  But in med surg, which typically has the,
• 6:16
  impression maybe of being
• 6:18
  kind of a melting bag of every a
• 6:20
  melting pot of everything Sure. We worked to,
• 6:24
  basically give identity to each of our nursing
• 6:26
  nursing floors and to put specialization within them
• 6:30
  as well.
• 6:31
  So we have medical specialty floors, and what
• 6:34
  those concentrations
• 6:35
  are. One of those floors actually,
• 6:38
  has a certification in niche, and we follow
• 6:41
  the four m's for, treating the aging adult.
• 6:44
  And we have those, things in place because
• 6:46
  there are nurses that like to take care
• 6:48
  of, patients that are less young.
• 6:51
  We our surgical floors have been segmented into
• 6:54
  the floor that takes care of orthopedics and
• 6:56
  neurosurgery
• 6:57
  and the floor that takes care of MIS
• 6:59
  and surgical specialties.
• 7:00
  We have, dedicated cancer floors.
• 7:03
  What we have found is by giving these
• 7:06
  med surg floors an identity and a specialization,
• 7:09
  nursing students were attracted to them. I am
• 7:12
  very, very proud and somewhat amazed to be
• 7:15
  able to say that our med surg units
• 7:18
  we have a 0% vacancy right now in
• 7:20
  our in all of our seven medical surgical
• 7:22
  units.
• 7:24
  And it was and it was the the
• 7:25
  nurses wanted to specialize in certain things and
• 7:28
  wanted to become expert,
• 7:30
  in certain in certain areas. Now, sure, all
• 7:33
  of those units do get mixed sometimes with
• 7:36
  other types of patients because we have to
• 7:38
  deal with the ups and downs of you
• 7:40
  know, right now, it's respiratory viruses. And so
• 7:43
  we do get other people on those floors,
• 7:45
  but the nurses are really enjoying to have
• 7:48
  that specialization
• 7:50
  and to add that to themselves so that
• 7:52
  they can become expert in certain specialty fields
• 7:54
  within nursing,
• 7:55
  in acute care, where we now have a
• 7:58
  0% nursing vacancy rate. And I am just
• 8:00
  so proud of what they've been able to
• 8:02
  do with that.
• 8:03
  That's incredible news about the the 0%
• 8:05
  vacancy.
• 8:07
  And looking ahead, what are the big priorities
• 8:10
  and the headwinds you're focused on for 2026?
• 8:13
  Well, there's a lot coming.
• 8:16
  So,
• 8:17
  you know, I think what all hospitals are
• 8:19
  worried about is, you know, what HR one
• 8:22
  is going to do as far as,
• 8:24
  having more and more, patients that perhaps do
• 8:27
  not have health care insurance or do not
• 8:29
  have adequate health care insurance
• 8:31
  and what it means to still provide the
• 8:33
  care that those patients need and provide the
• 8:35
  follow-up care that those patients needs.
• 8:37
  And nurses play a very big part in
• 8:40
  that. Nurses
• 8:41
  can help
• 8:43
  with what those patients need so that they
• 8:45
  can have a better course on all patients
• 8:48
  so that they can have a better course
• 8:49
  when they leave. But I'm particularly worried about
• 8:52
  nurses.
• 8:53
  I'm I'm particularly worried about what
• 8:56
  what hospitals will be able to do if
• 8:58
  we actually do see a decline in insurance
• 9:00
  and what will that will do as far
• 9:02
  as what we can fund.
• 9:04
  You know, clinical staff shortages continues to be
• 9:07
  an issue that we need to watch out
• 9:09
  for. We've done so much work building up
• 9:11
  what we have. We now have to sustain
• 9:14
  that. I I kind of liking it to,
• 9:16
  watering the grass. You know? You stop watering
• 9:19
  the grass, it turns brown. Then you water
• 9:21
  it again and it turns green again or
• 9:22
  sometimes it doesn't. You know? You you have
• 9:25
  to sustain.
• 9:26
  And I think sometimes that's where where we
• 9:29
  lose it,
• 9:30
  in in health care that we achieve something
• 9:32
  and then we let it go and then
• 9:34
  it deteriorates. So we have to keep nurturing
• 9:36
  what we have built. You know, I already
• 9:38
  touched on, you know, because of
• 9:41
  payer, payers perhaps, patients losing insurance as far
• 9:45
  as we might experience
• 9:47
  declining,
• 9:48
  margins. We're already hearing that there's increasing,
• 9:51
  insurance denials. So all of these things that
• 9:54
  affect a hospital from being able to support
• 9:57
  the mission.
• 9:58
  And we really I I see that as
• 10:00
  a very strong headwind.
• 10:02
  And with some of the,
• 10:04
  the the the rules and things coming out,
• 10:07
  there's also increasing
• 10:08
  regulatory complexity, which is also going to take
• 10:11
  people to do those functions as well. So
• 10:13
  we're gonna have to continue to
• 10:16
  look at that and figure out
• 10:19
  what we need to do to sustain patients
• 10:22
  in the meantime and, quite frankly, not lose
• 10:24
  focus on our essential mission, which is taking
• 10:26
  care of patients.
• 10:28
  I do think that nurses can contribute to
• 10:30
  that a lot. Nurses,
• 10:32
  besides affecting those things that are very important
• 10:35
  in health care,
• 10:36
  such as, you know, hospital acquired conditions and
• 10:39
  preparing for discharge and things like that, nursing
• 10:42
  can also be quite involved with those other
• 10:44
  things that are very important for hospital finances,
• 10:47
  such as
• 10:48
  really looking at the length of stay and
• 10:50
  getting patients ready to be discharged
• 10:53
  in a in a way so that their
• 10:54
  hospital stay stay does not,
• 10:57
  make them more
• 11:00
  infirm. You know? I mean, we
• 11:03
  hospitals,
• 11:04
  I like to say that, you know, hospitals
• 11:05
  you look in a hospital room. What is
• 11:07
  the central feature of a hospital room? It's
• 11:09
  the bed.
• 11:11
  At some time during a patient's hospital stay,
• 11:14
  what is the worst place for them to
• 11:16
  be located? In the bed. You know? We
• 11:18
  have the patients have to we need to,
• 11:21
  seek that cure and that rehabilitation
• 11:24
  of a nursing all of our patients while
• 11:25
  they're in the hospital in so many ways.
• 11:27
  And a lot of that is what nurses
• 11:28
  do with regards to mobility.
• 11:31
  So,
• 11:33
  I think what nursing can contribute can really
• 11:36
  help to,
• 11:37
  to help with some of these headwinds that
• 11:39
  we might be facing financially in the future.
• 11:42
  Well, you you just laid out a lot
• 11:44
  of headwinds for us. But what do you
• 11:45
  think is the hardest thing you'll have to
• 11:47
  do, this year to to maybe address some
• 11:50
  of those?
• 11:50
  Well, you know,
• 11:52
  when you look at a hospital's
• 11:55
  budget, one of the biggest numbers you'll see
• 11:57
  is the expensive labor and the expensive nursing
• 11:59
  labor.
• 12:00
  And how can we take
• 12:03
  that nursing expense
• 12:05
  and shift
• 12:07
  the focus from
• 12:09
  cost
• 12:10
  to value generator.
• 12:13
  And I I think that is the key
• 12:15
  for nursing
• 12:17
  helping hospitals
• 12:19
  to be successful in these financial headwinds.
• 12:22
  The things that affect hospitals' finances,
• 12:24
  length of stay. There are many,
• 12:28
  insurers
• 12:29
  that pay on DRG, and DRGs basically give
• 12:32
  you a number of days for
• 12:34
  the disease process that the, patient has.
• 12:37
  We have an opportunity from once the patient
• 12:39
  is admitted to be working on discharge and
• 12:42
  what does that patient need in order to
• 12:44
  be able to be discharged safely and to
• 12:46
  be discharged in a wellness state. And nursing
• 12:49
  who is next to a patient
• 12:51
  the whole time that they are here, can
• 12:52
  be so effective in making sure that we
• 12:55
  stay with that DRG rather than encumber
• 12:58
  costs that are basically unreimbursed.
• 13:01
  Nurses also help with decreasing readmissions by the
• 13:04
  education that they provide.
• 13:06
  And I would say too, nursing can help
• 13:09
  with CMI, case mix index,
• 13:12
  by making sure that their documentation
• 13:14
  is as mindful as possible. Be careful
• 13:18
  be taken care to,
• 13:20
  document
• 13:22
  what the patient's actual state is, what the
• 13:24
  level of their disease
• 13:26
  acuity and complexity is so that that can
• 13:29
  be
• 13:30
  considered
• 13:31
  when that CMI is imposed. And that really
• 13:33
  helps with that really helps with,
• 13:36
  the the financial
• 13:38
  the the the revenue that comes back at
• 13:40
  the hospital.
• 13:41
  If we can work on things like that
• 13:44
  and really you know, nursing is one of
• 13:47
  the most valuable resources in a hospital, and
• 13:49
  I believe it's one of the most
• 13:51
  underutilized
• 13:52
  in those three areas that I had just
• 13:54
  mentioned, which is CMI, length of stay,
• 13:57
  and readmissions.
• 13:58
  Nursing can
• 14:00
  directly affect those and raise
• 14:03
  what hospitals are able to receive revenue wise
• 14:06
  without a single extra patient
• 14:08
  entering the hospital.
• 14:10
  We just need to maximize that force and
• 14:14
  utilize that that important workforce that nursing represents.
• 14:19
  And the last last thing I wanna ask
• 14:20
  you, Michelle, where do you see the best
• 14:23
  opportunities for organizational growth right now?
• 14:26
  I I think part of it is in
• 14:28
  that, in that nurses can really be a
• 14:30
  value generator rather than just a cost center.
• 14:33
  And I think the other thing too is
• 14:35
  nursing needs to,
• 14:37
  bend and mold to what hospitals are experiencing.
• 14:39
  You know, hospitals are gonna have to continue
• 14:41
  to
• 14:44
  to look at their cost structures. You know?
• 14:44
  I think we're gonna see,
• 14:46
  the,
• 14:47
  administrative suites.
• 14:48
  We're already seeing administrative
• 14:50
  suites become smaller in numbers. We're seeing
• 14:53
  COO, CNO roles combining,
• 14:57
  and we're seeing shared services evolve around much
• 15:00
  of the health in much of the health
• 15:01
  systems.
• 15:02
  What we're also seeing is that when shared
• 15:04
  services become centralized,
• 15:07
  that more, I'll say, opportunity, but certainly more
• 15:10
  work falls to middle managers.
• 15:12
  So one of the most important things that
• 15:14
  I think I'll be doing this year and
• 15:16
  we've already started is developing our nurse leaders
• 15:19
  and those middle managers because they're gonna need
• 15:21
  to do more, and they're gonna need to
• 15:23
  work differently in order to be able to
• 15:25
  support
• 15:26
  those resources that are being restructured
• 15:29
  because you still need, management attention closer to,
• 15:33
  you know, where where everything is happening. You
• 15:35
  can't you can't support everything from that central
• 15:39
  centralization
• 15:40
  type of a focus. Although I think centralization
• 15:43
  of of many of these support services is
• 15:46
  very good for hospitals,
• 15:48
  some of it still needs to be on
• 15:49
  the ground, and I think that will be
• 15:51
  the middle manager's burden, like our nurse leaders,
• 15:53
  like our nurse managers.
• 15:55
  Michelle, thanks so much for a wonderful conversation
• 15:57
  and for for joining the podcast. I look
• 15:58
  forward to working with you again soon. Thank
• 16:00
  you so much, Scott.