Latest / Becker’s Healthcare - Clinical Leadership Podcast / Strengthening Nursing Governance and Building the Workforce at Trinity Health with Peggy Norton-Rosko

Transcript

Strengthening Nursing Governance and Building the Workforce at Trinity Health with Peggy Norton-Rosko · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - Hi everyone and welcome to the Becker's Healthcare
• 0:02
  - Clinical Leadership Podcast.
• 0:04
  - I'm Mackenzie Bean, associate vice president and managing
• 0:08
  - editor of Becker's Hospital Review.
• 0:10
  - Today I'm very excited to be joined on
• 0:13
  - the podcast by Doctor. Peggy Norton Roscoe, who
• 0:16
  - is senior vice president and chief nursing officer
• 0:18
  - of Trinity Health.
• 0:20
  - Peggy, thank you so much for being here
• 0:22
  - today. How are you doing?
• 0:24
  - I'm doing great, Mackenzie. Thank you. Thanks for
• 0:26
  - having me on the podcast.
• 0:28
  - It is all our pleasure. I'm looking forward
• 0:30
  - to our conversation. I know you,
• 0:33
  - started your role at Trinity Health in January,
• 0:36
  - so excited to hear more about all of
• 0:38
  - the meaningful work you're doing in that space.
• 0:41
  - And I thought I'd start off talking about
• 0:44
  - governance.
• 0:45
  - We know giving nurses a voice at the
• 0:48
  - table is such a crucial aspect
• 0:51
  - of retainment or satisfaction,
• 0:54
  - shaping organizational strategy and more. Can you define
• 0:57
  - governance at Trinity Health? What does that really
• 1:00
  - look like in practice?
• 1:02
  - Sure. Thanks for the question.
• 1:04
  - When I think of successful governance,
• 1:06
  - relating to nursing practice, and what we're striving
• 1:09
  - for at Trinity Trinity Health, I really believe
• 1:11
  - it's a culture where nurses feel heard and
• 1:13
  - are engaged in improving the collaborative relationships across
• 1:17
  - the multidisciplinary
• 1:18
  - team.
• 1:19
  - They're also engaged in a active reciprocal relationship
• 1:22
  - with the management team and invested in improving
• 1:24
  - patient outcomes and supporting other nurses.
• 1:27
  - The management responsibility in a successful government environment
• 1:30
  - requires,
• 1:31
  - transparent communication
• 1:33
  - and authentic listening to understand the barriers,
• 1:36
  - to creating the practice environment where nurses feel
• 1:39
  - heard and valued and where patients receive the
• 1:41
  - best care.
• 1:42
  - You know, I think, as nurse leaders across
• 1:44
  - the industry, we must we really have to
• 1:46
  - keep, evaluating and being aware of the measurable
• 1:49
  - impact,
• 1:50
  - nurses have on quality, safety, and clinical outcomes
• 1:53
  - and make sure that, other disciplines in the
• 1:56
  - industry as a whole understands the impact we
• 1:58
  - have,
• 1:59
  - as well.
• 2:00
  - From what does successful government look like, I
• 2:03
  - think it looks like an active respectful conversation
• 2:06
  - where nurses can elevate their concerns,
• 2:09
  - whether it's about clinical practice,
• 2:11
  - resources available for practice,
• 2:14
  - relationships.
• 2:16
  - It it really is an active two way
• 2:17
  - conversation
• 2:19
  - where we're making decisions together, sharing information so
• 2:22
  - we can do the best thing for for
• 2:24
  - our team members as well as our patients.
• 2:26
  - I
• 2:27
  - think it's always helpful to see
• 2:30
  - real world examples of governance in action and
• 2:32
  - just how powerful
• 2:34
  - a nurse's voice can be.
• 2:37
  - What's an example of a decision where nurses'
• 2:39
  - input at Trinity Health has actually changed the
• 2:42
  - outcome or or strategy of an initiative?
• 2:45
  - One of the most impactful
• 2:46
  - examples that I can give is,
• 2:49
  - at one of our larger hospitals are nurses
• 2:51
  - who, from the ICUs who were responsible for
• 2:54
  - responding to emergencies
• 2:56
  - in the hospital outside the ICU,
• 2:58
  - whether a patient required resuscitation or their condition
• 3:01
  - was changing rapidly.
• 3:03
  - The the nurses outside the ICU told us
• 3:05
  - that they really needed additional staffing resources to
• 3:08
  - be able to adequately,
• 3:10
  - cover the patient needs that they needed to
• 3:12
  - respond to and to prevent patient deterioration.
• 3:15
  - So we worked with them to evaluate to
• 3:17
  - really just look at the data. Right? We
• 3:19
  - looked at we we evaluated what types of
• 3:21
  - emergencies were they responding to outside the ICU,
• 3:24
  - how many emergencies were they responding to within
• 3:26
  - a shift or within a twenty four hour
• 3:28
  - period? And we worked together with them to
• 3:30
  - do and and how long did each of
• 3:32
  - those emergencies
• 3:33
  - or interactions take with with patients and other
• 3:35
  - staff outside the ICU?
• 3:37
  - And that helped us work together to come
• 3:39
  - up with a staffing plan that supported the
• 3:41
  - emergency response
• 3:42
  - as well as their availability to round on
• 3:44
  - patients who who were really statistically
• 3:47
  - more more likely to develop clinical problems, so
• 3:50
  - as to prevent that deterioration.
• 3:53
  - This actually had a huge impact on on
• 3:55
  - organizational outcomes from a patient perspective. It actually
• 3:58
  - resulted in far fewer patients who required resuscitation
• 4:02
  - outs and transfer to the outside the ICU
• 4:04
  - and then transfer to the ICU.
• 4:06
  - And, more patients so if they did have
• 4:09
  - a significant event, that required resuscitations,
• 4:11
  - more patients survived the event and left the
• 4:14
  - hospital.
• 4:15
  - So by nurses, you know, elevating the concern
• 4:18
  - about appropriate resources,
• 4:20
  - we could show a, you know, a demonstrated
• 4:22
  - measurable impact, not only on their workload and
• 4:25
  - their satisfaction,
• 4:26
  - but even more importantly on the impact that
• 4:28
  - it had on patients. And, if more patients
• 4:30
  - went home and had the next holiday with
• 4:32
  - their family,
• 4:33
  - I don't I can't think of a more
• 4:35
  - meaningful impact.
• 4:36
  - Absolutely. That's
• 4:38
  - the ultimate outcome, isn't it? And as you
• 4:40
  - said It is.
• 4:42
  - Significant wins both for nurse satisfaction and
• 4:45
  - retention on that side, but even more powerful,
• 4:48
  - the direct outcome,
• 4:50
  - on patient care. So, so significant there.
• 4:53
  - I appreciate you sharing that example, Peggy.
• 4:56
  - I also wanted to pick your brain on
• 4:58
  - the workforce piece. It's obviously a huge focus
• 5:01
  - for
• 5:02
  - chief nursing officers
• 5:04
  - nationwide.
• 5:05
  - I'm curious at Trinity Health, where are you
• 5:07
  - seeing the biggest bottleneck right now as it
• 5:09
  - comes to pipeline development? Is it actually getting
• 5:13
  - people into nursing schools? Is it clinical placements
• 5:16
  - and preceptor,
• 5:18
  - volumes, or is it really retaining new nurses
• 5:21
  - beyond the first year? Let's start there. Sure.
• 5:24
  - Well, it's probably a little bit of all
• 5:25
  - of those things that you mentioned, but I'll
• 5:27
  - I'll start with,
• 5:28
  - you know, qualified applicants being able to start
• 5:31
  - nursing school. According to the most recent information
• 5:34
  - I've seen from American Association of Colleges of
• 5:36
  - Nursing,
• 5:38
  - over 93,000
• 5:39
  - qualified applicants returned away
• 5:41
  - from admissions to schools in nursing between 2025
• 5:44
  - but during the 2025 and 2026
• 5:46
  - academic year. And 75,000
• 5:49
  - of those 93,000
• 5:50
  - were those students who wanted to enter nursing
• 5:53
  - practice for the first time. The other were
• 5:54
  - graduate degrees in advanced practice and maybe education,
• 5:58
  - type focused degrees, which are all also very
• 6:00
  - important.
• 6:02
  - Shortage of the nursing faculty and funding of
• 6:04
  - school schools of nursing in a way that
• 6:06
  - attracts the qualified qualified faculty is is a
• 6:09
  - real issue.
• 6:10
  - And, you know, if you really get to
• 6:12
  - the root of it, if we have 75,000
• 6:14
  - additional people who wanna enter the workforce every
• 6:16
  - year and can't,
• 6:18
  - that could go a long way in helping
• 6:19
  - us mitigate the challenges we're we're currently seeing.
• 6:22
  - So, what we're doing at Trinity and what
• 6:24
  - many other health systems are doing across the
• 6:26
  - country are looking at, you know, what do
• 6:28
  - our partnerships with the colleges of nursing look
• 6:29
  - like? Yes. It's making sure we can create
• 6:32
  - space for all the clinical rotations we possibly
• 6:34
  - can. Many of us are doing, you know,
• 6:36
  - things that we haven't done historically, you know,
• 6:38
  - night shift clinical rotations, weekend shift clinical rotations,
• 6:41
  - which actually works best for some of the
• 6:43
  - students who are,
• 6:44
  - in a more nontraditional student role as well.
• 6:47
  - So we're looking at and then we're also
• 6:48
  - looking at how can we share resources differently,
• 6:51
  - that that could perhaps help some of our,
• 6:53
  - team members become adjunct faculty to support,
• 6:57
  - the colleges and and their faculty shortages. So
• 7:00
  - that's, you know, that's I'm I'm always,
• 7:03
  - I'm on an advisory board for the School
• 7:05
  - of Nursing where I went, for my undergraduate
• 7:07
  - degree, Northern Illinois University. And,
• 7:10
  - this is the topic we talk about frequently
• 7:12
  - is how can industry
• 7:13
  - and,
• 7:15
  - and academia
• 7:16
  - partner differently to mitigate some of these workforce
• 7:18
  - challenges.
• 7:20
  - You know, and then beyond that, we need
• 7:22
  - to continue to focus on our work environment
• 7:24
  - and the factors that contribute to burnout.
• 7:26
  - You know, we we all know that there's
• 7:28
  - a lot of things that contribute to burnout,
• 7:29
  - and and it is not a lack of
• 7:31
  - resiliency
• 7:32
  - or strength in our frontline team members. We
• 7:35
  - eventually might see that in them be because
• 7:37
  - of the conditions that can contribute
• 7:39
  - to burnout, but we we have to start
• 7:41
  - looking at organizational factors. One of the things
• 7:43
  - we're doing at Trinity
• 7:44
  - is being really thoughtful about how we're looking
• 7:47
  - at new technology. We wanna I just wanna
• 7:49
  - make really sure that any technology
• 7:51
  - that we're gonna implement isn't just to implement
• 7:53
  - cool technology. It's to it's to mitigate the
• 7:56
  - workload. It's to improve the quality of patient
• 7:58
  - care,
• 7:59
  - and it's to, you know, most specifically and
• 8:02
  - most frequently to reduce the documentation burden, which
• 8:04
  - I know is difficult for all clinicians, not
• 8:07
  - just nursing. And then, you know, with a
• 8:10
  - large portion of the nursing workforce being new
• 8:12
  - to practice, we definitely have opportunity
• 8:14
  - to continue to support them across Trinity Health.
• 8:16
  - It's a requirement that every single one of
• 8:18
  - our organizations,
• 8:20
  - participates in a nationally recognized new grad residency
• 8:22
  - program so that we can support nurses through
• 8:25
  - that first year of practice,
• 8:27
  - not only from a clinical competency perspective, but
• 8:29
  - in culturation into nursing, profession and to health
• 8:32
  - care in general. And then beyond the residency
• 8:34
  - program, we work really hard to
• 8:37
  - focus our team members,
• 8:39
  - on,
• 8:40
  - communicating with us about what their career goals
• 8:42
  - are, whether it's, professional development at the bedside
• 8:45
  - or ongoing,
• 8:46
  - formal education that they wanna pursue. We have
• 8:48
  - multiple programs to help them do that.
• 8:51
  - I'd love to go one bit deeper on
• 8:53
  - the career development piece. As you said, there's
• 8:56
  - many different levers at play right now to
• 8:59
  - support pipeline development. You said the creative partnerships
• 9:02
  - with academia,
• 9:05
  - a huge focus on work environment and burnout,
• 9:07
  - thoughtful implementation of technology, your residency program, of
• 9:11
  - course. But go a little bit deeper on
• 9:13
  - those programs. Once you do have your new
• 9:15
  - nurses joining you, how do you encourage them
• 9:18
  - to not just stay, but really feel motivated
• 9:20
  - to grow with Trinity Health?
• 9:23
  - Yeah. I think I think the the foundation
• 9:25
  - we set in our residency program,
• 9:27
  - really,
• 9:28
  - gives us good opportunity there because, you know,
• 9:30
  - part of the residency program is purposeful conversations
• 9:33
  - with every single new graduate within that first
• 9:35
  - six months to understand what do you think
• 9:37
  - your career trajectory is. So they aren't afraid
• 9:39
  - to talk to their leader about, you know,
• 9:41
  - I'm only six months in. I don't wanna
• 9:42
  - tell my manager in a year. I wanna
• 9:44
  - move from med surg to ICU or from
• 9:46
  - ED to, you know,
• 9:47
  - OR or something like that. So we really
• 9:49
  - try to culturally open up the conversation and
• 9:51
  - make sure that they're
• 9:52
  - comfortable
• 9:53
  - in in talking to us about what they
• 9:55
  - wanna do. And then we really just kinda
• 9:56
  - help them road map that out. And and
• 9:59
  - and hopefully, we have a lot of people
• 10:00
  - telling us they really wanna stay at the
• 10:01
  - bedside for for their whole career. So then
• 10:03
  - it's, what does it look like to professionally
• 10:05
  - develop and stay at the bedside? How can
• 10:08
  - we successfully help them move into a preceptor
• 10:10
  - role or a charge nurse role? And then
• 10:12
  - beyond that, how can we help them gain
• 10:14
  - the skills and competency that will help us
• 10:16
  - improve quality so that they can really not
• 10:18
  - only engage in quality and process improvement efforts,
• 10:20
  - but help lead them. Again, you know, strengthening
• 10:23
  - that governance structure where they're they're helping us
• 10:25
  - impact outcomes.
• 10:27
  - So we have lots of opportunity to help
• 10:28
  - them really just draw out their road map
• 10:30
  - and then help them make sure that they
• 10:32
  - understand the the, benefits we have for them
• 10:34
  - to continue formal education
• 10:36
  - or professional development and develop in place.
• 10:40
  - So really starting those conversations on career growth
• 10:43
  - early and often perhaps. Very important. Very important.
• 10:47
  - So as we zoom out and look to
• 10:50
  - not just early career nurses, but all nurses
• 10:53
  - within your workforce,
• 10:55
  - What do you think actually makes an organization
• 10:57
  - a destination for top nursing talent
• 11:00
  - beyond compensation?
• 11:02
  - Well, I think, obviously, everybody wants to be
• 11:05
  - recognized for doing for doing a good job,
• 11:07
  - and and the work that we do is
• 11:08
  - is serious work and important work.
• 11:10
  - So I think meaningful recognition
• 11:13
  - recognition is important and difficult. Right? Meaningful recognition
• 11:15
  - might mean something different for every individual.
• 11:18
  - And but I also think that the the
• 11:20
  - fact that they know that you're going to
• 11:22
  - invest in them and help them be successful
• 11:24
  - in their career. So as we as we
• 11:25
  - spoke about some of the different career development
• 11:27
  - pathways are important.
• 11:29
  - And more than ever, I think, what's important
• 11:32
  - for people to understand is they're gonna be
• 11:34
  - safe in the work environment and, and feel
• 11:36
  - supported. You know, so everyone's doing a lot
• 11:38
  - to mitigate workplace violence and and we certainly
• 11:41
  - are doing the same. And and in addition
• 11:43
  - to, you know, the physical violence is how
• 11:45
  - are we supporting their emotional, emotional well-being and
• 11:48
  - and certainly,
• 11:49
  - making sure that we have the expertise,
• 11:52
  - within the organization
• 11:53
  - to help attend to people's emotional and physical
• 11:56
  - well-being is a big focus.
• 11:58
  - We get we get a lot of questions
• 11:59
  - about that from people as they're starting the
• 12:01
  - career as, you know, what are you doing
• 12:02
  - to help make sure we stay safe and
• 12:04
  - and,
• 12:05
  - have the right responses.
• 12:07
  - And then in the end, you know, true
• 12:08
  - collaboration and authentic leadership, as we talked about
• 12:11
  - earlier,
• 12:12
  - really open communication
• 12:14
  - between our frontline and and those who are,
• 12:16
  - charged with supporting them in leadership roles, I
• 12:18
  - think, is is just really key.
• 12:21
  - Absolutely. Well, Peggy, I think it's
• 12:24
  - so clear how much you
• 12:26
  - care about and are invested in the nursing
• 12:28
  - teams underneath you. So I just appreciate you
• 12:31
  - taking the time to join us on the
• 12:32
  - podcast and talk more about your governance and
• 12:35
  - workforce strategies with us. Thank you so much
• 12:37
  - for your time. Thank you, Mackenzie. It was
• 12:39
  - a pleasure.