Latest / Becker’s Healthcare Podcast / Terry McDonnell, DNP, RN, ACNP-BC, Senior Vice President and Chief Nurse Executive at Duke University Health System and Vice Dean for Clinical Affairs at Duke University School of Nursing

Transcript

Terry McDonnell, DNP, RN, ACNP-BC, Senior Vice President and Chief Nurse Executive at Duke University Health System and Vice Dean for Clinical Affairs at Duke University School of Nursing · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
• 0:11
  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Hello, everyone, and welcome to the Becker's Healthcare
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  - Clinical Leadership podcast.
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  - I'm Mackenzie Bean, associate vice president and managing
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  - editor of Becker's Hospital Review.
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  - Today, it is my distinct pleasure to be
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  - joined by doctor Terry McDonnell, who is senior
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  - vice president and chief nurse executive of Duke
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  - University Health System and vice dean for clinical
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  - affairs of the Duke University
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  - School of Nursing.
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  - Doctor McDonald, thank you again for joining us
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  - on the podcast. How are you doing today?
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  - I'm great, Mackenzie. It's always a pleasure to
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  - be here, and I appreciate the time together.
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  - A pleasure to have you. I know we
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  - were, excited to host you on our podcast
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  - in July. You had a great conversation with
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  - my colleague, Ry Taylor, all about AI and
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  - innovation and nursing co design.
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  - For anyone who didn't catch that episode, and
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  - if they didn't, I encourage them to go
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  - back and listen. Can you just briefly introduce
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  - yourself, and share more about your role at
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  - Duke?
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  - Sure. I, I I consider myself to be
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  - extremely fortunate. I get to,
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  - serve the organization in a few different capacities.
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  - So I have the opportunity of leading a
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  - workforce of about,
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  - 12,000
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  - nursing and patient care services staff,
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  - as well as,
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  - I I get to be part of the
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  - leadership that leads about 1,700
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  - APPs,
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  - but I also hold,
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  - a leadership role at the School of Nursing
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  - as the Vice Dean for Clinical Affairs.
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  - And what that means is, you know, being
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  - part of an academic system here at Duke,
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  - we we really take advantage of
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  - that. So we we really leverage the synergies
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  - of having
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  - a world class health system
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  - along with a world class school of nursing,
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  - school of engineering, school of business, and multiple
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  - other schools
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  - that we all get to partner with on
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  - really advancing and innovating care. So we're trying
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  - to really lead what healthcare of the next,
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  - I don't know, five years is going to
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  - look like. I think I think on are
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  - the days when we get to count in
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  - decade increments.
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  - I think change and innovation are
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  - are taking place so quickly that,
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  - it's really... It's an interesting time. It's an
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  - exciting time,
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  - but boy, change is happening quickly
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  - and we get to lead in that. Yeah.
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  - And how exciting is that? But I know
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  - even sometimes that five year forecast, I think
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  - can be difficult
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  - to,
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  - predict.
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  - But I wanna start off looking at,
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  - your
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  - distinct
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  - view across both the health system lens and
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  - academia, as you said, honing in on
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  - new nurse graduates.
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  - I've spoke with a lot of,
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  - nursing leaders both on the podcast and off,
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  - and about the clinical
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  - skills gap and
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  - efforts to
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  - keep nurses... To help nurses get practice ready
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  - for their first day on the job and
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  - then, of course, retaining them through that first
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  - year. Can you talk about how are new
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  - graduates
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  - landing at Duke,
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  - and what does it take to keep them
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  - and have them feel confident going into practice?
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  - Yeah. It's it's really interesting. So
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  - our new graduates
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  - are are coming to us with,
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  - you know, they've got a diversity of of
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  - skill and preparation.
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  - We actually have a school of nursing that
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  - is part of the health system that is
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  - our BSN program,
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  - the Watts College of Nursing, and we've got
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  - the Duke University School of Nursing,
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  - which is primarily,
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  - graduate degree. So we've got the master's
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  - of nursing, which is the pre licensure entry
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  - level,
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  - and then we've got
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  - masters and and doctoral,
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  - level prepared nurses.
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  - And as
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  - we bring new nurses into the system, we're
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  - actually trying to to bring them in while
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  - they're still in the training phase.
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  - So we've been working with HR and some
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  - of our local schools, not just our own
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  - affiliated schools, but schools within the area
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  - to try and make sure that
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  - we're capturing nursing
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  - students
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  - in that last semester prior to graduation.
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  - Trying to get them aligned with their capstone
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  - or really that so in the last semester
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  - generally
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  - they have a bulk of hours they have
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  - to do
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  - in bedside clinical care, bedside or ambulatory, whatever
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  - the case may be,
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  - but interacting in the clinical setting.
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  - So we try to identify
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  - and match
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  - students with their area of clinical interest so
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  - that they're starting in the area where we're
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  - seeking to employ them and where they want
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  - to be employed
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  - long before graduation
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  - so that they're already developing relationships, they're understanding
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  - the patient population, they're going deeper
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  - than,
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  - they have
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  - thus far in their career.
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  - And our hope is that that model continues
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  - to grow and we can then just,
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  - when they graduate,
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  - then put them into orientation. And orientation as
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  - a new grad also includes
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  - a residency.
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  - And we just finished a revamp of our
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  - residency programming to make sure that we've got
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  - it... That it's sub specialized.
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  - So a new nurse who wants to go
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  - into oncology, for instance, is going to have
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  - an oncology specific year long residency.
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  - So they'll get
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  - augmented education that's specific to oncology
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  - while they're also
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  - oriented to their roles. So they go through
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  - their orientation
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  - in the first six to eight weeks,
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  - and then they continue for a year in
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  - the residency.
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  - So we're really trying to make sure that
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  - people are well prepared. The other thing we're
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  - doing at just, again,
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  - being
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  - mindful
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  - of where we are in 2026,
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  - virtual care is becoming huge.
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  - We are a consumer driven industry.
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  - Our patients and families want virtual care.
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  - So we need to ensure that the the
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  - workforce
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  - is,
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  - skilled in
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  - delivering virtual care.
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  - So we are now working with the schools
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  - in the region to make sure that we
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  - are rotating
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  - our nursing students through the virtual care environment,
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  - the platform.
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  - So they're getting exposed to that early on.
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  - So we're doing a whole bunch of things
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  - to to to support our new grads.
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  - Yeah. Very much so. So you mentioned getting
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  - that skill and training in virtual care early
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  - on, revamping the nursing residency program with those
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  - subspecialties, and then, of course, trying to match
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  - nursing students in the areas they're most interested
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  - in. I think, like, having... I imagine
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  - having that
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  - relationship
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  - groundwork is probably so valuable in the familiarity
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  - with the setting for that psychological safety, the
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  - support network for those new nurses.
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  - Very much. Yeah. And then which...
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  - With the residency program, you mentioned the changes
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  - of the subspecialty focus. Were there any other
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  - significant
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  - shifts that you did in your revamp, or
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  - is that the biggest?
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  - Well, the biggest is really focusing on the
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  - specialties and making sure that it wasn't... What...
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  - The feedback we got is that it was
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  - overly generalized
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  - and that nurses found the most value in
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  - having deeper
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  - understanding
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  - and more support
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  - in learning their specialty
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  - and really getting that expertise because where do
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  - people feel uncomfortable and anxious?
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  - They feel uncomfortable and anxious when they're in
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  - a clinical situation and they feel like they're
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  - not prepared
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  - and they don't have the resources available to
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  - them to respond appropriately to the patient.
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  - So in giving them
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  - more
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  - specialized
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  - support and training early on,
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  - you alleviate some of that anxiety
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  - Mhmm. And help them feel more confident and
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  - comfortable in the setting.
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  - Yeah. Which can be so impactful.
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  - I wanna zoom out one bit more from
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  - new nurse graduates to your broader workforce. You
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  - mentioned 12,000 nurse... Nursing and patient care services
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  - staff. Can you talk through the workforce piece?
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  - Where do vacancy and turnover rates stand at
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  - Duke today compared to last year?
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  - You know, it's interesting.
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  - Turnover is about the same to slightly improved.
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  - And I think where we are at this
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  - point in time,
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  - where we are at we are at the
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  - turnover that I think is the new norm,
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  - which is right in that
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  - 14, 15%,
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  - which is which is pretty good when you
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  - consider where we were a few years ago.
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  - It is certainly,
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  - I would say,
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  - higher than it was,
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  - say, five years pre pandemic when we were
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  - probably down around 11 or 12%.
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  - But what's happening is is there is
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  - so much more opportunity available
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  - to bedside nurses
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  - that is more attractive, more attractive work schedules,
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  - different environments, exposure to technology.
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  - They don't need to stay at the bedside.
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  - You know, we've talked about this this nursing
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  - shortage
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  - and
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  - it's interesting
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  - when you really look at the just the
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  - numbers,
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  - just the pure numbers of registered nurses versus
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  - jobs for registered nurses,
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  - The math is equal. We have sufficient nurses
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  - to fill all roles.
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  - The problem is the roles that we can't
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  - really
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  - keep people in
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  - for long periods of time the way we
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  - used to ten years ago
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  - is really in the acute setting
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  - at the bedside.
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  - That work is labor intensive.
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  - It's acute by nature.
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  - Patients are sick. There's a lot going on.
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  - It's physical,
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  - and that's where we see the most turnover
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  - because there are all of these other roles
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  - that have come up
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  - that our our pharma... They offer nurses more
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  - flexible schedules,
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  - less intense work environments,
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  - so they're leaving the bedside
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  - faster to go to those other jobs.
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  - Yeah. Well, I'd love to talk about your
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  - response to that. Of everything you've tried on
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  - retention, what's moved the needle most? How are
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  - you creating that work environment to give nurses
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  - that flexibility and have them wanna stay?
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  - So our response to that has been something
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  - called the co care model. So we took
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  - three units
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  - at University Hospital
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  - a year ago and they were due for
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  - a refresh. We,
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  - put new cabling in.
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  - We brought in new technologies,
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  - computer vision,
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  - enhanced whiteboards,
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  - interactive,
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  - video,
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  - and we launched something called the co care
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  - model. We call these three units our innovative
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  - units.
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  - And what we've been able to do is
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  - we've been able to cross train those nurses,
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  - typical med surg units, pretty sick patients,
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  - and we cross trained those nurses
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  - to the virtual care center as well.
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  - So now we've gone from this nurse to
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  - patient ratio paradigm to a team based care
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  - paradigm.
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  - So we've got a team of nurses,
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  - nursing care assistants, remote safety observers,
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  - all coming together around the care of a
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  - cadre of patients
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  - on a 32 bed unit.
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  - And the nurses themselves many of them work
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  - two days, two twelves on the acute inpatient
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  - setting and one twelve in the virtual care
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  - center
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  - as part of the care team caring for
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  - the same cohort of patients
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  - with the same colleagues,
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  - it's...
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  - It gives them a nice break and they're
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  - doing more focused
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  - education for discharges,
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  - for admissions,
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  - helping do second signs, and really helping their
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  - colleagues.
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  - And we've seen our falls
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  - reduce. We've seen our staff satisfaction
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  - increase, our patient satisfaction increase,
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  - and it's a model that we're looking to
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  - scale across the system.
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  - Wow. I was just about to ask that.
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  - It's in three units now. I'm assuming it
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  - will continue to grow. Yeah. Very ex... Very
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  - exciting.
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  - A great
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  - example of truly reimagining care, infusing technology, and
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  - innovation
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  - in a way that's a win for both
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  - patients and the staff members.
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  - Absolutely.
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  - Yeah. Alright. My final question for you, doctor
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  - McDonald, if you think about a new nurse
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  - who's stepping into a care facility in their
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  - first day on the job at Duke University
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  - Health System,
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  - what would you tell them?
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  - There's never been a better time to be
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  - a nurse.
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  - There is...
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  - So first of all,
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  - as nurses,
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  - we still get to be right there with
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  - the patient.
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  - We get invited in to people's lives
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  - at the most intense,
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  - maybe some of the most joyous, maybe some
• 14:06
  - of the saddest, but we are part of
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  - the the human experience. We're part of the
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  - journey.
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  - Add to that,
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  - nurses
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  - have the... Have a unique perspective
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  - given where we sit in the care paradigm,
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  - and we get the opportunity
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  - to innovate and recreate what care looks like
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  - in 2026.
• 14:30
  - We get to lead in redesigning
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  - with nurse led models of care. We get
• 14:35
  - to lead in innovation in in how we
• 14:38
  - integrate technology,
• 14:41
  - how we get to inform how technology is
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  - going to be designed for the care setting,
• 14:46
  - inpatient,
• 14:47
  - outpatient, home,
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  - and we get to be part of that.
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  - So in my humble opinion, there's never been
• 14:54
  - a better time to become a nurse.
• 14:57
  - The opportunities are endless, and the innovation and
• 15:00
  - the excitement is all right there.
• 15:02
  - Yeah. Well, doctor McDowell, this has been, such
• 15:05
  - an interesting conversation. I appreciate you giving us
• 15:08
  - a peek behind the curtain at some of
• 15:09
  - your strategy at Duke University Health System. So
• 15:11
  - thank you so much for your
• 15:13
  - time. Always my pleasure, Mackenzie. Thank you.