Latest / Becker’s Healthcare - Clinical Leadership Podcast / Andrea Highfill, DNP, RN, Chief Nursing Officer at Carson Valley Health

Transcript

Andrea Highfill, DNP, RN, Chief Nursing Officer at Carson Valley Health · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Hi, everyone. Thank you so much for tuning
0:02
in to this episode of the Becker's health
0:05
care podcast.
0:06
I'm Erica Carbajal, an editor with Becker's, and
0:09
I'm excited today to be joined by Andrea
0:11
Highfill.
0:12
Andrea is the CNO at Carson Valley Health.
0:16
Andrea, thank you so much. A pleasure to
0:18
have you on today.
0:19
Thank you, Erica.
0:21
Nice to be here. Yeah. Well, to start
0:23
us off, do you mind just sharing a
0:25
bit about your role, the scope of your
0:27
work at Carson Valley to help set the
0:29
stage for attendees?
0:31
Sure. Sure. Yeah. So I've actually been at
0:33
Carson Valley Health in our hospital here,
0:36
for 15 years now. I've been a nurse
0:38
for about 25.
0:40
And, started out as a staff nurse on
0:42
the floor
0:44
and then became went into leadership a few
0:47
years after that, managing
0:49
a mental health department and then becoming the
0:52
senior manager
0:54
of ancillary services,
0:56
and then followed by my current role as
0:59
the chief nursing officer.
1:00
So in my current role, I'm over the
1:02
nursing
1:03
departments, which are med surg, ICU,
1:06
emergency department, the surgery department,
1:09
and then also,
1:10
our infusion department, respiratory
1:14
therapy,
1:15
and pharmacy.
1:16
So I oversee all those, in leadership and
1:19
operations
1:21
of the departments, the finances,
1:23
quality metrics,
1:25
and also,
1:27
just kind of,
1:28
the managers all report to me on on
1:31
their day to days.
1:33
Thanks, Andrea. Yeah. 25 years. Wow. I'm sure
1:36
you've seen a lot of, you know, different
1:38
iterations
1:39
of nursing in such an, a time of
1:41
change right now.
1:43
So I guess I'll, I'll start there. If
1:45
you could just tell us a little bit
1:46
about
1:47
over the past year kind of changes you've
1:50
seen with the nursing workforce.
1:52
I think we've really seen
1:53
national reports over the past year suggesting that
1:56
there's some more stabilization
1:58
happening within the nursing workforce. So
2:01
what are your reactions to that, you know,
2:02
living living it on the ground? Does that
2:04
resonate with your experience? What some of these
2:07
data reports say? And what if any improvements
2:10
are you seeing if
2:11
so? Yes. That definitely resonates, Erica. I took
2:15
this job in December of 2019
2:17
as the Chief Nursing Officer. And so,
2:21
this
2:22
is the biggest change that I've ever seen
2:25
in nursing,
2:27
going having started at the very beginning of
2:30
COVID and then going through COVID, and now
2:32
I'm just now we've
2:34
kind of we're moving past the post COVID
2:37
recovery now, and that means a lot to
2:39
us in the hospital. It means a lot
2:41
to us in staffing.
2:44
We have
2:45
learned to innovate
2:47
and not just do what we've always done
2:50
because that's what, you know, has been in
2:52
our box
2:53
of nursing, you know,
2:56
policies and procedures,
2:58
innovate and work with what we have, and
3:00
then also not
3:02
fear
3:03
of looking past
3:05
and
3:06
just working in different ways than we ever
3:08
have.
3:09
And so with that and with the recovery,
3:12
I think that the new graduates now,
3:15
you know, have been through
3:17
the nursing school during the times where
3:21
COVID was still a little bit fresh and
3:24
they were still being
3:26
taught a lot of the lessons and stuff.
3:28
And so now coming out into the real
3:30
world as new graduate nurses and still some
3:32
students,
3:34
it's probably a little bit more refreshing once
3:36
they get their
3:38
feet wet and see that it's not so
3:40
scary anymore.
3:41
And so we have been able to retain
3:45
a lot more nurses and hire a lot
3:47
more nurses. People are coming back into the
3:49
field, I think, now.
3:51
We went from half of our nursing force
3:54
as travelers,
3:55
and we're paying up to $160,
3:57
$180
3:58
an hour for all these travelers during
4:01
COVID. So now we only have 1 traveler
4:03
in our system,
4:05
and that's only at $80 an hour.
4:07
And so it's really a breath of fresh
4:10
air really
4:11
coming back to
4:13
what we can focus on now with our
4:16
improving the patient experience and continuing to improve
4:20
our quality metrics and the way we practice
4:22
and being able to focus on that and
4:24
not just looking around and wondering when we're
4:26
gonna get the next nurse to for the
4:28
night shift tonight,
4:30
for example. So it's it's a big improvement.
4:34
Yeah. Really interesting to hear just how many
4:37
nurses have come back
4:39
after having left from traveling and and coming
4:42
back to really a different,
4:44
you know, changes with technology and new care
4:46
delivery models, than they may have been used
4:49
to, you know, had they before they left
4:52
throughout the pandemic.
4:55
For this next question here,
4:57
do you mind sharing a bit about your
4:59
top initiative that you're prioritizing
5:01
to strengthen and elevate
5:03
Carson Valley Health's nursing workforce in 2025?
5:07
And how might this effort affect patient outcomes
5:09
and and staff satisfaction?
5:12
So I think our top initiative,
5:16
to strengthen our our nursing workforce and just
5:18
to continue to
5:20
elevate our practice in general is, our nurse
5:23
apprentice program and new graduate nurse program.
5:27
Right now, we are a 25
5:30
bed critical access hospital,
5:33
with
5:34
a 14 bed ER,
5:36
and we have 3 ORs in our surgery
5:39
department.
5:40
So we're a little bit smaller,
5:42
on the outskirts of Reno and Lake Tahoe.
5:45
So I think that actually helps us with
5:48
the nurse apprentice and new graduate nurses because
5:51
they're not shuffled into
5:54
a huge
5:55
system of getting lost. There's a lot of
5:57
1 on 1
5:58
attention
5:59
and training for the nurse apprentices.
6:02
And so starting with that program, we
6:06
hire nursing students
6:09
usually in their last year
6:11
of nursing school because once they
6:15
have been checked off in school for doing
6:18
different procedures and things like that, then they
6:20
can actually
6:29
apprentice's salaries and so we're able to really,
6:33
really hire as many as our staff can
6:36
handle
6:37
in order to, have a nice pipeline for,
6:40
you know, kind of try before you buy
6:42
for both of us, if the nurse thinks
6:44
it's a good fit to work here, the
6:46
nurse apprentice,
6:47
and then if we think they're a good
6:48
cultural fit and able to be trained here
6:50
in the hospital. So that's a really strong
6:52
program we have going.
6:54
And the new graduate program isn't one that
6:57
we
6:58
can
7:00
say it's just like the larger hospitals because
7:03
it's really not. We
7:06
have the new graduate nurses more on a
7:08
1 on 1 basis and not like a
7:10
huge cohort of 50 or 100
7:13
new graduate nurses.
7:15
And so these nurses,
7:17
will be paired up with a preceptor on
7:19
day or night shift,
7:21
in any of our nursing departments. And then,
7:24
they take they have an online course that
7:27
they take throughout the 1st 12 weeks.
7:31
And it actually is enhanced with AI,
7:34
and the AI
7:36
can tell through all the test questions and
7:38
things like that what they are struggling with
7:41
and what their
7:42
biggest opportunities
7:44
in their clinical work and then also in
7:47
their knowledge base,
7:49
are for us to help
7:52
really cater to an independent and individualized learning
7:56
for them. So those are our 2, really
7:59
big programs that hopefully will help us retain
8:03
nurses and then also
8:05
improve our patient outcomes as they become a
8:07
part of our team with still a lot
8:09
of oversight
8:11
during that first period.
8:14
Yeah. Thanks for sharing those too. With the
8:16
nurse apprenticeship program,
8:18
you said it was like
8:20
a robust program. How long has that one
8:22
been in place? I know we've seen,
8:24
some reports about health systems kind of reintroducing
8:27
nurse externship programs, which has been interesting,
8:31
as kind of kind of a reemerging trend.
8:33
But I just wanted to see how how
8:34
long that's been in place.
8:37
We've had the nurse apprentice program in place
8:40
for probably
8:41
7 years now.
8:43
You know, there's there's
8:45
been some slow years of it. And I
8:47
think when we talk about nurses coming back
8:49
into the workforce,
8:51
some of it is that I think that
8:54
they're coming back to school too. I I
8:57
haven't actually looked at the entrance numbers for
8:59
our local
9:01
nursing schools here,
9:02
but it seems like those also dropped during
9:05
COVID and kind of that post COVID area.
9:08
So our nurse apprentice program wasn't as strong
9:11
during that time either.
9:13
And so now it's pretty
9:15
it's getting to be very competitive. And we
9:18
have, you know, for our small
9:21
space, we probably have 5 or 6 spots,
9:24
and we definitely have more than double
9:27
applicants.
9:29
Yeah. Sure, Chris. I see that that interest.
9:31
By and large, nurses still have a lot
9:33
of questions surrounding what AI means for patient
9:36
care.
9:37
What role do you believe it will play
9:39
in care delivery in the coming years?
9:43
Sure. So
9:44
I think there's a role for AI in
9:46
nursing.
9:47
I think that when you look at AI
9:50
becoming developed, the limitation
9:52
of it and
9:54
is
9:55
is really
9:56
anything with human interaction, any anything that requires
10:00
human interaction
10:02
and relationship building is not gonna be enhanced
10:05
with AI necessarily,
10:07
or it's not going to be replaced by
10:09
AI
10:10
is probably a better way to say it.
10:12
And so I think with nursing,
10:15
we currently are not doing any piloting
10:19
of AI in our bedside nursing or our
10:21
nursing departments. We are piloting AI in our
10:24
behavioral health
10:26
outpatient
10:27
department as a part of therapy
10:31
and where the therapists are able to
10:34
use AI to
10:36
pick out the most common words and the
10:38
most common
10:43
patient's therapy session and things like that
10:45
to more accurately diagnose and treat the patients.
10:48
So I think that's
10:50
a really good first step. In the future,
10:52
though, for bedside nursing,
10:55
I think that,
10:56
it's going to be able to help AI
10:59
is going to be able to just play
11:00
more of a supportive role with nurses
11:03
in improving
11:04
things like efficiencies
11:06
and reducing workload and some of the things
11:09
that nurses do every day, like
11:11
documentation
11:12
and medication and administration. And then,
11:16
I'm sure that it will be really useful
11:18
in the analysis of the patient monitoring systems
11:21
as well, telemetry and recognizing rhythms,
11:25
much easier than sometimes if there's artifact on
11:29
the telemetry monitor, it's hard to tell if
11:31
the patient's in a specific,
11:34
rhythm. And then if they go into anything
11:36
that could
11:37
start down a life threatening rhythm, then,
11:41
I think AI would be useful in
11:44
detecting that earlier than possibly a human eye
11:47
could, or possibly a consistent human eye could,
11:50
right?
11:51
So I think there's some
11:53
real impacts that that could have on our
11:55
profession.
11:57
And then when you look at the staffing
11:59
and patient ratios, you know, if AI does
12:02
support the nurses so much more, then will
12:05
their jobs be easier and our staffing ratios
12:08
change,
12:10
so that nurses can take care of more
12:12
patients
12:13
with that.
12:14
Andrea, just around financial pressures, obviously, the industry
12:18
is navigating
12:19
those across the board. So
12:22
during this, how is Carson Valley really trying
12:24
to balance cost management with investments in the
12:27
nursing workforce and development
12:29
and patient care improvements?
12:33
Well, I think
12:34
what happens we do play a balancing sort
12:37
of
12:38
dance
12:39
and,
12:41
I think
12:42
it was about 10 or 15 years ago
12:44
when there was
12:45
a freeze on any capital items and it
12:47
was during, like, a recession period. There was
12:47
a freeze any capital items and it was
12:49
during like a recession period. There was a
12:52
freeze on capital items. There was a freeze
12:54
on,
12:56
wage increases
12:57
and this lasted like only about 2 years.
13:01
But recovering
13:03
from that,
13:04
we were so far behind that we had
13:07
to
13:08
budget
13:09
so aggressively
13:10
to catch up even to the rest of
13:13
the hospitals in our area
13:15
just to be able to compete that we
13:17
just can't get behind
13:19
on the latest technology and paying people fairly
13:23
and making sure everyone has what they need
13:26
to take care of patients.
13:29
And so that's sort of the spending piece
13:31
of it.
13:32
And then the responsibility piece of it. So
13:35
we don't want to be irresponsible
13:38
in fiscally
13:39
in that,
13:40
but we also don't want to fall behind
13:43
benchmarks and we don't want to fall behind
13:46
in technology. We want to have the latest
13:49
and the greatest
13:50
to be able to safely take care of
13:52
our patients.
13:53
And then
13:55
what we do on a day to day
13:56
basis that we're
13:58
more
13:59
in control of is,
14:02
always staffing to our volumes
14:04
and always looking at how we can be
14:07
more efficient
14:08
in
14:09
how we schedule our patients and then how
14:11
we staff our patients.
14:13
So staffing is one of the number one
14:15
expenses in the hospital setting.
14:17
And so
14:19
that's something we are always looking at. And
14:21
then also, obviously, supplies and costs,
14:24
just being very mindful
14:27
of those. And then we hold our managers
14:29
accountable.
14:31
In our health system, we create our own
14:33
budget. We're not given a budget and said,
14:35
hey. And like a lot of for profit
14:38
hospitals are given budgets from above,
14:41
But we actually have to work with I
14:44
work with my managers and my department leaders
14:47
to create the budget and then justify it
14:50
to our CEO and to our CFO
14:53
so that
14:54
we're responsible and accountable and we know every
14:58
line item that's in that budget. And every
15:00
month when we look at it, we say,
15:02
oh, gosh, we either did a really good
15:04
job of sticking to what we thought we
15:06
would have or we there's a little bit
15:09
of a variance based on this and that.
15:11
So
15:12
the more
15:14
we are we include our managers in that
15:16
and we're aware of what every line item
15:19
is, the more accountable
15:21
they are. And
15:23
we can continue to grow
15:25
each year with that and say, okay, what
15:27
did we do wrong last year? Let's improve
15:29
that this year.
15:30
And how can we educate the staff on
15:33
the reasons behind this, you know, instead of
15:36
sometimes the staff
15:38
think that the only thing that administration
15:41
cares about is money and the bottom line,
15:43
but that's not the case. The case is
15:45
we really want to take care of patients,
15:47
and we can't do it if we go
15:48
out of business.
15:49
So
15:50
there's there's both sides of the coin there.
15:53
So
15:55
Yeah. Andrea, and I think your point just
15:57
about
15:58
prioritizing
15:59
what to invest in when it comes to,
16:02
you know, the latest technology
16:04
and, you know, not wanting to be irresponsible
16:07
with spending, but also not wanting to fall
16:09
behind there with,
16:11
integrating,
16:13
new technology that could could make an organization
16:16
remain competitive. I think it's such a sentiment
16:18
that we hear from leaders and and trying
16:20
to navigate that. So do you have any
16:22
thoughts or advice on
16:25
how you go about actually doing so? How
16:27
you go about actually prioritizing
16:30
what to
16:31
invest in and move forward with,
16:33
given tight budget constraints?
16:37
Yeah. That's a that's a really good question.
16:39
So,
16:40
the very first thing is we establish the
16:43
demand for it. And I can give you
16:45
an example of
16:46
our Mako orthopedic robot. So this is a
16:50
very expensive piece of machinery. It's,
16:53
you know, probably over $1,000,000
16:56
for this piece of equipment.
16:58
So
17:00
we started just hearing surgeons say, hey, we
17:02
really want the Mako. Hey, we're going to
17:03
take our patients down the road
17:05
to the other hospital that has the Mako
17:07
because you guys don't have it. Hey, we're
17:09
starting to give our patients the choice. So
17:12
the doctors in their offices say, Hey, I
17:14
can
17:15
I
17:16
can operate at
17:18
2 different hospitals? 1 has the Mako and
17:21
one doesn't. And these are the benefits of
17:23
the Mako. Because a lot of the surgeons
17:24
these days, the orthopedic surgeons, are
17:28
are training in the Mako and see the
17:30
better outcomes and see the reduced sentinel events
17:33
and things like that.
17:35
And so
17:36
once we kind of started hearing this buzz
17:39
that it was a high demand,
17:42
we wanted to
17:44
capture that in data, like how many patients
17:47
are we seeing, how many patients are being
17:48
sent away.
17:50
And so we tried the best we could
17:53
to
17:53
capture the data through
17:56
the vendors that work with us,
17:58
because the Mako vendors
18:00
also
18:01
work
18:02
in a tight area here and are able
18:05
to say, hey, this is the amount of
18:07
patients that we generally see at these other
18:09
hospitals using the robotic equipment.
18:12
And then also,
18:14
getting like using part of our strategic plan
18:18
to navigate where our community has seen a
18:22
need in orthopedics
18:23
and
18:24
when are the peaks of these and just
18:26
collecting all of this data and then putting
18:29
it into
18:30
a pro form a, like a business case
18:32
and return on investment
18:35
and then
18:36
being like, okay, how
18:38
many Mako
18:39
surgery cases is it going to take to
18:41
pay this thing off? How many do we
18:43
need to do in a month? How many
18:44
can we do in a month?
18:46
And what's our capability on our side? And
18:49
then, how expensive would it be to continue
18:52
to take care of this thing.
18:54
And so
18:56
that's kind of one of the things that
18:58
that's a really good example of
19:01
the latest technology that
19:04
we also
19:05
would be losing out on a lot of
19:06
business. That's the other case of the that's
19:09
the other part of
19:10
the business case is what kind of business
19:12
would we be losing out on if we
19:14
didn't get it.
19:15
So at the end of the day,
19:18
we did
19:20
data
19:21
did show that we would be losing quite
19:22
a bit.
19:23
And if we didn't keep up with this
19:24
technology
19:26
and,
19:27
would be gaining
19:29
quite a bit if we if we did
19:30
acquire it. So
19:33
Yeah. Andrea, thanks for walking through that example.
19:35
I think it's interesting to hear just
19:38
how,
19:38
you know, you and your peers really did
19:40
the leg work on on building that that
19:42
business case.
19:44
You have to be able to speak to
19:46
the actual board who approves it, and and
19:49
they they may or may not understand just,
19:51
hey. Can we have $2,000,000
19:53
for a piece of equipment? They're gonna wanna
19:56
know a little more than that. So Sure.
19:58
Yeah.
19:59
Andrea, before we close out here, just wanted
20:02
to end with a piece of advice if
20:04
you could share for the next generation of
20:06
nurse leaders who may be listening.
20:10
Well, I think I think my number one
20:13
piece of advice is probably something that I
20:16
can pride myself in,
20:18
and that is always hiring the the best
20:21
people, always hiring the best managers,
20:24
people who I think are smarter than me,
20:26
especially at their
20:28
specific jobs.
20:29
If I hire the best and sometimes I
20:32
have left positions, manager positions open for
20:36
6, 8 months even sometimes,
20:38
because I just don't have the right fit.
20:41
I never hired just for a pulse,
20:43
because that will make my life much harder.
20:45
I'd rather manage it myself until I can
20:48
find the best fit.
20:49
And so that's my, that's my one piece
20:51
of advice.
20:53
Great advice.
20:55
Andrea, thank you so much for joining me.
20:57
It's been a pleasure chatting with you today.
20:59
Thank you, Erica.
21:01
And listeners, you can tune into additional episodes
21:04
of the Becker's Healthcare podcast by visiting the
21:07
podcast page
21:08
webpage on our website.
21:10
Thank you all so much.