Latest / Becker’s Healthcare - Clinical Leadership Podcast / Robert Rose, DNP, System Chief Nursing Officer and Senior Vice President of Nursing at Ascension

Transcript

Robert Rose, DNP, System Chief Nursing Officer and Senior Vice President of Nursing at Ascension · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  - 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.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - 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.
• 0:51
  - Hello, everyone, and welcome to the Becker's Healthcare
• 0:54
  - Clinical Leadership podcast.
• 0:57
  - I'm Mackenzie Bean, associate vice president and managing
• 1:00
  - editor of Becker's Hospital Review.
• 1:03
  - I am so thrilled to be joined by
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  - doctor Robert Rose, who is the chief nursing
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  - officer and senior vice president of nursing for
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  - Ascension
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  - on the podcast today. Doctor Rose, thank you
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  - so much for joining us. How are you
• 1:15
  - doing?
• 1:15
  - Good. It's my pleasure to be here. And
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  - please call me Rob.
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  - Rob, thank you so much. It's a pleasure
• 1:22
  - to have you.
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  - I'm sure
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  - many listeners on this podcast are are familiar
• 1:27
  - with your role and the work and, of
• 1:29
  - course, Ascension as such a prominent organization
• 1:32
  - nationwide. But for anyone who,
• 1:35
  - might be a first time listener to you
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  - on the podcast, can you just share a
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  - little bit more about yourself and your role
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  - to set the stage for our conversation?
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  - Yeah. Sure.
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  - As you mentioned, I serve as the chief
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  - nursing
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  - officer,
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  - for Ascension,
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  - which is a large Catholic health system,
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  - across The US.
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  - And,
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  - really, pleased to be here and talk about
• 2:01
  - the work of our nursing teams and our
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  - leadership teams here at Ascension.
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  - And, proud of the work that's being done
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  - and continues to be done.
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  - Very much so. With that, let's dive right
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  - into some of that work.
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  - I know you're really overseeing a a large
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  - nursing workforce. I believe it's about 35,000
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  - nurses.
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  - Correct. About 35,000
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  - nurses, 90
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  - acute care hospitals and or jointly owned ventured
• 2:30
  - hospitals,
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  - as well as a larger and getting larger
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  - ambulatory platform.
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  - Mhmm. So
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  - a huge footprint, a huge workforce. And that's
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  - where I wanna start the conversation
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  - now is on the workforce
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  - piece. You know, nursing executives nationwide
• 2:47
  - are highly focused on creating
• 2:49
  - a workplace where nurses want to stay and
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  - thrive and grow and really be able to
• 2:54
  - do meaningful work. Can you talk about some
• 2:57
  - of that work? And maybe we can start
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  - with,
• 3:00
  - where vacancy and turnover stand this year compared
• 3:04
  - to last.
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  - Yeah. Well, certainly, we've done a lot of
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  - focus in nursing and and not only nursing,
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  - but our nursing techs, we call them, or
• 3:14
  - nursing support. So that could be everything from
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  - a scrub tech to a radiology
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  - tech to, you know, some of the licensed
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  - techs like respiratory to our, you know, nursing
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  - assistants that work in the units with our
• 3:26
  - nursing team. So it's it's really the whole
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  - grouping of nursing and nursing techs that we
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  - are working with from a turnover and vacancy
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  - perspective.
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  - You know, depending on the different markets across
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  - Ascension,
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  - our vacancies,
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  - are, you know,
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  - nationally, they're probably around five to 8%, I
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  - would say. But, really, the work of our
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  - nursing retention has improved continuously.
• 3:53
  - In fact, this past year, we saw 4%
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  - improvement,
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  - for our nursing retention rate. We use retention
• 4:00
  - rates versus turnover rates. So they're a little
• 4:02
  - nuance and a little bit different than what
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  - what a turnover rate would look at. We
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  - do... We can put them into a turnover
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  - if we have to benchmark.
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  - But we've really seen,
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  - our nursing retention
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  - continue to,
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  - increase,
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  - post COVID,
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  - which we're really excited about. And we probably
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  - have one of the lowest traveler usage,
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  - across our ministries. Now, again, that doesn't mean
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  - we don't have travelers here and there, but
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  - we're certainly,
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  - reduced,
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  - the amount that we have,
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  - as we continue to onboard
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  - new nurses.
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  - So a lot of focus
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  - is put on the nursing retention in our
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  - turnover.
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  - You mentioned that 4% improvement in retention rate
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  - is significant.
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  - Can you talk through
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  - what's what's behind that number? I imagine it's
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  - a lot of work, many different initiatives. What
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  - are some of the biggest things that you
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  - think has helped move the needle there?
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  - Yeah. Well, it's multifactorial.
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  - So first, we... You have to have a...
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  - You know, one of the things you hear
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  - from the teams is we don't have enough
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  - staff. Right? And we get that. That's not
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  - just Ascension. That's everywhere.
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  - And so a couple things that we really
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  - try to do is, one, hire as much
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  - as we can. So we've partnered with HR,
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  - and we've done a number of hiring sprints
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  - where we really focus on bringing a large
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  - volume of nurses in the door, particularly in
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  - our ministries where we've seen
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  - some higher vacancy rates than others. And then
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  - we really wanna focus on what we call
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  - our our new grads or newly licensed nurses.
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  - We do... We are blessed in many of
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  - our markets
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  - to have good faculty academic partnerships
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  - where we work with the schools in nursing
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  - locally. And we... A lot of our students.
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  - I'm sort of a just say yes to
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  - nursing students because I think that gives everybody
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  - the opportunity.
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  - Number one, they get to see how we
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  - are, and we get to see how they
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  - are. And then we primarily do hire a
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  - lot of new grads, which helps. We have,
• 6:02
  - residency programs. We have an accredited residency program
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  - in Texas.
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  - We have, we're spreading our nurse residency program
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  - throughout Ascension, where all of our new grads
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  - will go through the residency program. And it
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  - will be... It will follow the accreditation
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  - standards that are nationally set by the accrediting
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  - bodies.
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  - A lot of people don't realize, and I,
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  - you know, I always say this, nursing is
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  - one of the few professions that does not
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  - have a residency as part of their education.
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  - So if you think of our colleagues in
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  - physical therapy or pharmacy
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  - or physicians,
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  - they all go through a residency before they
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  - graduate.
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  - So it's incumbent on the hospitals and health
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  - systems
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  - to create that residency program to be able
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  - to give and provide that support,
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  - for the transition of a registered nurse. What
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  - they learn in school is not nearly enough
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  - of what they need to have when they
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  - get out to the realities of taking care
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  - of patients in these complex acute care settings
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  - that we have.
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  - I've spoken with many nursing executives who are
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  - either
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  - revamping or growing their residency programs with that
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  - acknowledgment of the clinical skills gap, which seems
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  - to have also grown over the past few
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  - decades. So it seems like a a really
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  - top priority for for many, as you said,
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  - that alongside some of the nurse hiring,
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  - sprints to also
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  - bring in the workforce along with your academic
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  - partnerships.
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  - I think one other piece of the puzzle
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  - is,
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  - nurse leadership
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  - and really spurring that career development and growth
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  - among your work force. So can you talk
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  - more about how... What does a leadership path
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  - look like for nurses,
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  - and and how do you foster that?
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  - Yeah. I'm glad you said that. We,
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  - I have focused a lot on our nurse
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  - managers,
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  - since I've been at Ascension.
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  - They are pivotal to any organization
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  - and particularly
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  - to our new graduate nurses that come on
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  - board. The nurse manager is really
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  - sort of the, you know,
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  - the glue that holds the teams together.
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  - And many of our nurse managers can be
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  - new as well. Right? They might not have
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  - as lot of experience in nursing as others.
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  - So I think what we've been trying to
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  - do is really focus on that nurse manager.
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  - We've,
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  - we're we're kicking off a nurse manager executive
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  - coaching
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  - program. So typically, executive coaching programs are focused
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  - on executives, as the title says. This will
• 8:26
  - be for nurse managers, and it will be
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  - a six month program for a high performing
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  - nurse managers because we know that sometimes there's
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  - not
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  - typical advancement,
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  - necessarily where they are. Maybe their next stage
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  - is a director, and we don't have openings.
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  - So this gives them some,
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  - you know, some other skill sets
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  - and something to look forward to as part
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  - of their, career,
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  - while they're in a nurse manager role. The
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  - other thing that Ascension has has done, and
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  - this work started before me and we continue
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  - to refine it, is we have a nursing
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  - leadership structure. So depending on the
• 9:02
  - hospital census and the bed size,
• 9:04
  - we have a nurse leadership structure put in
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  - place. So there's no have and have nots.
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  - Everybody sort of has the same structure
• 9:11
  - depending on how many patients are in your
• 9:12
  - hospital.
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  - As such, we created the clinical lead role
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  - for,
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  - our newer nurses,
• 9:19
  - that are charged nurses are wanting to get
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  - into the, leadership ranks. This is a role
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  - that they can be in, and it gives
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  - some... It gives the nurses that are working
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  - on the floor a go to person on
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  - a regular basis. So that role isn't... You
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  - know, it's one person on a Monday, and
• 9:35
  - then Tuesday, it's someone else. So it's somebody
• 9:38
  - that's in that role, and then we can
• 9:39
  - develop them. We also have assistant nurse managers
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  - that we have depending on the size of
• 9:45
  - the amount, nurse managers have of their scope.
• 9:49
  - We put in assistant nurse managers. Again, number
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  - one, it helps our nurse managers manage their
• 9:53
  - workload, but it also gives nurses the ability
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  - to see how it is to be in
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  - the the leadership rank so that, you know,
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  - we can prepare our leaders of the future.
• 10:03
  - And then finally, we have an associate chief
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  - nursing officer role depending on the scope and
• 10:08
  - size of the hospital,
• 10:10
  - which this gives a director that perhaps is
• 10:13
  - looking for their next step in that,
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  - in that,
• 10:17
  - role transition
• 10:18
  - from the director to maybe a CNO. There's
• 10:21
  - that step in between.
• 10:23
  - And so, today, as a matter of fact,
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  - I met with our ACNOs.
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  - So I try to meet with them quarterly.
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  - It's informal. But, you know, we talk about
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  - things that, so one of the things we've
• 10:34
  - talked about is, like, what makes your world
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  - different from the CNO? And how do you
• 10:38
  - how do you sort of navigate your way
• 10:40
  - in the hospital arena when you're the associate
• 10:43
  - CNO?
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  - So we really focus on topics like that,
• 10:46
  - that,
• 10:47
  - we can have conversations about and kind of
• 10:49
  - go back and forth. And so we're developing
• 10:51
  - those so that when we do... You know,
• 10:53
  - we have a lot of hospitals. And, so,
• 10:56
  - inevitably,
• 10:57
  - you're gonna have CNO openings that's just normal
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  - in a size,
• 11:01
  - system this size. So is there somebody there
• 11:04
  - that's prepared and ready to take that next
• 11:06
  - step and become a CNO internally there? Ready
• 11:09
  - to know our culture?
• 11:10
  - And, and then speaking of culture, I wanted
• 11:13
  - to get back to our... We also have
• 11:15
  - a student nurse intern program.
• 11:17
  - I think what sets Ascension apart is really
• 11:20
  - our mission
• 11:21
  - and how,
• 11:23
  - how we react and respond to our patients,
• 11:25
  - the communities we serve.
• 11:27
  - And so if we if we can let
• 11:29
  - people in and they,
• 11:31
  - have an affinity for our mission,
• 11:34
  - that makes that stickiness to the system even
• 11:37
  - even better because they'll stay,
• 11:40
  - not because we're just another hospital on the
• 11:42
  - block, but because we are a Catholic health
• 11:45
  - care system.
• 11:46
  - And our mission,
• 11:48
  - has us stand apart from others in the
• 11:50
  - way that we care for the patients that
• 11:53
  - are most vulnerable and those experiencing poverty and
• 11:55
  - social determinants of health. So that's just another
• 11:58
  - way we do that. So we sort of
• 12:00
  - have the full spectrum from a student nurse
• 12:02
  - who is in nursing school all the way
• 12:04
  - up to a CNO so that nurses can
• 12:07
  - see that we do progress them if they
• 12:09
  - want to be, progressed. And then the other
• 12:12
  - thing that we've most recently did, we've hired
• 12:14
  - a, CNO for our ambulatory side of things.
• 12:17
  - So as we think about where health care
• 12:19
  - is going,
• 12:20
  - we wanna make sure that we have something
• 12:22
  - in place for our advanced practice providers. So
• 12:25
  - she partners with our national advanced practice
• 12:28
  - leader to ensure that we have,
• 12:31
  - have some orientation education
• 12:33
  - in place for the ambulatory side of things
• 12:36
  - because we know that's a growing area in
• 12:38
  - all health care systems. We really wanna make
• 12:41
  - sure that we have that
• 12:42
  - chief nurse there to influence,
• 12:45
  - how we care for those associates that are
• 12:47
  - providing care in those places.
• 12:49
  - Mhmm.
• 12:51
  - Absolutely. It's clear you're taking a very
• 12:54
  - thoughtful, intentional
• 12:56
  - approach to the leadership and career development, both
• 12:59
  - through the programming. And then of course, also
• 13:01
  - with some of the actual roles that you
• 13:03
  - have at Ascension, as you mentioned, to help
• 13:06
  - nurses sort of test the waters and put
• 13:08
  - one foot into leadership and then continue to
• 13:10
  - grow and grow, which I imagine benefits,
• 13:12
  - you know, so many. I'm curious with the
• 13:15
  - nurse manager
• 13:16
  - program. Can you share one bit more about
• 13:18
  - what that will actually look like operationally? Any
• 13:21
  - details you can give us? Yeah. So we,
• 13:24
  - we're working,
• 13:26
  - with,
• 13:28
  - some career coaches,
• 13:30
  - executive coaches,
• 13:31
  - and we do a very robust
• 13:33
  - nine box every year on our talent. Where
• 13:36
  - do they stand?
• 13:38
  - Do... Are some aspiring leaders where we know
• 13:41
  - we need to, you know,
• 13:42
  - provide some more,
• 13:44
  - opportunities
• 13:45
  - for them. Are they growing? Are they learning?
• 13:48
  - And so we take those nine box course
• 13:50
  - and we look at our high performers,
• 13:52
  - and we're starting our first cohort. And in
• 13:55
  - that cohort,
• 13:56
  - they'll get paired up with an executive coach
• 13:58
  - that they'll meet with monthly. We'll launch it
• 14:00
  - at the beginning with their one up, meaning
• 14:02
  - their leader, and the executive coach on what
• 14:04
  - they'd like to see. And then they'll go
• 14:07
  - through a six month sort of relationship with
• 14:10
  - this coach, and they'll do a project that
• 14:12
  - aligns to the goals of the hospital and
• 14:15
  - the units that they work on. And, it
• 14:17
  - will be something meaningful to them along the
• 14:20
  - way. But what we... What I've found having
• 14:22
  - done this before is you really...
• 14:24
  - They really get to grow, and it's a
• 14:26
  - different way than, you know, maybe just sitting
• 14:28
  - in and taking a course or, you know,
• 14:30
  - doing something like that.
• 14:32
  - That really,
• 14:33
  - I think, provides one on one,
• 14:36
  - career support for them for where they're at
• 14:39
  - and what are their challenges. And then also,
• 14:41
  - Mackenzie, it gives them a a safe space
• 14:44
  - to have conversations with an outside person that's
• 14:47
  - maybe not their one up or, you know,
• 14:49
  - a colleague that they could, you know, maybe,
• 14:51
  - talk some things out. Because we do
• 14:54
  - know that the nurse manager has a lot
• 14:56
  - on their plate.
• 14:57
  - And they're also leading
• 15:00
  - a very inexperienced
• 15:01
  - nursing team,
• 15:03
  - not... Again, not just at Ascension but across
• 15:06
  - health care because we know that new grads
• 15:08
  - often start in acute care and those with
• 15:10
  - experiences move on to ambulatory other areas. So
• 15:13
  - it's really designed to give them support along
• 15:16
  - the way.
• 15:18
  - Yeah. It sounds like such a innovative
• 15:21
  - program. And you mentioned that
• 15:23
  - safety
• 15:24
  - piece, and I think that's another big part
• 15:26
  - of it. Just in terms of retention in
• 15:27
  - general is that psychological safety and nurses really
• 15:29
  - feeling like they do have a strong support
• 15:31
  - system at their organization,
• 15:33
  - whether they're first year nurse or not.
• 15:35
  - A 100%. And I,
• 15:37
  - I do have a... An... A nurse manager
• 15:40
  - town hall meeting that I do. And that
• 15:42
  - meeting is really set. I I take the
• 15:45
  - feedback that they have, and I bring to
• 15:47
  - them what they wanna hear whether... So for
• 15:50
  - example,
• 15:51
  - our EVP for nursing and operations, Sally Deutsch,
• 15:54
  - was started off our fiscal year going over
• 15:57
  - our goals for the organization,
• 15:59
  - and then our goals for nursing. And so
• 16:02
  - number one, that gives them
• 16:04
  - FaceTime with Sally and other leaders in the
• 16:07
  - organization.
• 16:08
  - And then from there, that sort of sets
• 16:10
  - the stage for the year on our goals.
• 16:12
  - But then we also
• 16:13
  - work to,
• 16:15
  - bring best practices so that they can participate
• 16:18
  - and present. So if there's a best practice
• 16:20
  - on something that's aligned to our goals, they
• 16:22
  - can present it there. And there's usually about
• 16:24
  - 800,
• 16:25
  - leaders on your call. So, we track the
• 16:28
  - call numbers because we wanna make sure that
• 16:31
  - it's being effective. And so, obviously, it's it's,
• 16:34
  - you know, it's it's sort of voluntary, if
• 16:36
  - you will. It's not like, you know, we
• 16:37
  - make anybody attend. So we we tend to
• 16:40
  - get... And we do evaluations and extra feedback,
• 16:42
  - and then we try to incorporate anything in
• 16:45
  - that,
• 16:46
  - and, as pertinent to them. So, again, it's
• 16:49
  - just ways that we could keep connected to
• 16:51
  - the frontline teams. And then when I make
• 16:53
  - visits in our markets,
• 16:55
  - I make sure that I meet with our
• 16:57
  - nurse managers as well while I'm there too.
• 17:00
  - Mhmm. Sounds like very effective forum to really
• 17:03
  - ensure nurses' voices are heard and have that
• 17:05
  - two way as well.
• 17:07
  - Absolutely.
• 17:08
  - Well, Rob, this has been such an engaging
• 17:11
  - conversation.
• 17:13
  - I feel like we only scratched the surface
• 17:14
  - of all the amazing work that you're doing
• 17:16
  - in terms of the nursing workforce and leadership
• 17:19
  - development. But I just so appreciate the time
• 17:21
  - that you've taken to, share more about that
• 17:23
  - work.
• 17:25
  - Thank you. Sure.