Latest / Becker’s Healthcare - Clinical Leadership Podcast / Building a Resilient Nursing Workforce in Rural Texas with JohnRich Levine

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Building a Resilient Nursing Workforce in Rural Texas with JohnRich Levine · Becker’s Healthcare - Clinical Leadership Podcast

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  This is where health care leadership comes together.
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  Becker's sixteenth annual meeting brings more than 3,500
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  hospital and health system executives and nearly 800
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  speakers to Chicago
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  April.
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  This series event includes keynote conversations with Dallas
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  w Bush. 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. We're looking forward to hosting you
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  in Chicago.
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  Hi, everyone. You're listening to the Becker's Healthcare
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  podcast.
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  Thank you so much for tuning in to
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  this episode.
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  I'm Eric Carbajal, an editor with Becker's Hospital
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  Review.
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  And today, we're honored to be joined by
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  John Rich Levine, chief nursing officer of Reeves
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  Regional Health in Texas.
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  John Rich, thank you for joining us today.
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  Thank you, Erica. Good morning to you, and,
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  thank you for having me today.
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  Yeah. Good morning. Pleasure to have you on.
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  Can you start by talking about an issue
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  that is perhaps taking up most of your
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  time and energy as CNO right now and
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  how you're navigating that?
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  Yes. Of course.
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  Right now, most significant
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  focus for us in in our place is
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  workforce stability,
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  because we want to
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  be able to stabilize our workforce while building
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  long term
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  nursing infrastructure in a rural environment. So
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  the Reeves Regional Health is a small hospital.
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  It is an important
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  hub
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  for patient care in the area because we
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  are located,
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  in a geographical
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  location where we are the only hospital within
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  100 mile
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  radius. And so in that context,
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  one vacancy can shift the entire operational rhythm
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  for us. So every staffing decision that we
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  make, it carries financial,
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  crucial, and even clinical impact, and they they
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  happen almost at the same time.
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  And at this point, I'm navigating it by
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  shifting from
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  reactive
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  staffing management
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  to a structural
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  design approach that we've tried to
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  figure out. We are strengthening charge nurse leadership.
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  We have a charge nurse leadership program that
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  we just launched. And then we are tightening
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  onboarding processes,
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  and we're also aligning our staffing models
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  with patient acuity rather than on the tradition
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  that we've been used to for years and
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  years. As you can tell, probably
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  a lot of our listeners have can tell
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  that, the Reeves Regional Health has been in
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  existence for over sixty five years.
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  I also spend a great deal of time
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  on visibility.
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  When teams see leadership, I understand
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  that when leaders
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  listen
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  and make decisions with clarity and
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  and, all of that kind of thing,
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  stability
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  for the workforce
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  follows. And I really believe in that because
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  I see that in rural health care, culture
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  drives retention more
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  than compensation
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  alone.
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  We cannot compete with bigger citizen, bigger medical
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  centers in terms of probably
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  compensation, but we can at least work on
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  the culture that drives our retention.
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  Yeah. Absolutely, John Rajan. I know you mentioned
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  streamlining and tightening those onboarding processes. I think
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  that's something we tend to hear a lot
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  about right now from chief nursing officers. Can
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  you share a little bit more about why
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  that's so important right now and how that,
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  you know, factors into
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  retention, especially among earlier career nurses?
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  We know that earlier
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  career nurses, they
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  they move a lot. It's a different kind
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  of generation. It's a generation that we welcome,
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  but it's also the a generation that we
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  wanna learn so that we know how to
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  lead them.
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  And,
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  the most
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  obvious
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  characteristic
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  is movement.
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  And so we've been moving a while back,
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  And now that we have this kinds of
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  workforce,
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  we want to even
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  capitalize on movement.
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  There is always something that,
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  help me recall when people will say about
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  why do we need to train them? They
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  are going to go away anyway.
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  And the deeper question for me is
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  if we
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  we train them
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  and they stay,
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  That is the most stupid thing we can
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  do to ourselves. It's like a punishment to
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  ourselves.
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  And if we train them and they leave,
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  then it is better for them that we
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  set them up for success in their next
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  phases. So,
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  there's always a movement, but what what we
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  have, not everyone is designed to be in
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  a certain place at a certain time,
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  only those who are designed for that. Because
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  if we force it, then we're really creating
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  a barrier for them to move forward. So
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  that's my,
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  idea about those movements and newer nurses and
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  how to lead them in this health care
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  setting at this time.
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  Yeah. Certainly. And I know you mentioned just
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  the challenges with,
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  you know,
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  staffing stability
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  across the board, but even more so felt
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  in rural areas and how one shift can
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  can really affect the operational
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  rhythm as you put it. So
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  what do you feel like has been a
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  true differentiator
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  for Reeves Regional when it comes
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  to attracting and retaining nurses in in the
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  rural environment? I know you pointed to culture.
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  Can you expand a little bit about, you
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  know, the specific components
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  of that and what seems to really resonate
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  with the nursing staff?
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  Yeah. So, what I meant by that is
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  that,
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  our differentiator
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  is our ownership.
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  In rural hospitals well, I come from a
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  big, big hospital before I came here, and
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  so there's a big shift for me. But
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  I'm
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  doing my homework and understanding what rural hospital
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  is. And in that context,
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  nurses see the full continuum of care in
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  rural hospitals.
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  They know their patients personally. They shop with
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  them. They meet them in the aisles. They
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  go to church with them. They influence
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  operational decisions directly.
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  And to me, that level of voice and
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  impact is very powerful.
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  They own their own patients.
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  So in that context, we focus on three
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  things. First, we want to establish leadership with
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  accessibility.
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  Nurses can walk into my office. They can
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  just go in there. There's no need for
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  them to set up an appointment or that
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  they could do that, and they see decision
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  making in action.
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  The second part is the skill expansion.
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  The rural nurses develop broad competencies
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  weekly, so we can't,
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  compartmentalize
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  them and specialize them too much because their
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  growth is accelerated
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  because of their, ability to expand.
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  The other one is
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  cultural clarity, which ties up to what I
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  said before. We are intentional about accountability
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  and respect. We address issues early. We celebrate
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  performance openly because it's just us
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  around our community.
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  And, to me,
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  even if rural nursing is demanding,
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  it does help deeply
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  ingrain to us meaning into what we do,
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  and that's what we lean in, meaning and
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  ownership
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  to what we do. It is us. It
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  is ours, and no one will come in
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  come here to save us but us.
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  Yeah. And and I love what you mentioned
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  just about the
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  being so close to the decision making and
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  and being able to having such close
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  access to leaders in rural settings is something
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  that really stands out,
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  especially in the context of just seeing so
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  many reports
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  and surveys, data
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  that speak to how nurses want to be
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  involved directly in the decisions that affect their
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  practice, and it sounds like that can be
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  something that is, you know, a true differentiator
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  in in rural hospitals.
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  Well, Don Rich, I wanted to ask you
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  as well just about a topic we've been
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  obviously covering a lot of in the news,
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  which is how hospitals are anticipating seeing a
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  rise in in uncompensated
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  care with the lapse of ACA premium tax
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  credits
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  and looming cuts to Medicaid spending. So Yeah.
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  How are you preparing for the possibility of
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  caring for more uninsured or underinsured patients from
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  a nursing and care delivery standpoint? You know,
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  we cover a lot about this from the
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  financial lens, but curious, you know, from that
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  clinical and operational standpoint, what this looks like.
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  Yeah. The it's funny that you asked me
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  that question because yesterday, we had a a
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  in person meeting with
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  a congressman in our area, and we asked
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  those questions. And there are people who ask
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  similar questions as well. And I can feel
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  that he has a hard time
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  creating a generic answer to those different questions
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  that mean only one. And but to me,
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  preparation begins with operational
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  efficiency, if you know what I mean. We
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  are standardizing our workflows. We are strengthening
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  documentation accuracy. We are improving throughput by reducing
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  waste of supplies and materials and even time.
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  Every minute we save supports our sustainability
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  because we depend largely
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  on being sustainable
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  by utilizing the limited resources that we have.
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  The second is we are strengthening case management
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  integration.
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  Early discharge planning,
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  we we wanna be more aware of that.
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  We are want to be more aware or
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  increase our awareness on social determinants of health
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  to reduce readmissions
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  and avoidable,
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  utilization of our swing bed program, for example.
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  Third, we are focusing on cross training. I
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  just launched it last week. A flexible nursing
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  workforce, I believe, allows us to absorb volume
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  fluctuations
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  within different units without compromising our safety. So
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  we cross train are you from the ER?
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  Cross train the medsurg, ICU, OB, different areas
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  that are just versatile.
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  And then,
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  because we know that financial pressures are real,
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  and we can feel it in our area,
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  The response must be to us disciplined operations
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  paired with compassionate care.
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  And sometimes we feel like, no. They don't
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  one can exist, but not the other. And
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  the challenge that we're facing is to make
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  both coexist
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  for the disciplined operations and being
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  owning it and being a steward of it,
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  but also
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  displaying or deliver delivering
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  compassionate care.
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  Yeah. Certainly. I think,
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  Neemai here with us, especially when chatting with
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  clinical leaders is, you know, the environment that
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  hospitals are operating now has just made it
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  has just elevated the importance of the operational
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  efficiency and the ability to provide the best
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  care possible, if anything. So it's been interesting
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  to follow this.
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  John Rich, what is one policy shift or
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  perhaps workforce trend that you believe might have
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  the biggest effect on the nursing workforce in
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  rural America
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  in the next few years? What should leaders
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  maybe be paying some closer attention to right
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  now?
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  I would think that is the
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  the shift towards nurse workforce regulation
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  without operational new ones
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  that could, significantly impact rural hospitals.
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  We are,
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  for example,
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  us, for example, particularly, because we are in
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  the middle of what what you call nowhere.
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  The people that are coming to us can
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  come and go,
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  you know, and and then pretty much there
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  will be no more coming,
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  and therefore, we are stuck. And so we
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  wanna be able to
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  to regulate our workforce
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  without
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  so much of those new ones like immigration,
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  you know, visa processing for international hires,
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  for out of state that what what do
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  they need in order to come to us?
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  It's very expensive.
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  But what we're looking is that mandated ratios
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  or, broad federal staffing models, They may work
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  differently in urban tertiary centers,
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  but ours is a 25 bed rural facility,
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  and it may not apply. So what I'm
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  saying is that there's no such thing to
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  us as copy and paste because what works
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  in others may not work for us. We
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  can create our own models.
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  And in that context, leaders should pay close
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  attention to flexibility.
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  As rural health care depends on adaptable
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  staffing models,
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  we should be able to align with census
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  fluctuations, and that shouldn't scare us, but a
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  welcome
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  change in the dynamics of day to day
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  operations. And at the same time,
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  work workforce expectations,
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  they are evolving. As you can tell, we
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  have different,
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  generations in one team. Nurses are seeking also
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  career progressions. They ask me if they how
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  how so soon can they become manager
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  at the day they are interviewed, and it's
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  just amazing that people think that way. Back
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  in the days, it would take two, five
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  years to be able to to manage. Now
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  we have a six month old
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  nurse, six months in terms of their experience,
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  and they are ready to become charged nurses.
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  So
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  autonomy,
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  work life alignment,
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  system that integrate leadership development, and transparent career
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  pathways will attract
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  and, I believe, will retain talent more effectively
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  than those relying solely on pay incentives.
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  That's what I thought it was.
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  Yeah, John Rich. And I think that just
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  speaks to, again, a lot of what we're
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  hearing about is nurses coming in and wanting
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  to see that clear
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  career progression very quickly when they wanna be
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  able to envision exactly what that could potentially
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  look like.
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  Well, John Rich, to close us out here,
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  can you share
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  a leadership practice or mindset that has been
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  most important to your success in your career,
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  a piece of advice that you'd offer to
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  aspiring nurse leaders?
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  Yes. Of course, Erica. The the the thing
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  that I could say about this is
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  that my experience has taught me clarity
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  under pressure.
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  As a leader in health care,
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  I can tell that complexity is almost
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  always the constant.
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  My team look for steadiness.
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  They always watch how I respond when the
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  stakes are high. So, for those leaders out
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  there that are similarly situated,
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  my advice would be operational
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  fluency.
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  You wanna understand
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  finance. You wanna understand quality metrics and how
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  they work. You wanna understand
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  workforce analytics. Some people call that predictive analytics,
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  but you wanna understand what it is about.
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  Clinical expertise alone does not sustain an executive
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  leader.
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  Second thing I want to, make mention is
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  to
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  invest in relationships
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  because relationships
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  matter before crisis moments arrive. You
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  wanna establish trust.
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  You wanna build trust early on, and it
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  becomes your currency
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  in dealing with difficult decisions. And finally,
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  I would
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  say stay close to the bedside.
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  Leadership credibility grows when teens know that you
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  yourself understand
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  their reality, and sometimes I jump in there
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  and ask to give me a patient that
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  I can take care of just to know
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  to make to make them see and know
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  that I understand
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  them fully, and here I am doing the
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  same things that they're doing.
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  John read some great closing remarks there. Thank
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  you very much for carving some time out
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  of your schedule to join us on the
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  podcast.
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  Look forward to continuing to follow the work
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  that you're leading at Reeves Regional.
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  Thank you. Thank you, Erica, for having me.
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  Have a great day.