Latest / Becker’s Healthcare - Clinical Leadership Podcast / Meredith Foxx, Chief Nursing Officer at Cleveland Clinic

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Meredith Foxx, Chief Nursing Officer at Cleveland Clinic · Becker’s Healthcare - Clinical Leadership Podcast

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Hi, everyone. This is Erica Carbajal with the
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Becker's Healthcare podcast.
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Thank you so much for tuning in to
0:31
this episode where we're joined by Meredith Fox,
0:34
chief nursing officer at Cleveland Clinic.
0:37
We're gonna be talking about how the system
0:39
is tackling nurse retention, improving access to care,
0:42
and more.
0:43
Meredith, welcome. Thank you so much for being
0:46
here today.
0:47
Thank you. I'm so excited to talk nursing
0:49
with you. Yeah. We're thrilled to have you.
0:51
So much going on.
0:54
Meredith, can you start by sharing one initiative
0:56
that the clinic has implemented in the past
0:59
year or so that has had a measurable
1:01
effect on nurse retention and well-being,
1:04
something other systems might learn from?
1:07
Absolutely. So when I think back on my
1:09
career here at the Cleveland Clinic in terms
1:11
of,
1:12
whether I was in leadership or at the
1:14
bedside, we've always had a strong focus on
1:16
retention. We had to strengthen those efforts,
1:19
extensively
1:20
during the pandemic and then post the pandemic,
1:23
based on some of our health care challenges
1:25
with workforce. And what has really been successful
1:28
is having our what we call part of
1:31
our shared governance
1:32
structure and having retention councils at not only
1:34
the local hospital level, but also at the
1:37
organizational enterprise level, where we are talking to
1:40
our own nurses around
1:42
why they stay at the Cleveland Clinic, why
1:44
they stay at the bedside, why they became
1:46
nurses, and then trying to pepper that throughout
1:49
the organization.
1:50
One particular best practice and we believe that
1:53
has been really influential
1:55
is we've done a lot with peer retention
1:57
stay interviews. It started with one of our
1:59
hospitals who has pretty strong retention, and they
2:03
started doing peer to peer stay interviews with
2:05
particularly
2:06
new hires as well as new graduate nurses
2:09
and talking to them around
2:11
why they chose Cleveland Clinic, what's going well,
2:13
what would they consider doing differently, and, you
2:16
know, what is the one thing that potentially
2:18
might,
2:19
convince them to leave. And then taking that
2:21
information and drafting our strategies around that as
2:24
a nursing leadership and Cleveland Clinic organization and
2:27
understanding what really they wanna focus on in
2:30
terms of what keeps them, here at the
2:32
Cleveland Clinic. And so that's been great because
2:34
not only can it be local efforts at
2:35
the hospital level with local leadership teams, but
2:38
then also taking some themes and focusing our,
2:41
retention council work and offerings at the enterprise
2:44
level.
2:45
As for well-being,
2:46
I think one of the benefits that our
2:49
organization is
2:50
seeing on retention side of this is we
2:52
have tremendous resources within our caregiver office
2:57
and within the organization supporting that. So not
2:59
only is it our total rewards, but different
3:02
resources around,
3:04
well-being,
3:06
wellness,
3:07
balance,
3:09
resources around caring for yourself, caring for others.
3:13
We have mental first aid. We have different,
3:17
resources that caregivers can take advantage and leaders
3:19
can take advantage. The The other last thing
3:21
I would say about well-being is we have
3:23
had a very,
3:24
focused effort around
3:26
safety in the workplace for our caregivers, in
3:28
particular, our nursing caregivers and a focus on,
3:31
preventing safety issues for them to happen. And
3:33
that is not only at the nursing level,
3:35
but the caregiver office level. And our CEO
3:38
had a focus on caregiver safety, particularly with
3:40
workplace violence. We know that is on the
3:43
rise, not only within our organization, but within
3:45
society. And so how we can,
3:47
ensure that our caregivers wanna come back to
3:49
work and that they feel safe working here.
3:53
Yeah. Thanks for sharing all that, Meredith. Interesting
3:55
to hear the
3:56
retention council's structure and how those are implemented
4:00
at the local level, but then also at
4:02
the enterprise level so that some of the
4:04
the things that are really working can be
4:06
streamlined
4:08
across the health system.
4:10
With those peer retention
4:11
stay interviews,
4:13
you know, you had mentioned it started at
4:14
one of the one of the hospitals that
4:16
had really strong retention.
4:18
When were those is that more recent, or
4:20
has that been in place for a few
4:22
years now?
4:24
So it came from the caregivers themselves. So
4:26
it came from the nurses at that hospital
4:27
themselves that they wanted to talk to their
4:29
peers that had just started at the hospital
4:32
or had been there for a short amount
4:34
of time.
4:35
And it started several years ago, and it
4:37
built up over time and is now a
4:39
consistent practice for them. And we have now,
4:42
we are now working it across our other
4:44
organization
4:45
our our other hospitals within the organization to,
4:48
for other caregivers to learn from the other
4:50
nurses to learn from that process and then
4:52
also make it a little bit their own.
4:54
So not only doing it with the bedside
4:56
nurses, but also doing it with our nursing
4:58
assistants.
4:59
And then some of the groups have even
5:00
done it with, some of the nurse leaders
5:02
just to understand why people are staying in
5:04
their roles.
5:05
So I would say it was homegrown
5:07
at a unit level
5:09
with the nurses at the bedside who had
5:11
been there for some time wanting to understand
5:13
why their teams,
5:15
team members had joined and why they were
5:16
staying. It then went to the hospital level,
5:18
and now we're,
5:20
exploring it across the entire Cleveland Clinic system.
5:23
Oh, yeah. And it definitely sounds like something
5:26
that can be, you know, useful for an
5:29
a variety of roles too beyond nursing.
5:31
It's been great because they have standard questions
5:33
they ask,
5:35
so it's consistent. So we have strong data
5:37
around it to say, okay. You know, what
5:40
are the action items we can do from
5:41
this? What's going well? And we also use
5:43
it as a way to recognize and, you
5:45
know, celebrate what's going well in places.
5:49
Well, Meredith, Cleveland Clinic, like many systems, is
5:52
focused on improving access to care and exploring
5:55
innovative models of care. You know, this is
5:58
a really big focus across the board for
6:00
health systems across the country.
6:02
Can you share a bit about what role
6:03
nurses specifically play in system wide efforts to
6:07
expand access?
6:08
Sure. So we are definitely on this journey,
6:11
and we've been trying different care delivery models
6:13
as well as been involved in a lot
6:15
of different efforts to expand access.
6:18
I'd like to talk about our first, our
6:20
care delivery models. So we looked at our
6:22
particularly inpatient setting, our hospital setting, and looked
6:26
at the teams that support,
6:28
the care that's provided, particularly the nursing care.
6:30
So we've been exploring some different ways of
6:32
doing those,
6:34
models of care delivery a little bit differently.
6:36
And it's not one size fits all because
6:38
we have different makeups of how nursing units
6:41
as as simple as how many beds are
6:43
in a unit or what is the current
6:44
team makeup. So that's been in process for
6:47
several years already at many locations. And what
6:49
I push with those teams around creating team
6:52
models using different licensed personnel is really being
6:55
agile and being willing to take risks and
6:58
trying to do things differently and getting the
7:01
nursing caregivers and team members,
7:03
feedback and involving them in the creation of
7:06
these care delivery models. So that's been really
7:08
successful at quite a few of our hospitals.
7:11
Some have been, early adopters. Some have a
7:13
little bit more been, at the end of
7:15
adopting due to some speculation or concerns of
7:18
how it would go. But I'm happy to
7:20
report that most of our hospitals are exploring
7:23
some way differently to deliver care in the
7:25
inpatient
7:26
setting. When I look at how other roles
7:29
that nurses have played in terms of improving
7:31
access, we have a very robust hospital at
7:34
home program,
7:36
which is in our Florida market, which is
7:38
very exciting. It expanded pretty quickly and has
7:41
been
7:41
well received, not only by the teams, but
7:44
the patients that end up in that program,
7:46
and we are looking to explore it now
7:48
into Ohio.
7:49
That was a model that started,
7:51
mid to late pandemic and started at different,
7:54
locations. And our Florida market really took it
7:57
and ran with it. And the nurses are,
8:00
you know, really happy in those roles. It
8:02
is providing direct patient care through a virtual
8:05
model, and it's really exciting to see how
8:08
much that's,
8:10
gone well, as well as getting from the
8:12
nursing caregivers
8:13
the innovative spirit and so how they can
8:15
make changes to making that successful.
8:17
And the last one I would, share is
8:19
we have done a lot around our emergency
8:22
room access and involving the nurses in care
8:25
in different places of our emergency rooms.
8:27
It's not, it's not news to anyone in
8:29
the health care world. There's been a high
8:31
demand for emergency room care. You know, you
8:34
can read almost any day to hear about
8:36
the the access points there. And the teams
8:38
have really come together
8:40
to explore virtual care there, different ways of
8:42
monitoring patients in the emergency room, as well
8:45
as, ensuring that they have the same level
8:47
of care,
8:49
at that level as they would possibly in
8:51
the hospital and working with their physician and
8:53
APP colleagues,
8:54
whether it's to use a virtual
8:56
provider and triage model, some different monitoring capabilities.
9:00
So I would say that, you know, they're
9:01
really diving into how we can care for
9:03
the patients that are coming into our doors.
9:06
Yeah. Thanks for touching on all that. Definitely
9:09
a ton of innovative
9:11
ways, that technology is coming in to streamline
9:13
emergency department operations at health system. It's been
9:16
interesting to see.
9:17
Mhmm.
9:19
Meredith, what's one strategic goal you have for
9:22
Cleveland Clinic's nursing operations this year? When you
9:25
look back at the end of twenty twenty
9:26
five, where do you hope to have made
9:28
some measurable progress?
9:31
So I'm really excited about this. At the,
9:33
all throughout 2024,
9:35
the nursing executive team with other leaders as
9:38
stakeholders,
9:39
we really looked at what the nursing strategic
9:41
themes were for our organization based on our
9:44
Cleveland Clinic four care priorities and the Cleveland
9:46
Clinic strategic themes and how we align with
9:49
them.
9:49
We launched those strategic themes at our annual
9:52
nursing leadership summit at the end of twenty
9:54
twenty four, and we're now really focused on
9:57
how we're going to deliver on operationalizing what
9:59
those themes and goals were. We also set
10:02
a new vision, which was very exciting for
10:04
nursing.
10:06
In true form, we wanted to support the
10:08
Cleveland Clinic mission of caring for life, researching
10:11
for health, and educating those who serve. And
10:13
we know that's what we do every day.
10:15
But then how do we operationally do that?
10:17
So when I look back at the end
10:19
of twenty twenty five, what I'm really hoping
10:22
to have made measurable progress on is the,
10:25
safe patient care
10:27
as well as our,
10:29
recruitment and retention efforts, not only of our
10:31
bedside nurses, but our nursing assistants and our
10:34
nursing support roles. So I'd like to look
10:36
back at the end and say that we've
10:38
been able to fill a lot of roles
10:40
again. We have great our turnover is great,
10:42
but we still have some vacancy. And then
10:44
really looking at being able to say we
10:46
are, a safe place to get care not
10:49
only excuse me. I should say, not only
10:50
to receive care, but also to be a
10:52
caregiver at.
10:54
Yeah. Meredith, quickly too. When when you talk
10:56
about, like, recruitment and retention,
10:59
not just for bedside nurses, but also for
11:01
those support roles, nursing assistants,
11:04
patient care assistants, etcetera,
11:06
is there any way that comes to mind
11:08
that recruitment looks different
11:10
for those roles versus a bedside nurse?
11:15
So I would say yes, and no. But
11:18
what I would say we're doing a little
11:19
bit differently is we are really looking at
11:21
it as
11:23
a pipeline. Right? This is your career entry.
11:25
So we have spent a lot of time
11:27
on,
11:28
focus on what we call our center for
11:30
nursing career exploration. So anybody who has an
11:33
interest in patient care in the nursing realm
11:35
can start to explore,
11:37
what opportunities the Cleveland Clinic has. And so
11:39
that could be their entry point, whether they
11:41
are a nursing student or not a nursing
11:43
student
11:44
into patient care. We've also created some different
11:47
job opportunities and job types that allow for,
11:50
entry level exposure to patient care to see
11:52
if that's really what an individual's,
11:55
you know, in interests are. We know it
11:57
takes a team effort, and there are other
11:59
roles that provide patient care that's a little
12:01
bit different than nursing. So if it's not
12:03
meant to be somebody to be a registered
12:05
nurse, that we sustain them in our organization,
12:08
possibly with another career progression. But really looking
12:10
at the pipeline, ensuring that those entry folks
12:14
know what the opportunities lie within the Cleveland
12:16
Clinic, and is nursing the career path they
12:19
want to pursue as well, or are there
12:21
other opportunities outside of nursing that are patient
12:23
care focused? I'm also really proud that we
12:26
are supporting
12:27
our nursing support caregivers. We call the majority
12:30
of them patient care nursing assistants, and we've
12:32
done some, focused work with them to develop
12:35
them at the bedside and develop their role.
12:38
We had a great leadership ex brunch experiential
12:41
program
12:42
that originally was only for registered nurses that
12:44
we now offer to our, patient care nursing
12:46
assistant programs. And the feedback from that has
12:49
been wonderful, and it's allowing them to grow
12:51
in that role. Many of them wanna stay
12:53
in that role, and then it's also allowing
12:55
them to explore, wow, I can be a
12:57
nurse. And then with supporting them with our
12:59
great,
13:00
total rewards to consider future careers.
13:04
Yeah. Meredith, staying on on the topic of
13:06
workforce, the APP workforce is growing rapidly. We've
13:10
we've done a lot of coverage around this
13:12
over the last year. Nurse practitioner employment alone
13:15
is expected to grow 46%
13:17
by 2031.
13:19
Can you tell us a bit about any
13:20
strategic adjustments the clinic is making to hire,
13:23
integrate,
13:24
and support this workforce?
13:27
So near and dear to my heart, I
13:29
started out as a leader in advanced practice,
13:31
particularly for our advanced practice registered nurse group.
13:34
And it's been amazing to see the support
13:36
and growth, not only of advanced practice registered
13:38
nurses, but all APPs,
13:40
not only in the Cleveland Clinic, but nationally.
13:42
I mean, those statistics are out there that
13:44
it's both nurse practitioners and physician's assistants are
13:47
some of the fastest growing roles.
13:50
What I believe at Cleveland Clinic, what we've
13:51
done strategically was a a big shift in
13:54
the end of twenty twenty four. We created
13:56
the first vice president of, advanced practice providers.
14:00
So we are bringing all advanced practice providers
14:02
under one leader for the entire enterprise.
14:06
This started and was homegrown,
14:08
over ten years ago where myself and my,
14:10
physician's assistant leader colleague, we had started the
14:13
development of leadership roles for advanced practice providers.
14:16
And it's been amazing to see the growth
14:18
and now have it all come under one
14:20
structure,
14:21
for one enterprise role with all the advanced
14:24
practice, folks being together and caregivers being together
14:27
as one unified team, whether it's within their
14:29
hospital, within their clinical specialty.
14:32
It's really important to think about them as
14:34
a part of the workforce,
14:36
but not just lumped into all the providers.
14:38
There's different licensure requirements. There's different standards of
14:41
expectations of practice.
14:43
We want to treat them at being able
14:45
to walk to work to top of license,
14:47
top of scope, but they also want leadership
14:50
opportunities and want to be developed within the
14:52
organization. So I'm really excited about that not
14:55
only have we been able to sustain and
14:57
maintain a leadership structure
14:59
for our advanced practice providers, but that it's
15:01
growing and that, you know, if I can
15:04
think back to when I started in advanced
15:05
practice nursing as a leader, I think we
15:08
had around 450 to 500 advanced practice registered
15:11
nurses.
15:12
We are over 3,000 now advanced practice providers
15:15
in just over a decade. So pretty exciting
15:17
stuff here.
15:18
And I'm I think to be able to
15:20
hire and to integrate the their roles across
15:23
the enterprise to have one leader
15:25
that all of the other leaders are reporting
15:27
up to is gonna be lead us to
15:29
success for the future.
15:32
Yeah. That's such rapid growth when you talk
15:34
about 500 to now over 3,000 in just
15:37
the last ten years. And over the past
15:40
year even,
15:42
we've seen I think Cleveland Clinic was one
15:44
of the first that we reported on and
15:45
then saw a handful of of health systems
15:47
that had created,
15:49
a c suite role to oversee their advanced
15:52
practitioner
15:53
provider workforce, so definitely a growing trend.
15:58
Meredith, to close us out, what do you
16:00
see as the biggest challenge chief nursing officers
16:03
will face in the next several years? What
16:05
should they be thinking about or doing now
16:07
to prepare?
16:09
Well, I think we know that the workforce
16:12
has been changing not only from the time
16:14
the pandemic started, but probably even pre pandemic.
16:17
And how do we
16:19
have a workforce that stays engaged about their
16:21
profession and understands their why of becoming
16:24
a nurse? And so
16:26
myself
16:27
with the Cleveland Clinic nursing leaders at this,
16:30
we talk a lot about that is, like,
16:31
what is the why and what is the
16:33
passion, and what is the purpose for being
16:35
a nurse here, not only as your profession,
16:37
but also at the Cleveland Clinic. And how
16:39
do we continue to foster that professional growth?
16:42
I'm a firm believer that,
16:44
the professional the what you put into your
16:46
profession is what you get out of your
16:48
profession, and so the contributions there will only
16:50
pay it forward. And that's what really where
16:52
you find the value there. And if we
16:54
can instill that into
16:56
all different generations of our workforce, we're gonna
16:59
set us up for strong success in terms
17:01
of,
17:02
having a pipeline and a future workforce that
17:05
can take care of our populations.
17:08
Thank you so much for joining us today,
17:10
Meredith. It's been a pleasure.
17:12
Yeah. Thank you. Thanks for having me. Yeah.
17:14
And to our listeners, you can tune in
17:16
to additional episodes of the podcast by visiting
17:19
the podcast page on our website at beckershospitalreview.com.
17:24
Thanks, everyone.