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Bill Klaproth (host): The American organization for nursing leadership or ANOL is leading a national effort to develop a compendium of workforce best practices and innovations. To aid and support nurse leaders. The Aon L workforce committee sent out a nationwide call for exemplars from nurse leaders in all healthcare settings to share their best practices in local scenarios with particular attention to scenarios, including diversity, equity, inclusion, and belonging. Before the COVID 19 pandemic nurse leaders were challenged to staff appropriately and experienced scope expansion within a dynamic work environment. The workforce committee and subcommittees evaluated best practices and innovations, structured recommendations, and set forth leadership opportunities and resources.

Additionally information was leveraged and gathered to define areas for future evaluation and research. The workforce compendium will go beyond published literature and focus on successful strategies. Use to effectively improve the work setting and support nurse leaders. So let's learn more with Lynda Benton, senior director, strategic initiatives of global community impact with Johnson and Johnson. And Mercedes Lopez, a nurse manager with Methodist Dallas medical center.

This is today in nursing leadership. A podcast from the American organization for nursing leadership. I'm Bill Klaproth Mercedes, and Lynda. Thank you so much for your time. Interested to talk to you about positive practice environment, which I know you've spent a lot of time on. So Mercedes, first off, can you tell us about the workforce compendium and the workforce challenge you saw to address and why?

Mercedes Lopez: Yeah, so in partnership with AHA, the American Organization for Nursing Leader. Created this really dynamic team of experts, nurse leaders, and healthcare advocate. to kind of help guide the work of the a and l workforce Committee. And the overall goal was to create a compendium that would inform and address some of the most challenging workforce issues that us as nurse leaders are currently facing. The healthcare workforce, especially our nursing profession, is trying to navigate a post pandemic environment that has us really all questioning where we go from here. COVID really challenged us in so many ways. But it also pushed us to think about the future of our healthcare environment.

And so our chapter of the Compendium, really focused on how leaders can foster those healthy workplace environments where nurse leaders can really grow and thrive and. be well, be safe, and ultimately stay well. there were so many layers, and intertwined strategies when we started to look at what encompasses a positive practice environment, and how can those lis really address and create something to foster that environment. So our team really dedicated. to weed out some of the things that are yes, important, but we had to really put a focus on this topic. And so we chose four main topics, to really address within that positive practice environment.

The first one was really focused on looking at how we build the culture and environment in our work. so, so important. The second one really sought to share some of those meaningful ways that we can engage, recognize, and really appreciate our nursing workforce. the third topic. Addresses the importance of wellness and wellbeing programs and initiatives. And the fourth topic, we really try to focus on those new innovative care models that support the delivery of care and how we need to kind of reinvent ourselves as we're going into this post pandemic environment. Overall, these positive practice environment topics, each important in their own way.

They really help to address, how we become these healthier, work environments for everybody. We really found that creating these environments really lead to a more satisfied workforce, which of course, you can only imagine, ultimately results in better job performance and higher quality of patient care.

Host: Yeah. I love that. That is so important, what you just mentioned, Mercedes, and I love those four topics. One, how do we build culture two? Sharing ways to engage. Three, concentrate on wellness and wellness programs, and then pay attention to new care models. So speaking of the topic or topics, if you will, and our challenging work environment, what did you learn about this and what are some of the possible solutions that we can apply to this issue?

Mercedes Lopez: Yeah. So in the fall of this year, AONL actually conducted several virtual focus groups. They surveyed our members and the remesh findings aligned with what we are experiencing and seeing in our healthcare settings. we found that nearly half or about 49% of all nurse leaders ranked building the culture and environment. Something that was most important when you're cultivating a positive practice environment. This tells us that nursing leaders understand the importance of culture in the work environment, and that healthcare leaders need to evaluate their current organizational culture.

So that they can really work towards creating these really safe and supportive and ethically grounded environments for the entire workforce. something that we also found, the survey. also reinforced for us that the need to foster a diverse and equitable and inclusive workplace, was important because only one in four nurse leaders strongly agreed that their organization was focused on DEI initiatives, that support and sustained these positive practice environ. So, as healthcare leaders, we have a responsibility, to ensure that just culture and bias training is embedded into our organizational culture and of course our ongoing education.

Another interesting thing that we found, and a grave challenge right now facing our workforce is burnout. we've heard a lot about healthcare burnout, especially in these recent years because of the Covid pandemic. You know, it's really pushed our clinicians to the brink of mental and physical exhaustion at times. so I think that our, AONL survey highlighted this truth, as over 50% of nurse leaders expressed to us that they were experiencing burnout multiple times each week. This statistic is very alarming to me and it should be to everybody. and it should really prompt healthcare leaders to take action.

One of the things that we did learn from our work is that when we focus on creating and sustaining these positive practice environments, we ultimately support and increase joy and meaningful work for our nurse leaders, which we know then in turn is gonna decrease that burnout. So those were some of the, key highlights that I really found through this work and through the topic. I, I know Linda, Has some insight too in her field and how we've kind of innovated and focused on our care models as well. So we'll kinda let her speak to that.

Lynda Benton: Yeah, I think before I go into that Mercedes, what I would add is, from our research here at Johnson and Johnson, we've been paying very close attention to what's been happening to the nursing workforce, prior to the pandemic, during the pandemic and coming out of the pandemic. To your point with, so much in the media being reported about. burnout leading to, increased turnover and then leading to accelerated agency rates. some people are, claiming it to be a nursing crisis and I'm always quick to jump in and say, no, no, no.

If it's a nursing crisis, it's really a healthcare crisis for us all because healthcare is not gonna work if we don't have nurses to really help to be so, intimately involved in healthcare as they are. So I think one of the things that we've been trying to do, and I think what this particular compendium does such a beautiful job of is really getting underneath the hood to understand what is contributing to that burnout. turnover and vacancy rates and what can be done to help address those core challenges.

And that's where I think the work that we're doing here, as it relates to the positive practice environment is so practical and so needed because I think health systems and nurses in those health systems across the country have been suffering. But I also know that from talking to so many people, like we are able to do, there's some amazing work that's going on around the country, where nurses, and nurse leaders are really able to step in and lead, and they're trying new, innovative ways to get at these core challenges so that you do have a more positive practice environment.

But the challenge has been, of, they're happening in different pockets and there hasn't been a really easy way and a simple way to really share some of these, examples in terms of how people are really, changing the environment and moving things forward and improving things. So that's one of the things I'm just so excited about with this compendium, is that we're able to actually lift up some of the very best examples that we've been hearing and seeing about that I think could be useful to so many nurse leaders across the.

Host: Yeah, that's really great. Can you dive into some of those care models for us?

Lynda Benton: So one of the things that we know from the research, certainly if you look at almost any different piece of market research, I think including with Remesh work, is that, work scheduling is one of those things that tends to be the greatest area of, shall I say, depleting joy in the nursing workforce. It's a big headache. It's something that's very contentious. And I think, having innovative care models, as relates to that has been a very important part of understanding, you know, how things can be improved. we've been doing our homework again, talking to, and trying to find some of these exemplars across the country, and I wanted to share a couple of them.

One of which is one that actually just. Came into my viewpoint in the last couple of weeks, and then I'll share a couple of examples from the report itself. One is happening through Mercy Health, which is a large healthcare system being based in St. Louis. It's a multi-state system, and with their chief nursing officer, Betty Joe Rokio. What she's doing, which is just amazing, is she's taking a page out of the, you know, a gig approach to the nursing workforce. If you think the way Uber works or Lyft or some of these other types of apps that are so common, these.

She's been trying to leverage that kind of technology to deliver a staffing model where nurses can then be better prepared to deliver the care that they need to deliver. So what she's been able to do as an example, is develop this App that's called Mercy Works On Demand. That enables nur nurses to open the app and figure out when they wanna work, where they wanna work, how many hours they wanna work and sign up for those shifts. So it gives them complete control, over their schedules as a way to help support what their work needs are, as well as their personal needs.

And I think what's been really cool about it is it's one of those, in my opinion, the win-win win where they've been able to really stack up to the needs that they need. They've, actually already piloted this, particular since the spring of 2022, and now it's been rolled out across their 30 hospitals with 5,700 users, in 85,000 shifts covered. What's really happening is it's while it's also, again, filling the needs of the nursing staffing that they need to deliver patient care. They've also been able to deliver the cost to deliver the care by 12%, and they've cut the amount of dollars they're spending on agency factors by half.

So that's just one example where a nurse leader took it upon herself to work with a, an outside firm to develop an App that's gonna make it easier for nurses to do the work that they love to do. That's one such example. Another great example that we heard about innovative care models, came from Atrium Health. And this is where, during the pandemic, they obviously recognized the. To free up some of the times that the nurses on the floor, but realize that some patients also need some more hands-on, personal care as well. So this is where they developed something called the Virtual Nurse Observation Program, which really enables nurses, on the floor to do what they need to do.

But it also has a nurse at the bedside, basically through an iPad type technology where they can take some of that, workload off that bedside nurse to compliment the work that they're doing. And they really found that this tool was not only a great recruitment tool for new nurses who needed additional support, but also enabled nurses who might be more closer to retirement age to be able to step in and really contribute and maintain a presence of the bedside. Even if they couldn't be there physically. They know from their results that Patient experience, increased as well as there was increased team satisfaction across the nursing workforce, as an example.

And then beyond that, just at a high level, there's a couple of other examples that we point to in the actual report itself, which is, I hope people take a moment to read through it, that look at new innovative models related to team-based care, really trying to divide and conquer on tasks so nurses are freed up to do the work that they are so well trained to. And then leaving additional pieces of the work to be done by other people on the team. We saw that at Memorial Herman, as well as at a place called Community Medical Center, where again, in some cases they're using RNs, LPNs, and patient care technicians, and in some cases other types of ancillary support as well.

So there's a host of examples. I could talk about this all day. So the important thing is there's some incredible work happening in these health systems across the country that's really delivering into these innovative care models.

Host: Yeah, those are great examples. Thank you for sharing those with us. The Mercy Works On Demand app sounds really interesting and very innovative for sure in the Atrium Health Virtual Nurse Observation Program as well. So those are great examples. And I like how you say we need to highlight, there are people doing, great work out there. So thank you for sharing that with us. And Mercedes for nurse leaders listening to this podcast, what is then the overall takeaway from all of this in your opinion?

Mercedes Lopez: I think the compendium, each chapter is supporting the voice of the nurse. . nurses need to find their voice. They need to be able to speak to their challenges, speak to their needs, and find a way to empower themselves in one another. And I think we have to support nurses to the fullest, right? And as leaders, we need to learn how to drive and build that culture and environment that's really necessary to create those positive changes in the work environment. And I think the podcast. briefly shows a little highlight of what is encompassed in that compendium. I think overall we need to really focus on how we engage and appreciate our nurses, at all levels.

How we support and build better teams, and the teamwork within that. And the teamwork and the appreciation goes a long way. And ultimately those really help to increase retention and joy at work. Which again, when we have those two elements, it really drives our patient outcomes. And that's part of the point is when you foster that positive practice environment, it really impacts the patient outcome. And so that's what we're trying to show the world is if you really put value, and effort into creating, fostering these environments, you will see impact on the patient outcomes.

So I think this podcast is a wonderful introduction on the impact that those positive practice environments have on the workforce. but I think to fully understand the challenges, and the strategies and also the resources. I really recommend everybody read the full AONL workforce compendium that we're gonna be publishing. One chapter already was released and several chapters will be coming over the next few months. So I think that's important to see the full picture.

Host: Yeah. And that full picture, as you say, the positive practice environment ultimately drives better patient outcomes. So that definitely is a key takeaway. So when we talk about positive practice environment, Lynda, are there key tactics someone can deploy in their organization to start driving towards that positive practice environment? What are some things people can start doing right away?

Lynda Benton: Certainly Bill, it's a great question, and again, once the compendium is published, I think that's what I love about this so much is that it really is very simple, very actionable, and it's not a one size fits all. So, there's incredible examples in this compendium, in our case, in the positive practice environment chapter. that will speak to different aspects of what nurse leaders are dealing with. so I think it's a matter of what that health system is focused on, what their needs are. And I think we've got some really core, basic, easily actionable examples of ways to address those challenges based upon other health systems that are experiencing the same thing and driving change based upon these approaches that we.

So it's really not a one size fits all. There's a lot of examples here that people can tap into. And just to point out, again, we were very intentional. This is not something that is about what we specifically didn't call it a best practice companion because some of these things are very new and very on the cutting edge and they're too new. And we didn't wanna wait until you have two more years of data to say, did this work? Did it not work? We feel. Positive and excited about a lot of the incredible exemplars that we heard, and we wanted to share the wealth basically with other health systems as a way to again, lift all boats. So we're excited about this and we really, depend on people to check out the compendium and really see what works for them.

Host: Yeah. So when we talk about measurable successes, really at this point, there's a lot of innovation taking place right now, but as far as conclusions, we don't have those yet. Is that correct?

Lynda Benton: Some of them, some of the exemplars that we have direct, outcomes that you can take a look at. I mentioned the one, for example on Mercy Health. but there's also some statistics related to Memorial Hermann that people can check out in relation to what happened with morbidity, mortality employee engagement scores. So depends on the exemplar and where it was in its stage of being teste. But I would say some things are newer, but for some things there definitely are statistics there that are worth checking out.

Host: So as we wrap up, thank you both for your time. This has really been informative. I'd like to just get your final closing thoughts. Mercedes, can I start with you? Any additional thoughts you want to add?

Mercedes Lopez: Yes. I would just say overall, we as nurse leaders, we have to continue to raise awareness. on the impact of building and sustaining these very healthy, positive practice environments. It's so important, not only for us as healthcare workers, but for our patients. and I also know that as nurse leaders, we can and have the greatest positive influence. on the nursing workforce. We truly have to be active list centers, who honest, transparent, open to these new ideas. We have to be accessible and present for our staff. And I think if we want to successfully rebuild our post pandemic workforce, we have to have these really hard conversations at the table.

You know, we have to highlight and speak to the value of our nursing workforce. We have to support the investments in these strategies and programs that ensure safety and wellbeing and appreciation, and of course the innovation, that can really lessen the burden at the bedside. we have our work cut out for us. But I think this, again, this compendium just brings to light. There are a lot of great healthcare systems doing really great work, but we still have a lot of work to do. I think again, I would just say, look at the full compendium, tailor it and customize it to your needs at your organization.

There's a really, really, lots of great information, lots of, national resources embedded in there. so like Linda said, we're just very, very excited about this work. We're really excited to, see this chapter specifically, hopefully published, this month or early January. But yeah. I mean, take a look at it.

Host: Yeah. Very well said. Thank you, Mercedes. And like you said, we have to continue to raise awareness and many people like you are doing that. So thank you very much. Lynda, final thoughts from you? Anything you'd like to add?

Lynda Benton: Yeah, I would just say I'm just super excited that a o l was able to really spearhead this work and focus specifically on nurse leaders. Because As we originally talked about, the nursing profession as a whole has been under tremendous burden. And the nurse leaders, I would have to imagine, have been really bearing the brunt of that because they're obviously managers, but they're also getting pressure from above. And so to have a resource. Specifically deployed, for the nursing leader, to really help continue to support them and the work that they're doing. I'm just super excited about this because this is not something that I've seen specifically done before, focused on this very, very important profession within the nursing profession as a whole.

Host: Absolutely. Great point Lynda, and thank you so much for your time. we appreciate it. This has been a great discussion, Lynda and Mercedes, thank you again and, this is an important topic and one that hopefully we will continue to discuss as we continue to innovate and make changes for sure, to create that positive practice environment. Lynda and Mercedes, thank you both.

Lynda Benton: Thank you BIll.

Mercedes Lopez: Thank you.

Host: And once again, that's Lynda Benton and Mercedes Lopez. And for more information, please visit AONl.org/compendium. And if you found this podcast helpful, please share it on your social channels. And check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.