Bill Klaproth (Host): This is a special AONL podcast as we speak with session presenters from the AONL 2023 Conference. With me is Maureen Sintich, she is a Chief Nurse Executive and Jane Yang, Business Operations Manager at Surgery Service Line. And we're going to talk about their session, You May Be Onto Something, A New Model for Frontline Nursing Leadership.

Host: This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Maureen and Jane, welcome. Appreciate your time.

Maureen Sintich: Thank you, Bill. It's great to be here with you today.

Host: You bet. Thank you for being here. So Maureen, let me start with you. When we talk about a new model for frontline nursing, and as we know, as you were just mentioning before we started the interview, frontline nurse leaders, it's one of the most difficult jobs out there. So, why is it important that we try to come up with a new model for frontline nurses?

Maureen Sintich: Well, the frontline nurse leaders, they have the greatest opportunity to make the biggest impact for the care for our patients as well as for the team members. And if you think about their role, they're responsible for all the clinical outcomes, the patient experience, the financial implications of the care that's delivered on the unit, as well as their team members' experience. And they really drive that culture. And so, we want to be able to maximize their expertise, so that they don't get bogged down in things that maybe don't require the nurse to focus on. And also, when you think about that difficulty, there are no other departments within healthcare where you have other members of the healthcare team, respiratory therapists, pharmacists, other types of clinical experts coming on and off and within your department where they are not responsible for those team members, yet they're still accountable for the outcomes. And that's really what makes it so challenging and difficult.

Host: Yeah. Jane, you want to chime in on that? Any thoughts on that?

Jane Yang: I think the biggest thing that I noticed when I was in my fellowship and sort of on a grand tour of our health system, seeing different units at our different hospitals, meeting nurse leaders and really getting my first look from an outside perspective and also from a nonclinical background, that I just noticed that the job is so huge and it's far beyond really anyone's training, much less someone who probably came from frontline nursing themselves. And so, they were responsible for all these financial outcomes that they didn't take the same courses that I did in healthcare administration or in a business undergrad, and still responsible for those outcomes. So, they're learning on the job where they get, you know, a great six-hour orientation when they start, and that's their onboarding. And as the role progresses and as they get deeper into it, there's just more and more and more that's added on.

Host: Right. So, Maureen, let me ask you this then, for a nurse leader listening to this, saying looking for a new model, this is great, what are some of the things they should know or first steps they should take?

Maureen Sintich: I think really it's what is the work, right? What is it that he or she is doing every day? And then, what matters most to them, to their patients, to their team members? And to really be able to bifurcate that work, if you will, and direct the nonclinical administrative duties and to be able to offload some of those to other roles.

And unfortunately, within our health system, we didn't have that other role. And so, it really did require Jane and I to take a step back after holding focus groups with our frontline nurse leaders, with our clinical directors to learn what was bogging them down and what got in their way of having a great day to really rethink the roles and to create something new and different. And that's really how our session title sort of came about, because we were pitching the role to our CEO and to our cabinet. And then, this great article came out about the same time in the Harvard Business Review, and he said, "You know, you may be onto something here."

Host: Yes. I think we are onto something. This is great. Well, you said trying to find out the things that are bogging nurse leaders down, nurse managers down, the frontline nurse down. So, what did you find out? "Okay, here's how we're gonna address this problem."

Jane Yang: One of the questions that we asked in the focus groups was, "What are the pebbles or the boulders in your shoes?"

Host: That's a good way to it.

Jane Yang: The things that are bothering you throughout the day, or that just take you away from what you consider to be your chief duties? One of charges that Maureen gave her hospital CNOs and service line VPs of nursing was to really charge the clinical directors and those who were leaders of different nursing units to be the chief retention officers. That's really difficult to do if you're spending six hours in your day chasing down a patient's lost ring.

Host: So, you would've never uncovered this unless you asked those questions. Is that right?

Jane Yang: It's really about listening and taking stock of what you've tried before as an organization. It's going to be different from place to place, the history behind that, why you did those things and what's working well right now, and what's in your shoes and in your way as you're walking throughout the day.

Host: I love the pebbles or boulders in your shoes. That's a great visual way to-- and everybody hates it, right? When you get your walking, you get a little rock in the shoe. It's like, "God, darn this thing," right? So, that's a great way to put it. So once you've uncovered these things, how did you take that information and then turn that into programs or changes? Jane, how did you do that?

Jane Yang: It was partly because our shared governance at the organization is so strong much to Maureen's leadership and credit, where they took different things that came out of those focus groups. and dispersed the work amongst our different committees. And then, the part that she and I really took ownership of was thinking of how to bifurcate that role of clinical directors. And so, the largest opportunity that we saw was in these interim nurse leader roles, where clinical directors, where there was turnover, someone left or moved to another role, someone in the interim was asked to be over to different units. And so again, their role expanded and now they're covering two units. And in the interim, that might be sustainable for someone, but certainly not in the long

Host: Absolutely. Maureen, give us your thoughts on what you and Jane discovered and put into place to address this issue.

Maureen Sintich: Well, in just building upon what Jane just mentioned, as we saw these amazing leaders expanding their roles and thinking about, "Okay. It was hard enough with one department and now I have two, and how are we going to do this?" We said, "What if? What if we identified a nonclinical leader that we could partner with this clinical leader, bifurcate the work, and so the non-clinical leader could focus on things like supply chain, biomedical equipment, labor planning?"

Jane Yang: Productivity, financial outcomes, interfacing with all the other departments in the hospital to take care of all the equipment.

Maureen Sintich: Schedules, time cards, you name it. And so, moving that to a different leader, a non-clinical leader, environment of care, some of the preparation for Joint Commission, all of those types of things. And then, they would partner together to help support the teams. And so, we had a brave leader in one department who raised her hand and said that she would be willing to try it. And it was about a year ago. And trying it turned into an amazing relationship between these two leaders.

Host: Okay.

Maureen Sintich: And when you watch them and you think about how they work together and how they --I don't know if the right phraseology is divide and conquer, but that's kind of what they do.

Host: That's kind of what it sounds like. So by you doing this, you really did free up the frontline nurse leader, so he or she could maximize their expertise.

Maureen Sintich: Absolutely.

Host: So, you said you did this about a year ago. So Maureen, what have the results been so far? I know you just shared a little bit of it, but can you go a little deeper on that? What have you seen?

Maureen Sintich: Sure. So, let's just take these two departments as an example. From 2021 to 2022, they've seen a 10% reduction in turnover. They've seen nearly an 18% improvement in their engagement scores. They have also improved upon their clinical outcomes. They've reduced their C-section rates. This was a labor and delivery department and a mother-baby-family-centered care department that were combined, they increased their breastfeeding rates by 4% and they've also significantly decreased their vacancy rate. And so when you think about that and think about what matters most, both to the team members and their engagement and their likelihood to stay on the unit as well as to the patients and the families that they're serving on those two units, I would say that that combined is a success in the making.

Host: Like a win-win-win.

Maureen Sintich: Absolutely.

Host: That's great. Jane, thoughts on that as far as measurables or what you've seen or something you learned along the way?

Jane Yang: I think it's hard to measure. But we learned this as we had followup focus groups and we caught back up with the folks who had implemented this role in their departments. And of course, they were the first pilot and asked them, "Now, how's it going? How have you actually put this into practice?" And we saw that it was completely different from place to place. I mean, we have EDs, we have peds unit, we've got L&D, we've got ICU, PCU, IMCU. It's really across the gamut. And so in all these different contexts and different types of patients really as well as team members and just team dynamics, the role looks so different for all of them.

And the other interesting thing is that they really have taken those what were pebbles in the shoes for clinical directors and those are places that we're seeing that the operations managers are thriving and they're taking their backgrounds with MBAs and MHAs, and running analytics that the clinical leaders didn't have time to do before. And doing these PDSA cycles, they're able to get their PAR levels updated, all these things that they didn't have the capacity to do because they were busy being chief retention officers and also doing things like chasing down someone's ring and all these things that pop up in the middle of the day.

The operations managers have also taken on engaging with not just the day teams, but also the night teams. And so, some of them will come in at 3:00 and start their shift then and hand off to the clinical director when they come on in the afternoon. So, they've gotten to know all of the teams and not just one. And if you think about how challenging that is for one person to do with one department, this way, the teams have gotten to know both the operations manager and the clinical director. They've also started to pick up on what kinds of questions they should direct to the operations manager and which ones they should go to the clinical director for. So if equipment is down, you go to the operations manager. If you have a nursing competency question, probably go to the clinical director. And that's really to the credit of the operations managers who got deep and dug in on what were pebbles in the shoes of the frontline nurses.

Host: Right. Sounds like you've increased the communication throughout the whole nursing department then. You each know more about what everybody else does. And you said we've kind of learned the questions to ask and where to go when things happen. Is that right?

Maureen Sintich: Exactly. And the team members see the two of them as true partners. And so while they may know who to go to for one type of concern or idea or another, they also see them as an aligned representation of their department. And I think that that has also helped them really understand that they can rely on non-clinical leaders in the same way that they can rely on their clinical leadership team, which is really important when we think about everybody's contribution to healthcare.

Host: Yeah, that's a really good point. Well, this has been a great discussion. So as we wrap up, if we could just get final thoughts from each of you, that'd be great. Jane, let's start with you.

Jane Yang: I think the big crux of all of this is just trying something new. For us, this was unprecedented, really. And it really takes that elbow grease on an individual level to get to know each department. And it's really about recruitment and looking for the right person. Not just the right clinical leader, but also someone who's willing to be flexible and dig into an environment that's really new for them.

Host: Yeah, I think that's a really good point. It takes work. It's elbow grease. You got to be willing to go in and do the work to learn these things like you both have done. And Maureen, wrapping up, final thoughts from you.

Maureen Sintich: Both roles are grounded in trusting relationships and it's a partnership. As Jane said, it takes the right people to be able to enter into these relationships. But at the end of the day, I would say that they probably don't feel so lonely and they recognize that they don't have to go it alone.

Host: That's a really good point. That's an added benefit to all of this. People feel seen and heard, and they feel like they're all in it together then.

Maureen Sintich: You're right.

Host: Yeah. Maureen and Jane, thank you so much for your time. I really appreciate it.

Maureen Sintich: Thank you. Thank you for the opportunity.

Host: Yeah, you bet. So for more information, please visit aonl.org.

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.