Bill Klaproth (Host):
This is a special AONL podcast as we speak with session presenters from the
AONL 2023 Conference. With me is Jennifer Orbin, she is the Director of Nursing
and Debra Raupers, Chief Nursing Executive at Guthrie Healthcare System, as we
talk about Rise From the Ashes of a Pandemic: Changing Care Models, Changing
Cultures.

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Host: This is Today in Nursing Leadership, a podcast
from the American Organization for Nursing Leadership. I'm Bill Klaproth. Jen
and Deb, welcome.

Debra Raupers: Thank you. Thanks, Bill, for having us.

Jennifer Orbin: Thank you. Yes. We're excited to be
here.

Host: Well, I'm excited to talk to you about this. So
Deb, let me start with you. What is the compelling leadership issue or the
problem that your session addresses?

Debra Raupers: We do not have enough nurses. And the
supply and demand of nurses today is at an all-time high and we are all
fighting over the same pool, and it is not meeting our needs. So, we are coming
up with innovation and different ways to do this.

Host: So, the nursing shortage really, as we all know,
has been very problematic.

Debra Raupers: Correct.

Host: Yeah. So Jen, let me ask you this then, and
congratulations, Director of Nursing, I understand congratulations are in
order. For someone to follow your path or try to understand what you've learned
or uncovered, what are the key things to remember for that nurse leader?

Jennifer Orbin: Yeah. As Deb mentioned, innovation is
huge, right? So, looking at different opportunities to do something
differently. And so with our new care model Team Nursing, it was an opportunity
to come in and try something new and different for our organization and it
really paid off. And as a new leader starting and if this is something that you
would want to do at your organization, my suggestion is to start with the
research part, understanding the scope of practice for your state and those key
roles that every person can play in this model is really important.

Host: Yeah, I think that's really well said. So, start
with the research. And you mentioned your new care model, Team Nursing. Jen,
can you go into that a little bit more. What did you exactly do or the
specifics of this new strategy or program?

Jennifer Orbin: Yup. So, we originally had primary
nursing where an RN is responsible for a group of patients. And so, we brought
LPNs back into the acute care setting. And so with that, the LPN and the RN are
paired together to take care of their group of patients. And it really did
allow us a lot more flexibility in our staffing plans and, more importantly, it
brought more hands on deck to take care of our patients.

Host: And that's something new then? Most LPNs aren't
brought in and married like that. Is that true with RNs? That's correct?

Jennifer Orbin: Correct. So, several years back, LPNs
were really taken out of the acute care setting. And this was an opportunity to
kind of bring them back in and reteach them and excite them about the acute
care arena and get those skills that they learned in school back. So, it really
was a great opportunity for our LPNs, our fellow nurses to come in and grow
professionally.

Host: Yeah. Deb, what's your thoughts on that?

Debra Raupers: Yeah. So, we needed more hands to care
for our patients. We were leaving patients in emergency rooms and not allowing
them care because we didn't have enough nurses to care for them. Allowing the
LPN to come in and partner with an RN, it's more hands and we are really seeing
great patient outcomes because we have more nurses to actually give the
hands-on care.

Host: Yeah. Can you talk more about the results or the
outcomes of this? What have you seen? I know you just mentioned a little bit of
it, but give us more in depth of what you've seen.

Jennifer Orbin: So, originally when we had implemented
this model, we actually started with a trial unit. We really wanted to make
sure that we were making the best decision for our patients and for our teams.
So, we had a 20-bed med-surg unit. And we started with this care model and
very, very quickly we saw huge changes, huge changes in our staff's demeanor.
They were excited to come to work. They were excited to have a partner in
crime. And the RNs would fight over who got to be partnered with an LPN that
day, which was really exciting because they felt like they always had built-in
support.

You know, nursing, especially during a pandemic, can be
extremely isolating, right? And in a pandemic where you have to stay six feet
apart and you have to isolate, you know, it can be very daunting for a nurse
who is all by herself and has all these patients and all these things to do,
and they're drowning. And so, the team model really does help give additional
support for them where they always have a second set of eyes, a buddy to talk
to, somebody to relieve them for breaks, right? A nurse taking a lunch break,
are you kidding me? And so, the outcomes that we saw, we saw a huge improvement
in our team engagement, our staff satisfaction year over year. Our patient
experience really did, again, improve year over year. The patients loved it.
They loved having two nurses for the price of one, right? Literally. They were
so excited when they found out, "What do you mean? I got two nurses
today." And so, we saw that in our results. Quality metrics, we watched
all of our quality metrics. Again, year over year, we saw improvement. We started
this in 2020. We're now three years in and have three years worth of data. Our
falls, our falls were reduced year over a year. And that was huge, right? We
had more hands and more people to take care of our patients. So, those quality
metrics aligned with that.

Host: Yeah. Thank you. Deb?

Debra Raupers: So, the exciting thing is then we looked
at it at this facility in the trial and we decided that's it, we're going
across our whole system. So then, we deployed this at each one of our entities.
We immediately were like, "How are we going to recruit these nurses to
partner with us?" And we went out and Jen did a phenomenal job of hitting
every LPN school and we were able to attain 60 nurses in 30 days, so three
months.

Host: Wow. That's amazing.

Debra Raupers: We were able to attain 60 nurses in three
months and we have since then just continued to bring in those nurses and think
about nursing care hours. Again, a team, it has just been phenomenal on our
patient outcomes.

Host: Yeah. Well, I can hear and see, because I'm
talking with you, the passion that you have for this and how excited you are
about this, which I think is just great, what you've done for sure. So overall,
as a nurse leader, someone listening to this, what would you say is the key takeaway
for them to remember? Jen, I'll start with you.

Jennifer Orbin: Definitely understanding the scope,
understanding what everybody can and cannot do is very, very important. We do
not want scope creep. We want to make sure that everybody is doing everything
to give the best quality care to our patients and that they're trained to do.
So, that is a big piece of it.

The flexibility that this model provides with staffing, I
didn't mention what the outcomes, but we took from the trial unit, we went from
a 40% vacancy to zero. Zero. We eliminated all agency staff on that trial unit
starting in 2020 and have remained without any travelers or agency use on that
unit, which is huge. And we saw those same results at the system level with a
huge reduction in our agency costs and salary costs on top of that. I just
wanted to throw that in because the flexibility you have to build the model for
your organization, knowing the sizes of each of the departments is huge because
it doesn't make sense on every single unit or every area. Majority of them,
yes, it does. But we learned that throughout this process. So, understanding
the size of the project or the size of the implementation and what that model
looks like for your organization is really important.

Host: Deb, how about you?

Debra Raupers: So for me, it's an answer to all of the
things that keep us awake at night, you know, knowing that patients can be
harmed in our care and anything to do to prevent that. And the more people
caring for them, obviously, is going to reduce those risks. I would share with
you the people practicing at the top of their scope, it's teamwork. It is
teamwork. We do it with providers and then we just add this clinical team that
all works together. And I'm really proud, we're now adding virtual nursing on
top of that. So, clinicians that are not on the sites that are actually able to
give clinical care based off of all that they're monitoring of our patients.
And it's almost like a phone-a-friend. So, we know we have inexperienced
clinicians today, and these virtual nurses can step in and help. They can call
and say, "Hey, I'd love to see you do this. Why don't you try this?"
And we are just implementing those models and seeing great results with that
also.

Host: Wow, that is great to hear. So, thank you for
sharing that really good information. So as we wrap up, thank you both. This
has really been informative and I know people are really going to enjoy what
you've had to say. Any additional thoughts you want to add before we end? Jen,
we'll start with you.

Jennifer Orbin: I think, you know, for me, it comes back
to again the culture shift that we saw with this. You know, as I mentioned
before, being a nurse can be extremely isolating, right? And you have the weight
of the world on your shoulders. That's how it feels sometimes. And so, to have
that additional support and friend at all times while you're working, while the
most critical times are happening in your patient's life, right? The most
tragic circumstances. We saw this resiliency that was borne out of this model
and the support and the love and the connections that those team members made
with each other, I think it was an outcome we never anticipated, but we
definitely feel blessed that we were able to create this.

Host: Yeah, I like how you called it a culture shift.
And Deb, final thoughts from you. Anything you want to add?

Debra Raupers: So from an executive level, financially
this makes sense. This is something that actually really helps our healthcare
organizations recoup some of the monies that were lost during the pandemic. And
I really think teamwork is dream work, right? People enjoy coming to work
because they're working with their colleagues and it's fun. It is bringing joy
back into the workplace at a time when we need it more than ever.

Host: So true. So very true. And I love that, teamwork
makes the dream work. That's right. Well, Jen and Deb, so much for your time
today. This has been great.

Debra Raupers: Thank you, Bill.

Jennifer Orbin: Thank you. Thanks for having us.

Host: You bet. And for more information, please visit
aonl.org. 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.