Bill Klaproth (Host): So, how can we address today's critical nursing shortage? While the shortage is a complex issue exacerbated by factors such as an aging population, burnout, and insufficient training capacity, there are actionable strategies that nurse leaders can deploy to mitigate these challenges and ensure high-quality patient care.

So, let's learn more with Laurie Laxton, Bachelor's-Prepared RN, Certified Auditor, and Certified in Quality Assurance and Infection Control. She is also the Principal Product Manager at Inovalon as we discuss how nurse leaders can address the critical healthcare worker shortage by implementing measures to improve nurse retention.

 This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Laurie, welcome.

Laurie Laxton: Thanks, Bill. Thanks for having me.

Host: Yeah. Thank you so much for your time. I appreciate it. So, let's dig into this. How are many healthcare organizations addressing staffing shortages today?

Laurie Laxton: Well, some of the organizations are very familiar with how they personally do their recruitment and retention tactics. I mean, some of them will do sign-on bonuses. Some organizations I've worked with, they try wherever they can to increase their pay and other financial incentives to both attract new staff as well as retain those existing staff they have. But some other things that I've noticed in working with organizations around the country, focusing on the different generational needs. So many of us have heard of Generation X, Generation Y, Generation Z, the Millennials, all this stuff. Well, the younger generation, we find they really need to feel meaning with their work. And they come out of school with certain expectations and having a better visibility and transparency for their future career path, their potential for upward mobility. We are seeing improvements in those younger staff by having some of that transparency available.

Other things that I've seen that are working pretty nicely are having partnerships with local high schools or tech schools. So, there's high schools out there that have a tech school attached in their senior year. These kids can be going to school to be a certified nurse assistant and offering them to have their clinicals in your buildings. That has been really successful.

I also knew of some organizations that are offering scholarships to those programs that are helping drive those new grads to come to their buildings to look for work. And, you know, the Biden administration, when they rolled out the minimum staffing requirements just recently for nursing homes, they promised, and we'll see, hopefully, it'll go through. But they are promising a partnership with health resources in, I think, it's called the Health Resources and Services Administration. They're promising to invest $75 million in scholarships and tuition reimbursement. And so, hopefully, that'll help drive more nurses into the post-acute care realm.

Something else that I just learned about that kind of dates me, but I know since the pandemic, we've had a lot more virtual care. Well, they have something called virtual nursing. And so, there are certain tasks that nurses have to do when a patient is admitted, doing discharge planning. Sometimes you have to do some medication administration training for the patient and their family members or their caretakers. And that can be done virtually. So, nurse groups, these virtual nurse groups that are not physically on site in these hospitals and nursing homes and things that they will tap into these virtual nursing avenues. And that seems to be helping address some of their shortages.

And then, of course, technology, I work for a technology company. And so, there's certain tasks that can be assisted with using technology in that it will assimilate data into one nice dashboard kind of view to help save time and manual effort.

Host: So, that's really interesting. There are several things that you mentioned that healthcare organizations are using to address staffing shortages. You talked about transparency, partnerships with high schools, scholarships, virtual nursing, of course, technology. So, let me ask you this, Laurie, with all of these really good things that are happening, why is nursing turnover persisting despite these types of efforts?

Laurie Laxton: You know, you mentioned earlier on that I'm certified in quality assurance. Well, part of QAPI or quality assurance performance improvement is identifying the root cause. And I think part of the problem is we're not in some places identifying what those root causes of burnout and inadequate staffing are. They're not being financially addressed. They're not being fully addressed. We know there's high patient to nurse ratios and excessive workloads and things like that, but you can look deeper into it. For example, I know that some organizations where they're showing some staff burnout, they're actually frustrated because the existing staff see an overuse of agency workers who are often paid a little bit more and treated a little bit different. And that causes an emotional toll on the nurses. And so, sometimes little root causes like that may not be addressed.

As you mentioned, I talk about technology. I'm in the technology world as a nurse now. I'm not on the floor every single day, and I've found as I get into the technology more and more and thinking back to the days when I was doing direct patient care, technology can cause fatigue in nurses if it's not used properly. And so, just because we buy a software, it doesn't mean that the nurses are going to, first of all, know how to use it, and that it's going to necessarily save them time. We've got to be very careful deciding what softwares we're going to use to make sure that it's designed to support the nurses, not overburden them with more unnecessary tasks.

For example, there are some softwares out there that have numerous questions and steps involved in capturing the data that really serve no clear purpose at all, such as maybe improving the patient's safety or saving the nurses' time. And that in turn can cause fatigue in the nurses and burnout and frustration.

Host: So, technology can kind of be a double-edged sword then, it sounds like, what you're saying, if you don't use it properly.

Laurie Laxton: Correct. And trained in it properly and choosing the right types of software, not just buying it and just putting it in and nobody uses it or uses it properly.

Host: Let's talk more about burnout. Burnout has been obviously a hot topic since the pandemic. Can you talk more about that?

Laurie Laxton: Yeah. It's actually quite concerning. As we've done some studies here at Inovalon with some of the software that we have in looking more into staff burnout and talking with organizations, it can manifest itself in all kinds of ways, physically, emotionally, and mental exhaustion in our nurses. And actually, there was an article, it was either late 2023 or early '24, the American Hospital Association put out. And they said that efforts to reduce burnout and foster that sense of community have only led to a 6% improvement in mental health. And there was another stat out of there. I think I wrote it down here somewhere. Yeah, it says 88% of nurses still report that staffing shortages negatively impact patient care, and 63% feel overwhelmed by being assigned too many patients. I mean, that is just staggering.

And then, what was really shocking to me was 50% of nurses have experienced verbal or physical assaults from patients or their families in the last year. I mean, that's just, oh my gosh, can you imagine going to work with that kind of safety concern? So, we really need to look at those root causes of what's causing this nurse burnout and really get to the core, and each individual is different. Stress and burnout can affect each nurse differently. One could have physical symptoms. One could have emotional and mental symptoms. So, it really needs to be addressed down to the root cause for each individual nurse.

Host: Yeah, as you said, burnout affects the whole person physically, emotionally, mentally. And those statistics are very staggering, 63% say they're overwhelmed by too many patients. And you're right, 50% have reported some type of verbal abuse. You're right, who wants to go to work in that environment? My goodness, those stats really do paint kind of a dim picture, if you will. So, what steps can nurse leaders take then to prevent burnout and encourage staff nurses to stay on board?

Laurie Laxton: Well, I think they really need to create a supportive work environment where the nurses really feel valued and heard. Maybe offering professional development opportunities, additional training, talk to the nurses themselves, have those one on one conversations, seeing if they need any mental health support. I know here at Inovalon, when we get our yearly benefits, we have counselors like it's a mental health counselor that we could talk to, in addition to our regular medical and dental benefits and things like that. Tap into some of those things and training is so important because nurses do these day to day tasks that we have patients' lives in our hands. And if we are not comfortable performing certain types of dressing changes or certain types of equipment that's new equipment on the market, and we're not sure how to sterilize it properly or use it properly, that causes additional stress. And so, also learning from each individual nurse, how do they want to learn? Some like return demonstrations, some like videos, some like to read it in a book, all of that can be taken into account to help create a supportive environment for them to work in.

Also, I know that nurses, we like to have some say in the decision-making process. And so, whether it be offer them ways to participate in committees or put in their inputs in a random anonymous box, but also let them know that they are heard. Put things up on the bulletin board. Transparency, share what everybody else is wanting and asking for. Like I said, there's technology out there. Inovalon has one that's a schedule management software that helps nurses and the HR people really look at the critical areas that need to be staffed and juggle where needed. And we actually had a customer who was a behavioral health customer, and this one lady, she was really cool. I love what she said. If your staffing isn't right, your goals aren't right. She said they needed tools and processes in place that support the nurses, not just create additional work for them.

And then, something else, balancing staff and staff distribution, pairing up your experienced staff with your new staff, that helps a lot, like a mentoring program, creating a culture of safety so that they learn from one another and they have each other to depend on each other. That see one, do one, teach one is a model that nurses often have and allowing them to speak up and not be afraid to make a mistake and have that experienced nurse right there with them, being careful how they correct them in a positive manner. And that's how we learn best. We have to make mistakes in order to learn, but that will help foster that mentorship program and help with the burnout.

And then, staff distribution is the last thing that I like to bring up whenever somebody asks me this question. Like I mentioned, Inovalon Schedule Management, it has a way that, let's say I have five different units. And Unit 4, we have a lot of staff available, and our census went down recently. But the nurses on Unit 4 can cross over and they are trained and available and they can work also on Unit 2 or Unit 1. Well, and let's say that unit, our census went up, well, we can juggle nurses around very easily using a software and a phone app, which the young people love where you can swap shifts really easily and distribute everybody evenly so that everybody's a team effort sharing in the workload.

Host: So, staff distribution, that's really an important factor of this, and the software from Inovalon certainly can help with that. You also mentioned balancing staff, creating a culture of safety, that is really important as well. The proper use of technology, supportive environment. I think what's really important, one of the things you first said, is making sure that the workforce, the nurses feel valued and heard. I mean, that is so important, right? So you don't feel like you're in this alone. I think that's really important.

Laurie Laxton: Absolutely. I've had positions where I've felt that my voice wasn't heard. And those were the jobs that I couldn't wait to get out of and move into a new place where they did value my opinion.

Host: What's that saying? You don't leave companies, you leave bad bosses or bad managers. So, I think there's truth in that. If not feeling heard or valued, chances are potentially the person, your supervisor, is not giving you what you need. And a lot of times that is why people leave.

Laurie Laxton: Again, getting to that root cause of why your staff are getting burned out.

Host: Right. So, Laurie, then what additional strategies can help healthcare organizations retain their nursing workforce in a financially sustainable way. We could have a leadership listening to this podcast saying, you know, "This is going to cost money. just don't have it."

Laurie Laxton: Okay. Well, let's break down some of the things that we've already talked about. So, I kind of mentioned about like the mentorship and residency kind of programs. Well, right there, that's like free. You have a more experienced worker partnered up with one who's new when you're doing your scheduling. Well, they're right there so that your newer staff are going to be learning from the ones who are super experienced and allowing those local trade schools to have their clinicals in there, of course, side by side with an experienced nurse, but you're going to have additional help right there, volunteer help that could help.

Flexible scheduling is another big thing that the younger generation level, any generation. I know, when my kids were into all the sports, it's very important to be able to have flexible scheduling. And there's various ways I've seen it done. You can just put a calendar out there and say, "These are the shifts that need covered." And everybody goes and picks and chooses what they want first come first serve. And then, what's not covered, then you'll sign out. I've seen that done. That can be done with the Inovalon software.

The other thing is, let's say that my daughter, she makes her softball team, makes it to the playoffs on Saturday. I can get on my app. I can say, "Hey Susie, nurse, could you swap shifts with me on Saturday?" And she could go, "Oh, absolutely." And once we get it all hammered out, we send it up to the supervisor and all they have to do is click a button and our shifts are swapped. That kind of flexibility, it goes a long way to keeping people happy and a work life balance, super important.

And when you do that training where I say, some people like to learn with hands on, some like to learn by video, even if the training that you give them is internally created or is some kind of a YouTube video that CMS offers or that's a free one, at least if you provide some kind of a certificate that they have in hand, it means a lot to somebody to be recognized. I have a certificate and you keep it in your file that, "Oh, she's taking training in this or that." It doesn't have to cost any money. Some, there is some really good training out there on the internet that we can find from various organizations that we can just create a certificate for our staff. They love recognition. We all know that. When I went to college, I took a management class and you always have to give positive feedback with the negative. It's just part of good management and recognizing. And however you do that, that your people like, sometimes they don't like too much. You can go over the top and it seems too sappy. But other times, you can put it up on the wall and recognize that, you know, the employee of the month or, hey, in a standup meeting, "Job well done, you really went above and beyond in that really complicated admission last week. And we really appreciate it." I mean, that goes a long way. And then, of course, we talked about all the different kinds of staffing models that are out there, just creating a good culture where everybody is heard.

Host: Yeah, it seems like that is job one. Well, Laurie, this has really been fascinating. Thank you so much for your time today. Before we wrap up, can you share any additional thoughts you might have as we talk about measures to improve nurse retention?

Laurie Laxton: Well, again, I really appreciate you asking me to come on this podcast. It's been fun talking to you as well. I really think that leaders, we talked a lot about managers and leaders and If they can care for the caregivers, we really need to take care of our staff so that we create those environments that give our patients the very best care and outcomes possible. Never ever forget that every patient is someone or someone's loved one, or that someone could be me. I could be a patient at any time, and we have the responsibility to help in any way we can. So, I really thank you for your time today as well.

Host: Well, you're welcome, and great final thoughts. And, Laurie, thank you again. I appreciate it. Thank you.

Laurie Laxton: Oh, thanks, Bill.

Host: Laurie, great talking with you. And once again, that is Laurie Laxton. And please join Inovalon at Empower 2024 this October in Washington, D.C., where you'll have the opportunity to engage with and learn from other health care leaders on how to use data and technology to drive meaningful change at your organization.

You can register now for this exciting event at Inovalon, that's I-N-O-V-A-L-O-N, inovalon.com/empower. 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 from the AONL. Thanks for listening.