Today’ post comes to us from Nanne Finis, Chief Nurse Executive at UKG.

A special thank you to Anne-Marie Schenk, DNP, MBA, RN, NE-BC, UKG Chief Nurse Executive Advisory Board member, Nurse Executive and Founder of Lead.2Gether, who contributed her real-world nurse leader perspective to this article.

In my role as the Chief Nurse Executive at UKG, I have the opportunity to talk with and learn from nurse leaders across the U.S. Based on these interactions, here are some insights into the COVID-19 experience from the nursing perspective that healthcare leaders must pay attention to now.

This Pandemic is a Clinical Crisis.

COVID-19 has poured gasoline on the already difficult role of nurse leaders. Nurses and physicians have been the leaders in this fight, and it’s evident that business leaders have had to rely on them to manage the business of healthcare like never before. This expanded responsibility for operational control has led to increased emotional burden and stress on nursing leaders, as they have borne increased responsibility for the success or failure of their organizations and have had to lead those they used to follow. The view of the organization through the eyes of the nurse leader portrays a uniquely different place than a year ago. Essentially, the goal for every nurse leader in 2020 was simply survival. The three most prevalent focus areas of nurse leaders and their organizations are:

1. Focus on Finance

The surgical volume is the bread-and-butter of hospital finances and without this surgical revenue hospitals cannot survive. Labor costs associated with salaries as well as recruitment, retention and training are a major burden to hospitals. This fact, coupled with the loss of hospital revenues and increased non-labor expenses, challenged organizations to manage day-to-day finances without forecast or prediction models---knowing that the future was uncertain.

Nurse leader impact

Nurse leaders have been under constant pressure to keep the volume rolling, despite staffing, process, and often limited supply resources to support the volume. Nursing leaders have had to navigate the fine balance between finance and safety as many nurses have left  to take lucrative assignments elsewhere, leaving already understaffed units even more vulnerable.

2. Focus on Workforce

With the on-again-off-again elective surgical volume, hospitals have had to figure out how to keep staff working when elective surgeries were canceled. Once elective surgeries resumed, nurse leaders had to scramble to find staff to work on a dime. As the aforementioned travel contracts and "life-changing" salaries were offered (out of clear desperation), hospitals across the country began “recirculating” the same resources, leading to enormous salaries while driving down quality. States paid huge sums of money for crisis staff. In retrospect, many continue to wonder if this money might have been better-allocated by providing staff incentives to stay in their home organizations, still costing money, still allowing them to benefit, but not negatively impacting quality.

A February 2021 AONL COVID-19 longitudinal study report highlights many critical changes that have occurred since July 2020. The most critical data point from this study concerns nurse managers: 24% of the manager respondents indicated that they are not or not at all emotionally healthy. Nurse managers also are more likely than Chief Nurse Executives to leave the profession of nursing.

Nurse leader impact

For a nursing leader, staffing is simply their daily work; they begin learning staffing the first day on the job as a staff nurse. During COVID-19, approvals for incentives to increase staffing often came to organizations too slowly. These leaders likely knew what was needed but had little control over solving the problem. They were left powerless, watching the impact on both their staff and their patients. Absences due to exposures and illness crippled many nursing units. Many organizations were reluctant to monitor absences, because they were concerned this would drive staff to come to work ill. Some staff took advantage of absences without consequence, further burdening their peers, while others were simply caught between the desire to fulfill work commitments and their own personal time stresses, including childcare and schooling. Pre-COVID hospitals had attendance policies and procedures to keep absences in check, but those controls were no longer reasonable in this new environment. As the year progressed, maintaining the morale of staff became more and more challenging and further drained the leaders, who themselves needed a cheerleader.

Attention to the issues that impact nurse retention and wellbeing is a challenging but critical priority for leaders today. According to the AONL study mentioned above, managers and employees at all levels are experiencing stress and burnout symptoms in different ways, with those closest to point-of-care, including nurse managers, experiencing the highest levels stress.

3. Focus on Safety

The politics of COVID-19 bled into the workplace. Politicization of masking mandates and quarantine guidelines in hospitals often created hostility between non-clinicians and the clinical staff mandated to follow CDC guidelines. Process changes associated with COVID-19 (both for prevention of transmission and supply chain shortages) had to be designed and executed and the impact of staffing on patient care had to be measured in new ways.  Quality nursing care takes time and requires the application of consistent evidence-based practices. COVID-19 created significantly worse staffing and the increase of contract staff often negatively impacted compliance with care “bundles” and practice guidelines.

Nurse leader impact

Nurse leaders found themselves emotionally drained as they often had to defend the science and the regulatory requirements to their non-clinician peers. For the non-clinical leaders, it was just “opinion”. For the nurse leaders, their license, profession and job called them to drive safe care. This led to exhausting daily review and redesign of processes. Nurse leaders were responsible for creating new processes and executing on successful change. Errors most often are born from process errors, rather than people errors. Burnout related to negotiating the new processes with stakeholders and maintaining responsibility for any errors associated with the new process created additional burden to the leaders’ emotional stability. Nurse leaders everywhere found themselves with a deep desire and professional commitment to deliver high-quality care to every patient in the face of limited resources created a constant state of distress.

A New Playbook is Needed

The work, the workplace, and the workforce have all dramatically changed in the last year and the nursing playbook must be completely rewritten and re-tested. Public health officials are still warning caution but also beginning to see reasons for hope as millions of people around the world are being vaccinated. We have depended on our nurse leaders for guidance during this time and we will continue to depend on their leadership for the future. We find ourselves at a daunting place, but one that may also be a time of innovation and change that will be professionally rewarding. 

There is emerging science and technology that can help to predict both workload and workplace stress that can hopefully be used to better plan for future pandemics where we can better support our nurse leaders.

Key resources used:

• National Academy of Medicine and its Action Collaborative on Clinician Well-Being and Resilience
• American Nurses Association (ANA) and its well-being initiative Healthy Nurse Healthy Nation and the Strength through Resiliency Committee
• Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare at Ohio State’s College of Nursing, which partnered with the Health Policy Institute of Ohio to craft an evidence-based policy brief for Improving Clinician Wellbeing and Patient Care and Safety
• U.S. Senate Bill 4349 (Dr. Lorna Breen Healthcare Provider Protection Act), a bipartisan bill introduced in July which would establish a national clinician mental health and wellbeing awareness campaign through the CDC; authorize grants for training health professionals on reducing and preventing suicide, burnout, mental health conditions and substance use disorders; launch comprehensive studies on healthcare professional mental and behavioral health and burnout
• American Association of Colleges of Nursing, which just passed a resolution calling for academic nurse leaders to promote practices to enhance optimal well-being, resilience and suicide prevention in schools of nursing across the U.S.
• AONL COVID-19 Longitudinal Study Report:  Nurse Leaders’ Top Challenges and Areas for Needed Support, July 2020 to February 2021: https://www.aonl.org/resources/nursing-leadership-covid-19-survey
• https://www.nursingworld.org/practice-policy/work-environment/health-safety/disaster-preparedness/coronavirus/what-you-need-to-know/year-one-covid-19-impact-assessment-survey/
• Clinician Burnout is only getting worse.  Here’s how to Tackle the Problem
• Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic (Ritin Fernandez, Heidi Lord, Elizabeth Halcomb, Lorna Moxham, Rebekkah Middleton, Ibrahim Alananzeh, Laura Ellwood Int J Nurs Stud. 2020 Nov; 111: 103637. Published online 2020 May 8. doi: 10.1016/j.ijnurstu.2020.103637 PMCID: PMC7206441)

Today’s post comes to us from Workforce Institute board member and Chief Nurse Executive at UKG, Nanne Finis.

As a nurse currently working in a corporate position, I often take the opportunity to think about my healthcare colleagues and about the state of the healthcare industry at large. As we embark upon what is sure to be a challenging winter with COVID-19, some of the questions I find myself asking are:

• What has happened to the most impressive healthcare industry in the world as we now experience significant organization closures, safety issues, chaotic day-to-day COVID-19 surge scenarios that come in waves, and weary leaders?

• What long term impact will this pandemic have on my healthcare colleagues: nurses, physicians, pharmacists, physical therapists, psychologists, respiratory therapists and others that work to the best of their capability day in and day out caring for others and risking their own safety?

• What will happen to technology adoption and innovation as we move out of crisis-mode? What are the most important strategic considerations?  

• How will our workforce welcome newcomers who won’t have participated in this trial-by-fire that our healthcare teams have just been through together?

I have no doubt whatsoever that we will survive as an industry and dramatic improvements and innovation will result. I am a firm believer that beyond any crisis there is deep learning followed by creativity and energizing change.

Some of the incredibly positive changes or shifts that I have seen include:

• Our public health experts and colleagues have taken center stage as never before and for the first time are really being appreciated for their tireless work to protect us. They will remain in the spotlight for the foreseeable future as they put in place a national immunization strategy.
• The public is more informed about infection prevention strategies and knowledge of the science of immunity and viral spread than ever before. This will hopefully keep us healthier as a population even as we move beyond COVID-19.
• Consumers overall are more informed, have growing expectations as a result and are more engaged in their own health status.
• The multiple surges of hospitalizations and acceleration of COVID-19 incidences has caused our healthcare organizations to pressure-test their own internal operating policies and procedures as they work tirelessly to maintain safe, high-quality operations in all care settings. This will improve healthcare forever.
• The use of social media and other forms of communication to enable telehealth has opened up our world to connect in real-time with others with no attention paid to geography. This will have a long-term and I think very positive impact on healthcare.
• Telecommuting is now a normal way of work for many people and this change has lifted geographical borders to the access of talent.
• The talent of teams has been obviated as healthcare workers describe their lives in their care settings as too difficult to do alone. Care providers have flown from one coast to the other to support their colleagues and care for their patient populations together, and local communities have come together to support those in need.
• There is a greater dependency on each other—each of us has been challenged to maintain relationships in new and different ways, fighting isolation as the winter ensues and understanding the impact that socialization can have on each other’s personal health status. 

As a nurse, I am deeply engaged in watching this evolutionary time in our healthcare system and in my own personal life. While we grieve during this period of worldwide devastation, and feel the pain in our local communities, we are constantly reminded of the richness of our connections and relationships, the importance of health and wellness, and the bright future of change and innovation that now has a stronger foothold in our world. 

Happy Holidays!

Note: The American Organization for Nursing Leadership has a wonderful compendium of leadership resources that was helpful to me in drafting this article and is a terrific resource for anyone managing in healthcare today.

In addition, this interview in McKinsey Quarterly with Admiral John Richardson, a retired four-star admiral and former chief of naval operations, is also a wealth of information and gave me much to think about.

 The following post is submitted by our board member Nanne Finis, Chief Nursing Officer at Kronos. Here she discusses the critical importance of the nurse informaticists who translate the needs of clinicians for the analytics systems that empower them.

The History of the Specialty 

“Nursing informatics competencies, which include the ability to design, structure, and represent data as information, are essential in today’s healthcare environment. The International Year of the Nurse is the perfect time to acknowledge and thank nurse informaticists for the important role that they play in improving health outcomes through data, information, knowledge, and wisdom.” â€“ JOYCE SENSMEIER, MS, RN-BC, CPHIMS, FHIMSS, FAAN Senior Advisor, Informatics, HIMSS  

Two hundred years ago, Florence Nightingale established nursing practice rigor as she applied data and critical thinking translation into knowledge. She represents the early start to the nursing informatics specialty. Today, we recognize this specialty of nurses. They are true heroes who often are behind the scenes: patient-focused and translating the needs of the clinicians while leveraging the power of technology to its fullest. Thank you, nurse informaticists, for all that you do!   

The Unique Competencies of These Experts 

At a time when the use and expansion of technology is constant, having the expertise to harness that technology to better inform clinical practices, streamline inefficient documentation practices, and facilitate the information needed to deliver seamless care continuity is a highly valued capability.  

That’s the role of a nurse informaticist: These registered nurses are trained to re-engineer clinical workflow and to facilitate change management. Leveraging their clinical background, nurse informaticists serve as a translator between clinicians and those who design and develop clinical technologies. They not only apply nursing science to technological processes, but also have the skills, knowledge, and ability to recommend best approaches to achieve better patient outcomes across care settings.  

This specialty â€“ about 20,000 strong and growing â€“ working across clinical specialties, settings, industry, academia, and practice to support the 4 million registered nurses practicing in the U.S. today. Represented by the Alliance for Nurse Informatics*, together this group forms a unifying voice and plays a critical role in advancing nursing informatics leadership, practice, education, policy, and research.  

The Future of Nurse Informaticists 

I’m confident that the demand for nursing informatics will not subside any time soon. Nurse informaticists are on the forefront of informing others about how emerging technologies, such as artificial intelligence and wearables, are and will continue to impact the nursing profession. As healthcare costs and redesign efforts undoubtably accelerate in the future, demand for their expertise will surge.   

A consensus study from the National Academy of Medicine has convened an expert committee to engage in visioning the nursing profession into 2030 and to detail a plan for the profession of nursing to help the U.S. create a culture of health for the 21^st century. There will undoubtably be a deep examination of the current state of the nursing profession, and with particular attention on the use of technology and science. Nurse informaticists have been critical to the design of technology to support the safe well-being of our population and patients. The next decade will continue to demand innovations and rapid deployment as the health of the population is essential for the economic and social well-being of all.   

Join the Kronos family in thanking nurses everywhere by using the hashtag  #ThankANurse for International Nurses Week (May 6-12), and check out our webpage and video message here!  
 

A special thank you to Kathy Owen MS, RN-BC, Nurse Informaticist and Lead Workforce Solutions Consultant at Kronos Incorporated for her guidance on this content. 

* The Alliance for Nurse Informatics is cosponsored by the American Medical Informatics Association (AMIA) and the Healthcare Information and Management Systems Society (HIMSS) 

Today's post comes to us from Workforce Institute board member and Chief Nurse Executive at Kronos, Nanne Finis. Nanne has spent forty years in the healthcare industry focused on the profession of nursing and patient care delivery. Here she reflects on the bravery, knowledge and skills of nurses on the front line of the Covid-19 pandemic.

Nurses are unique individuals; I know because I am one.  As I reflect on the global condition and consider the millions of nurses involved in the care of others I am struck by the bravery, knowledge, skills, and ability of my colleagues that care directly for patients and residents daily.

The curriculum for nursing offers a framework of theory, science, human psychology, and practical skills. This training has provided me an abundance of lifetime skills. My clinical background offered me the opportunity to care for emergency department patients, medical and surgical patients, and to lead many clinical departments including one unique intensive care unit – a Surgical ICU where the most complex trauma and surgical patients were cared for. When I consider over a decade of my career in this ICU and in the Emergency Department, I am awed by the learning that I garnered during those years.

During crises or emergent situations, I learned that my decision-making process must remain factually based and my emotional responses had to be suppressed. There obviously is a time and place for human emotion but in a period of crisis the confidence and directed action of the nurse is critical for all. Nurses are taught to act on the rigorous process and critical thinking skills that becomes second nature in practice. 

I learned a great deal from the clinical experts in that ICU. Those memories have formed my ideal image of nursing and the passion and excellence of care delivery. It is a memory that I remember endearingly. Patients arriving to the ICU would come directly from the operating room following hours of life saving surgeries and often with more IV lines than an individual nurse could count. These nurses always started their review of the patient from head to toe—a rigorous, consistent and detailed process of assessment and interpretation. All IV lines were traced to the origin of the line and labeled one by one starting with the most toxic of the intravenous drips. The sheets of the beds that these patients lay on were taut, without one wrinkle. Patients were turned routinely, provided back rubs and foot massages when appropriate, and they quickly became part of that unit’s family. These nurses modeled expert clinical and emotional care for every patient in their midst and expected the same from the many excellent physicians who serviced patient there.

It is amazing how the rigor of professional training when witnessed over and over becomes inbred in your ethos and spirit. In pictures and news clips of nurses these past several weeks, I notice the faces of the many nurses. They must be frightened for their own lives and families, but their full attention is on the patient before them. The routines of care, decision making, and rigorous assessment take hold and they perform in a caring and sensitive manner.

It is an honor to watch nurses perform. In this year of the nurse, we must honor their work and hold them up as heroes in our midst. Thank you for all you do and thank you to all the wonderful nurses who mentored and taught us the skills that today are impacting the world.

This post was previously featured on the Kronos Industry Insights Blog.

A new Kronos Incorporated survey titled “Employee Engagement in Nursing” finds that 93 percent of U.S.-based registered nurses (RNs) are satisfied in their career choice. Despite this, nurse fatigue is a substantial issue with 98 percent of nurses stating that the work of a nurse is both physically and mentally demanding. Of note, 44 percent say that their managers don’t know how tired they are and 43 percent hide how tired they are from their managers. More than four out of five (83 percent) also say that hospitals today are losing good nurses because corporations and other employers offer a better work/life balance. The survey also finds that gaining more control over their schedules is the top factor that can help nurses alleviate a significant amount of fatigue, with more than half (55 percent) of nurses agreeing to it.

This national survey of 257 RNs who work in a hospital setting was designed to look at the issue of fatigue in nursing, and also what nurses and their hospitals are doing about it. The data shows that nurses, while satisfied with their career choice, are definitely fatigued.

Director of the healthcare practice group at Kronos, Susan Reese, DNP, MBA, RN, CPHIMS, says:

“This survey shows that it’s time to care for the caregivers. It also confirms what we instinctively know – nurses are compassionate, hardworking professionals who love what they do. A workforce that is so inspired by their work is hard to find in other industries and hospitals and health systems need to invest in nurturing and supporting their nurses. A fatigued employee at risk of burnout is not an engaged employee. Combating fatigue can be achieved by giving nurses more control over their work schedules, ensuring they have regular breaks, along with offering adequate rest periods between shifts and access to health and wellness programs. These benefits will ultimately help nurses, patients, and hospitals and health systems.”

Survey Highlights:

• Nurses are exhausted and fatigue has consequences
  • Ninety-eight percent of nurses say that the work of a nurse is both physically and mentally demanding, and 93 percent state that at the end of a typical day they are mentally and/or physically tired. Four out of five nurses say they find it hard to balance mind, body, and spirit.
  • More than four out of five (85 percent) note that their work causes them to be fatigued overall, and this has consequences:
    • Fifty-six percent of nurses overall and 70 percent of night-shift nurses say they have driven home from work drowsy, and 12 percent overall and nearly a quarter (23 percent) of night-shift nurses have pulled their vehicle off the road  to rest;
    • Forty-four percent of nurses worry their patient care will suffer because they are so tired;
    • Thirty-seven percent of nurses say they worry about making a mistake, and 11 percent state they have made a mistake at work because they were so tired; and
    • Twenty-eight percent of nurses have called in sick just to get some rest.
  • Among the top causes of fatigue, nurses identify the following – excessive workloads (60 percent); being unable to take lunch and dinner breaks during a shift (42 percent); not being able to take any breaks during a shift (41 percent); and not being able to get enough sleep between shifts (25 percent). Additionally, 24 percent of nurses say that 12-hour shifts (as opposed to eight-hour shifts) are key for causing fatigue.

• Nurse fatigue can lead to job burnout
  • Though nurses love their work, more than three out of five (63 percent) say their work has caused job burnout and two out of five (41 percent) state they have considered changing hospitals in the past year because they have felt burned out.
  • Hospitals and health systems should be concerned as 90 percent of nurses say they have thought of leaving the hospital they work at to find a different job with better work/life balance and 83 percent state that hospitals are losing good nurses because corporations and other employers offer a better work/life balance.

• Nurses want more control over their schedules
  • When asked who in their organization handles nurse scheduling, 47 percent of nurses say that it is a nurse manager, 35 percent note that they handle it themselves through self-scheduling, and 11 percent say that a central staffing office handles scheduling.
  • Conversely, when asked who they think should handle scheduling in their organization, 43 percent say they think nurses should self schedule, while only nine percent think that a nurse manager should own scheduling. Two percent of nurses say that a central staffing office should be in charge, and 46 percent note that ownership of scheduling should be some combination of the three (self scheduling/nurse manager/central staffing office).
  • While 86 percent of nurses say their scheduling preferences are taken into account when creating their schedules and 55 percent agree they can ask their manager to alter their schedules to reduce fatigue, 49 percent say that it would help reduce fatigue if they could easily swap shifts with another nurse.
  • Sixty percent of nurses say that if they had more say in their shift scheduling they would have a better work/life balance, and 55 percent agree that having more control over their scheduling would help alleviate fatigue.

• Some hospitals are trying to help combat fatigue but not always in the most effective ways
  • While 60 percent of nurses say their hospital offers a wellness program for employees, only 31 percent agree that their employers make sure they take a meal break, and only 14 percent say their employers ensure they leave on time. A full 20 percent say that their employers don’t offer any program to help with fatigue.
  • When asked what their hospitals can do to combat fatigue, the top answer (55 percent) is to offer better schedules. Providing more breaks (47 percent), offering health and wellness programs (41 percent), and managing overtime more effectively (35 percent) are also top-of-mind solutions.

• Despite fatigue, nurses love their work and colleagues
  • Ninety-three percent of nurses say that, when they consider all aspects of their work, they are satisfied with being a nurse and 77 percent note they are energized by their work.
  • Eighty-three percent of nurses have helped another nurse when that person was so tired that they needed a break, and 75 percent of nurses say that if it wasn’t for their team at work they don’t know how they would survive

October 5-11 is Emergency Nurses Week here in the US.   At Kronos, our single largest customer population is in healthcare.  From standalone long term care facilities to the biggest healthcare networks in the world, we are helping healthcare providers help their patients.

In the latest installment in our 1 in One Hundred Million video series celebrating workers, we talk to Vanessa, an ER nurse in Massachusetts.  Like most nurses you meet, her overwhelming focus is on providing care.  Watch, enjoy, and share with a nurse who's made a difference in your life.

You can watch Vanessa's story here:[youtube=://www.youtube.com/watch?v=oRGQ32hbKyI&w=560&h=315]

Prior Posts About Why We Value Nurses:

Kronos Video Tributes to Nurses

Thank You Post to Dad's Nurse, Katy