Hospitals are grappling with a less experienced nursing workforce. Here's how one health system is closing the knowledge gap
Jefferson Health is one of the largest hospital networks in the United States, employing 10,000 nurses.
And like all healthcare providers, it’s grappling with a changing workforce — one that is less experienced, demands more flexibility and is seeing a brain drain as nurses leave the profession.?
Bringing all the pieces together is Kate FitzPatrick,DNP, RN, ACNP, NEA-BC, FAAN , the chief nursing officer for the Philadelphia-based health system. She’s on the forefront of a number of initiatives to boost recruitment, increase retention and prevent frontline managers from burning out.
I’ll let her tell you about them. But here are some discussion points I’ll leave with you:
Read my conversation with Fitzpatrick below and let me know your thoughts in the comments.
The following transcript has been edited for length and clarity.
LinkedIn News: Where is your focus these days when it comes to staffing?
FitzPatrick: As I look across Jefferson Health, of our 10,000 nurses, about 55% have less than five years experience. And that's in the context of a clinical environment where there's much more complexity. Patient acuity is higher.?
The other key piece that I think is on everybody's mind is the increasing complexity around safety in the work environment. Like other health systems, we have seen patients who have escalations in mental health conditions. We've seen increasing substance use disorder. All of that can lead to an environment where our healthcare workers are being exposed to violence. That's been a big focus for us .
LinkedIn News: How are you thinking about recruitment these days?
FitzPatrick: We created a Capstone program a couple years ago where we completely revised the spring semester of senior year experience for Jefferson College of Nursing students. They get a three-week immersion as part of their final semester in one of our hospitals, ideally on a type of unit they want to work in. We do that with the intention of getting them an offer with Jefferson before they graduate. And then we have a much more streamlined approach to their onboarding because they've had this experience.
We have three years of experience now and our retention rate is over 90% — even 95% in many cases — for that specific group of nurses in the first year. It’s incredible.
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LinkedIn News: How are you getting new nurses up to speed?
FitzPatrick: We've adopted the Vizient, Inc nurse residency program. It's a year-long, very structured program. It includes some of the typical components of refining clinical skills. But the real rich part of it is that there's this “tales from the bedside” component that brings together peer groups of new-to-practice nurses with facilitators to help them debrief and talk about some of the things they're seeing, helping them understand that they’re not alone. The other thing we've done is introduce virtual nursing, and part of that is to address what we know is the ongoing gap we're going to have in the pipeline of registered nurses. We're exploring how virtual nurses can be mentors and provide in-the-moment support to a new-to-practice nurse, even though this virtual nurse is not in person with them at the elbow.
LinkedIn News: As experienced nurses leave the workforce, how are you addressing that knowledge gap?
FitzPatrick: We’ve been looking at a very small test-of-concept around an emeritus nurse program we launched. One area we're interested to look at is how these experienced nurses who've retired can come back to help support new-to-practice nurses and new nurse leaders. I've got two retired chief nurses who are on our emeritus team now and we're actively thinking about how we're going to deploy them.
LinkedIn News: How are you thinking about generative AI?
FitzPatrick: From my perspective, anything that can help the workload burden for a nurse at the bedside is going to be critically important for us to explore, especially at a time when we have workforce challenges and we know that we're going to have to reimagine the care delivery team, particularly in med-surg.
LinkedIn News: What’s happening in med-surg?
FitzPatrick: A frontline nurse manager in New Jersey said to me that he was really struggling as a med-surg nurse manager. With the amount of turnover, he feels like he spends a lot of his time just being in recruitment mode. A formal work team that has representatives from across the system — some that are nurses, some outside of nursing — is now looking at rebranding med-surg nursing: How do we make it a destination of choice for nurses? How do we look at the support systems? How do we make sure we have a unit-based educator or education resource? Is this an area where we think differently about pay structures for med-surg nurses?
LinkedIn News: How are you supporting your nurse managers?
FitzPatrick: Jefferson has made a fair investment in developing our new-to-practice nurse managers. For those with less than 18 months experience, we offer a nurse leader development program. It's based on the American Organization for Nursing Leadership competencies. We've had three cohorts graduate from that, and we're about to have our fourth start, and we've been refining it based on their feedback as we go. Part of what's been really wonderful is the new peer connections they make because these are leaders in different types of units, in different parts of the system.
When they graduate from that, they join what I call the Chief Nurse Exec Advisory group. Every month, I have a dialogue with them and hear about what's important to them. We usually get 40 or so who hop on.
Lastly, we just merged with Lehigh Valley Health Network . I do a lot of work with the Dean of the College of Nursing, and we are launching two cohorts in January: one for nurses, who want to become masters prepared, and a second group who are already masters prepared and want to get their doctorates in executive leadership. We are fully funding 10 nurses from Jefferson Health and 10 from Lehigh Valley in each of those cohorts.
LinkedIn News: What’s top of mind for your nurse managers?
FitzPatrick? One of the things that they've said loud and clear is how difficult it is to lead in a time when there's so many novice nurses. Another thing that was a big dissatisfier for them was all the work they do around supply chain: having to order supplies, manage a store room, etc.
While there are a lot of challenges right now in healthcare, I think what I've been proud about with the team at Jefferson is the innovative spirit of listening to the voices of those frontline nurse leaders to help us envision how we navigate the challenges in front of us and how do we do that while we make sure that they're paying attention to their own holistic health and wellbeing.
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1 周This is something to celebrate: "team at Jefferson is the innovative spirit of listening to the voices of those frontline nurse leaders to help us envision how we navigate the challenges in front of us and how do we do that while we make sure that they're paying attention to their own holistic health and wellbeing"
Registered Nurse, BSN
1 周The hospitals should assign new nurses to kind, knowledgeable preceptors. Education should be broad and also unit specific. The most prevalent issues I’m observed began after training, when fledging nurses are on their own. For at least the first six months the new nurses should work near supportive staff. Questions should be encouraged and new nurses or any nurse should be expected to perform tasks that they have not been trained or adequately trained to perform. Hospitals chronically short staff. CNAs are spread thin as well. A monthly meeting with peers should be mandatory and allow nurses to talk about what they’ve encountered and feelings. Providers need to be respectful to nurses and the new nurse needs to go to charge or another nurse if a provider has been disrespectful. Older nurses have zero tolerance for belittling providers. Many new nurses quit, bout much of the blame is due to short staffing and rude family members are belittling and intimidating. Hospitals have finally moved forward to at least decrease these incidents. In the end, nursing takes perseverance and resilience. I always make a point to let new nurses know I’m available and welcoming.
Director| Executive & Team Coach |Registered Nurse| Thought leader
2 周We need to support Nurse managers with the leadership skills required to transition from being a clinical nurse into a management role. For many new nurse managers, this is a hugely stressful transition that, as a profession, we are neglecting to support and invest in growing the nurse leaders of the future. At the same time we also need innovative strategies that look to retain experienced nurse leaders by providing flexibility in working hours that support a transition to retirement approach and a supernumerary status to support and foster leadership. We also need to utilise exit interviews to understand why nurses are leaving and implement measures to address this feedback. A once-size-fits-all approach to nurse leadership must be radically overhauled to prepare new nurse leaders and equip them with the knowledge and skills required for the role.
Nursing leader with extensive experience in building successful, supportive teams and improving culture. Experience in improving quality metrics by setting standards, communicating opportunities and celebrating success.
2 周Nurse Managers need to feel supported and heard by senior leadership. Consistent evaluation of their scope of work and the number of direct reports they manage. I agree with scheduling flexibility and the support to develop leadership skills and be supported to try new leadership roles and paths.