The evolving role of nursing in today’s healthcare organizations, and its inherent challenges.

 

 

Episode Introduction

 

The role of nursing has undergone a transformation in recent years, accelerated by COVID. Physician shortages have had a key impact on this evolution, but burnout is still the reality for many nurses. In this first episode of a two-part discussion, VIE Healthcare Consulting’s founder and CEO Lisa Miller interviewed Jim Cagliostro to discuss the day-to-day demands on the nursing profession, offer strategies to prevent burnout, and discuss the role of nurses in leadership. 

 

Show Topics 

 

• The evolving role of nursing in the US
• CRNAs operate without an on-site anesthesiologist
• Specialized nursing roles lead to better and safer patient care
• Learning the business side of healthcare 
• The current state of the nursing profession
• Understanding the causes of burnout 
• Nursing in leadership: having a seat at the table

 

 

01:55 The evolving role of nursing in the US  

Jim explained that nursing has expanded beyond the traditional helping role. 

‘’… nurses as the frontline healthcare providers, they have grown also to become the backbone of the healthcare system because it's no longer viewed as just a helping role. Nursing has become a more prominent profession that has had a louder voice. Maybe the voice hasn't gotten louder, but maybe it's that more people are listening. I mean, there's so many descriptions we can give for nurses: patient advocates, policy makers, researchers, educators, community partners, caregivers. There are so many different descriptions in terms of what nurses do. So I love being a nurse. And I think when I got into it, I didn't realize just the breadth of what that might include, what it means to be a nurse. But I'm excited to be a part of a profession that really does have an impact in so many different aspects of healthcare in this country.’’

 

 

04:02: CRNAs operate without an on-site anesthesiologist

 

Jim said that due to staffing shortages, the need for nursing practitioners and CRNAs is increasing. 

 

‘’I remember there was a client we were working with, and we were looking just at the topic of CRNAs, certified registered nurse anesthetists. And I know not in New Jersey, but in some other states, CRNAs are legally allowed to operate without an anesthesiologist on site. And simply that's just out of need. You have very rural locations, and you simply don't have enough anesthesiologists to cover every surgery center or whatever the operation might be in a very rural location. And so you have those who are still nurses. Now they've had more training, they've had more experience and they're perfectly capable of handling whatever the situation might be, but nurse practitioners is another example. They might work under the authority of a physician, but the need for nurse practitioners has really increased. And that's even before COVID.’’

 

 

06:47 Specialized nursing roles lead to better and safer patient care

 

Jim said that the passion at the heart of nursing can help hospitals to establish effective policies, in addition to better and safer patient care. 

 

‘’I mentioned specialized roles like the nurse anesthetists and nurse practitioners. Those again are increasing in terms of not just the numbers, but what they're able to do and how they're able to provide better patient care. And that's in partnership with the whole system and partnership with physicians and administrators. I think the value comes in when there's like the hands-on direct patient care that nurses have as their foundation. That's where our training is. That's where our heart is. I believe that lays a wonderful foundation to bring with us into other areas, whether it's leadership, management, helping in terms of policy and creating policy that works because a lot of times I think in our minds... But policies are made by those who... whatever their educational background is, but then when it comes down to the rubber hitting the road, it doesn't necessarily work that way. And so when you have someone with a nursing background and someone with that experience at the bedside, that can really aid in terms of establishing policies that work, that you know are going to work on a day to day. And it's not going to create barriers to care, but it's going to make it possible to provide excellent care and safe care.’’

 

 

10:41 Learning the business side of healthcare

 

Lisa emphasized the benefits that learning the business side of healthcare brings to nursing. 

 

‘’ I thought about it from a resident perspective and nursing, and there's a class on the business side of healthcare. I think it would be valuable because I feel like it's like anything else in life. If you're not exposed to it then, okay, well, you're not exposed to a nursing school. Or for me, I wasn't exposed to a clinical side and had to learn in our experience. So I tremendously value when we come into a hospital, we're working with nurses and clinicians and they explain to us the specifics behind what we're looking at. I'm like, "Oh, well, that makes sense. Okay, well, now I understand why you would use that product versus something else or why that might be more expensive." And so I can really appreciate that frontline experience where we really push to understand that.’’

 

 

14:27 The current state of the nursing profession

 

Jim said after the last two years of COVID, nursing staff are facing burnout.

 

‘’Well, one thing, whenever somebody asks me that question I say, "The current state of nursing is tired." And that's not just how I feel, but you talk with people and you read where people are doing studies on nurses and at various stages in their career, nurses are tired, especially after the last two years, especially in the hospital, but everywhere. They've been through a lot, we've been through a lot in terms of a profession. COVID has also, it's brought attention to the nursing profession. So it's a good thing. There's definitely been... I think respect for the profession has grown over the last two years in terms of what nurses do on a daily basis. And you see some of the sacrifices, some of these long shifts that nurses are taking without a break, without even a break to go to the bathroom. Now, things have settled down, I believe, and things are getting better because the last two years have really opened our eyes. And I think burnout and early retirement is a reality’’. 

 

 

18:46 Understanding the causes of burnout

 

Jim discussed the potential causes of burnout and why increasing pay isn’t a long-term solution. 

 

‘’Sometimes if we get into this job where we're going in and we're not being challenged, but it's still taxing us, it's still physically draining on us, but we're mentally not being challenged or stretched, that can lead to burnout. That's not something that would come to mind normally. But the fact that you mentioned it, and I know I shared with you working for VIE, that was a new challenge for me. It was stretching me, but it definitely got me more engaged in the work. And so I think having opportunities for nurses to get engaged in their work or to look for innovation, that can definitely prevent burnout. But I think initially when people talk about burnout, they'll say, "Well, how can we prevent that? Well, here, let's just pay the nurses better, let's just pay the frontline workers better." And I just say, great, sure we're all in favor of more pay for those who are providing direct care, but I think that only pushes off the inevitable.’’

 

 

20:04 Strategies to prevent burnout 

 

Jim offered several strategies to help prevent nursing burnout, from better nurse to patient ratios to guaranteed breaks. 

 

‘’I'll go through probably a list in my mind here that come to mind in terms of preventing burnout. And please Lisa, feel free to stop me at any of them. But I think policy changes where again, you have nurses in leadership that are helping to create policies, better conditions in the hospital in particular, better nurse to patient ratios, more support staff. So even if you don't have better nurse to patient ratios, maybe you have an extra patient care assistant or maybe you have two or three extra that can just help answer call bells and help with cleaning and trips to the bathroom just to kind of ease the stress on the nursing staff. Better staffing, where you're not constantly running shorthanded if one nurse calls off, but you have provisions for that. Ensuring breaks on longer shifts. I know that's something historically that's been discussed.’’

 

 

21:09 Nursing in leadership: having a seat at the table 

 

Jim recommended that nurses be empowered in leadership roles to improve staff retention. 

 

‘’And then lastly, I know we've touched on this. I'd say having nurses in leadership. I think you hear the phrase, "Having a seat at the table." But not just having a seat at the table, but really listening to nurses and allowing nurses to be in positions of leadership to say, "Hey, this is how we can make a difference. This is how we can create a better condition where we're not losing our nurses." 

 

 

Show Links

 

Connect with Jim Cagliostro on LinkedIn

Connect with Lisa on LinkedIn

Check out VIE Healthcare Consulting

 

You’ll Also Hear:

 

Why the nursing profession is critical to the survival and success of healthcare in the United States. 

 

Bridging the gap in a skills shortage: How staffing shortages and an aging population have transformed traditional nursing. ‘’In the last five to ten years, advanced practice nurses have really been able to fill in the gaps that have arisen, just because of the need of an aging population.’’

 

The growth of formal education in nursing, from Florence Nightingale, to present day. 

 

Training future leaders for healthcare: why a diploma in the patient experience can transform patient care. 

 

Why expanding the nursing skillset can open up the potential for more cost savings. ‘’Whether it's analytics or cost or reimbursement or even negotiation….I think it's important even to have some exposure and pointers or skills you can have in your mind … to be confident maybe to push a little bit more…or ask different questions.‘’

 

The impact of COVID and two types of reaction: while some nurses are leaving, others have discovered their vocation.  

 

The other side of patient satisfaction – expressing gratitude for the nursing profession ‘’..from a patient perspective and their families, we need to just really be so grateful for nurses and need to be reminded that they are really sacrificing their life in a lot of cases, especially in COVID.’’

 

Why nursing needs leadership that listens. ‘’The cost of training a new nurse is so much more expensive, of finding nurses, bringing them in, orienting them, training them, rather than just keeping the great nurses that you already have. ‘’

 

 

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