The role of nursing in healthcare, with a focus on the challenges of burnout.

 

 

Episode Introduction

 

The role of nursing has undergone a transformation in recent years. In this second episode of a two-part discussion, VIE Healthcare Consulting’s founder and CEO Lisa Miller interviewed Jim Cagliostro to explore effective solutions for burnout, the benefits of frontline driven innovation, and encourages all hospital leaders to listen to their nursing teams.

 

 

Show Topics 

 

• Patient care assistance enables nursing staff to focus on their strengths
• Volunteers can enhance the patient experience 
• Cost effective staffing solutions to overcome burnout 
• Healthcare needs leadership that listens – and shows up
• Lessons for the healthcare sector from Undercover Boss
• The concept of shared governance
• When leadership doesn’t listen: an example from a patient’s bedside

 

02:13 Patient care assistance enables nursing staff to focus on their strengths

Jim shared his experience on the benefits of patient care assistance.

 

‘’And so I mentioned that patient care assistance. And by that, for anybody, most people know, these are people that are trained in terms of what's the safe way to help a patient who's had a certain procedure to help them to the bathroom, or to sit them up or get them over to the chair and set them up for a meal. For recognizing, "Okay, there's certain restrictions that this patient has. So I can go get a drink of water for this patient, but that one needs thickener in their liquid." Or when do we need vital signs and daily weights. These are all activities that patient care assistants or nurse assistants, depending on where you're at, they have different names, that they can help with. And then it allows nurses to focus on the things that only the nurses can do.’’

 

 

04:28 Volunteers can enhance the patient experience

Lisa shared a personal experience of her daughter’s stay in hospital.

 

‘‘My daughter was in the hospital, and we were in a children's wing of a hospital. And it's interesting, because I think that anything to do with children, people tend to be more innovative….But this young man that came in, and I would say he was about 17 or 18, and he would just come into the room and talk to me, talk to my daughter, and really just chatt with her. And he is like, "Oh, I'll go get coloring books and I'll color with her." And I'm just like, "Okay, who are you?" I'm like, "This is great." I mean, he was great. I mean, I knew he had a badge and I knew he was there legit, but I'm like, "What's your role? You got to tell me your story. What's going on here?" And he's like, "Oh, I'm going to start medical school and I have a program here at the hospital where I can volunteer." And he wanted to be a pediatric orthopedic surgeon, which is amazing, because he was not even in medical school and he knew what he wanted to be, but of course that made a change.’’

 

 

06:56 Cost effective staffing strategies to overcome burnout 

Jim said improving nurse-to-patient ratios was just one way of better managing resources. 

 

‘Every state should, I don't know if every state does, but states will have a minimum nurse-to-patient ratio. And so if you have this number of patients, then you need this number of nurses. So that's one thing... They have to meet that as a minimum, but they can have better standards in terms of, "Okay, the state says five-to-one or four-to-one on this step down unit. But we, as a hospital, are going to say, 'No, we're going to say three patients to one nurse, because we want to provide better care. And yeah, it's going to cost us more maybe upfront, but in terms of the quality of care, in terms of safety, in terms of preventing falls or infection or things like that, it might end up saving us money in the end if we have a better nurse-to-patient ratio. And then the other thing you touched on was staffing and managing the resources. In this case, managing your personnel, the nurses, in a better way. And a lot of hospitals will have a float pool to say, "Okay, we know of this 500-bed hospital, there's going to be 10 to 15 nurses that call off each night." For whatever reason, sickness or whatever happens. So now we have a float pool that is coming in every night. And this float pool, instead of staffing it with eight nurses per night, we're going to say, "Let's have 12 to 15 nurses coming in, ready to fill those gaps."

 

 

11:01 Healthcare needs leadership that listens – and shows up

Jim believed it is beneficial for hospital leaders to engage directly with nursing teams during their shifts.

 

‘’When it comes to leadership that listens, I would say, in my mind, probably the key there is leadership that's initiating the conversation. Because a lot of times the busyness of what's going on on the floor, and sometimes you don't even know where to start in terms of, "Well, how do I reach out to ..." Usually a manager. Sure, if there's a manager of a unit, you'll see them. But sometimes on night shift, I worked night shift much of my career, you don't necessarily see your manager, except in passing when they're running to start the day. So I think it's good, whether it's from the unit manager or from the director of your department, or from even higher up, the C-suite, to see that they're initiating the conversation. And there may be even walking onto the floor at change of shift, maybe that's a busy time to do it. But touching the day shift and the night shift and saying, "Hey, we are here to listen. What concerns do you have?"

 

 

12:43 Lessons for the healthcare sector from Undercover Boss

Lisa outlined the concept of Undercover Boss and its potential benefits for healthcare.

 

‘’I've watched several episodes, but Undercover Boss. It just gets me thinking every single time, it would be very difficult for a hospital CEO or someone in the C-suite to do an undercover, but they probably could. And it's always the same story. It's someone's owner, leader, and is going undercover in their own organization, completely disguised. And they've got to do jobs that they know nothing about and they have to learn and they're clumsy through it. Meanwhile, it's their own business or the business that they run. And they meet people and they hear stories on the front lines where they see things that have to be changed…. I've just given everyone the episode, it's just a matter of what do they see differently. What stories do they hear and how they're touched by it. But it's so fascinating to me that every organization has these stories, has these people. And why aren't we just doing it regularly, just making it part of your routine, your weekly routine. "I'm going to go to this floor and have those conversations." So you just got me thinking about Undercover Boss, binge watching.’’

 

 

15:08 The concept of shared governance

Jim said shared governance offers nurses a voice, but communication is essential to avoid frustration. 

 

‘’There's something, a concept, and there might be different names for it. But one place that we saw had something called shared governance. And so that's something where they bring in nurses from various areas of the hospital to come together. And this one particular hospital they met monthly. And one thing was the pre-op checklist was something that they were working on, "How can we make this better? How can we make it more efficient? How can we really make it so it's the best for the patient and the best for the staff?...And they worked on this for months and it's something that ... Changing in the language, adding things here, taking things away there. And unfortunately, the concept of shared governance was great because it was in place there, and they said, "Okay, we want the nurses to have a voice." But then the decisions that were made ended up going up the chain of command and back down, and ultimately no change was made….. ‘’

There needs to be something, even the conversation from the higher ups to say, "Hey. Well, this is why we didn't go with those changes." But that can be very frustrating for staff that has poured in their time and their energy in terms of saying, "Okay, we have a voice, we have this concept of shared governance. Well, is it really making a difference?" And I think the responsibility ultimately does fall on leadership to say, "Okay, we want to listen. And we want to make changes based off what the front line is telling us." 

 

 

17:47 When leadership doesn’t listen: an example from a patient’s bedside

Lisa shared a second experience from her daughter’s stay in hospital. 

 

‘’My daughter was in the hospital and I had to take her into the bathroom. Now this was a new wing, so I had to have her IV pole in. I couldn't get her IV pole in, nurse said, "They didn't ask us any of this. They didn't come through here."  There was something particular about the IV pole and we just couldn't get it in. And I'm like, "Wow, this is brand new." And they were like, "Yeah." The door closed the other way and it was just awkward and like, "Oh, they didn't ask the nurses anything about the rooms." And I'm like, "Wow, that's so fascinating." If architects and engineers are really smart people, yet you don't go to those who are working to say, "How does this flow’’…. But there's so many lessons here in this discussion, and you just wonder why it takes burnout, COVID, frustration, for us to be at this place. And it's unfortunate, because so many of these fixes I think could be really easy. And I don't mean flip the switch on easy, but they're solvable. These are not unsolvable challenges.’’

 

 

Show Links

 

Connect with Jim Cagliostro on LinkedIn

Connect with Lisa on LinkedIn

Check out VIE Healthcare Consulting

 

 

You’ll also hear:

 

How secretaries and volunteers can help to alleviate levels of burnout among nursing staff. ‘’Volunteers can really help lighten that burden and really provide an excellent experience for patients.’’

 

Don’t just match the float pools: Why doubling up is an innovative and cost effective way to reduce the pressure on nurses. 

 

‘’Have you ever seen a CFO walk the floors on a night shift?’’ Why showing up on the hospital night shift and listening to concerns could make a difference to burnout. 

 

Hospital executives need to discover what they can do to help to improve the role of nurses and enhance patient care. 

 

The need to treat every patient like a VIP. ‘’I was caring for someone who ended up being the head of anesthesia in the hospital that I was working, and didn't realize it… but we need to be treating every patient like they're someone extremely important.’’

 

The frustration nurses feel when their suggestions and efforts are unrecognized or discarded. ‘’And you realize, well, do we really have a seat at the table? Is anybody really listening?’’

 

Why frontline-driven innovation offers huge benefits for every health system. ‘’No one knows best than those in the front lines. I'm a big believer in frontline-driven innovation. And I think that needs to be tapped and harnessed a lot more.’’

 

 

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