Leadership Impact on Nursing Burnout

Episode Overview

Transcript:

Daniel J. Marino:  

Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. Ever since the pandemic, many hospitals have been challenged with nursing support on multiple levels. And not only has it impacted patient care dramatically in some cases, but it certainly has impacted the financial positioning of many of our hospitals and physician medical groups to the point where many hospitals can't even afford to continue to provide the clinical services that they want to perform because it's either not cost effective for them to do so, or they can't get the personnel to deliver the right level of here to talk about it. Today, I am pleased to have a colleague of mine, Nancy Lakier here. Nancy is a nurse and a former administrator. She's had numerous senior level leadership roles at at many prestigious health care organizations across the country. She is owner and founder of Novia Placement Solutions and helps many organizations improve their nursing structure and provides a lot of support to hospitals and health systems. Pleased to have Nancy with us today. Nancy, welcome to the program. 

Nancy Lakier: 

Thank you, Dan. It's nice to be here. 

Daniel J. Marino: 

So, Nancy, maybe we could start with talking a little bit about what you are seeing culture challenges or changes that have occurred over time. 

Nancy Lakier: 

Well, I think as you said we've been here for quite a few years and we've had nursing shortages in the past. I think that some things that are better this time and some things that are maybe not better this time. The things that are better is that we do have more diversity in our workforce today. We have more racially and gender diverse nursing workforce. We have far more systems to support our nursing practice, which allows us to practice more effectively. We also have many more advanced degrees across nursing, and I think that supports the practice of nursing more effectively than maybe it has in the past. And I think those are all things are very positive as well as the fact that we remain at the top of the public trust in we see that not only in the Gallup poll in 21, but also 19 nurses were at the top of the Commonwealth Fund and Harvard. Those are very, very positives for the nursing profession. 

Daniel J. Marino : 

Well, and I think those are important points because for many patients, myself included, you end up having almost a stronger relationship with your nurse than you do with your physician. Right. Especially if there's a lot of follow up that you have. So yeah, I think to your point, that relationship is critical. 

Nancy Lakier: 

It is, and I think sometimes we're moving so fast that we forget to think about the very positive role and influence we play on a patient's life every day. A the beginning of covid, there were a lot of people applauding the health care worker and we need to remember that positive impact that we play every day on a patient's life. 

Daniel J. Marino: 

So, how have you seen that sort of erode since the pandemic? 

Nancy Lakier: 

I think everybody has gotten busier. The hospitals have become a little bit more isolated people. The general public has gotten more frustrated. It is sad to see that, unfortunately, I think the general public has taken maybe some of their frustration out on the nurses physicians lab. It's not just nurses, but everybody in the health care field. Right. But, you know, nurses tend to be more at that front line or certainly their exposure rate is higher than some of the other caregivers. 

Daniel J. Marino: 

In your opinion though, what role has leadership responded in some of these hospitals, whether it's nursing leadership or, you know, CCC C-suite leadership, do you think they've responded appropriately or is there things that leadership should be doing differently? 

Nancy Lakier: 

Well, clearly I think it depends upon the organization. I mean, I think many leaders are trying hard to respond. Their pressures have gone up. They have been spending enormous amounts of, and so let's also look at the reality. Their revenues have gone down. Their financial pressures have increased. Their expenses have gone way up. They're paying far more for the supplies. They're paying far more for the resources that they're spending. We all know that travel nurses, I mean, we're talking about nurses travel, nursing costs have risen travel nursing costs rose enormously, which meant that not only travel nursing costs went up, but also staff nursing costs went up because 

Daniel J. Marino : 

Oh, absolutely. Right. 

Nancy Lakier : 

We can't bring travel nurses in without raising staff nurses costs. We have many leaders that we hear from that staff nurses and travel nurses are making more than the leaders are making, and they're working far more than 40 hours a week, or 36 hours for 12 hour nurses. And so it's very frustrating to them. So I think, while many leaders are trying to address these extremely complex situations, plus the fact that they have extraordinarily full hospitals, I mean, let's talk about right now, they've got the triple situation of Covid and Flu and R S V so they have full hospitals, plus they're trying to vaccinate people, plus they're trying to deal with all these ther issues. It isn't easy being a leader today.  

Daniel J. Marino : 

Well that is trying 

Nancy Lakier : 

To address it. Yes. But I'm sure there are some organizations addressing it far better than others.  I just think it also is a very, very complex situation.  

Daniel J. Marino: 

I oftentimes, when I think about organizations, and we do a lot of strategy work as you know, and we help organizations advance their strategic initiatives focusing on development of, say, service lines or development of certain business units and that sort of thing. And a big component of that always comes down to leadership development. And I often hear it's important for the administrators to be on a track, to continue to grow and to continue to develop. Of course, there's a lot of reference right now to development of physician leaders because they're leading a lot of these service lines. I don't hear a lot around development of nursing leadership, and I sort of wonder, do you think our nursing leaders of today are as equipped as they could potentially be to manage some of the challenges of today and even to think about how to overcome some of these challenges that undoubtedly we're gonna see tomorrow? 

Nancy Lakier:

Dan, that is such an excellent point. You know, I think that we have eroded that leadership perspective. Yes. And I think that is a huge gap. I believe that strong leadership in nursing is the cornerstone to retain nurses. 

Daniel J. Marino:

Oh, I couldn't agree with you more. And not only to retain nurses, but I think to really think about how to advance some of the nursing services and even even  the overall support in the industry, you know, so for instance, let's talk about the burnout factor. I think nurses, and I've got a few friends of mine that went through covid and really supported patients. And these are very tough individuals. And I'll tell you what they went through in Covid really broke them down. And you can see that as really a contributor of clinical burnout, bringing together leadership to address that clinical burnout in a way where you're able to create some type of wellness or activities or something that enhances the overall wellbeing of nurses at the same time trying to retain our good nurses. To me, that's a leadership role, right? That's a direction leadership needs to take in order to really advance the profession. 

Nancy Lakier:

Absolutely. My biggest concern is reducing leadership, not filling positions that are, I mean, first of all, not providing the training, the coaching and the mentoring, not filling open positions due to the tight financial situations, not replacing those open positions with interims or to ensure that because that's how you're going to ensure that nurses are supported during the time that that position is open. 

Daniel J. Marino:

Wow, that's a good point. 

Nancy Lakier:

They need that leader. Yeah. They need to know that somebody is there supporting them. So to me, the biggest challenge is the lack of funding to support strong nursing leadership. And it's the frontline that really retains the staff nurse, but it's the mid-level that retains the nurse manager, and it's the senior level nurse that ensures that the education, the support, and the nursing processes and infrastructure is there for all of nursing. So all three levels are so critical. And so I think that really replacing those experienced individuals are so critical for you to have the individuals across the organization who have the leadership and the support and the coaching and mentoring that's going to help ensure that you've got the infrastructure necessary for your staff. 

Daniel J. Marino:

If you're just joining us, I'm Daniel Marino, you're listening to Value-Based Care Insights. I'm here today talking with Nancy Lakier, owner, founder, and CEO of Novi Placement Solutions. We're talking about the challenges within the nursing industry and having a great conversation around the support around nursing and nursing leadership. So one question that I have as you're kind of talking through some of these challenges with leadership, do you see a lot of organizations, if a nursing leader resigns, say a nursing director or a particular unit, are they filling those roles? Are they keeping them vacant? Are they trying to cost cutting measure or are they filling it maybe with a staff nurse to give them an opportunity maybe to grow into the role or maybe to do more with less? What, what are you seeing? 

Nancy Lakier:

I think in the past they would fill that role in with an interim. If they had somebody inside, they'd use an inside person if they had, or they'd go outside for an interim placement today, I think what they're trying to do is find somebody who could fill it from the inside, or just asking, for instance, for a manager asking the charge nurses to just fill in for a period of time, right? Asking other directors to just cover another unit, asking other C-suite members if they could just cover that area or having directors cover the C N O role, or share that role until they could find another C N O. So no, I don't think they're replacing that position, you know, a small percentage of the time compared to what they used to. And it is definitely a cost saving method. 

Daniel J. Marino:

But when you think about them, the additional pressures, I mean, that's just contributing to the overall clinical burnout factor, right? Because you're piling more on these staff nurses who are probably already look working long hours, may not be really equipped to do the job. And is sort of just, the way I see it exacerbating the problem. 

Nancy Lakier: 

And according to an article at the University of Michigan, having effective leadership correlates with better patient outcomes. And studies have found that exceptional nursing leaders have that positive impact on patient mortality. So you're affecting patient care, you're affecting nurse retention. And so the cost of that vacancy is probably far greater than the cost of filling that person with either taking somebody else out of staffing elsewhere and filling it internally or hiring externally because there is a high cost. 

Daniel J. Marino:

Yeah. Well, a lot of times folks may not necessarily see that those are sort of the intrinsic costs, right. Big cost nonetheless. I want to talk a little bit about wellness within the nursing profession. I had an opportunity not too long ago to work with an organization and we've created what we've called a workforce wellness program where we've taken into consideration different activities and initiatives to improve the overall wellness of the entire workforce, physicians, nurses, non-clinical staff and support. And it's really gained a lot of momentum and from what we've been able to tell, it's been great towards trying to improve the culture of the organization, but one of the areas that we found was the biggest challenged area was in the clinical setting and really was nurses. I'm sure no surprise to you. What do you see are some of the key things that are important as organizations want to address nursing wellness or put in place some type of initiative to improve the overall wellbeing of their nursing staff? 

Nancy Lakier:

I think one of the things is asking the nurses what do they need? Sometimes we don't listen carefully to what they feel that they need. I think the other thing is, is that sometimes it's a matter of time off, but sometimes it's a matter of the patient workload and just even listening to how they balance the patient load on the unit. We tend to not pay attention to how we're making patient assignments. And so we might make patient assignments by room, and there might be heavy patient assignments in the three room to four rooms that are close together. Sometimes if we're just creative in looking at how we make patient assignments and shift those around, we might be able to better balance the workload on a shift for each of the nurses by being careful. And if we can train our nurse charge nurses on how to make patient assignments on a daily basis, that might help. So we have to really listen to what is causing them stress on a daily basis? What is it that's going to help their work life balance? What's going to help their daily work routine, but also what is it that's going to help them when they're off as well? 

Daniel J. Marino:

How much does performance improvement or operational effectiveness of certain units come into play? I'm thinking like of the, or we've done quite a bit of work of perioperative improvement, surgical services improvements where we've looked at overall efficiencies and patient throughput of the, or how much does that come into play in improving nursing wellness and wellbeing when you're thinking about it? Or is that just more work that we're just piling on to the nursing staff? 

Nancy Lakier:

I think it's huge. I think there's two things there. Dan. First, let the nurse work to the top of their license, take away the things that you really don't need that RN to do. But second , to your point, how much work is a nurse doing that is repetitive because someone isn't doing their job. When we do observation on a unit, I cannot tell you how many times a nurse is calling the pharmacy again, how many times they're looking for a supply that's not on the cart, how many times they're going down a hallway to pick up linen because it wasn't where it should have been. You know, there's just so many additional steps and calls and efforts that if things were running smoothly, they wouldn't have to do. That is a huge frustrater to nursing. And then we add the computer system on top of it. And so you add those frustrating elements on top of an already complex work component for them, and that really is what tips them over the edge. And so I think that you've hit on something that if you can smooth their operations and make sure they're working at the top of their license and that you're eliminating unnecessary work, what is it that they do not need to be doing today because your operations are running smoothly or somebody else is doing that work that you don't need the nurse to do? That is critical. 

Daniel J. Marino:

Oh, I'm happy to hear you say that, certainly music to my ears. When we look at organizations and, we focus on some of the operational opportunities or efficiencies that are there, eliminating some of those unnecessary tasks or let's say relocating those two other into individuals. When we're able to do that, I'll tell you the responses that we get from those that are impacted, particularly nursing because again, I mean, they see it, right? You know, it's like, oh my gosh, this is the holy grail. And oftentimes what I find is those are like easy solutions. It's some low hanging fruit, but to your point, you really do have to listen to the nursing personnel, and you have to give them the resources to make the changes. 

Nancy Lakier:

And it's a simple question. Ask them to log, what did you do today that you didn't need to do? 

Daniel J. Marino:

Mm-hmm. Yeah. 

Nancy Lakier:

And just collect that for a week from a nursing unit. And you would be surprised probably at how much work they did that they really did not need to do. Yeah. And how much time they spent doing it. Now they'll grouse about having to keep one more log, but you then have to do something with it, right? Because don't ask if you're not going to do something. 

Daniel J. Marino:

Well, that's a responsibility of leadership, right? So hospital leadership, you're going to ask, you have to be able to respond to it. Well, Nancy, this has been great, and I know many of our listeners, many of our hospital leaders across the country are struggling with this. If you were give any advice to our listeners or suggestions in terms of how they could respond to their nursing challenges, any thoughts come to mind? 

Nancy Lakier:

Yes, I have a couple. First, hire excellent nursing leaders. And if you need outside help find it and hire it, because while people oftentimes think it's expensive, it's worth it because getting that excellent person is worth their weight in gold. Second, do provide education for your nursing leaders at all levels. And, it is something that we have not done for way too long, and we need  to really start putting in solid nursing leadership programs, both the education as well as ongoing monitoring and coaching. And that's not just in clinical quality of care, but it's finance, it's HR, it's communication,  all across the board, what are those components that are needed. If a position is vacant, put an internal or an external interim in the position. Don't leave it vacant. Get somebody in there so that you can ensure that your staff is supported and that you know that there is somebody there holding on and making sure that your patients are taken care of, your productivity is maintained, but most of all, that your staff is supported, it's going to save you money in the long term. 

Nancy Lakier:

And finally, if you want quality of care and you want to retain your staff, spend money on nursing leadership and have finance and senior leadership truly, listen, I don't know that we have taught nursing leaders how to articulate correctly what they need always to senior leadership. Sometimes the language they use isn't in finance, or it's not in C F O / C E O speak. Right? But please listen, because they're articulating what they need , so please listen and try to understand what they're asking for. 

Daniel J. Marino:

Yeah. I think you're spot on. I think you know, the three things, listening, supporting your nursing staff and investing in nurses, those are, in my mind the three key things that are going to be critical towards really advancing the support of all of our nursing, of our nursing personnel and, and hopefully even advancing a lot of the activities and, and the care delivery models that we're seeing within our hospitals and our medical groups. Well, Nancy, this has been great. I can't thank you enough for coming on and talking about this. Just a wealth of great information. If any of our listeners want to reach out to you or if they have any questions, how would they get ahold of you? 

Nancy Lakier:

Please feel free to email me at N Lakier. That's n as in Nancy, L a K I E R, @noviasolutions.com, or my cell phone number is (858) 243-1918. You can give me a call. Our website is Novia Solutions, we're on the internet, so you can go to our website as well and find us there. We'd love to hear from 

Daniel J. Marino:

Thanks again for joining us today. Wonderful conversation. Look forward to talking with you again sometime. 

Nancy Lakier:

Thank you very much, Dan. It was a pleasure. 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners