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Newsday - Traveling Nurses: A Problem or Solution in Healthcare and Health Systems?
Episode 11323rd May 2022 • This Week Health: News • This Week in Health IT - Hello@ThisWeekinHealthIT.com
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Today on This Week Health.

About 90% of nurses that were surveyed are considering leaving the profession. So think of all that knowledge and care leaving the profession and that, that is extraordinary. So I think it's worth a conversation to have within institutions as well as in those supportive organizations.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

All right. It is news day. And today we are joined by Christine Parent with MEDITECH and Christine. Welcome to the show. MEDITECH is a global company, and sometimes you're called on to do global kind of work. And you did A call with a country. what time, like 2:00 AM in the morning, two to four at some ridiculous hours.

tan. So in Boston time it was:

So, yeah, so I, I I'm hopeful that I'm, I'm looking at alert on the the screen here, but it was actually a great a great panel, great keynote and a lot of energy going on in that part of the world. And they're they're actually really transitioning to the EHR. Medical record, the full blown digital medical record right now.

So it's been wonderful. hearing from the folks across the globe that are really supporting and helping and providing some good.

It was really interesting to me. Whenever we talk about the EHR market people know who the big three or four are in the U S but globally, the numbers sort of change when you start factoring in global and The and the market and there's some, the market's very different and there's some other players in, in the markets as you go into some of these other countries, it's really, it's kind of, it's not as I mean, we're down to like three or four major players in the U S but that's not the case globally.

There's a lot of players globally. It's pretty interesting. you gave me a couple of stories and I really like them. So let's, let's start with the nurse bill of rights. I'll give a little, Background here. So this comes from healthcare. It news American nurses association released an updated nurse bill of rights during the national nurses week aiming at affirming the role of nurses play in the healthcare profession, embed increasingly complex care landscape that says a bunch of other things, which supporting our nurses and those kinds of things.

And there's a lot to talk about here. But I wanted to give a couple of, so the rights are outlined as follows full authority for nurses to practice at the top of their license, credentials and professional standards without barriers and in a manner that fulfills their obligations to society, patients, and community.

Number two, continuous access to training education and professional development. I hope that's happening. Number three, work in practice in environments that ensure respect inclusivity diversity. And during the pandemic, some of that stuff sort of went by the wayside. They, they face some pretty hostile environments and it was very difficult work environment.

Number four, Just care settings that facilitate ethical nursing practices, standards and care in accordance with the code of ethics number five safe work environments that prioritize and protect nurses. Which again, that's great. That's stated. I would assume that would be one of those things.

I would assume six, a freedom for nurses to advocate for their patients and raise legitimate concerns, a seven competitive compensation, consistent with their clinical knowledge experience and so forth. Number eight collective and individual rights for nurses to negotiate terms with. And we're conditioned. There's a lot going on in nursing. Isn't there right now.

There is and I tend to harp on the nursing component because they are still our largest healthcare worker out there. And you mentioned some of those. Bill of Rights. And, obviously we all can understand what this really means is is this isn't law. This is not a legal document, but it is a kind of a way for us to guide the conversation development of policies and practices within the institution, as well as different areas that different supportive organizations can, work and get involved.

You mentioned one that really hits close to home is the safe work environment inter to protect nurses. And I recently had a podcast with Kelsey Reed. Who's out of Phoebe Putney in Georgia, and she's a member of the Georgia state Senate. That's in they're doing a study or committee on violence against healthcare workers, and there's still a lot of work to be done.

She actually cites that there's about approximately 80% of healthcare workers. That have been insulted at least once over their careers, which that's a very high number, 80%, and that she, she did mention that the stress over the past two years, especially with the pandemic has almost exacerbated the problem.

So it is real. You would think that the Maslow's hierarchy of needs where security is the number two of the pillars of that triangle nurses need our support more than ever before. And just one thing I want to mention that we can open it up. Cause I'd love to get your thoughts on this as well is there's there's a lot of, I mean, all of this makes logical.

I don't think that there's anything on here that anyone can point to say, well that's crazy to be in their bill of rights, but you still have post pandemic. And as we're entering in a recent study that says the nurse burnout has never been higher than before. And we have about 90% of nurses that were surveyed that are considering leaving the profession.

So think of all that knowledge and care leaving the profession and that, that is extraordinary. So I'm glad that they came out with this. It was the right timing around nurses week. And I think it's, it's worth a conversation to have within institutions as well as it's worth the conversation to have in those supportive organizations.

Just prior to this, I took a look at the stock market and I shouldn't have, because it puts me in a different mood when I look at that. But one of the articles was on restaurant workers. Now I don't want to equate the two, but some of the statistics.

And there were pretty interesting in terms of well, first of all, the restaurant workers were all furloughed early on in the pandemic because people couldn't go to restaurants and then they tried to bring them back. Well, a significant number are not going back to working in restaurants.

That's one of the findings. And then the second is, as they are coming back into the workforce, they're looking for other things. They don't want to go back into restaurants. And part of the things that they cited, where people are more demanding, people are more rude. People are more all those things.

And the only correlation I'll make is it's a service industry. You have to deal with people and those kinds of things. we described this environment and it's no wonder that we have a nurse shortage today. I mean, there's, there's certain amount of it. Pure demographics.

It was happening. We knew this has been going on for the better part of a decade. We knew that this was, we were heading in this direction, but I think the pandemic, the work environment, the way they were treated and whatnot created a, I don't know, it's just a confluence of events. And now it's, it is a collective top of mind. Like it is driving a wage inflation. We have traveling nurse challenge, not challenges. We have traveling nurses filling the roles that need to be filled, but they're getting paid significantly higher than the, the local. And it only exacerbates the problem. Right? So then the local nurses are looking at it going, wait a minute, what's going on? I'm going to become a traveling nurse. Cause this is, this is silly and it's kind of.

Dynamic. Yeah, no, it's, it's interesting. And I was just at the HIMSS new England event. And I was talking to a couple of nurses that were there and that's happening within their institution to fill those gaps. They're bringing in some of these traveling nurses in there is you can kind of see where there could be. The tension between the two as, as they're trying to fill in and do care, but their costs have to be sky rocking as part of this. And I know that at a time when we're not back to normal and everything's not back to normal, it has to be hitting their bottom dollar.

Bringing in this, this. Expenses. So one of the things I've been doing recently, bill, and you can probably attribute to this is I've been looking at when I look at a problem or, or a topic I've been looking at what the challenges are, but then also what are some of the solution areas? So when I started to look at this, one of the things I do want to point out too, is there are some some potential areas for solution for the nurses. I know that they have a burden of documentation. So how can we start to use some of the technology, some of the mobile devices, some of the more even voice, voice to text type of documentation components, streamlining of documentation, and really starting to harness the use of technology to really streamline and create those efficiencies from a documentation perspective.

And then the second thing that goes to, and I think you mentioned this as one of the bill of rights is we talked a little bit about the ability to recognize them as. As experts in their field and leaders within the healthcare environment and really bringing them to the table. So how do we start to employ that nursing community into leadership within our institutions?

And I I've gone into health systems before and they're very proud to say our CEO is an, is a nurse. It's a nurse led organization. So how do you start to build. That credential build up that culture so that you're including the nurses. I think I've said it before on one of our past podcasts, the nurses to me are some of the best problem solvers.

And we've seen it in hackathons where they brought in nurses to help solve a problem. And sometimes nurses are independent at the bedside having to try to figure out what to do with a patient or whatnot. So they, they are an ad untapped or Under recognized resource within health systems.

And as I've mentioned, they're also the largest care providers. So we have to make sure that we, we keep that group intact and we tap in to what they can do in their potential.

📍 📍 All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. 📍 📍

It's interesting. There's a couple of things that are happening. One is we're seeing nurse unions, we're starting to see some walkouts are starting to see some chatter of strikes and those kinds of things. And I think it's indicative of what we're talking about here, which is. Multiple years very difficult, a work environment.

We lean on nurses very heavily, and we're getting into that situation where some are saying, okay, no more. And these this situation is really working for us. When I talk about the traveling nurses, I don't want to portray them as a problem. They are actually solving a challenge that we have, but I talked to some CMIS.

Who said the traveling nurses don't want to learn the workflows and the other things like the. Like the nurses who are going to be there full time, because they might only be there for two months or three months. So they're not going to spend the time to really learn the EHR, the workflows that all the protocols and stuff.

So that creates another problem. And then the, probably the problem that's the most. Right now for health systems is the financial one. And you have a common spirit posted half, half a billion. I, when I say this, I think people hear a million, but it's half a billion dollar loss, Providence, half a billion dollar loss for the quarter.

By the way, it's just one quarter, a quarter of a quarter of a billion for advocate Aurora. And. Yeah, and everyone I'm talking to, and by the way, those are the big ones and those are big numbers. Why I share it. But when you go to the smaller ones, it's really problematic. They are they might only be burning 10 or $20 million a quarter or a month, but that's a lot of money to a small health system.

And everybody's trying to figure this out right now. And it's it's really hard. And I'm wondering like, where does this problem go in a health system? Like when, when they look at it and go look, we can't sustain the costs, the the nurses aren't happy. We definitely need to sit down with them and understand what's going on.

We need to address this long-term problem. I'm on the record of saying, I believe the nurse shortage will last For the rest of my lifetime. So hopefully that'll be another 40 years, but I don't think the nurse shortage is going away in my lifetime. That's what I have said. And so that creates a problem that you go, okay, if it's going to go on that long, then we have to take care of the nurses that we have now.

And we cannot continue with this financial arrangement the way it is, who does that get that problem? I know it's shared in a health system and it's clearly at the CEO level, but who do they go to? Do they go to the chief nursing officer? Do they go to the CMO? Do they go to the CMIO I mean, who, who looks at that and goes, all right, we've got some work to do

here.

I think in, in to your point, I don't think it's any one person. I think it has to be collective. every person has to come together for their organization. I will, I will say also that. you have to Include the board in the discussion I've actually been at conferences. And I sat down with a gentleman who is at a health it conference, who was in banking, but he sat on a board for his local hospital and he was having a nurse strike And he wanted to better understand and start to understand what he could be doing different, what leadership could be doing different how they can maybe add in some different, either benefits or education or training looking at technology to make sure that they're staying current. So I do think that it's, it's collective, it's not any one person and I would actually include.

The board in those conversations, because I think you're right. I don't think it's going to be one year and done. I'd love to see a lot more. And I know that this is happening at more local levels where they're reaching out to different teaching institutions to actually pay for the nurse education in some components.

So how do we start to, to bridge that gap? How do we start to train workers? That may be, are looking for a change in their roles with this great resignation. Maybe there's folks that want to go into healthcare that have new ideas, maybe it's their second career. How do we, how do we start to onboard that next group of of nurse leaders?

And in, like I said, it has to be an institutional commitment and it has to be cultural. You have to include them in leadership. You have to look at technology. And I think it needs to be a complete organization led initiative.

Yeah, I agree. Though, so let's take this to technology. We have a couple more articles here. EHR intelligence, supportive health, it structure linked to global EHR satisfaction. And this is one of the things that comes up whenever we look at clinician burnout and those kind of things, they, they talk about the EHR. So a little bit from this supportive health, it. Structure is a factor most associated with the HR satisfaction, according to KLAS arch collaborative report.

And we've talked to the people from class and the art collaborative on the show, and we shared some of those. If you want to look for those shows on the on the website, you can do that in global health systems, clinicians who strongly. That their organization supports the EHR are 132 times more likely to report EHR satisfaction than those who strongly disagree.

So this is, is this really about training? If I, if I'm reading this correctly, this is about putting the right training and support alongside the clinicians to help them use the EHR. Is that, is that what I'm reading?

So there is a lot to that. And that's that's really, if you were looking for the boiler plate or the one, the one-liner, I would say that, that, that is a correct summation. However, it gets a little bit more complicated as you start to go into and delve into what they actually looked at. So I like you have had the luxury of, of at least having some conversations with class specifically or. Some of the arch data and it's interesting when they did this survey they actually were able to show that there's two institutions that went through an implementation.

And they have same EHR, but they have very vast. Of satisfaction. And so as they started to dig in that's where they started to look at I think their top, their top number one was personalization, which, you know, that, that means that you have to go in and it's either by specialty or content or whatnot.

But number two, around the 20% mark was around that that training now. And so what I would say is it's, it's funny because when we go in into an implementation, we're very prescriptive. We try to put together what we think is best practices. I love the fact that arch is actually looking globally to best practices and providing that information.

So that everyone, regardless of EHR vendor can take advantage of, okay, this is the this is the number of hours, et cetera, but it's not one hour in done and you get a password and you go on a system. You need to make sure that they're there in it's by specialty is there set up appropriate?

Do they have the right content? What does their practice look like? So there is a wide of nuances that go into training in it needs to be personal. We've had one, a couple of customers that have kind of pushed back on the amount of training that we've suggested and said, well, they're not interested in the training.

Why dispute that? Based on some of the numbers that we talked about. Cause they did say that almost I think it was a two thirds said that they would actually. Physicians take on more training if it was offered, because as you start to go up with your EHR, you start to realize that the only things that you're calling in are those things that are stopping you, getting your.

But you're not looking to see how you can optimize other areas. So it's, it's a continuous investment in new functionality trying to refine your workflow process. And we had one customer and this is my favorite had t-shirts made up that said. No training, no password, no kidding. So they, they made their physicians go through because their investment is this big EHR.

And the only thing that's going to be successful is to make sure that the EHR is working for the physician. The nurses and the patients. And if we don't have the training, it's obvious based on the data that they're not going to have the satisfaction.

All right. So to tie this to the last story, so nurses and allied health professionals are more likely to experience burnout compared to other clinical roles as part of this article.

let's talk about training. So there's a lot of different ways you can do training. You can do. high touch, low touch. So you can do computer-based training. You can do classroom-based training. You can do. Yeah, elbow support, concierge type support.

We're talking about a tight financial time. and you're bringing in a lot of traveling nurses and those kinds of things. I could see how systems saying, Hey, you know what? Our training departments costing us X amount of dollars. Let's go to more computer-based training. Is there a different levels of satisfaction or effectiveness based on those three types of.

So it's interesting that you bring this up. I know that in the arch one of the outcomes of their report said that self-directed, which is your LMS or e-learning trainings, which is growing in popularity in health systems that you're on online learning is less effective than other types of trainings. So I will put that out there. I pushed back on that a little bit.

It's the least expensive to deliver.

Exactly. So that's where I'm pushed back on the arch a little bit, because I do think that they need to Expand that to understand that there are certain pieces in times in functionality where the e-learning actually makes a lot of sense.

And I go back to during the past two years, just dealing in supporting our health systems through this process, a lot of them did e-learning as part of the workflow to onboard some of the COVID practices. They did the workflow to onboard the tele-health and he visits and it worked very well for them.

So there is a need for the elbow support. There is a need, I think, for the classroom settings. But I think that I, I would not actually think it's on the rise, the LMS, the e-learning systems. How do you Institute that into your point? Especially with these positions, they might go home at night and watch like an hour of an e-learning session instead of taking that out during their day and having to come in.

So I do think we're going to see more and more of that, and I think it's becoming more effective as we learn what's working, what's not working. What sort of. But almost loud to see either by not so not so much of a, kind of a one-liner about self-directed e-learning that, that paints a picture on the whole concept of health systems, but maybe into different segments functionality. And I'd love to see them do this in three to five years to see if there's a difference.

So the, the concierge at the elbow support is the most expensive. And let me tell you how we use that, how we use that was we would identify it because every, every EHR gives you all the feedback of how people are using it, how effective, how much time they're in there that kind of stuff.

And so you could look at the effectiveness of the clinician using the EHR. And then what we did is we went out to them because one of the. And the RS collaborative is that customizing the EHR to your workflow, to your environment is so critical to effectively using the EHR. And that's what we would use the, at the elbow support for.

And a lot of times what we found when we send those people out and they're at the elbow. Y you didn't customize this at all. I mean, no wonder you hate using this thing, it's like, did you know, you could do this and you could, you could group these things. So you get, and typically that, that led to a very high satisfaction rate for us. And I'd love to do at the elbow with everybody, but it's just not practical.

I agree. And I think that in the survey itself, you kind of identify maybe with the areas or specialties that are struggling, and maybe you prioritize those a little bit more for the elbow support. You do some classroom training, some e-learning training.

And I know for us, anyways, we, we tend to do some annual even optimization, which are more global and virtual by nature. And we bring in the masses. So. I do think that there is a time and place for everything. I, I do know, at least for myself we have started to loot use the e-learning. Even in some of our trainings with our customers, especially during the pandemic, when we weren't necessarily on able to go into site all the time for each training visit.

So we are doing a hybrid of classroom elbow train, train the super users as well as doing some LMS training. And it's the combination is working out well. What is the subject matter to your point? What's the use case in what's the what's the economics of doing some of that.

All right. we'll close on this five key stats on clinician EHR burnout. And this is actually from the class report, but it's from Becker's and they just captured some key stats here. So during the first 15 months of the pandemic, physicians experienced a small, but sustained increase in EHR.

Messages from patients according to a study released. So that's one, one thing we are generating more messages directly from the patients and putting that in their cues and queuing that up for them. A number two, nearly 33% of physicians spend two hours or more completing documentation outside work hours daily, according to class research also released in March.

41% of physicians agree. The time they spend completing documentation as appropriate, whereas 58% disagree. According to class research for clinicians who are very dissatisfied with their organization's EHR are nearly three times as likely to leave. Wow. Compared to clinicians who are very satisfied with the organizations EHR.

And then finally, the percentage of clinicians who strongly disagree with their organization's ongoing EHR training is sufficient, are twice as likely to leave compared to clinicians who are, who strongly agree. So in this environment where we're worried about clinicians leaving and we're worried about burnout the effectiveness of the EHR is, is pretty important.

Now some of these things are, technology-related a significant amount of it is the implementation itself. I was talking to I was talking to Jake Lancaster CMIO at Baptist in out of Tennessee Baptist, Mora, Tennessee, cause there's so many Baptists. But he he was saying they were experiencing a million alerts and they brought that down to a hundred thousand alerts. It's that kind of work that is so critical on this burnout thing, because a million alerts who can digest that I know that was across clinic, all clinician classes and whatnot, but still who can digest all those alerts. Every time you log into the EHR alert, alert, alert, alert, alert. you just can't do it.

Absolutely. And to your point we're talking about the cost. You just actually shared with us some, some information on some quarterly stock information from some other health systems and what they reported.

But if you're losing your nurses, physicians, what is the expense? If it's over-training. To actually replace and fill in that spot. So they there needs to be an investment somewhere for retention in it. Again, I go back to the first article I do think that regardless of what you think that that needs to be done, there needs to be some input in value.

To the training on a yearly basis, not just during the implementation or optimization phases and the cost of not doing that is far greater to losing and not retaining your staff than it is to make sure that you have something that is systemically in place.

the nice thing about these quarterly first quarter numbers is they're showing me that this is aa industry-wide problem at least across the US I'm not looking at it globally at this point, but so we can paint the picture. it's not us. It's all of us. That's that's fine. But now we have a number to put in there. The cost of not doing training. This kind of return versus this kind of return.

And I like it, or not, a lot of health system leaders still speak finance much more than they speak any other language. And so when we can put it into very clear terms that this is the minor investment you have over here for education and at the, even at the elbow support. And here's the here's your first quarter results and this is what it's gonna look like.

I think that tells a pretty compelling story. Absolutely. Well, Christine as always these 30 minutes fly by so quickly, but I love our conversations. I did want to note that that you're gonna take a little bit of break here. you're going to be sending us some of your clients to participate in the Newsday show. I always look forward to that. You get a little different perspectives, but hopefully you'll be back again. Sometime soon and we'll continue to have these conversations.

Absolutely. Thank you, bill.

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