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 Today on Town Hall

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My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare.

Alright, let's jump right into today's episode.

 Hey everybody, and welcome to another episode of This Week in Health IT. I'm Jake Lancaster, a Chief Medical Information Officer for Baptist Memorial Health Care based out of Memphis, Tennessee. And today I'm very excited to be talking with Kelsey Reed from Phoebe Putney Health System about nursing shortages and nursing burnout.

Kelsey, welcome to the program.

Thank you so much for having me. I'm excited to be here.

Yeah, I'm very excited to have you. Can you tell the audience just a little bit about yourself and also about your health system?

Absolutely. So, I'm Kelsey Reed. I'm one of our Directors of Nursing here at Phoebe. I have responsibility for a few different areas here in the inpatient setting, from our observation unit to our inpatient oncology unit, in addition to our vascular access unit.

It's wonderful to have you. And I know a lot of people Systems around the country are still dealing with nursing shortages and burnout.

I know we are in particular here, so I'd love to hear your story about how you've been addressing this. I know nursing shortages have been going on for a long time, even before the pandemic, but the pandemic really exacerbated the problem. So take us through. What y'all experienced, how bad did it get for Phoebe, and what have y'all done to address it?

Sure. I would say that here at Phoebe, we probably experienced the worst of the worst during the 19 pandemic. The nursing shortage was not new for us. It's not new to anyone, but certainly heightened to a new level in our post pandemic era. I will say that what we started to experience were a lot of our baby boomer nurses decided to retire early, leave the profession altogether.

Or move to a new career. And then the other concerning thing that we began to experience was even some of our newer nurses, those with maybe just five to 10 years of experience because of the level of burnout that they experienced through the pandemic, they were considering. Do they still want to stay in the nursing profession?

Should they consider a new career? Or what might their future look like in the world of nursing? So, after the pandemic we were able to come together and formalize a work group where we talked about what does the future of nursing here at Phoebe look like, talked about innovative care models, what could we do differently, really as an effort to challenge the status quo and to look at things from a different lens.

How could we make this applicable to our team, to our staff, for our patients? And we went from there. We've built the entire model ourselves. And it has been very successful here at Phoebe.

Let's talk a little bit more about virtual nursing. We've been doing it ourselves here at Baptist for a little while but you're right.

It's a foreign concept when you, when I first started thinking about it because nursing is so hands on, so at the bedside, it's one of the few things I would have thought you can't do virtually. So tell us exactly what the virtual nurses doing and and how did you all manage that paradigm shift?

Jake, when our CNO at the time first presented the idea of virtual nursing to me, I thought, what, how will we even make this happen? What are we talking about? Just me being very unfamiliar with the concept in general. I had my own hesitation. But as you start to think about the amount of administrative tasks that our nurses do on a day to day basis, and really think about how could we shift those tasks to another individual so that we can have our bedside nurses truly at the bedside away from being stuck behind a keyboard all day.

That's when it started to click and to make sense for me. So here at Phoebe, our model is fairly simple. We utilize an iPad. on wheels to communicate with our patients. And so that iPad can be taken into any patient's room at any time. And our virtual nurses are in a command center type hub at our Phoebe North campus.

We started with one virtual nurse. We now have 30 virtual nurses and they are primarily responsible for throughput number one. So they do all of our admissions. They do all of our discharge teaching Med recs, you name it, as the patient arrives and then prior to discharge. But during the patient's inpatient hospital stay, they are also responsible for a great deal of quality surveillance as well.

So making sure that they're monitoring for early deterioration of patients. Also, they do sepsis screening and surveillance and follow that with alerts to the bedside team to screen for sepsis. They also do a great deal of Braden score audits, central line audits. So you name it from a quality perspective, they are involved.

What I love about utilizing our virtual nurse for these tasks is it is uninterrupted time for them and the patient. So when they are doing discharge teaching, whereas the Bedside nurse may have a million things going on at that one given time. That virtual nurse is solely responsible for that patient's discharge teaching.

So it's focused and it's thorough and that patient has their undivided attention. So they also don't have the voceric calls going off while they're doing the discharge teaching or a bed alarm or a code chime or whatever it may be. So it really is focused in our patients. They value that and they can really see that difference in the level of discharge teaching that they get from the virtual nurse versus our bedside team completing that.

So we've been able to really transform our model of care here at Phoebe, partnering with our virtual nurse team to really shift those more administrative type tasks so that we can ensure that they're thorough, that, Great quality and that they're safe for our patients and that we allow our bedside nurses to focus on true patient care and being at the bedside with our patients.

Now, that's really impressive. Y'all have done a lot more with the program that I've heard of other people doing, including myself. Tell me a little bit more about how you got it implemented. Did y'all run into any barriers? What sort of technologies did you need in order for this to be a success?

what were the major lessons learned from the project?

So we really started with more of a proof of concept model. So we sat down with our IT team in addition to some of our bedside nurses and we began to think about what responsibilities could we shift to a virtual nurse if we had a program in order to do so.

And we started to write down that list of responsibilities and what they may be. And then we started talking with our IT team about. What does technology look like? How can we make this happen? Ultimately, we decided they need access to all the same systems that our bedside teams need. MEDITECH, teletracking, sepsis surveillance monitoring, all of the same systems our virtual nurses need access to in real time.

And then we also, We happen to have a fair amount of iPads available from our utilization of those iPads during the COVID pandemic, and so we were able to put these iPads that we had available to use. So we attached them to a monitor on wheels and we really began our journey a proof of concept, let's see if this will work.

So we started with one unit and we are now at nine units. We fully expanded to nine units and our. Facility here at Phoebe, Maine. As far as barriers we experience first and foremost, I think with anything new you're gonna have some eyebrows raised and a lot of questions asked.

And you still, as a nurse sometimes it's hard to let go and let somebody else to have that responsibility. So some of our nurses were immediately, oh, thank you. We so appreciate this. We're so glad we can hand off this task. And then some others may say. I think I'd rather just do the discharge myself and I will tell you with people that we just had to change that perspective with, it just took time.

And so the model, , once you use it time and time again, it begins to prove itself to those that may have some issues. So, of course, we experienced that with that change in workflow. Also, one thing that I was most hesitant about as a nursing leader, when we implemented this, was, what will the perspective be for our patients?

What will they think about this new level of innovation? And I will tell you, they have been so appreciative of it. They love it, and I really believe it's because they have that uninterrupted time between the virtual nurse the patient. is focused, and it's thorough, and we review a great deal of detail with the patient that they may otherwise not get.

So our patients have really responded well to the concept too.

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Hi everyone, I'm Sarah Richardson, president of the 229 Executive Development Community at This Week Health. I'm thrilled to share some exciting news with you. I'm launching a new show on our conference channel called Flourish. In Flourish, we dive into captivating career origin stories, offering insights and inspiration to help you thrive in your own career journey.

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That's good to hear. Yeah, I was definitely going to ask about patient satisfaction, but what can you tell me about some of the other results you've had? were y'all monitoring? to know that this was going to be a success.

So we have a good bit of metrics that we track.

First we look at our quality metrics. So we analyze our readmissions most specifically one that we continue to track are our CHF readmissions. We do that because our virtual nurses are heavily. fully responsible for medication teaching both on admission and at time of discharge, especially for our CHF patients.

So we have a partnership with our pharmacy team here at Phoebe that if we have a patient that may need some enhanced medication teaching especially for, Especially those that may be a CHF 📍 readmission, then we partner with our pharmacy team to provide that in addition to us doing it and the patient may follow up with our medication management clinic as well.

So that is certainly one of the quality measures that we track because of our role in sepsis surveillance. We also track our three and six hour sepsis bundle compliance measures. . I'll tell you that we have improved our three hour bundle compliance by 20%. 20%. Wow. Since our virtual nurses have been so intimately involved in that process we utilize a sepsis monitor system to review that service criteria if the patient may trigger a sepsis alert, the virtual nurse team.

response to that by calling the clinicians involved, whether it be the provider and that bedside or charge nurse involved. And then we immediately initiate that sepsis bundle and we do real time bundle compliance. Has the patient had that lactic drawn? Have blood cultures been drawn? Have they received fluids?

Have they received antibiotics? So we match up our sepsis surveillance system with what we see in Meditech to make sure that we are meeting those measures as well. So we take it that step further and we have definitely shown improvement in that metric overall. Of course, we track a great deal of patient satisfaction, our HCaTS metrics.

The two most specific items that we track from the virtual nurse standpoint is that communication about medication. So making sure that we are educating patients on any new medications prescribed, what those side effects may be as well, and then also that HCAHPS discharge information domain.

Are we properly preparing our patients to go home with all the right tools in their belt so that they're prepared to take care of themselves in the home setting? So those are the two HCAHPS metrics that we track. As far as nurse engagement, we do look at first year voluntary turnover. One thing that we have initiated with our virtual nurse team is having all new graduates rotate time with the virtual nurses so that they build that partnership, they see our workflow, and then whenever a new nurse comes out of orientation, our virtual nurses are aware of that, and we monitor them very closely to be that second set of eyes for them right off of that orientation period.

So a little bit of a security blanket, if you will. And then we monitor those nurse engagement scores as well through our employee engagement system. And then some other things that we do, in our world here and in our virtual nurse program is our virtual nurses do post discharge phone calls.

So 24 to 48 hours after discharge every patient from our facility receives a call. We take them through a set of questions where we make sure that they've received their medications. If home health was supposed to come to their house, have they seen home health yet? Do they have all of their follow up appointments in order?

We track those items and then we help close the gap. So, that's what we do. Maybe home health hasn't arrived yet. Then we follow up with that company or maybe the patient's confused about their medication. We follow up with the pharmacy or help answer any questions that they may have. So we not only provide that service here while the patient's in the inpatient setting, but we also follow it up outpatient and we provide those touch point calls to them too.

Wow, again, very impressive. Let's pivot a moment. I would like to talk about nursing burnout and What Phoebe has been able to do to address that, it's certainly a huge issue for us internally. We've talked a lot about provider burnout, but nursing burnout and nursing turnover is just as big of a problem.

Tell us a little bit about the problem. Why is it so high right now? And then what have you all done to go after that?

I think there's not necessarily one thing overall that is contributing to nursing burnout. I think it's really multifactorial. When you consider it, I think first and foremost, one would think the state of staffing, and that is certainly the case.

We continue to experience a nursing shortage. And so staffing will continue, will always continue to affect us, and that certainly contributes to that. That's why we've looked to adopt different innovative models that we can use to help close that gap to ensure that we have resources in all the right places for our bedside teams.

I think the other item that you will most commonly hear from bedside nurses and our staff that are contributing to burnout is just the fact that patients. Patients are a lot sicker. It seems just very anecdotal to say that, but I think we see a lot of patients, especially here in our region in Southwest Georgia that are very acutely ill when they arrive to the hospital.

Maybe they haven't engaged in preventative medicine. And so when they see us, They are very sick. And so those patients are obviously more challenging to take care of and can be more taxing on our teams. And then the other item that, that we have to think about is the fact that we ask our staff to do a lot more from a documentation standpoint

So a few things that we have done to address that documentation burden that our staff experience are, of course, one, virtual nursing. But the other item that we have done, rolled out is the use of our point of care devices. And so these handheld devices, our staff are able to take into the patient's room at any time and do quick assessments on those.

So they're not having to take also a computer on wheels into the room too. They're able to do their med pass utilizing the handheld devices. So really looking at things operationally from What can we do different? What's not working? What are our staff frustrated about? So, what can we do differently to meet them where they are, those resources?

What can we provide to them? So, I think rollout of those point of care devices so far has been very successful. Our staff are appreciative of that quick way that they can document versus having to go to You can't find a computer or push that computer on wheels in the room. But to help with that acuity, the increase in inpatient acuity as well, one thing that we implemented a little bit over a year ago here at Phoebe was our medical emergency team.

Most commonly called the MET team here or in other facilities, maybe your rapid response team. Previously, our code team was the one responsible for responding to all codes. Thanks. And so we decided because of code blues increasing and our Met calls increasing, we've really had an opportunity to have a dedicated Met nurse every single day here at our facility for every shift.

And so we rolled that out about a year ago, and we've seen a ton of improvement in our. One, where we've got 50 percent less code blues called. If we've increased our MET calls, which is exactly what we want to see, but we have that dedicated individual to be another set of eyes and ears at, in real time for our staff as an available resource.

That individual also, they look at news scores throughout the shift. If we have a patient with an elevated news score, they help follow them. Any patient that Most recently transferred from the ICU setting to the floor. They monitor them within those first 24 hours, but a great resource to our team as well, and of course for our patients to help keep them safe.

Those are all very great innovations, and I'm certainly learning a lot, and hopefully I can take some of the things y'all are doing and bring them to Baptist. Y'all seem to be really on the cutting edge for a lot of these interventions. What are you looking forward to in the future? Are there new things that y'all plan to adopt in the coming weeks or months or years?

What's next for Phoebe?

We do have our Meditech expanse rolling out in the next few months specifically for our nurses. I think this is gonna be a big win for nursing at looking to better operationalize our EMR to remove any potential redundancies that our staff were experiencing.

So we are thrilled about that. That Meditech nursing expense 2.2. In addition to that. We have a great nurse residency program here that our nurses go through during their first year of employment. In that work group, we address issues like burnout with them. And one that we are focused on right now is how can we reduce that EMR?

burden, the EMR workload. So we are having focus sessions focus feedback sessions to hear from the frontline staff at what makes your job difficult? And then where can we meet in the middle to make it easier for you? What can we do differently? So from a technology standpoint, we do have some great things coming.

Also, we, All the time at Phoebe, we are looking to better partner with our area schools, whether that be with Albany State University, Albany Technical College, Georgia Southwestern. We intimately work with those programs to assist them and their students. We do have the upcoming Living and Learning Center.

This is going to be right across the street from our location here at This will house nursing students, lobotomy students, support staff and really helps us close that gap on the staffing shortage that we continue to experience. So those students, , once they enroll, we're starting this in August they will be enrolled and they will be living right across from the street from the hospital where they will be doing clinical.

So they'll take classes there at the facility and then be able to walk across. So, we're thrilled about that. One thing I love about Phoebe is that we are always looking ahead. We are very innovative in our practice, always looking to see what may be coming down the line and what can we do now to get ahead of it.

So, I appreciate that about what we do here at Phoebe.

Thank you so much, Kelsey. It sounds like y'all are doing amazing things at Phoebe. And thank you everybody for listening to This Week in Health. Have a great day.

Thank you.

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