Rae Woods: From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. I've convened today's group in honor of nurses month and of nurses week. There's a lot of talk about nurses right now. Frankly, every conversation I see includes the word crisis. So today I want to do something a little bit different. In honor of nurses, we'll be celebrating nursing's impact and discussing how leaders across the industry can help bring joy back to nursing. To do that, I've brought two experts, Carol Boston-Fleischhauer and Lauren Rewers. Welcome back to Radio Advisory, Carol and Lauren. It is hard to believe that this is going to be our third nurses week episode on Radio Advisory. Lauren Rewers: Yeah, hopefully a happier one. Carol Boston-Fleischhauer: I'm happy to be back. And you're right. We have been chatting about what's going on with nursing as colleagues for the past several years. And I'm delighted to be here today to talk about where we see the profession now headed. Rae Woods: I do want to use our time together to try to have a more optimistic conversation about nursing. But before we do that, we do have to acknowledge the elephant in the room. Nurses have been through an unbelievable amount over the last two years, and you both work with nurse leaders every day. What are you hearing from the front lines? Carol Boston-Fleischhauer: I'm hearing two different themes. On the one hand from nurse leaders, I'm feeling a sense of optimism. Nurse leaders are working hard to pivot as the pandemic stabilizes and start to figure out how to get at root cause of everything that's happened over the past couple years in terms of the practice environment to stabilize their nursing workforce and move forward. But I would say frontline staff are still in a different place. Rae Woods: Yeah. Carol Boston-Fleischhauer: I think they're still frustrated with how long it's taking to make some of the types of changes in the practice environment that everyone agrees needs to be addressed, but there is a sense of impatience, Rae Woods: Yeah. Carol Boston-Fleischhauer: Regarding just how long it's going to take in order to get there. Rae Woods: High level optimism, frontline frustration. Lauren, what are you hearing? Lauren Rewers: Well, just to contextualize it, my conversations with nurse leaders in 2020 were more like therapy than they were actual strategy. We talked about grief, we talked about isolation. Nurse leaders along with their frontline were risking their own safety and that of their families to care for the patients who needed it. And now on top of all of that trauma from the pandemic, they're also dealing with some of the strategic challenges of their career. Rae Woods: And once again, as an industry, we are doing our very best to celebrate nurses despite everything that they have been through. What is the theme of nurses week this year? Or is it nurses month this year? Lauren Rewers: Technically it is nurses month, but I think a lot of health systems are going back to celebrating it as a week. We will be having content all week and not all month, but the theme is nurses make a difference. Rae Woods: Do you feel like the challenges of the last two years are really reflected in that statement? Nurses make a difference? Carol Boston-Fleischhauer: Gosh, from my perspective, it absolutely is a spot on theme. Nurses make a difference because think of all the things that individual nurses did across the past two and a half years, not only to support care as part of their job, but also take care of themselves and their families during the height of this pandemic as well. But I would, not to push up against the marketing collateral, I would say nursing makes a difference perhaps is the more apt theme here, because it's a collective set of impacts. It's not just one individual as much as the entire profession. Rae Woods: And that is a subtle, but I think very, very important edit because so many leaders are focused on putting out the fire that's directly in front of them. They're just focused on staffing and maybe they're missing the broader benefit that nursing has on the business. Lauren, what impact does nursing have? Lauren Rewers: Well, nursing has so many impacts that I know that we could not squeeze them all into this podcast, but I actually want to raise a slightly different impact that we don't always think about with the nursing workforce. And to do that, I'm going to borrow a concept known as nursing's Triple Impact, which was actually first proposed in a movement in 2019 called Nursing Now for all the Royal fans out there, it's actually sponsored by Kate Middleton. But the concept of nursing's Triple Impact is that it not only does it improve health outcomes, but the profession also promotes gender equity and also stimulates local economic growth. So what we want to think about is that not only do investments in nursing actually improve the quality of care and improve patient's lives and all the other things that we know that it does, but it also narrows employment and pay gaps for women in particular who make up almost 90% of the workforce. And it helps them to support themselves and their families. Rae Woods: Carol, you are a nurse and you are Advisory Boards, chief nursing officer. I wonder if you can give me an example of how this triple impact can actually support the overall business goals of an organization. How might this actually manifest at a hospital or health system? Carol Boston-Fleischhauer: Well, as a matter of fact, I'm working with a number of healthcare systems right now as they try to reboot their nursing strategic plan, which quite frankly, most chief nursing officers had to put in the drawer for the past couple of years because of everything else that they were trying to deal with. But the purpose of a nursing strategic plan is to leverage the power and the expertise of the nursing enterprise to advance a healthcare systems goals and objectives. Rae Woods: What's an example of something that is part of a nursing strategic plan that is also part of a larger health system strategic plan? Carol Boston-Fleischhauer: Well, if a healthcare system is attempting in its community to reduce healthcare disparities, in nursing's wheelhouse is understanding social determinants of health and putting processes in place at the point of care or service to not only identify unique social determinants of health for an individual patient and his or her family, but also trying to address them so that he or she, meaning the patient and that ultimately his or her family can have improved healthcare outcomes. Now pre pandemic, we talked about social determinants of health within the nursing space, but because of the pandemic and the bright light that was shown on healthcare disparities, Rae Woods: That's right. Carol Boston-Fleischhauer: We've got an opportunity now more than ever before to get at this in a very deliberate way. Rae Woods: I think our listeners will see the connection between nursing and outcomes and outcomes and equity, especially because nurses tend to have the most interaction with patients. But the other two aims that you mentioned, Lauren are probably less intuitive for our audience. Tell me, how does gender equity and economic growth connect to investment in nursing? Lauren Rewers: Well, I will cement my reputation as quite possibly the only expert who talks about their mom on every Radio Advisory appearance. But I actually come from a nursing family. My mom was an RN and my grandmother was an LPN. And it's not only that they loved being nurses, which they really did, it was because it was one of the only well paying jobs available for women in their hometown. Nursing is an accessible profession. Many organizations still hire nurses with associate degrees. And beyond that most organizations offer some pretty significant tuition reimbursement benefits. So it's those benefits that really made it possible for my mom to go to college, the first in her generation to do so. And if you think about it, it's really the opportunity that nursing affords women and the communities that they by and large support, that is what made it possible for me to have the opportunities that I have to sit here in a big glass building in DC, talking to you right now. Rae Woods: So I see what you're saying, that by investing in nursing, which is a predominantly female profession, more women are going to be in the workforce and that's going to then trickle down to more economic growth in local communities, more money to be spent on local businesses, more money to go around, et cetera, which by the way back to Carol's point is a connection to health systems, larger equity goals. Lauren Rewers: Absolutely. And I actually want to give you an example of the ways that we, the much needed changes we are making right now to stabilize the workforce actually helps us further this sort of side benefit of enabling gender equity in the community. So for example, take flexibility. Organizations know they need to offer flexible roles to be able to retain folks in the workforce. We don't necessarily need to dive into that, which we've talked about on a couple of other podcasts. Rae Woods: But maybe we can link to them in the show notes. Lauren Rewers: Sure. When you're breaking the 12 hour shift model, when you're creating a variety of options for women who are taking on disproportionately childcare and elder care burdens, then you're enabling them to stay in the workforce for a longer period of time. Rae Woods: I have to say, I applaud both of your efforts to kind of refocus our view on the impact of nursing on the industry. But this week, this month is still about celebrating the work of nurses themselves. On that note, how can leaders offer true support to frontline nurses? Carol Boston-Fleischhauer: Well, there's support and then there's recognition. And I think those are two different concepts as it relates to support for nursing. I don't believe there's an executive in the country that's not well aware at this point, what it's going to take to get at the structural challenges associated with the complexities of the inpatient care environment. People are working hard on this now. I mean, this is not just an occasional conversation, but it's a top of mind conversation for every C-suite in the country. So support for the profession of nursing has got to continue to mobilize the type of resources, attention, and effort needed to address the structural barriers associated with the complexities of the inpatient care environment. That's different than providing recognition. Rae Woods: That's right. Carol Boston-Fleischhauer: Right. Rae Woods: That's right. Carol Boston-Fleischhauer: Or what it is that nurses have achieved as well as what they can achieve moving forward. Rae Woods: And Carol, we talked about this the last time that you came on this podcast with our colleague Monica Westhead and you made the point that the only way to actually support nurses is to get at the root cause of these structural barriers. Lauren mentioned one of them flexibility, also things like insufficient staff, kind of broken old world practices, compensation, professional advancement, lack of a sense of value. We have to get at those things to provide the support, perhaps before we get to the recognition. Carol Boston-Fleischhauer: It's not an either or, it's a both and as it relates to what you just said. I would submit, it's going to take a while to get at these structural barriers. In the meantime, we can't not recognize nurses and nursing for what has been accomplished and what nurses and nursing can continue to accomplish. I would say Rae, adding to your list of structural barriers that I'm seeing a number of systems start to get at is this notion of quite frankly, how do we start to think about changing the work? Rae Woods: Yeah. Carol Boston-Fleischhauer: Changing the work that not only nurses, but all clinicians do collectively as a team to support care delivery in this post pandemic environment. We can throw more bodies into the mix, but if we don't change the work, we're still going to have a fair amount of inefficiency, which is going to continue to breed frustration. And it's not going to address the burnout issue that I think a lot of nurses are still looking to organizations to address. Lauren Rewers: Yeah. On that note about changing the work Carol, I'm glad that you bring that up because it's really a part of reinfusing joy back into the nursing workforce because there's a ton of work that nurses do not want to do that is not necessarily top of license practice or things that they feel very attached to. If we could change the way that we're delivering work, such that it created more attractive nursing roles that helps us get at the inefficiencies, but it also helps us put structure around getting joy back in nursing. Rae Woods: So let's say we're able to actually solve all the structural problems. I've waved my magic wand, all of the root causes of challenges in nursing have disappeared. Would that bring back joy to the practice of nursing? Lauren Rewers: I think it would make joy in the practice of nursing possible, but hospitals still need to engage their nurses and make an effort to partner with them to bring back that joy. So they first need to solve the structural barriers, but they also need to create space and opportunity for nurses themselves to reconnect back with that joy. Rae Woods: And is that part of what Carol was talking about when she talked about recognition? Carol Boston-Fleischhauer: Well, I'm not so sure that it's recognition as much as providing the opportunity and the space for nurses to reflect on why they became a nurse in the first place. I've been a nurse for over 40 years and I cannot recall a time when I practiced at the bedside, now my mind you, it was a long time ago, where I didn't feel a sense of joy. And I didn't feel that I was making a difference and I didn't feel that I was contributing to the greater good of the patients and families that I cared for. Somehow we've lost that element of the nursing profession with many nurses and we got to figure out how nurses themselves can take some time during the course of their day to reflect on exactly why it is they committed to this profession in the first place. And all it is that they are in fact making a difference on and in, on a daily basis, if they're just given the time to reflect, celebrate, and of course collectively have a conversation with their peers. Rae Woods: Which of course is one of the reasons why we have this moment to celebrate every year. But I think you're saying that we need to do this more often than 30 days or seven days out of a given year. Carol Boston-Fleischhauer: Yeah. I mean, I'm working with an organization that is very, very focused on quality and safety huddles. They do them every shift just to make certain that at the start of the shift, everybody is very clear as to what the quality and the safety issues are going to be for that shift. Well, they're having a conversation about whether or not they should introduce into the quality and safety huddle, gratitude huddles. In other words, let's take five minutes before we start the shift to just reflect on what we're grateful for. And what we feel is if we have the opportunity to make a difference in over the next shift. That's a small but specific example of what we can do to introduce into the workflow, this opportunity to reflect right, as well as to remember what it is that we committed to in the first place. Rae Woods: And I like that example, Carol, because it's a good example of the partnership between organizations, organizational leaders, and the frontline nurses. It would be very different if the CEO of that health system sent out an email and said, take five minutes out of your busy day to practice gratitude. Instead, what they did is say, we are going to embed this into our workflow. We're going to hard wire this to make sure that you have a moment to actually embrace joy, but we're not going to put it all on you. We're going to create that space. And that's really the give and take. Carol Boston-Fleischhauer: I would agree. Rae Woods: If I'm honest, this conversation is kind of naturally focused on the impact that provider organizations have on nursing. And that makes sense, but I do have to believe that all stakeholders play a role here. What can other parts of the healthcare ecosystem do to support nurses? Lauren Rewers: So I will just jump in with one of those forces, although I think there are many more, and that's thinking about digital solutions and the vendors that create those. I don't want to say that there has been none of that in the nursing space by any means, but I don't think that we've seen as much movement in the nursing space, as we have thinking about physician workflow or virtual visits, for example. So one of the things that has given me a lot of optimism is that way back in the day, a few years ago, when we were doing research about flexible nursing solutions, I felt like a lot of the platforms had been around for a long time. Lauren Rewers: It didn't really seem as if folks were getting everything that they wanted out of them or that they were really pushing the envelope in terms of how they were working for them. But lo and behold, going through the pandemic, realizing how difficult that was to do manually, how difficult it was to move nurses from one scheduling platform to the other. We're starting to see a lot of movement in that space in terms of AI scheduling and machine learning and other solutions that I think always could have been applied to this function in nursing, but haven't necessarily until now. Rae Woods: And that goes back to the point that both you and Carol made about changing the work. Right. And thinking about what actually goes into the day to day of nursing practice and what might we be able to offload onto a technology platform rather than offloading onto a nurse, which we all know happens far too often. Carol Boston-Fleischhauer: Yeah. And let me give you another example on that regard. We know that documentation, even though we've got EMRs continues to monopolize a registered nurse's time during the course of their shift. And quite frankly, it doesn't matter what platform you've got, documentation requirements and regulations for nursing are excessive. And so it's very interesting that we're seeing a number of vendors think about how they can support physician workflow as it relates to their documentation requirements, by developing transcription services and devices to audio record what it is that needs to be ultimately documented. Where are vendors in terms of helping registered nurses with the incredible documentation requirements that registered nurses on a daily basis have got to comply with? Man, oh man, if you could cut documentation time in half by creating some sort of a product to help registered nurses deal with those types of work expectations, not only would the system benefit, but also the registered nurse would as well because she or he would have time then to be at the bedside to care for the patient versus care for the medical record. Rae Woods: That's right. That's right. Lauren Rewers: Yeah. Carol, let's just expand on that last statement too. I think there's a lot of nervousness when we talk about automation and labor and sometimes for good reason, that that is going to lead to people losing their jobs, or it's a rejection of nursing. When we think about these technological solutions, we want to help nurses do more of the stuff that they actually want to do, which is connect with patients and deliver bedside care and develop care plans, address social determinants of health. We want to get rid of the tasks, not the nursing tasks, but the other things that nurses have to do, but don't necessarily want to do. Rae Woods: Yeah. On the physician's side, we call this the administrative burden of medicine. And to your point, Carol, why are we focused on the physician's administrative burden and not every other member of the clinical workforce and their administrative burden? Carol Boston-Fleischhauer: Yeah. And that's why if a C-suite can get involved in stabilizing a workforce, their nursing workforce and really get serious about what are the problems inherent in the complexities of the inpatient care environment, getting at the administrative burdens of why nurses are leaving the bedside in the first place would be a home run for a C-suite, but we're going to need vendors to pivot away from supporting just the physician component of the workforce, Rae Woods: That's right. Carol Boston-Fleischhauer: To the broader workforce needs, including registered nurses. Rae Woods: Well, Carol, Lauren, as always, I want to give you a moment to speak directly to our listeners, but I am going to ask a slightly different version of my final question. I am still feeling like there is so much negativity surrounding the nursing workforce today. I often hear the word crisis and nursing connected together in conversation. So to close us out, I want you to tell us what is giving you a sense of hope and optimism when it comes to the nursing workforce? Carol Boston-Fleischhauer: Well, I'll start as it relates to where I feel optimistic, and that is continued collaboration amongst various stakeholders in the broader healthcare industry on how to address the nursing workforce challenges that we're currently experiencing. Two examples come to mind. First, the partners for nurse staffing initiative that was launched by the American Nurses Association several months ago in collaboration with several other organizations, including HFMA and IHI have just released a series of recommendations on how to get at the structural barriers associated with the complexities of the inpatient care environment. Likewise, the National Academy of Medicine also just released a draft plan for workforce wellbeing. Both of those cross industry reports include a whole slew of recommendations on how to help healthcare workers regain a sense of joy at work. And so my optimism is predicated on all of these stakeholders coming together. This isn't just nursing anymore that's talking about the need to regain joy in the workplace. Its other stakeholders within the industry as well. All saying exactly the same thing. That gives me hope and optimism. Rae Woods: Lauren, what about you? Lauren Rewers: Yeah. I think that as much as nurses and nurse leaders are hurting right now, this is providing an opportunity to really reckon with some of the cultural assumptions that we've made around nursing's value, what it offers to the health system and really the value of what is quote women's work often, or what is seen has been women's work for a long time. I'm hopeful that by reckoning with a lot of those assumptions that we're setting ourselves up for a better future, even if it is a very painful process to be going through right now. Rae Woods: Well, Carol, Lauren, thanks for coming on Radio Advisory. Carol Boston-Fleischhauer: Rae, thanks for inviting us back again. And we really appreciate the opportunity. Rae Woods: There is so much that all of us can do to support and to celebrate nurses. We've added a link to our show notes so that you can learn more. There's everything from resilience training to how to support safe and effective staffing and how to provide emotional support. Because remember, as always, we're here to help.