With more than 40 years of experience — and a track record of leading six Magnet-designated hospitals — Dr. Johnson is at the helm of CHLA’s nursing strategy. In a recent conversation with Becker’s, she discussed the cultural drivers behind CHLA’s nursing excellence, the challenges pediatric hospitals face in a shifting healthcare landscape and how nurse leaders must evolve to meet the demands of the future.
Question: Four CHLA units recently earned Beacon Awards for Excellence in patient outcomes and nursing excellence. What key strategies or cultural factors within these units do you believe contributed to this achievement?
Kelly Johnson: I would say first and foremost the quality of nurses and nursing leadership. At Children’s Hospital Los Angeles, we have dedicated resources to the development of strong nursing leaders, from our front-line supervisors to senior leadership. Our teams are laser focused on the CHLA mission — to create hope and build healthier futures for children — and our values, most notably that “we achieve our best together.” This is our true
North Star and it guides and inspires us, unconditionally.
Caring Science is the nursing theory that drives our professional practice model. Care of self, each other, and our patients is foundational to our practice at CHLA. This has helped transform the culture in our clinical areas. The well-being of our team members is a high priority at CHLA. We have a robust well-being
program that is driven by strategy set by our team in the office of well-being. We are also blessed to have Chris Griffin, PhD, RN, leading as our chief well-being officer. Team members and leaders form our Beacon units not only actively participate in well-being programs, but they are also very active in Professional Collaborative Governance to drive decision making for the practice of nursing.
Q: The AACN’s award process evaluates key nursing-sensitive indicators, including infection rates, falls and nurse turnover. What were some of the most significant improvements the hospital made in these areas leading up to this recognition, and what mechanisms are in place to sustain or further advance these gains in quality and safety?
KJ: We have very strong leadership in our quality improvement and patient safety program at CHLA. The executive director for clinical quality, Sandy Hall, DNP, works closely with ourenterprise quality leadership and has been instrumental in developing the quality team, involving the front-line team members in improvement efforts, and providing strategy for continued improvement. She added a role that is accountable for the hospital acquired condition improvement tracking and implementation of new processes in conjunction with clinical nurse specialists and front-line team members. HAC reduction is an enterprise goal and cascaded to the front-line to provide ongoing visibility to the importance of this work.
Q: Pediatric nursing presents unique challenges, from the complexity of family-centered care to the specialized skill sets required for young patients. Given your deep leadership experience in this space, what do you see as the most pressing challenges facing pediatric nursing today, and how is CHLA addressing them?
KJ: This is a complex question at this time in healthcare. The biggest challenge we face right now is the looming cuts to Medicaid — Medi-Cal in California. CHLA is a safety net hospital with over 70% of our patients covered by California Medi-Cal. We have one of the highest case mix
index indicators in the country and care for the most complex children in our region, and in some cases in the country. Further cuts to Medi-Cal will threaten our ability to care for the complex needs of these infants and children, and the services they require will be challenging to
provide. CHLA is actively engaged at the local and national level advocating for children’s health. Our kids are our future!
Specifically looking at the challenges with the nursing profession in tertiary pediatric settings is the ongoing advances in care that require nurses to be very well educated and participate in ongoing professional development to keep their practice current. Innovation in care, technology, pharmacology developments, all stress the day-to-day work of registered nurses. The expense to cover education time and the cost of training is escalating and requires resources. Workforce development is top of mind. Training, recruitment and retention of our workforce are challenges we all face. These challenges are magnified for academic, pediatric specialty hospitals that require specialty trained nurses to care for our complex patient population. We are laser focused on clinical-academic partnerships and devising new models for training the next generation of nurses. CHLA is fortunate to have so much community support and we were recently awarded a very large gift to support workforce development and training for all the specialties in pediatric healthcare. We are dealing with workforce shortages in different types of roles and disciplines. This is creating a major challenge in care model redesign and will require dedicated focus on building our workforce and utilizing everyone at top of scope in roles.
Q: In 2021, CHLA spearheaded the formation of a regional NICU nursing leadership roundtable to improve collaboration and best practices across community hospitals in Los Angeles and surrounding counties. What tangible outcomes or improvements have emerged from these discussions, and how do you see this initiative evolving to further strengthen neonatal care in the region?
KJ: Kathy Van Allen, MSN, RN, CPN, administrative director of the hospital’s fetal and neonatal institute, spearheaded the formation of this group in August 2021 and they have been meeting quarterly. The meetings started with a focus on NICU nurse managers but quickly grew to include directors and clinical nurse specialists. Feedback from these leaders is that they value the roundtable’s safe and open space that allows them to share issues, resources, and receive support from their peers. Several have stated that this group has helped them to grow professionally through networking and collaboration and that information discussed has impacted how they incorporate evidence-based practice and community standards into policy and practice. Participating leaders have identified learning, and resource needs to improve care
within their NICU, and we have been able to create and offer learning opportunities to meet these needs.
There is a concept called nurses’ workplace social capital. This is the development of shared assets and a way of being that is developed through nurses’ networks of social relationships at work. There are five attributes of nurses’ workplace social capital — a relational network, trust, shared understanding, reciprocity and social cohesion. Feedback that has been received from the participants have demonstrated these five attributes have been developed/met through this group. I think this group can further evolve to strengthen neonatal care by contributing to local/regional policy through advocacy, research and developing shared
resources for patient care and patient/family education.
Q: You’ve had a distinguished career leading nursing teams at some of the country’s top children’s hospitals. As you look ahead, what are your top priorities for advancing nursing practice at CHLA, and how do you see the role of pediatric nurse leaders evolving in the next five to 10 years?
KJ: I have had the good fortune of serving as the CNO at six Magnet-designated organizations, with two first-time designations and three redesignations under my leadership. CHLA is in the re-designation process for our fifth Magnet designation. This is exciting and indicative of nursing excellence at CHLA, and a clear priority to support our Magnet leaders during the redesignation process.
As I mentioned above, we received a transformational gift from the Chuck Lorre Family Foundation to develop an institute for healthcare workforce development. This major project will be a priority for me for the next several years as it will support all our initiatives to train, recruit and retain top talent. It is very exciting to innovate for the future of the pediatric workforce. All leaders will need to be thought leaders in how we educate future generations. A prior, very generous gift provided us the opportunity to key in on leader development. I am a strong believer we need to develop those we promote; we will continue with our leader development programs at CHLA. Nurse leader development will continue to require the capacity for horizontal partnerships across our organizations and in our community. Interprofessional work is essential to great outcomes, and we will continue to develop interprofessional clinical learning environments and opportunities. Advocacy for our profession, our institutions, our patient populations, and healthcare in our communities and nationally will be a core competency for nurse leaders of the future.