Nursing shortage is more than a pandemic problem, says CommonSpirit's CNO Dr. Kathleen Sanford

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As a young adult figuring out her career path, Kathleen Sanford, BSN, RN, had no interest in being a nurse. However, a full-ride scholarship to the Walter Reed Institute of Nursing in Washington, D.C., unearthed an unexpected love for the profession. Today, Dr. Sanford oversees about 45,000 nurses as executive vice president and chief nursing officer of Chicago-based CommonSpirit Health.

The 140-hospital organization is one year into a five-year strategic plan to become the employer of choice for nurses and chip away at some of the long-standing issues that plagued the profession long before COVID-19 hit. Efforts include the creation of the system's own nurse staffing agency, a revamped nurse residency program and an emphasis on virtual nursing programs. 

Dr. Sanford outlined these efforts during a recent conversation with Becker's and shared the most important skills chief nursing officers need to thrive in today's healthcare environment, among other insights. 

Editor's note: This article was lightly edited for length and clarity. 

Question: What is the biggest issue you're facing as a CNO today?

Dr. Kathleen Stafford: The nurses — and the rest of the professionals that work with nursing — their health and well-being is number one right now, along with the health of the profession and how many people we have to take care of patients. Something I think people forget sometimes is that this isn't all about COVID-19. Even if we never had COVID-19, I would be concerned about the health and well-being of the care staff because of all the other things that are coming together: the aging population, the number of nurses who are retiring and the age-old problems that we haven't fixed for the 40-plus years that I've been doing this. For example, problems with nurses being considered a commodity. We have to make sure that people stay in this profession and want to be in this profession. If the nurses don't want to be here, and if they don't feel good about their work and if they're burned out, then that's going to hurt our patient care.

Speaking of being burned out, that's been in the literature for nursing for 40 years too, if not longer. People act as if that's a big surprise. Physicians are now talking about being burned out and have been for the last decade or so. But nursing has been talking about it for many, many decades. Research shows that nurses have felt they haven't had a voice in their jobs; they don't like being treated as a commodity; they've had respect issues; they've had issues because it's [traditionally] a female gender profession. There's confusion over our education and what the educational levels should be. And when many people think of nurses as angels, mostly they talk about women that way. They forget that there is a great intellect that goes with that love. It's intellect plus love, empathy, kindness, scientific knowledge, and ability and skills. So all of this has led to a time when more mature nurses are leaving, and the younger nurses are saying, 'Hey there's something wrong here.' 

The shortage that we're facing right now, we know that it's going to get worse, at least for the next five years. It can't be fixed by just taking care of the post COVID-19 problems. We are already working on mental health and wellness programs for our staff. But it's also about fixing some of the long-term issues that need to be fixed if we're going to be attractive to the people that we need to attract to this profession, so that we can take care of people. 

Question: How is CommonSpirit working to address the issues you just laid out?

KS: We have a five-year strategic plan, which we started right before COVID-19. It correlates with the CommonSpirit Health five-year strategic journey, but it's specific to nursing. It works on all those things that we were just talking about. So, for example, we're doing a complete revisioning of patient care, and we're starting with acute care, looking at what it is that makes nurses' jobs less than joyful or less than satisfying. You have to have good pay and working conditions to get them to come work for you at all, but beyond that, what is it that makes a workplace the best place for people to work at the top of their license? What makes it a good place to have a voice? What makes it a good place to work as a team? What makes it a place that you can be proud of?

So right before the pandemic, we put together our nursing vision, and we came up with a major goal to become the employer of choice for nurses and the entire care team in a system that's widely recognized for outstanding care and service. Research shows that nurses — and I'm assuming for all clinicians, as well — that they want to be associated with an organization that gives great care and great service and cares about patients. 

This is a five-year strategic plan because many of the issues in nursing have been built up over 100 years. And you don't solve those issues in a year. You have to do this step by step by step. I always tell people I'm a pretty simple thinker about strategy. Have a vision of where you want to go, see where you are now and figure out what you're going to do every year to get there.

Q: What are your top nursing priorities right now?

KS: As we have looked at our five-year plan, we have a variety of committees and task forces to make sure that we're involving every single nurse who wants to be involved. We're making sure that there are frontline voices there to help us figure out what we do year by year. 

There are some priorities though that we need to do in year one just because there is such an immediate need, and those are the ones we've started this year. The first one is we're doing a systemwide residency program that's going to include a couple new things. One is, in addition to the preceptor who is on site with the new grad, we're going to have a virtual preceptor available 24 hours a day so a new grad can call or Zoom with a more experienced nurse if they have questions. We are also going to spend time on a variety of issues that most residencies don't. We are going to teach people about themselves, about how they react and how that will help them work with different people on the team. So what to do if you feel that you're being bullied — we'll have a class on that. What to do if a patient is less than pleasant. We're going to go through all of the softer skills of working with people. In addition, we will be starting those new grads on their careers and discussing how to plan their entire career. Because in years two, three, four and five, we're going to be working on career ladders and how we can help different nurses succeed.

The second priority is we are working on our own staffing agency. We will not ever probably be able to meet all of our nurse traveler needs, but we're a large enough organization that we believe we should have our own staffing agency, which will allow our nurses to travel if they want to go and see different parts of the system. This will help us maintain the right levels of nurses a little more easily than when you have to depend on other partners. I don't want to say that we won't depend on other partners, but we believe that the agency is a step in the right direction.

The third piece that is a must-do this first year is extending our virtual nursing programs. We've worked for over a decade on different types of virtual nursing inside of acute care. We've done several pilots and research studies, which helped during COVID-19. It was easier for us to start using virtual nurses to help nurses on the hospital units do admissions, discharges, patient education and medication reconciliation. We're going to be extending that and beginning more of our work on virtual nursing throughout our system, because this nursing shortage is not going to go away.

Q: What are the most important skills CNOs need to thrive in today's healthcare landscape?

KS: The first is adapting and managing change. I tell people all the time that if you cannot live in the gray, you are not going to be happy in healthcare or probably in life, because change will happen all the time. Consider how quickly we have new technology, or how quickly laws and regulations change. The ability to adapt and manage people through change is really important. Kurt Lewin's change theory says that you are frozen in the way you are now and then there has to be enough of a reason to change that you thaw and you change, then you freeze again. For years, I've teased people and said that I've changed his theory to what I call the 'slush puppy theory' because we don't have time to be freezing and unfreezing. I think that's difficult for people, because we like our homeostasis.

The second is partnering and team skills. People will say we've always done really well at that. We've done a lot of what's called parallel play in our different professions. We've all been doing the right thing, according to what our profession thinks is the right thing. We need to be sure that the people we're taking care of are in the center and that the rest of us are all coordinating to make sure we're doing the right things for that person. If the slush is getting too high, you better be holding hands with everybody around you or we're not going to get through it, and that's the team part. 

The third is balancing stakeholders' needs. Everyone's a stakeholder in healthcare, right? The people we take care of; the nurses and the staff; the management team; the community; and the organization itself. If you can't balance all of those needs, I think that you're not as skilled as you need to be. And people will say, 'Well, sometimes there needs to be a decision that's best for the patients that might not be the best for all the rest of those stakeholders,' but we have to consider every one of them in every decision we make. The skill is knowing how to consider those, balance them and figure out what the best answer is.

Q: What's the best piece of leadership advice you've ever received?

KS: Years ago I had a head nurse in the Army who said everyone wants to lead and tell everyone what to do, but most people don't want to do the hard work of management. Soft skills are a lot harder to learn than hard skills, and fewer people are really good at them. So my best advice is to become extremely competent in management, as well as leadership. I took that to heart and spent much of my educational time trying to learn to be a better manager.

I tell people that one of the issues that we're going to need to deal with in the future is helping the different clinical professions understand that clinical management is a valid specialty. If we're going to lead, we better know all of those scientific, evidence-based best practices and be trying to use them to the best of our ability and help our clinical teams understand that this is important.

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