'Resilience isn't a pillar by itself': CommonSpirit's plan to support 44,000 nurses in 2023

Leaders at small health systems might be quick to dismiss the idea of an internal nurse staffing agency, thinking it's not an option for them. Kathy Sanford, DBA, RN, would challenge that assumption.

"People always think it's just something that large organizations can do," the executive vice president and chief nursing officer of Chicago-based CommonSpirit Health, told Becker's. "[But] I think we're going to have to learn to work together a little bit better." 

The 140-hospital organization operates in 21 states and has started hiring nurses for its own travel agency. The effort is part of the system's five-year strategic plan created right before the start of the COVID-19 pandemic.

With the right partnerships, Dr. Sanford is optimistic an internal staffing agency can be a reality even for healthcare organizations with a much smaller geographic footprint. She suggested smaller systems think about combining with like-minded organizations that have similar missions and needs to develop their own staffing agency. 

"I think they can do that by working together in ways they've never done before," she said. 

Ahead of 2023, Becker's spoke to Dr. Sanford about how to best support new nursing graduates, CommonSpirit's approach to prioritizing resilience, and other changes the system's 44,000 nurses would like to see in the coming year. 

Note: Responses have been lightly edited for length. 

Question: Turnover rates among new nursing grads were already relatively high pre-pandemic. Earlier this year, you talked to Becker's about how COVID-19 further complicated that. How can health systems try to get ahead of this — what types of support are needed to reduce the turnover among nurses in their first few years on the job?

Kathy Sanford: Turnover hasn't gone down dramatically since COVID-19 has waned a little bit, so that says to me that we really, really do have to take strategic actions. The No. 1 thing that we've found talking to new grads is they have to have a lot of support. New grads, no matter whether they graduated during COVID-19 or whether they graduated after COVID-19, come into a situation where we are very, very busy; where most organizations don't have as many nurses as they'd like. And they don't have the attention paid to them that they need as new graduates. So we think it's essential to have a residency program for nurses just like there's a residency program for other professions, such as physicians. Of course, the nursing residency would not be as long, but ours is going to be a full year. 

We feel that making that transition from a student — where you have a classroom and you really only have one or two patients at a time, and you get to know that patient really well —  is quite different from when you graduate and then have multiple patients to take care of and multiple activities that you're responsible for. So the No. 1 thing is they need support right out of school. They need a preceptor. They need a program. They need to know they are not alone when they first start taking care of their own number of patients. It all just comes back to support. 

Q: Many nurses retired early during the pandemic. What are one to two key ways health systems can retain nurses nearing retirement in the workforce for longer? 

KS: One is try to have less lengthy schedules. Many nurses work 12-hour shifts now, and that is pretty wearing as you get closer to retirement age. Not to say we don't have some really peppy people at all ages, but it does get wearing and so one of the things we are all going to have to look at is giving people who want to retire or are close to retirement, the opportunity to work shorter shifts. That's a little bit difficult for management leadership because they have to fit that puzzle together and make sure there is enough staff there, but it is something that we can do. 

The second thing that we think is going to help us a lot is using more and more virtual nurses. And those virtual nurses are needed that have the wisdom and experience to help the other nurses to do things like admissions, discharges and transfers, educating the patients and making rounds with the physicians virtually — that will be a way, we think, to extend some of our nurses' careers because it's not so physically taxing. 

Q: Some hospitals were able to cut back on costly travel nurse reliance this year. How do you think contract labor trends may shift in 2023? 

KS: I think we're still going to have travel nurses. I remember that Leland Kaiser said this 30 years ago when I attended one of his meetings: The future physicians will become employees more and more and nurses will become private contractors more and more. Of course when he said that, as with all futurists, we thought, "How could that be?" Now, we're looking at things that he said 30 years ago that are happening. So I think we're always going to have travel nurses. 

What we're doing at CommonSpirit Health is putting in place our own travel agency. We have started hiring and already have some of those nurses out in our med-surge and critical care units. We intend to have 200 hired by the end of our fiscal year in the middle of 2023. It looks like that is coming along. We are meeting our goals for each month as we bring this program up. So that will be an opportunity for our nurses who want to be travel nurses to do that, and yet maintain their connection with us and their seniority; being part of an organization and still be able to travel when it is more convenient to their lifestyles. We're also going to look at local pools of people who don't want to travel but would like to be our employees, though still more like agency nurses in that they can really choose when they are available and when they want to work for us. We may be able to let those nurses, just like the nurses near retirement, have an opportunity to work different lengths of shifts to fit into their lifestyle. 

One of the things I like to tell everybody who is in nursing leadership is there is no one answer. We're going to have to look at a variety of solutions to mitigate the shortage because we have a variety of issues, so we cannot just look at one thing or one way because one size does not fit all organizations and one size does not fit all for all of our nurses.  

Q: Clinician burnout remains a key challenge for healthcare leaders. How does CommonSpirit plan to tackle nurse burnout in 2023 or how is the health system changing its approach here?

KS: We are planning to do a few things differently, but not a lot differently because during COVID-19, we put in several programs that we want to continue. We have a mental health first aid program. We have a new EAP program. We have a program called healing together: an introduction to mind body medicine. We have zen rooms and a variety of things like that across the system, and we realize that the reason we need to have a variety is because not everybody is the same. Different nurses and different people have different things that could help them with the difficulties of our work these days. 

One of the things we do that might be a little bit different is a program where we actually provide wellness for our employees in a way that they can take care of themselves and we reward them to do it. Within that self-care program called My Wellness, we have programs where people can learn about mindfulness, how to build resilience, how to manage pain, and virtual fitness and nutrition classes — those sorts of things. When we talk about resilience, it's also about your employees' health. We have them sign up for this program if they want to, and they get rewarded with points that are worth something. They can turn them in for things they can buy or cash. It's one way to help people take care of themselves because an issue with nursing is that when we offer a variety of programs like this, not all of [the nurses] feel that they have the time because the majority are women who have a lot of responsibilities at home, and they often don't take care of themselves. So this is one of our ways to say, "OK, we are offering all of this, but guess what? We're also going to reward you for taking care of yourself because we think it's that important." 

Q: Are there any other significant changes or improvements to the nursing workforce you're hoping to see in 2023?

KS: We asked our nurses last year what it is they wanted — a list of all the things that would make work even more rewarding or less stressful. And they gave us a long list, so this year we went market by market and had about 200 nurses give us input in our focus group as to what they wanted [to prioritize.] What I tell people is look at this long list because these are all the things that we want to do — and we intend to do them all — but we can't do them all at once, so we have to figure out what's most important. These are the top four that they told us:

1. Shared governance throughout the entire U.S. — a formal shared governance program where they know nurses have a voice in everything that affects them.

2. A program for personal growth. They would like it to be about them as individuals. Not everyone is going to stay at the bedside for 40 years and there are so many different jobs that nurses can do, but nurses don't always know what those are, how to change or get the education and certifications they would need to change. They're asking us for some help in personal growth surrounding how they can make decisions about their careers. 

3. Closer academic partnerships. Nurses realize that if we're going to have great teams, we have to have more people on the teams. We have a couple really strong academic partnerships in our various markets and we're working on some others to make nationally. We're working with [Atlanta-based] Morehouse School of Medicine and [Los Angeles-based Charles R. Drew University of Medicine and Science in California to increase diversity in nursing, and we have several others that we are talking to right now. 

4. A continuation of wellness, health and resilience. Wellness and resilience isn't a pillar by itself; all of these other things [above] matter. The things that nurses are telling us they want lead to resilience. A class about resilience, burnout — it's all very helpful, but root cause needs to be looked at. So the other three things nurses are telling us they want will support resilience, as well as our efforts with the residency program, virtual nursing and the ability to do things like travel. 

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