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Advancing Health
Rebuilding the Pipeline: The Nurse Retention Turnaround at NYC Health + Hospitals
00:10:23
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- [00:01]
A
Welcome to Advancing Health. We love them, we need them. In fact, we can't do without them. But keeping America's nurses engaged and supported in doing what they love and were trained to do has been a challenge for many hospitals and health systems. Today we get some tips from New York City's biggest health system on its amazing progress in nurse retention over the past several years.
- [00:27]
B
Welcome to Advancing Health. I'm Elisa Adaspakwachaya, Group Vice President for Clinical affairs and Workforce at the American Hospital association, and I'm delighted to be joined by Natalia Sinias, Senior Vice President and Chief Nursing Executive for NYC Health and Hospitals, to talk about the amazing work they've been doing and their progress on nurse retention. So welcome.
- [00:46]
C
Thank you so much. Thank you for having me.
- [00:48]
B
All right, let's get into it. You started a little bit ahead of the curve in terms of when people were starting to focus on nurse retention and how to keep your team intact. But what prompted you and the organization to say, hey, this is a problem and this is where we need to put our attention?
- [01:07]
C
Sure. So when I was appointed in 2019, the data really led us to focusing on retention. We had a turnover rate of 46%. And as you can imagine, that was really shocking. And so at the time, we decided to focus on establishing a nurse residency program. I then hired an amazing senior Director of Professional Practice for Nursing that really helped put together not only the nurse residency program, but also spearhead over 200 professional governance councils that we now have throughout our entire enterprise. And I think those two programs were truly the catalyst of our work as it entails surrounding nursing retention. But that was in 2019, you are correct.
- [02:02]
B
So you really double down on engagement, like, let's get these nursing teams fully engaged in the work that we're doing and let them tell us what are the things that we need to do. As a new leader, that must have been a bit of a tough challenge to say, hey, you know what? Something's not working. Tell me what you think.
- [02:21]
C
Actually, it was exciting. I've always been a leader that believes in the power of our front line. Establishing structural empowerment and that infrastructure was actually really exciting. And I think hearing from our nurses, understanding what they wanted to see, partnering with our labor unions, was the answer, really, to ensuring that our nurses were engaged. And we were establishing programs that they found meaningful and, to your point, giving them an opportunity to have their voices heard. And I think it was really important at the time to educate our leaders about the importance of listening to Frontline. And I think that was a learning curve, but we've succeeded. And now we have a positive practice environment where we have five Pathway to Excellence designated sites to with distinction. And that designation really focuses on a positive practice environment. So to me, that's indicative of the work that we have done over the last six years to focus on engagement and retention.
- [03:35]
B
That's awesome. So where are your numbers today?
- [03:37]
C
So our turnover rate is now 7%, which is phenomenal. Yeah, we've come a long, long way for our staff nurses. We've hired over 3,000 nurses not long ago, and we continue to monitor those numbers. But we're so proud because of the nurse residency program, because of our professional governance councils, because of the amazing fellowship programs that we've established to train our new nurses and our clinical ladder program. A lot of professional development programs have been established in the last six years and that we now see that our turnover rate is 7%. And that is because of the commitment of the entire C suite here at New York City Health and Hospitals. I have to give credit to our President and CEO, Dr. Mitchell Katz. He would say he loves nurses and we believe it because he has been our number one supporter with the City of New York to ensure that our nurses have great contracts that have also been combined with the amazing programs that we've implemented to see this remarkable result.
- [04:50]
B
That is amazing. That is, just to put it into perspective, significantly below, in fact, less than half of the national number of turnover rates. So that is amazing. I love that. One of the programs you've mentioned a couple of times is that nurse residency program, because we know that new nurses, particularly those who were trained during the pandemic, who might have had less clinical exposure, that that turnover rate is through the roof. And it's a challenge to help them understand what does this job look like when they're ready to start it. So can you tell me a little bit about how you've not only helped them figure out how to grow from I'm a brand new nurse to I'm a nurse who knows what I'm doing in this organization, but how you've been able to help them see pathways for them to stay.
- [05:37]
C
Excellent question. So I have to give credit to our amazing team at our corporate office and also our nurse leaders across the entire system that support our nurses in the nurse residency program. We've had over 2,000 participants to date, over 1,000 graduates. And I think that during the nurse residency program, we educate our nurses about a, the importance of the health system that they selected to begin their careers or whether they're new to nursing or new to their specialty. You know, we definitely have conversation about the importance of our mission here at New York City Health and Hospitals to really care for the underserved. And they understand the importance of that, the significance of that. I think they believe in our mission and our vision, and we educate them on the opportunities and the ways to transition within the profession when they are employees of New York City Health and Hospitals. And I think that's been really important. And we talk to them about how they can get connected with other opportunities, how they can become part of the different councils so that they continue to grow and develop professionally. But also once they graduate from the nurse residency program. We created something here at New York City Health and Hospitals which is really unique, that many systems do not have, and I don't think any system has, quite frankly, is the mentorship opportunity. So when they graduate from our nurse residency program, they are able to become mentors to their peers, to really talk about the first year of practice and to give guidance to others. And we're really excited about that program where we're using an AI platform to pair a mentor with mentee of the new residency program graduates. And that has been just phenomenal. We've had over 100 mentors now who come back to support other peers. And I think that's just one of the ways that we continue to retain our nurses, by educating them that while they are new, there's so many ways they can contribute within nursing here at health and hospitals.
- [07:52]
B
I love that because, I mean, if you're tapping into what is in a nurse's genetics, it is about caring for other people. So the ability to then say immediately, not only are you trained and are you in a good place to take care of your patients, but here let's connect you with some of your colleagues. Let's have that best friend at work who you are helping through the same path that you had to tread. I love that. So what are some of the lessons that you learned along the way? Because you started this in 2019 and then there was a pandemic and then the whole world changed. So what are some of the things that you either started and stopped or changed or moved along the way, lessons learned that you wanna share with our listeners?
- [08:34]
C
I think the one lesson I've learned is the importance of communication and staying connected with those doing the work. And I think back to COVID 19 and the fact that we continued to run our nurse residency program to give our nurses a safe space to ask questions, questions to share. Whether or not they were afraid of being in the front lines and providing them support, just to remain consistent, to remain visible, has really been key, and we've said it already today. But I think the importance of listening, listening to others, and that's one thing that I do in all of our programs, whether it's a fireside chat with our front line, whether it's a leadership town hall, just listening to our community of nurses here has been really, really important. And I think that's why we're seeing our success. I think that's why our nurses are staying, because they believe not only in the mission and our vision, but also they know that they are part of the fabric that makes us great and that they are part of the solution to continuing to provide excellent care to our patients.
- [09:41]
B
That sounds amazing. And it sounds like they believe in you, Natalia, that you're part of this solution. You're there to serve them in the way they are there to serve their patients. And I think there's no higher compliment for a leader than to know that. Thank you so much for joining me today for sharing the amazing work that you've been able to do. And I wish you continued good luck with all of this work and I look forward to interviewing you again in a year and finding out what else you've been able to solve.
- [10:09]
C
Thank you so much.
- [10:10]
A
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