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Becker’s Healthcare Podcast
Building a Resilient Nursing Workforce in Rural Texas with JohnRich Levine
00:16:28
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
Hi, everyone. You're listening to the Becker's Healthcare Podcast. Thank you so much for tuning into this episode. I'm Eric Carbajal, an editor with Becker's Hospital Review. And today we're honored to be joined by John Rich Levine, Chief Nursing Officer of Reeves Regional Health in Texas. John Rich, thank you for joining us today.
- [00:52]
C
Thank you. Erica, good morning to you and thank you for having me today.
- [00:57]
B
Yeah, good morning. Pleasure to have you. On. Can you start by talking about an issue that is perhaps taking up most of your time and energy as CNO right now and how you're navigating that?
- [01:10]
C
Yes, of course. Right now, the most significant focus for us in, in our place is workforce stability because we want to be able to stabilize our workforce while building long term nursing infrastructure in a rural environment. So the Reims Regional Health is a small hospital. It is an important hub for patient care in the area because we are located in a geographical location where we are the only hospital within 100 mile radius. And so in that context, one. One vacancy can shift the entire operational rhythm for us. So every staffing decision that we make, it carries financial, cultural, and even clinical impact. And they happen almost at the same time. And at this point, I'm navigating it by shifting from reactive staffing management to a structural design approach that we tried to figure out. We are strengthening charge nurse leadership. We have a charge nurse leadership program that we just launched, and then we are tightening onboarding processes. And we're also aligning our staffing models with patient acuity rather than on the tradition that we've been used to for years and years. As you can tell, probably a lot of our listeners can tell that the Reeves Regional Health has been in existence for over 65 years. I also spend a great deal of time on visibility when teams see leadership. I understand that when leaders listen and make decisions with clarity and all of that kind of thing, stability for the workforce follows. And I really believe in that because I see that in rural health care, culture drives retention more than compensation alone. We cannot compete with bigger cities and bigger medical centers in terms of probably compensation. But we can at least work on the culture that drives our retention.
- [03:23]
B
Yeah, absolutely. John Rich and I know you mentioned streamlining and tightening those onboarding processes. I think that's something we tend to hear a lot about right now from chief nursing officers. Can you share a little bit more about why that's so important right now and how that, you know, factors into retention, especially among earlier career nurses.
- [03:44]
C
We know that earlier career nurses, they, they move a lot. It's a different kind of generation. It's a generation that we welcome, but it's also a generation that we want to learn so that we know how to lead them. And the most obvious characteristic is movement. And so we've been moving a while back and now that we have this kinds of workforce, we want to even capitalize on movement. There is always something that help me recall when people will say about why do we need to train them? They are going to go away anyway. And the deeper question for me is if we, we train them and they stay, that is the most stupid thing we can do to ourselves. It's like a punishment to ourselves. And if we train them and they leave, then it is better for them that we set them up for success in their next phases. So there's always a movement. But what we have, not everyone is designed to be in a certain place at a certain time, only those who are designed for that. Because if we force it, then we're really creating a barrier for them to move forward. So that's my idea about those movements and newer nurses and how to lead them in this healthcare setting at this time.
- [05:13]
B
Yeah, certainly. And I know you mentioned just the challenges with, you know, staffing stability across the board, but even more so felt in rural areas and how one shift can, can really affect the operational rhythm, as you put it. So what do you feel like has been a true differentiator for Reeves Regional when it comes to attracting and retaining nurses in the rural environment? I know you pointed to culture. Can you expand a little bit about, you know, the specific components of that and what seems to really resonate with the nursing staff?
- [05:47]
C
Yeah, so what I meant by that is that our differentiator is our ownership in rural hospitals. Well, I come from a big, big hospital before I came here, and so there's a big shift for me, but doing my homework and understanding what rural hospital is and in that context, nurses see the full continuum of care in rural hospitals. They know their patients personally, they sh with them, they meet them in the aisles, they go to church with them. They influence operational decisions directly. And to me, that level of voice and impact is very powerful. They own their own patients. So in that context, we focus on three things. First, we want to establish leadership with accessibility. Nurses can walk into my office, they can just go in there. There's no need for them to set up an appointment or that they could do that. And they see decision making in action. The second part is the skill expansion. Rural nurses develop broad competences quickly so we can't compartmentalize them and specialize them too much because their growth is accelerated because of their ability to expand. The other one is cultural clarity, which ties up to what I said before. We are intentional about accountability and respect. We address issues early. We celebrate performance openly because it's just us around our community. And to me, even if rural nursing is demanding, it does help deeply ingrained to us, meaning into what we do. And that's what we lean in meaning and ownership to what we do. It is us, it is ours. And no one will come here to save us but us.
- [07:45]
B
Yeah, and I love what you mentioned, just about the being so close to the decision making and being able to having such close access to leaders in rural settings is something that really stands out, especially in the context of just seeing so many reports and surveys, data that speak to how nurses want to be involved directly in the decisions that affect their practice. And it sounds like that can be something that is, you know, a true differentiator in rural hospitals. Well, John Rich, I wanted to ask you as well, just about a topic we've been obviously covering a lot of in the news, which is how hospitals are anticipating seeing a rise in uncompensated care with the lapse of ACA premium tax credits and looming cuts to Medicaid spending. So how are you preparing for the possibility of caring for more uninsured or underinsured patients from a nursing and care delivery standpoint? You know, we cover a lot about this from the financial lens, but curious, you know, from that clinical, an operational standpoint, what this looks like.
- [08:49]
C
Yeah, it's funny that you asked me that question because yesterday we had an in person meeting with a congressman in our area and we asked those questions. And there are people who ask similar questions as well. And I can feel that he has a hard time creating a generic answer to those different questions that mean only one. But to me, preparation begins with operational of efficiency, if you know what I mean. We are standardizing our workflows. We are strengthening documentation accuracy. We are improving throughput by reducing Waste of supplies and materials and even time, every minute we save supports our sustainability because we depend largely on being sustainable by utilizing the limited resources that we have. The second is we are strengthening case management, integration, early discharge planning. We want to be more aware of that. We want to be more aware or increase our awareness of social determinants of health to reduce readmissions and avoidable utilization of our swing bed program, for example. Third, we are focusing on cross training. I just launched it last week. A flexible nursing workforce, I believe, allows us to absorb volume fluctuations within different units without compromising our safety. So we cross train. Are you from the er? Cross train, the med surg, icu, OB different areas. They are just versatile. And then because we know that financial pressures are real and we can feel it in our area, the response must be to us discipline operations paired with compassionate care. And sometimes we feel like, no, they don't. One can exist, but not the other. And the challenge that we're facing is to make both coexist for the discipline operations and owning it and being a steward of it, but also displaying or delivered, delivering compassionate care.
- [10:59]
B
Yeah, certainly, I think I hear with this, especially when chatting with clinical leaders, is the environment that hospitals are operating now has just made. It has just elevated the importance of the operational efficiency and the ability to provide the best care possible, if anything. So it's been interesting to follow this. John Rich, what is one policy shift or perhaps workforce trend that you believe might have the biggest effect on the nursing workforce in rural America in the next few years? What should leaders maybe be paying some closer attention to right now?
- [11:35]
C
I would think that is the shift towards nurse workforce regulation without operational nuance that could significantly impact rural hospitals. We are, for example, us, for example, particularly because we are in the middle of what you call nowhere. The people that are coming to us can come and go and then pretty much there will be no more coming and therefore we are stuck. And so we want to be able to regulate our workforce without so much of those nuance like immigration, you know, visa processing for international hires for out of state. What do they need in order to come to us? It's very expensive. But what we're looking is that mandated ratios or broad federal staffing models, they may work differently in urban tertiary centers, but ours is a 25 bed rural facility and it may not apply. So what I'm saying is that there's no such thing to us as copy and paste, because what works and others may not work for us. We can create our own models. And in that Context leaders should pay close attention to flexibility. As rural health care depends on adaptable staffing models, we should be able to align with census fluctuations and that shouldn't scare us, but a welcomed change in the dynamics of day to day operations. At the same time, work workforce expectations, they are evolving. As you can tell, we have different generations in one team. Nurses are seeking also career progressions. They asked me if they, how, how soon can they become manager the day they are interviewed and it's just amazing that people think that. Way back in the days it would take two, five years to be able to manage. Now we have a six month old nurse, six months in terms of their experience and they are ready to become charged nurses. So autonomy, work, life alignment system that integrate leadership development and transparent career pathways will attract and I believe will retain talent more effectively than those relying solely on pay incentives. That's what I thought it was.
- [14:03]
B
Yeah, John Rich. And I think that just speaks to again, a lot of what we're hearing about is nurses coming in and wanting to see that clear career progression very quickly when they want to be able to envision exactly what that could potentially look like. Well, John Rich, to close us out here, can you share a leadership practice or mindset that has been most important to your success in your career, a piece of advice that you'd offer to aspiring nurse leaders?
- [14:32]
C
Yes, of course, Erica. The thing that I could say about this is that my experience has taught me clarity under pressure. As a leader in healthcare, I can tell that complexity is almost always the constant. My team look for steadiness. They always watch how I respond when the stakes are high. So for those leaders out there that are similarly situated, my advice would be operational fluency. You want to understand finance, you want to understand quality metrics and how they work, you want to understand workforce analytics. Some people call that predictive analytics, but you want to understand what it is about. Clinical expertise alone does not sustain an executive leader. Second thing I want to make mention is to invest in relationships because relationships matter. Before crisis moments arrive, you want to establish trust. You want to build trust early on and it becomes your currency in dealing with difficult decisions. And finally, I would say stay close to the bedside. Leadership credibility grows when teams know that you yourself understand their reality. And sometimes I jump in there and ask to give me a patient that I can take care of, just to know, to make them see and know that I understand them fully. And here I am doing the same things that they're doing.
- [16:09]
B
John Rich, some great closing remarks there. Thank you very much. For carving some time out of your schedule to join us on the podcast. Look forward to continuing to follow the work that you're leading at Reeves Regional.
- [16:22]
C
Thank you. Thank you, Erica, for having me. Have a great day.