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Becker’s Healthcare Podcast
Building the Future Nursing Workforce and Advancing Pediatric Care with Cicely “CC” Brooks
00:20:58
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- [00:00]
A
Hi, everyone. Thank you for listening to the Becker's Healthcare Podcast. I'm Erica Carbajal with Becker's Hospital Review, and for today's episode, we are honored to be joined by Cece Brooks, Senior Vice President and Chief Nursing Officer at Children's national hospital in Washington, D.C. ceCe, pleasure to have you on today. Thank you for taking the time.
- [00:22]
B
Thank you. Pleasure's all mine. Yeah.
- [00:25]
A
Well, to start us off, can you share a little bit about your role, the scope of your work at Children's National?
- [00:31]
B
Sure. So, as a Chief Nursing Officer here at Children's national, obviously I'm responsible for the clinical nursing practice that occurs not just within the four walls of the hospital, but within our ambulatory settings as well. And so, basically, I'm primarily responsible in working with my physician colleagues and partners and my operational leaders and making sure we have a solid delivery care model here that keep all of our patients and our families safe.
- [01:03]
A
Great. Thanks for sharing, Cece. Well, what is one goal or priority that is really driving your work right now as CNO at Children's National?
- [01:13]
B
I think one of my current goals and a goal that I've had over the last few years is really to make sure I'm creating a pipeline into nursing through different programs and partnerships coming through Covid, which was a game changer for all of us. We had to be very creative and innovative and how we made sure we had a robust workforce. So, for example, utilization of apprenticeships that allows high school students and others who might be at an entry level position, such as environmental services or food and nutrition, to help create a clear path to nursing for those that are interested. I think it's important that we have these opportunities for folks who may never have considered getting into health care because they find it kind of complex, but this provides them the ability to tap into some resources that they never knew existed. So, you know, my biggest driving force here at Children's national is to create a strong nursing workforce, because that's going to be critical in how we deliver care in the future.
- [02:16]
A
Yeah, absolutely. And I know over the past few years, we've had, you know, heard from so many hospitals who are really focused on going more and more upstream. You know, working with the high schools, working with even elementary schools, and getting in front of those students to plant that seed early and start to show younger folks what a career in healthcare could look like, how many high schools or what is the footprint of Children's National's partnerships look like right now?
- [02:44]
B
So we have a couple. You know, there's quite a few local colleges and universities here, like Howard and Trinity Catholic and some of the other schools, you know, GW in town that, you know, we are in a very rich environment as far as healthcare is concerned. But again, it's all about access, opportunity. So we want to make sure people have access and exposure to what we do here in healthcare. So even beyond nursing, I think sometimes people think nursing is a little scary. Right. And, you know, coming through Covid, a lot of folks left the profession. And so I think with anything, creating those partnerships with our local colleges and universities and some of our other community partners is just so important. Getting upstream, like you mentioned in the high school, is a program that we actually have, through one of our local philanthropic supporters, has been a major donor to Children's national. And their foundation's primary focus is to create nursing jobs for the future. And we actually have a goal of like 5,000 nurses in the next five or 10 years. And so I think we have a great support system at all levels. But to your point, getting upstream, I think is super important so that these kids can see there is a pathway to health care.
- [04:12]
A
Yeah, certainly. Thanks, Cece. It's great to hear about that goal. 5,000. The next five to ten.
- [04:17]
B
Wow.
- [04:18]
A
Well, Cece, I know we talked about recruitment and building the pipeline, so I want to talk now a little bit about retention. I think nationally, you know, we've seen a lot of data and reporting that nurse staffing has stabilized, you know, at least from where we were during the pandemic. Pandemic. And a big theme now is chief nursing officers. We hear sentiment is that they're talking about the importance of individualized career support and how important that is in retention, especially when it comes to those younger, early career nurses. So wanted to ask about that. How does Children's national, you know, approach that at scale? Can you share an example of what that type of individualized support actually looks like in practice? Sure.
- [05:02]
B
So Children's national have done an amazing job with providing nurses opportunity for both professional growth and development. You know, nurses, we're pretty much lifelong learners. So when we have super smart, well educated, certified bedside nurses, that helps us become more efficient and innovative in how we deliver care. And so our focus really hasn't just been on title changes. You know, I think sometimes when people think of career support, they're thinking, you know, what's my next? Pick something, you know, my next job or my next role. But we're actually looking at how do we invest more in nursing at the bedside, you know, for Those that aspire to do more or to do something different, you know, we have those resources in place. We, we've got a very robust learning and development team that specifically focuses on, on leadership development and career opportunities. Again, I mentioned through philanthropic support, we obviously encourage our nurses to obtain higher level degrees. We want them to become certified in their specialty, but we also like them to participate in research. And so a lot of times when we talk about career support, again, it doesn't mean you have to physically move. You can really learn and grow where you are. We do have tuition reimbursement available, like a lot of healthcare systems. And we also have dedicated special funds for attending conferences and other educational opportunities. And I think for us, we really believe that the more we invest in our nurses, the more patients and families will get that return on investment. But I will say, like, the best retention strategy is really to make nurses feel valued and rewarded for the work that they do. So it just depends on where folks are in their career. Because we do have some nurses, they're like, cece, I'm fine where I am. I love what I do. I just want to grow where I am. And so again, that looks different for where nurses are in their career. And our learning and development team will help establish a specified career plan through conversations and assessments. We have a lot of things online that folks can learn more about. And again, exposing them to opportunities outside of what they're currently doing.
- [07:30]
A
Yeah, absolutely. And certainly so much value and thinking about growth and keeping folks in their current roles at the bedside too. Ccb. Yeah. And when you mentioned investing at the bedside, what is that? What does that look like today? What does that entail in terms of technology and like, different care models?
- [07:51]
B
Yeah. So again, we have a, we've got a lot of opportunities and educational opportunities for nurses to have exposure to different roles and responsibilities within nursing. So, you know, whether that looks like a shadowing program for a nurse who may be on a medical surgical floor that might be interested in joining the ICU team. You know, is there a way to have a day in the life? And so we do afford nurses that opportunity to have a shadow experience if there's another area they may be interested in. Each of our team members do have a certain dollar amount that is allotted for them to spend on their own professional career and development. Again, whether that's getting a certification and paying for that or going to a conference, we do, through our shared governance and magnet structure, highly encourage our bedside nurses to participate in research, whether that's submitting abstracts to Professional organizations that often do, because I believe we have the smartest pediatric often results in being called upon to do poster and podium presentations. And so these are our bedside nurses that get the opportunity to speak in front of hundreds of people depending on their particular topic. And we have a team that invests in that and encourages that. So not just our HR learning and development team, but also we have a very nursing specific education team that also focuses on career development. There's clinical laddering opportunities available. So those are some of the things that our team members have access to.
- [09:41]
A
Yeah, that's great. Thanks. Cece, what is one clinical trend or perhaps policy shift that you believe will have the most significant effect on pediatric care in the next few years? I know there's a lot of happening just at policy change level. And how is Children's national positioning itself in response?
- [10:02]
B
Yeah, that's a great question. You know, healthcare continues to evolve, so we've got to learn how to evolve with it either at the same pace or even faster. And I think one of the biggest policy implications for pediatric health systems today is how do we support families related to vaccines? Right. There's a lot of discussion about that going on. This has become a rather controversial discussion that has to be handled very delicately while at the same time making sure we are providing evidence based recommendations to our patients and our families. And for me, as much as I want kids in our hospital, children's, we focus on improving access to preventative care medicine. That's really where the rubber meets the road. There is a tremendous amount of research out there that confirms vaccines are safe. And that's what we rely on, that evidence based research. Recently, I think, I think we've all seen the national spike in the measles outbreaks. You know, and this is a disease that we previously thought had been totally eradicated. But based on recent data, at the rate we're going now, we will have either doubled or maybe even tripled the number of measles cases over the year nationally. For us here at Children's, we continue to provide education as we're starting to look at these trends nationally, making sure we have the appropriate policies and procedures in place. That includes you, you know, for measles specifically, rapidly identifying kids who may be experiencing symptoms, minimizing that exposure as much as possible to others that may be in the hospital, as well as our staff through our different precaution standards, and then also providing early treatment. And so we are so fortunate to have an amazing infection prevention team that tracks this very closely along with nursing. So we can make sure pivoting as needed. So I think at the moment, that's probably our biggest kind of clinical trend that we're seeing in pediatric care.
- [12:10]
A
Yeah. And I think you raised just such a relevant point about just having to shore up policies and education around what was once perhaps an afterthought or not something that you had to think about as much as today with the outbreaks that are resurfacing.
- [12:26]
B
And I think another comment along that, along those lines is, you know, measles is not something you see every day. Right. And we have a very young workforce that has never had to deal with this type of disease process. And so the education has been imperative, and we've done a great job when there have been kids that come in that we suspect may have measles, that we move quickly. Right. Because we want to minimize that exposure. It is. It is a disease that is very highly transmittable. And so we have to do our part to keep our team members safe and also our other patients and families.
- [13:08]
A
Sure, sure. Cece, I wanted to ask you as well, just about nurse residency programs. Obviously, those have become really a cornerstone of early career retention. And one of the things I've been hearing lately is some nursing leaders talking about how their hospitals and systems are revisiting or updating them to reflect just of today's new graduates, because I know a lot of those programs were initially expanded or shored up during the COVID pandemic. So how is Children's national thinking about evolving its residency program? And maybe what do you think a strong program actually needs to get right today that not might have been a priority a few years ago?
- [13:48]
B
Right. Great. Great question. You know, within our nursing residency, we developed a program called Transition to Practice. So it's. It's incorporated into their residency experience. And basically, there's about four different pillars in that program, because our goal is really not to just focus on clinical competency, which obviously is the foundational and the primary pillar. We want people to have those technical skills, but there's so many other things that a new nurse has to master over time. But how do we create a program that helps them with those steps, you know, each of those steps along the way? And so one of the things that we identified, that's another pillar, is instilling confidence and their comfort level within their own practice. And so it's one thing for us to teach you a technical skill, how to administer medications, how to do this or how to do that, but at some point, we need to help them with their level of confidence, especially if there are new activities that they're learning. You know, pediatric care can be very complex in that we take care of patients from age 0, even up to beyond their younger 20s. And so that takes time to develop those skill sets, but also that comfort level. So we have. Part of our. One of our pillars is really focused on how do we grow their confidence. A third kind of pillar really focuses on how to help them cultivate their own robust professional identity. Again, being a new nurse, it could be very scary, especially in pediatrics, when there's so much to learn. You're learning not just how to be a nurse, but you're also learning how to be a professional, how to interact with your patients and families, how to represent nursing within the other disciplines, and then creating your own high standard of professionalism, like, what is your North Star? What. What drives you? How do we make sure we maintain a high level of integrity in how we deliver care? And that's where it comes down to having a high reliable organization. We want our nurse residents, even as novice nurses, to feel comfortable with speaking up. So if they see something, we want them to say something, right? And so that takes time and courage to do that as well. So that is something that we do focus on. And, you know, basically our fourth pillar just kind of moves us into that growth and retention by helping establish, like, a clear pathway for career advancement when they're ready, and again, going back to their ongoing professional growth because, you know, day one, yes, we want to make sure that you are proficient, but we know that we also want to invest in your future. And so we don't wait until they, you know, are out of the program to talk about what do you really want to be when you grow up? And let's figure out how to help you get there. So having those conversations at the beginning, I think has helped us go a long way. We've seen a lot of great success in providing a more comprehensive residency program that also includes mentorship. You know, we encourage research from the very, very beginning, and then a healthy participation in our shared governance model so that our residents know that you have a voice, too. Right. Whether you've been doing this for two months or 20 years, what you have to say is important. And this is how. This is the platform in which you can use that voice. So we've shifted a little bit by surrounding our clinical competency with some of these other programs.
- [17:51]
A
Yeah, Cece, it's interesting, and I know heard just a lot about that, just in terms of the intentionality now about putting structures and resources in place to really help ease that transition to practice and build toward that confidence, which is so important. Well, lastly, before we wrap up here, what is one thing the broader healthcare system still maybe gets wrong or underestimates about pediatric care today?
- [18:17]
B
Wow, that's a. That's a really loaded question. You know, our hashtag is kids are everything. And that holds true because saving kids and delivering great pediatric care, you impact generations. And so I think sometimes our adult colleagues may not truly understand that, that pediatric health care is foundational to what adult healthcare is going to look like one, two, three decades from now. And the work we do is innovative. I think pediatric care, especially myself, having previous adult experience, we tend to be a little bit more innovative. There's a lot of research that happens in the pediatric healthcare space that is life changing. And so, you know, having a full appreciation for that, I think is very important. Also making sure we have the appropriate resources from a funding perspective to be able to take care of these kids to the best of our ability, but also invest in some of those innovative ways to deliver care. And so, you know, being in the pediatric healthcare business, you know, you're not in it to make money. Right. Most of the. Most of our kids are on some type of governmental subsidy or funding that doesn't always cover the cost of their health care. But it's important to what we do. It's something that needs to be done. And so I think continuing to invest in research and education surrounding pediatric health care will have great positive ripple effects in the future, because if you could save that one child or cure that one disease, you basically are impacting generations to come. But it starts with that pediatric care.
- [20:38]
A
Yeah. Some great closing thoughts there, Cece. So wonderful to have you on today. Thank you.
- [20:43]
B
Thank you.
- [20:44]
A
Yeah, absolutely. We look forward to continue following the work that Children's national is leading to enhance pediatric care and build the workforce of the future.
- [20:54]
B
Thank you. Appreciate it.