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Becker’s Healthcare Podcast
Restoring the Nursing Workforce at Penn State Health, Milton S. Hershey Medical Center with Michele Szkolnicki
00:16:05
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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
Hello everyone and welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Michelle Skolnicki, Senior Vice president and Chief Nursing Officer over at Penn State Health, Milton S. Hershey Medical Center. Michelle, how are you doing? Thanks so much for joining us today.
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C
I'm doing great. Thank you. And I so appreciate the invitation to join you today.
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B
Appreciate you joining us. We have a lot of, you know, big topics in healthcare and what's going on right now to get to. But before doing that, I just wonder if you could please share a little bit about your background and your career.
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C
Well, as you said, I'm currently the Chief Nursing Officer here at Hershey Medical center, part of Penn State Health. We are the academic medical center of the Penn State Health System. I have been here as the CNO for the last four and a half years. Just a little plug. I'm happy to say that we just put in our application for our fifth magnet reaccreditation. So, so happy about that. The Hershey Medical center has 471 beds in its adult hospital and 160 beds in our children's hospital. And we are part of a seven hospital system. And we also have about 180 physician practices, about 22,000 employees. And we also are a learning organization. We are on the campus here at Hershey Medical center of the Penn State University College of Medicine.
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B
That's excellent, Michelle. Thanks so much for that background info and all that other info about your system. The first topic I wanted to get to is what was the most important initiative you led in the last year? What did you do for that initiative and what were the results?
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C
So I have to say for the last year, or maybe the last several years, culminating in this last year, was restoring the workforce. Covid really hit us and hit all of hospitals across the nation as far as needing to replenish the nursing staff as well as other staff that care for patients within the hospital. And we started off with a high vacancy rate, a high turnover rate and just a lot of Nursing repair work as far as the emotional strain of COVID as well. So we put, we had a several year initiative and put a lot of things in place. I am not a person who believes in this silver bullet theory. There's a lot of things you need to do in tandem in order to restore nursing workforce. Everything from how we need to retool our different units so that nurses who are graduating are enticed by what we offer in each of our floors. Because nurses come out choosing with an idea of the kinds of specialties that they want to be in. How do we look at other ways to get nursing staff interested in us, such as international nurses? We have started with that program. Those international nurses didn't come in during COVID because of some of the busy requirements and timelines that are involved. But they have started coming in now and they have turned into kind of a replenishment plan for us too. And we are just so happy to have those nurses here. And they really inspire us in different ways with the different types of experiences that they come with from all over the world. We also involved our nurses. We have nurses that we call RN ambassadors that go to nursing schools and other recruiters fairs and things like that. And they speak from their own heart as far as what it is like to work here. And that has been one of our most successful initiatives as far as the our actual nurses talking about their excitement in being here. We have showcased all of the things that we do for nurses to grow nursing. We have very strong certification programs and are into BSN programs which we just highlighted in our recent magnet submission. And the results of it have been great. You know, we have under a 9% turnover rate that we have sustained for the last 13 months combined. You know, our vacancy rate measured as of last as of December is 2.65. Our continue, our quality continues to grow and be better and better. And we recently got the results of our staff engagement story that shows that our staff are also more engaged and happier. So restabilizing that workforce and preparing for the headwinds for what to come come next has been so vital. And I think we are now in a very good position in which to do that and have put a lot of processes in place that will help to continue to sustain us. And a lot of our focus has been not to continue to ride that up and down roller coasters. You're well staffed, you're not well staffed, but to really put things in place at work and to work at sustaining those things.
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B
Yeah, I appreciate you sharing that Michelle, because, you know, obviously a lot of systems nationwide are still dealing with workforce shortages. So, you know, and I think you just touched on it. But could you kind of tell us what you think was the biggest step in restoring your workforce?
- [05:45]
C
I'm not sure we have a biggest step, but I'll give you an example or 2. So, one, I think that there is a lot of. A lot of hospitals have hardship with staffing, medical surgical units, for an example. For example, a lot of nurses are graduating nursing school and they want the flash, you know, they want the critical care units, they want the emergency department for which we have wonderful programs in order to help those nursing students be successful. But in med surg, which typically has the impression maybe of being kind of a melting bag of everything, a melting pot of everything, we worked to basically give identity to each of our nursing floors and to put specialization within them as well. So we have medical specialty floors and what those concentrations are. One of those floors actually has a certification in niche, and we follow the 4ms. For treating the aging adult. And we have those things in place because there are nurses that like to take care of patients that are less young. Our surgical floors have been segmented into the floor that takes care of orthopedics and neurosurgery and the floor that takes care of mis and surgical specialties. We have dedicated cancer floors. What we have found is by giving these med surg floors an identity and a specialization, nursing students were attracted to them. I am very, very proud and somewhat amazed to be able to say that our med surg units, we have a zero percent vacancy right now in all of our seven medical surgical units. And it was. And it was. The nurses wanted to specialize in certain things and wanting to become expert in certain areas. Now, sure, all of those units do get mixed sometimes with other types of patients because we have to deal with the ups and downs of, you know, right now it's respiratory viruses. And so we do get other people on those floors. But the nurses are really enjoying to have that specialization and to add that to themselves so that they can become expert in certain specialty fields within nurses. Nursing in acute care, where we now have a 0% nursing vacancy rate. And I am just so proud of what they've been able to do with that.
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B
That's incredible news about the 0% vacancy and looking ahead, what are the big priorities and the headwinds you're focused on for 2026?
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C
Well, there's a lot coming. So, you know, I think what all hospitals are worried about is you know what HR1 is going to do as far as having more and more patients that perhaps do not have health care insurance or do not have adequate health care insurance and what it means to still provide the care that those patients need and provide the follow up care that those patients needs. Nurses play a very big part in that. Nurses can help with what those patients need so that they can have a better course on all patients so that they can have a better course when they leave. But I'm particularly worried about nurses. I'm particularly worried about what, what hospitals will be able to do if we actually do see a decline in insurance and what that will do as far as what we can fund. You know, clinical staff shortages continues to be an issue that we need to watch out for. We've done so much work building up what we have, we now have to sustain that. I kind of liking it to water in the grass. You know, you stop watering the grass, it turns brown. Then you water it again and it turns green again. Or sometimes it doesn't. You know, you have to sustain. And I think sometimes that's where we lose it in health care, that we achieve something and then we let it go and then it deteriorates. So we have to keep nurturing what we have built. You know, I already touched on, you know, because of payers, perhaps patients losing insurance as far as we might experience declining margins, we're already hearing that there's increasing insurance denials. So all of these things that affect a hospital from being able to support the mission. And we really, I see that as a very strong headwind. And with some of the rules and things coming out, there's also increasing regulatory complexity which is also going to take people to do those functions as well. So we're going to have to continue to look at that and figure out what we need to do to sustain patients. And in the meantime, and quite frankly not lose focus on our essential mission which is taking care of patients. I do think that nurses can contribute to that a lot. Nurses, besides affecting those things that are very important in health care, such as, you know, hospital acquired conditions and preparing for discharge and things like that, nursing can also be quite involved with those other things that are very important for hospital finances, such as really looking at the length of stay and getting patients ready to be discharged and you know, in a way so that their hospital state stay does not make them more infirm. You know, I mean we hospitals, I like to say that, you know, hospitals, you look in a hospital room, what is the central feature of a Hospital room, it's the bed. At some time during a patient's hospital stay, what is the worst place for them to be located in the bed? You know, we have to, patients have to. We need to seek that cure and that rehabilitation of a nursing of patients while they're in the hospital in so many ways. And a lot of that is what nurses do with regards to mobility. So I think what nursing can contribute, can really help to, to help with some of these headwinds that we might be facing financially in the future.
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B
You just laid out a lot of headwinds for us. But what do you think is the hardest thing you'll have to do this year to maybe address some of those?
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C
Well, you know, when you look at a hospital's budget, one of the biggest numbers you'll see is the expense of labor and the expense of nursing labor. And how can we take that nursing expense and shift the focus from cost to value generator? And I think that is the key for nursing helping hospitals to be successful in these financial headwinds. The things that affect hospital finances, length of stay. There are many insurers that pay on DRG and DRGs basically give you a number of days for the disease process that the patient has. We have an opportunity from once the patient is admitted to be working on discharge. And what does that patient need in order to be able to be discharged safely and to be discharged in a wellness state. And nursing who is next to a patient the whole time that they are here can be so effective in making sure that we stay with that DRG rather than encumber costs that are basically unreimbursed. Nurses also help with decreasing readmissions by the education that they provide. And I would say too, nursing can help with CMI case mix index by making sure that their documentation is as mindful as possible. Be careful, be taken care to document what the patient's actual state is, what the level of their disease acuity and complexity is so that that can be considered when that CMI is imposed. And that really helps with, that really helps with the financial, the revenue that comes back at the hospital if we can work on things like that. And really, you know, nursing is one of the most valuable resources in a hospital and I believe it's one of the most underutilized in those three areas that I had just mentioned, which is cmi, length of stay and readmissions. Nursing can directly affect those and raise what hospitals are able to receive revenue wise without a single extra patient entering the hospital. We just need to maximize that force and utilize that, that important workforce that nursing represents.
- [14:19]
B
And the last thing I want to ask you, Michelle, where do you see the best opportunities for organizational growth right now?
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C
I think part of it is in that, in that nurses can really be a value generator rather than just a cost center. And I think the other thing, too is nursing needs to bend and mold to what hospitals are experiencing. You know, hospitals are going to have to continue to look at their cost structures. You know, I think we're going to see the administrative suites. We're already seeing administrative suites become smaller in numbers. We're seeing COOC roles combining, and we're seeing shared services evolve around much of the health in much of the health systems. What we're also seeing is that when shared services become centralized, that more, I'll say opportunity, but certainly more work falls to middle managers. So one of the most important things that I think I'll be doing this year, and we've already started, is developing our nurse leaders and those middle managers because they're going to need to do more and they're going to need to work differently in order to be able to support those resources that are being restructured. Because you still need management attention closer to, you know, where everything is happening. You can't support everything from that central, centralization type of a focus. Although I think centralization of many of these support services is very good for hospitals, some of it still needs to be on the ground. And I think that will be the middle manager's burden. Like our nurse leaders. Like our nurse managers.
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B
Michelle, thanks so much for a wonderful conversation and for joining the podcast. I look forward to working with you again soon.
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C
Thank you so much, Scott.