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Becker’s Healthcare Podcast
Vicky Tilton, DNP, MSN, RN, Vice President of Patient Care Services and Chief Nursing Officer at Valley Children's Healthcare
00:23:44
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- [00:01]
Erica Carbajal
Hi, everyone. Thank you so much for tuning into this episode of the Beckers Healthcare Podcast. I'm Erica Carbajal and today we're joined by Vicki Tilton, Vice President of Patient Care Services and Chief Nursing Officer at Valley Children's Healthcare in California. Vicki, welcome, welcome. Thanks for being here.
- [00:22]
Vicki Tilton
Thank you, Erica. It's a pleasure to be here. As Erica said. I'm Vicki Tilton, happy to represent Valley Children's Healthcare. I am the chief Nursing Officer and Vice President of Patient Care Services and also have oversight of perioperative services. So basically anything that touches patient care, I have purview over it inpatient wise and then all of nursing reports up to me.
- [00:49]
Erica Carbajal
Yeah. Thank you again for being on. Excited to chat here. Now, we've got a range of different things we're going to chat about, but let's just start with priorities through the end of the year, almost halfway through 2025. So what's one priority that you and your nursing leadership team are zeroing in on to strengthen patient care or support your nursing workforce? Maybe something you're really hoping to make some progress on by the end of the year?
- [01:17]
Vicki Tilton
Sure. One of our top priorities, especially the nursing team, is really it's about optimizing our staffing models to better align with our patient acuity and the clinical complexity we're seeing within our critical care areas and even our acute care environments. So we're actively working on that. It's a pretty, it's a multi system approach that includes looking at our onboarding, our orientation, our training of our staff. We've been incorporating some new positions and leveraging advanced practitioners, providing the team with just additional support to strengthen that clinical presence, making sure our nurse leaders are present within their units and rounding, and then really focus on nurse wellbeing. So all of that kind of ties together to support really what we're focused on.
- [02:12]
Erica Carbajal
Yeah, thanks, Vicky. And I know you mentioned just optimizing those staffing models to align with the reality of the care needs you're facing. So we'll definitely get to that. I think it's a super relevant topic, especially when we talk to folks at children's hospitals and they often mention how the acuity of the patients that they're seeing is very high compared to years back. Well, Vicki, I want to turn now to the nursing workforce. So the National Council of State Boards of Nursing had recently published a biennial study on the nursing workforce. It showed that nearly 40% of nurses are considering leaving the field by 2029. There were some encouraging signs in the report when you think about workforce recovery, but many of the same factors that weighed on nurses pre pandemic. So burnout, staffing, press, workforce safety continue to be the top points of pressure across the industry. Can you share a little bit about how this national picture compares to what you're actually seeing on the ground at Valley Children's? How is it shaping the health system's efforts to support and retain your nursing workforce?
- [03:28]
Vicki Tilton
Yes, the national trends at first somewhat daunting, but as you said, a little glimmer of hope. Though we're seeing at first, it did feel post Covid that we did feel that little bit of shift. However, it does feel a bit of a turnaround here at Valley Children's and I think it's due to really we've made a major investment in our culture, making sure our leadership is very present and supporting the structure that we need to make a difference within our workforce. So we're focusing a lot on building resilience. I mentioned leadership rounding, which is really important, and a lot of transparency. We are doing we hear you sessions. We're allowing our team's voices to be heard, their ideas to come forward, and some of those things we can't always do. But we're doing our best to implement things that are coming forward to the best of our ability and make sure the team is feeling like they're a part of solutions. I mentioned wellness and we've implemented a lot of wellness resources and actual positions to ensure that again, we're taking care of our team. We've redesigned some of our orientation and onboarding, offering different types of mentorship. We've prioritized leadership development and retention really is about compensation for a lot of folks. Right. However, it's also about creating a practice environment where nurses really feel psychologically safe. They feel like they're professionally valued and and that they really have a purpose and that they're professionally driven to be in that environment. And Valley Children's is putting a lot of effort behind that and creating that so that we can retain those folks and we're really proud of what we're seeing coming out of that.
- [05:17]
Erica Carbajal
Yeah. Vicki, thanks for sharing. I think your comments touch on so much of what, you know, we hear about from nurses on the front line in surveys of wanting to be a part of the workflows and changes that direct the directly affect them on a daily basis and affect their workflows. When you mentioned those we hear you sessions, is that something that's relatively newer? What sort of got those off the ground?
- [05:44]
Vicki Tilton
So it stemmed from some opportunities that, you know, I think all organizations go through moments where it feels like, you know, the administration team or the executive team or just the upper leadership team, whatever terminology you'd like to use, aren't always in sync with the frontline workforce or they don't always have the time to connect or it doesn't feel like they're connecting. And we certainly started feeling a little bit of a disconnect there and just feedback we were getting and opportunities that we saw. So that led to some forums that were held and our CEO actually kicked off that for us. And that led to an opportunity for our chief operating officer, our chief people officer and myself as Chief Nursing Officer to connect more genuinely in person with smaller subsets of our team. We kind of divided up into unit level based staff meetings, if you will, and we allowed our frontline staff and leaders of those areas to actually sit down with us and have an opportunity for question answers. And we even made it very personable. We kind of introduced ourselves to some of the frontline staff that don't know us or don't get an opportunity to work with us and told a little bit about our families and our work history, our education backgrounds, again to get them an opportunity to know us at a different level and hopefully more comfortable with approaching us and again, kind of making us more personable to them. And then that led to those we hear your conversations and then that led to forums in person, as I mentioned. And then also we now have a spot on our internal website page where it's actually, it's a. We hear your box and you can click on that and submit an idea anonymously, or you can tag your name to it. And then we're actually collecting that information. And then whether we do something with it or not, or are able to do something with it or not, we are following up with that individual. If they're leaving their name, if it's anonymous, we're actually putting what we're doing with that information on the website as well. Again, a lot of visibility to the team because we found that it's a lot of value to the team to know that they have some input and decisions and that again, their voices and ideas are being heard and they're important to us. So, you know, it's been a huge benefit for us too. And that time with the team is meaningful for myself and my colleagues at the executive level also. And it takes us away from our day to day meeting, all the meetings and that, to really touch base with the team and get to see them in their work environments.
- [08:26]
Erica Carbajal
Yeah. Yeah. I can imagine that that effort goes such a long way in just improving the overall culture and engagement among the frontline nurses. Is there maybe an example that comes to mind of where feedback that was collected through those we hear your forums or through ideas that are submitted through the box tool that you had mentioned, virtually. Example that comes to mind of something that sparked a change recently.
- [08:56]
Vicki Tilton
I'm trying to think. We've had a lot of ideas come forward, and that's a good question. I know earlier on we needed some equipment. And as simple as it sounds and as much as we would put out there to, you know, let us know, let your leaders know, we tended to not hear a lot. And so the team had brought forward that we were low on IV poles, of all things. And within hearing that, I think within seven days, we had enough IV poles throughout the whole hospital that I think you couldn't turn a corner without hitting an IV pole. So, you know, truly, it's. It's those things that make a big difference, especially in the work environment. When you need something, you know, you need it now. And again, it was just that resource. There's been other ideas, though, brought forward around, you know, I think on. I know there was something around a cafeteria, like on patient trays and menus and things of that nature. So it's also little things that are associated with our patients that might make a big difference for the patient and family experience. So again, those things that we might not encounter or think of coming forward from the team really make a difference and an impact, and we're all for it, and we love the difference that it's making.
- [10:13]
Erica Carbajal
Yeah, certainly it sounds like all those smaller things add up too, when they're being addressed. Vicki, I want to turn to pipeline development. So I know Valley Children's recently launched an associate to Bachelor of Science in Nursing pathway program in partnership with Fresno State. And from what I understand, the program covers tuition. But then another unique aspect is that paid study time is built in where nurses can have a shift dedicated to fully focusing on completing their coursework and their education. Can you tell us a little bit more about how this model's working so far, what you're learning as you support the first cohort through this experience?
- [10:59]
Vicki Tilton
Yes, we're incredibly proud of our partnership with Fresno State. It does represent a new model for our workforce development with Valley Children's. This first cohort is, as you mentioned, an ASN to BSN program, and it's really shown remarkable engagement of our 15 nurses that are enrolled. And so what it entails is that these nurses are doing their education through Fresno State to meet the bachelor's requirements. And Valley Children's is paying for the schooling piece. But also we're paying for a day, a 12 hour shift, if you will, so that they actually can have one full day of study time, school time to focus on and they're not really taking a pay cut. So, you know, when you're working full time and knowing that, you know, we're encouraging staff to go back and obtain their an advanced degree, it's hard to. When you have a family or other things and you're used to receiving a certain paycheck, you know, having that be an adjustment is something hard to give up to continue in your education or to take on something more. So Valley Children's taking that on for our team has been so huge and the team is so grateful that 12 hours of paid time has allowed them the freedom to really take the pressure off to get their work done for school, be engaged when they're here at work and not really stress over, you know, having to work those extra shifts trying to get their schoolwork done and cover it all. So it's really been one of the, one of the most satisfiers out of the program as well as, you know, obtaining that bachelor's degree. But the team has really been very grateful and it's really inspiring. The next group of cohorts we're already getting asked because they've seen how well the work life balance has been for this first cohort of students, staff members of ours, and the logistics with the college. Everything's been pretty smooth sailing. I will say. I think the only hiccup we kind of encountered was the realization that there's graduating requirements for the bachelor's degree for Fresno State College, the university itself, and then there's requirements for the nursing program. So we ironed out some of that pretty quickly and we've had a great relationship in collaboration with the Fresno State nursing director of their program as well as their health science dean. And then our executive team that have been engaged, we meet regularly, we check in with our cohort class staff regularly, and they give us feedback. One of the greatest things I think I've heard recent is they said that they've never felt as much support with any education or training throughout their whole nursing pathway as they felt going through this program. So, you know, that's been really great for us to know that we're providing that for them, but also that that's their takeaway. And then that's, you know, they're sharing that with their colleagues and back in the units and that positive influence impact and it's, you know, the next, the next group is coming down the pike. And so we want that advanced growth and opportunity for our staff. So we couldn't be more excited about this partnership.
- [14:39]
Erica Carbajal
Yeah, what great feedback. I know, you know, it's been great to see over the last few years so many hospitals and health systems to really focus on formalizing a lot of these employer sponsored education programs or earn to learn, earn as you loan programs, if you will. One of the pieces too that often comes up is retention. Retention being such a big part of success with employer sponsored education programs and the sustainability of them. What does long term success look like to you with this program? How are you thinking about keeping these nurses engaged, growing with Valley Children's long after they've, they've completed the program and earned their degrees?
- [15:22]
Vicki Tilton
Yeah, long term success to me, you know, it does mean that our nurses don't just stay, that they truly are growing, that they become a leader within our organization, that they are influencing and making a difference not only within our nursing profession, but really in the health and wellness of our patients and their care that we provide. Our goal really is to cultivate a pipeline of that highly engaged, academically prepared nurse who see Valley Children's not just as a place of employment, but really as a long term professional home. So to achieve this, we are trying to really align our educational advancement opportunities with our internal clinical ladder. We've offered some leadership opportunities associated with that, and we're trying to make it very easy and doable, but also in alignment with our organizational initiatives. And then we're expanding our mentorship that I had shared earlier on one of the other topics and then the cohort, you know, working with that network also to maintain that pipeline with Fresno State. There's other opportunities for advanced degree attainment there, which also opens other doors and offers another resource that Valley Children's can support and that aids in retention efforts also. Retention also for me is about being tied to something, right, to belonging. And we're seeing that sense of feeling, feeling a sense of belonging from our newer staff, especially wanting to feel like they're making a difference, that they're here for a purpose and a mission. And we really want that lasting sense of purpose and mission driven value within our team. And so we're seeing that coming from our nursing staff also. And so that's helping us model the way and lead to retention. And all those efforts that we're really striving to align with our magnet status, encourage our team to further obtain certifications, their education track, and doing all that, investing in our team, showing them that we care about them, supporting them on their journey. They want to stay, they want to be a part of our team and they feel valued. And I do see it in our numbers. I see that our retention is, it's going in the right direction and we want to sustain that.
- [17:58]
Erica Carbajal
Yeah, definitely sounds like tackling it, you know, from all angles. And I think about leadership development, career growth, mentorship, all play such big roles. Vicki, I want to talk a little bit about capacity management, patient access, things that come up in nearly every conversation we have with clinical, hospital and health system leaders today. You started to mention a bit about the beginning of our conversation just around some of the challenges with acuity. What are some of the unique challenges that you are facing in a pediatric system when it comes to managing capacity? And maybe one area that you and your teams are really focused on right now that's helping improve patient throughput or reduce length of stay.
- [18:44]
Vicki Tilton
Our capacity management is really complicated, typically by our longer length of stays for our children with very complex medical or social needs. There seems to be fewer post acute care options with pediatrics versus the adult health system. So at Valley Children's, I think our biggest challenge more recently is those hard to place pediatric patients. Those patients for us are some of our kiddos that need behavioral health or skilled nursing care. Some of our child welfare related placements become quite complex. And to address some of these challenges, we do plan for discharges, we do interdisciplinary huddles and we've tried to launch some targeted improvement projects to streamline decision making approaches and align proactive, reaching out to different organizations and things to get placement conversations happening quicker. But it has become challenging in a lot of different areas. And with some of our, again, more complex patients, we are lucky in that we do have a behavioral health center right on our campus for those medically cleared patients that do need some behavioral health care. And we have seen that help expedite those medically cleared patients. And so that has been a huge win for us and a positive. So we are leveraging that. And then, you know, when we're able to obviously get these patients placed, it does open in that next bed for that next patient. And we really are focused on getting, you know, those tertiary quaternary, those higher acuity patients in the bed so that we can offer that care that they need. And when we have those medically complex patients that are ready for that next step of care and we can get them placed timely. It does free that bed up for those more complex patients.
- [20:55]
Erica Carbajal
Yeah, Vicki, thanks for sharing that. To close us out here, can you share maybe one prediction you'd make about where the nursing profession is headed in the next five to 10, 10 years.
- [21:09]
Vicki Tilton
Over the next decade? I've been thinking a lot about some of these things. Right. It weighs on you sometimes, and especially in my role. I hope that we see nursing evolve into a distributed leadership model. And what I mean by that is where our clinical nurses kind of are empowered to become stronger decision makers, drive innovation at the point of care. I think the profession will start leaning into more technology. We know AI is hot on the radar on most organizations now. Virtual care is up and coming. Predictive tools, predictive analytics, all those things. I do think, though, the human factor will not go anywhere. I really think the empathy, the advocacy, the role of the nurse is vital to healthcare and what we do every day. So I foresee that not losing its value. I think that career trajectories in nursing will be a little bit more personalized too, with some flexible paths, honoring the bedside side of things with also, there's a lot of folks that have leadership aspirations, which is a great thing. And I think the future of nursing will be shaped by not what we do, but also how we intentionally do things to support and elevate our staff, our workforce, and really going back to what we talked about, retaining those individuals that we have invested in and strive to keep a part of our team.
- [22:52]
Erica Carbajal
Yeah. Vicki, some great closing thoughts. I think a great point about empathy and the human factor, you know, if anything, becoming more important as virtual care and telehealth become a bigger part of care delivery. Well, Vicki, it was such a pleasure. Thank you so much for being on today.
- [23:12]
Vicki Tilton
Thank you so much, Erica.
- [23:14]
Erica Carbajal
Thanks so much. And listeners, you can tune into more episodes of the podcasts by visiting the podcast page on our website and@beckershospitalreview.com thank you all.