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Q&A: Nurse Leaders on Affecting Outcomes Through Leadership, Part II

Alexandra Wilson Pecci, for HealthLeaders Media, March 5, 2013

Three nurse leaders from the Premier CNO Network, an organization made up of 235 CNOs from across the country that aims to promote networking, collaboration, advocacy, and peer-based learning share their views in an open-ended, roundtable discussion:

  • Kathleen D. Davis, RN, MBA, Senior Vice President and CNO of Presbyterian Healthcare Services in Albuquerque, NM;
  • Judy Watland, R.N., MSN, Senior Vice President and Chief Clinical Officer/Nurse Executive at O'Connor Hospital in San Jose, CA (part of Daughters of Charity Health System); and
  • Carolyn C. Scott, RN, M.Ed, MHA, vice president of performance improvement/quality for the Premier Healthcare Alliance

This is the second of two parts; read Part I here.

HLM: I seems like it would be really easy to get overwhelmed by all the changes that are coming with healthcare reform. Do you feel that's the case for nursing staff, and if so, how can leaders help alleviate that a little bit?

Davis: I think absolutely it can be overwhelming. I think leaders really have an obligation to communicate, to the extent that we can to bring clarity to the conversation, to help connect the dots and align.

I'm often a translator: why we have to do this, what does it mean to us, and what does it look like in our day-to-day work and how does it really link to other things that we're doing? So I think…simplifying the complexity in the discussion and in the work as much as you can is a critical skill for nurse leaders.

Watland: I would add to that. I think when people feel like they don't have any control it's more overwhelming and I think having ways that people can have a voice is really, really important. Even at the local level, or your employment level, having opportunities for nurses to have a voice in how things are shaped [is important].

I'll give you an example. We were at 12-hour shifts; I think most hospitals are. But we also had a pretty high-priced price tag on that which was a bonus that was being given to nurses for essentially working a 36-hour week and getting paid for 40. And that cost us a lot of money to do that.

And so essentially, we need to go back to eight-hour shifts because we can't afford to do this anymore. And it shaved off about between $5 and $6 million a year for us.

And we shared that with staff, we told them the why, we told them why it was so important. Not that everybody liked it, but people understood it, and got onboard and we worked together to make this change house-wide in 2011. They feel like they can trust you; they know the why.

Davis: Some of the changes we need to make are challenging. One for us is we don't have a high percentage of bachelor's-prepared nurses in our market and we have adopted the 80% BSN by 2010 principle, the strategic goal from the IOM report.

And now we're working to work through our career ladder and some of the other things we have in place to help move us in that direction. I would agree that the communication, input, [and] open dialogue, are critical to making changes, understanding the "why." Not just to irritate everyone, but to really help us grow and be viable in the future as a nursing community.

Scott: I would say to add on: This sounds really simple. But it's really such an important part of the process. When the bedside nurses understand the reasons for the requests, for changes in process or implementation of new processes, and understand how it aligns with what's in an IOM report or value-based purchasing or other healthcare reform legislation, they are so willing to get involved and help the organization meet the objectives.

And beyond that, there're some incredibly creative and innovative bedside nurses in each and every organization. I'm always amazed at the ideas and the strategies that they're even able to bring forward themselves; how to make something better. So the whole idea about communication and having a line of sight to why they're doing what they're being asked to do, I think is critical going forward.

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