Interviews with Executive Nurse Leaders NGR 6725 - 2017

Nurse Executive Comments 23 Interviews with Nurse Executives Comments in red were frequently cited.

Major Changes in their Role Medicare reimbursement changes – declining revenue and focus on value-based caring including nursing care Care is more globally focused Many more mergers and consolidations Even public health agencies pursue insurance reimbursement Nurse Executives more involved in policy discussions and strategic planning A focus on population health and care in the community EHR playing a bigger role in care. Clinical staff reporting to non-clinicians Staff much more disengaged Nursing has much broader role responsibilities – need to have financial savvy and be strategic – different priorities.

Top Role Challenges Interviews Conducted Sept/Oct 2017 Recruitment and retention of staff Managing the needs of Millennials Staff engagement Implementing the many changes that occur and ensuring standardization Staying connected to staff Many competing demands for time Reimbursement for care – heavy Medicare and Medicaid payer mix Lack of resources to provide optimal care. Physician-nurse communication Maintaining a patient-centered approach in the face of financial constraints. Ensuring patient safety, quality and good outcomes. Integration of our organization with another organization that was recently acquired. Standardization of practice Lack of Mental Health resources in the community Consumers posting reviews on social media of nursing care. Interviews Conducted Sept/Oct 2017

Key Competencies Needed Be at least Masters prepared – a must today – MBA would be helpful and a DNP is a real plus Strong business skills and fiscal acumen – a must Strategic thinking and planning Patient-centered in thinking and customer focused Team Player with Strong Interpersonal Skills Generationally sensitive Life-long learner AONE Core Competencies are a good starting place Passion for the work and nursing Strong advocacy skills and compassion Understanding of safety and compliance issues Mindful communication Executive presence Emotional intelligence Strong clinical background a plus Political savvy and ability to deal with conflict Ability to integrate evidence-based information into practice

What is Needed to Be an Employer of Choice? Good reputation and known for patient safety Competitive salary-benefits Generational sensitivity and accommodation Just culture Tuition reimbursement Employee advocate Health work environment Career development Culture of caring Shared governance Great leadership Flexibility Solid physician-nurse collaboration A walk the talk culture Work-life balance High Quality Care Magnet or Pathways to Excellent Environment

Pros and Cons of Magnet Cons Pros Expensive Time consuming Resource intensive Not enough return on investment Magnet has become a business onto itself Nurses need to be on board with it. Must have high percentage of BSNs Keeping up your scores All about nursing Shared governance Well structured Gives organization recognition Magnet for recruitment Attracts patients Improves quality of care The pride that nurses feel when they achieve it. Better Recruitment and Retention of Staff

Changes Needed to Adapt to a Nursing Shortage Much more flexible with scheduling – retain Baby Boomer with shorter shifts See shorter term employment as the “new norm” Look at staffing ratios Confront staff burnout Relook at the Team Model of Care with RNs, LPNs & NAs Accreditation of all nursing programs Higher value placed on nurse professionalism Nurses need to practice at the full scope of their licenses. Look for a way to incorporate all the RNs going back to become NPs into the practice model Less reliance on traditional means of staffing – redesign of care Nursing residency programs for new graduates Rethink the focus on BSNs

What is Needed to Mentor Younger Nurses into Leadership? Improve the onboarding of current leaders Instill the idea that every nurse is a leader Provide exposure to the role by shadowing Listen to their hopes and dreams – don’t feel threatened Identify the high potential candidates for every leader role Be a great role model for leadership Mentoring into the role beginning in the academic setting Set up mentoring and leadership development programs Current leaders must engage nurses in leadership activities on their units and empower them – promote shared governance Plant the seeds – give them small projects and assignments Encourage them to take risks by getting involved in councils and professional organizations Don’t set them up for failure – let them try new things Map out development plans for high potential staff Stop talking about the challenges of being a leader and mention the positives – project enthusiasm.

Strengths You Bring to the Executive Team My experience Passion Respectfulness Honesty Energy Flexibility Advocacy for clinical care giving and patients Professionalism Caring Strategic and visionary Insight into challenges Nursing Lens Enthusiasm Skilled Communicator Life Long Learner People Person Realism Positivity Courage Team player Transparent Ability to Multitask Creativity Accountability for my areas of responsibility Timely decision making

What Keeps You Awake at Night? The Nursing Shortage – it will grow worse Staying Relevant Patient safety – too many inexperienced staff without good mentors Volumes are too high Inadequate Staffing and Lack of Resources Budget Constraints and Reimbursement Organizational politics Nurses who practice outside their scope of practice Insuring I have a competent workforce Staff retention Lack of Staff engagement Medication Reconciliation Staff adaptation to change Staff morale and satisfaction Nothing keeps me awake at night

Advice for Emerging Nurse Leaders Be a lifelong learner and keep learning always Take care of staff so they can take care of patients Ask good questions Make a leadership development plan – don’t leave it to chance Keep the focus on the patient Take opportunities to advance Look inside yourself first before you lead others – make sure you are ready Keeping learning and do each role well. Be a good listener Be true to who you are Advance your education – get certified…stay educated about healthcare changes. Be flexible – say yes if possible. Don’t get discourage but be willing to leave your comfort zone. Think outside the box Make the difficult decisions

More Advice for Emerging Nurse Leaders Develop a career you can be proud of Read (a lot) and observe leaders Put yourself in uncomfortable situations – this is how you learn. Don’t try to fix everything that is broken Recognize that leadership positions carry enormous responsibilities. Find a good mentor Get good solid clinical experience before you move into leadership Don’t rush to move up the ladder – stop and learn each role Be humble Acknowledge your mistakes Be the leader that you would want to follow Walk the talk Be consistent Aim for Excellence

To our 23 Nurse Executives