Dr Begley: What do we need to do in the immediate future to support our nurse leaders?
Dr Swick: Well-being for our nurse leaders is one of my top concerns. I was not at the front line with them. I did round, but that's a very different experience. I could see it in their eyes and on their faces, everything that they've been through. Within our organization, we have done a variety of things to support nurse leader well-being. Before COVID, we held a day of reflection. During the pandemic, that was put on hold and many of our nurse leaders were actually in staffing. We're now resurrecting this, and we're looking at some other things that we can do to support our nurse leaders, both in education and the work environment. What can we do to alleviate some of the tasks or barriers that they're bogged down with? This could be assistance with payroll or supply chain management or something else.
Dr Begley: Those are things that really do make a difference right now. Longer term, what do you think we need to do to build the pathway for nurses to want to be nurse leaders?
Dr Swick: I'm always kind of baffled at how we become leaders. We're staff nurses, then we're charge nurses, and then we're clinical leaders or clinical supervisors. And then you're so awesome, you're it. You're the nurse manager and you're it. I think that we need to introduce leadership education much sooner than when a nurse assumes a leadership role. We started with our clinical supervisors, getting them into training, based on AONL's competencies, which is ongoing all year. And of course, most of it now is virtual, which works well. The sooner we can give education to our nurses, because I look at every nurse as a leader, the more beneficial it will be for them when they step into those roles. This is a better way than starting a program once you have assumed the role. We need to start earlier.
Dr Begley: So, what fills your cup and keeps you inspired?
Dr Swick: A couple of things. I have to practice what I preach on well-being. A few years ago, I started walking. I walk rain or shine, 5 miles every morning. When you are working virtually and you're in front of the computer screen all day, [this helped] to get my mind in a good place. I tell leaders, you need to control your calendar. In the past, I worked crazy hours but decided I needed to take more control over my life and myself. And if I can't model that, then what message am I sending to leaders? To take care of others, you need to take care of yourself-it's critically important. What fills my cup is when I round and get to recognize nurse leaders and their teams. We've really stepped up that practice this year. We have a Nursing Stars Program where administrators, physicians, nurse leaders, and grateful patients can make donations to our fund honoring nurses and receive stars to give to their clinicians. I ask the chief nurses, "Who do you want to recognize?" And they usually give me a really nice write-up about a nurse or nurse leader. Then, we pull the team together and recognize them with a nursing star.
Audience member: A lot of nurse leaders are concerned about the experience gap we are seeing with new grads. Any advice on that?
Dr Swick: At Atrium, we implemented a virtual nurse observation program during COVID. It supported a progressive care unit at one of our hospitals because we were using it for ICU overflow and they needed more support. One of the side benefits was the feedback that we got from new grads who were on that unit. They said, "I didn't feel alone. I could call on a nurse anytime I needed them and they were right there." They would bring the cart [with a camera] in with the nurse, and the virtual nurse could look at the vitals, check in the chart, and do the assessment to help the new grad. I think we're going to have to use more technology support and adoption. We need more support in real time. My advice to nurse leaders who can't fill all of their positions is to convert some to jobs they may be able to fill. Convert the position to an educator, clinical nurse specialist, or another position that can support the team. I think that's how we're going to bridge the gap.
Audience member: Have you started work on redesigning care using support staff for RNs?
Dr Swick: Our rural areas that are struggling with staffing issues have hired LPNs in their model to support RNs, and they're doing great. We've hired them in the [nonrural] emergency departments as well. They've been a great support there. We had started a program pre-COVID to train our certified nursing assistants (CNAs) to do a lot more work. We've also added pharmacy technicians in some settings. But like most nurse leaders today, we are still struggling with being fully staffed with our own nurses.
Audience member: How do we improve the work environment? Somehow, we have drifted into this acceptance that nurses can work 13 hours on their feet and not take lunch or have a place to clear their heads. I think it's a unique opportunity for leaders. The Great Resignation sent a lot of nurses traveling. Some of my leaders believe they're going to come back for the stability. Are we going to be ready for them with a different work environment?
Dr Swick: That's a great point. At Atrium, we collectively decided to follow the Pathways to Excellence for our non-Magnet(R) and Magnet facilities. That journey focuses on a healthy work environment, which is so important. We devised a nursing strategic goal to make sure that our teams get their breaks. We have a way that we can monitor that and hold each other accountable for making sure staff take breaks. It has to be our priority.
Dr Begley: I know mentorship is very important to you. We have learned from so many, and now it's our time to give back. Talk a little bit about how you're mentoring.
Dr Swick: I love to mentor others. It's about giving back. Sometimes we can be scary to some of our new nurse leaders. So, just by being present and acknowledging we're not perfect and we make mistakes[horizontal ellipsis]when we show that vulnerability, it allows others to open up more and have an honest exchange of information. I try to be present. I like to get out and round and try to engage the nursing leaders as much as I can about what's on their minds and what support we can offer them. We have a nurse manager enterprise-wide council, with representation from every facility within Atrium Health. We come together on a quarterly basis and talk about the nurse managers' issues. If it is a mentoring moment they need, we try to match up folks together. I would say my chief nurses and others within my corporate support team are all mentors. It comes naturally to them. We like to lift each other up and want to see each other succeed.