Next Up Podcast: How health systems can support their nursing teams


Hello and welcome to Modern Healthcare’s Next Up, the podcast for women who are emerging healthcare leaders. My name is Kadesha Smith. I’m your host and I am also the CEO of CareContent, a digital marketing agency for healthcare organizations.

Today, we are talking about nurses — this is a population that has been and continues to be severely impacted by the COVID-19 pandemic.

Over a year ago, nurses everywhere saw their lives upended by the pandemic.

Now, they’re continuing to treat patients with COVID-19 as the delta variant creates another surge in the United States. As of this recording, cases are rising in 42 states. What was once a hopeful end in sight may be further off than we all expected.

On top of that, nurses are continuing to experience emotions ranging from disillusionment, to anxiety, to a lost sense of meaning in their work. Meanwhile, there’s an ongoing nursing shortage that is making all of these problems worse.

Nurses helped health systems get through the height of the pandemic. And in many cases, health systems are returning to that much-needed support. However, not everyone is meeting the mark.

In this episode, we’re talking to a known advocate of nurses and their mental health, Dr. Ernest Grant, PhD, President of the American Nurses Association. The ANA is the nation’s largest nursing organization, representing more than 4 million registered nurses. Dr. Grant has more than 30 years of nursing experience. In 2002, he was awarded the Nurse of the Year Award by President George W. Bush. In 2014, he was inducted as a fellow into the American Academy of Nursing. In 2020, Dr. Grant was named one of Modern Healthcare’s 100 Most Influential People in Healthcare.

Now, let’s dive into our conversation with Dr. Ernest Grant of the American Nurses Association.


MODERN HEALTHCARE: Hello, Dr. Ernest Grant. How are you doing?

DR. ERNEST GRANT: I’m doing very well, and thank you very much for having me today.

MODERN HEALTHCARE: Nurses are the busiest people on the planet right now, so thank you so much for making time for this. So, let’s start with some data points to highlight the landscape of the topic we’re talking about. An American Nursing Foundation survey on the impact of COVID-19 found that when asked about how nurses are doing — given everything they’ve experienced — more than 50% feel exhausted, more than 35% feel anxious or unable to relax, and over 20% are dealing with depression. That’s one.

The next thing is that less than a quarter of nurses have sought professional mental health support since the onset of the pandemic — 30% of whom cite a lack of time as their reason why. And then the last point is that nurses die at twice the rate of the national average of the general population. So, let’s start with just your personal perspective. What has it looked like on the front lines? What kinds of stories are you hearing from nurses as far as how they’re mentally and emotionally dealing with the stress of the pandemic?

DR. ERNEST GRANT: Those numbers that you just read are all accurate and since that survey, has actually unfortunately increased. I am extremely, extremely worried about our nurses and the healthcare system in general. These are individuals who have spent the last 18 months day in and day out, working 12 hours shifts. Not even being able to get lunch breaks or bathroom breaks, to care for people who have come down with COVID and other healthcare issues as well. Because keep in mind, yes we’re in the middle of a pandemic, but other illnesses are happening as well. You’ve still got that person who’s having a heart attack. You still have that person who’s had a stroke. You still have that person who’s had to have surgery. And maybe if they’re lucky, they get one day off a week because of how short-staffed things are. And then now we’re in this, you know, with the delta variant.

Nurses tell me on a daily basis, “I just can’t take it anymore. I need to take a break. I am just mentally and physically exhausted. I need to step away from the bedside.” And I’m happy that they’re doing that because one of the things we know — when nurses are exhausted, then it shows up in their work. There is an increased potential for mistakes. When you read or hear nurses say, “I really don’t want to go to work today. I used to love my job, I used to love to see that I was making a difference.” But when they realize that it’s taking its toll on them, or maybe they come home and they’ve snapped at their family member or their, you know, their children. All those are signs that, yes, they do need to step away from the bedside and take a physical and mental health break.

One of the things that we’ve been advocating for nurses to do is to recognize those signs and symptoms, and to be prepared to do something about it. There are a number of things that we have in place on our website and other resources that nurses can go to, to get that much-needed help. Without nurses, there is no health and/or healthcare.

MODERN HEALTHCARE: That’s right.

DR. ERNEST GRANT: And if this toll continues, I’m afraid that it’s going to drive more and more nurses away from the profession. I know nurses who, instead of going home to their families, they stayed at their institutions because they were short-staffed.

MODERN HEALTHCARE: Yeah.

DR. ERNEST GRANT: And just as we’re recording this, it’s right after Hurricane Ida. I feel sorry for the nurses in New Orleans — a number of the hospitals that are without power, that are without water. They answered the call and came in because they knew what was going to happen and they knew that a workforce needed to be there. So, they reported to work and are prepared to take care of what needs to be done.

MODERN HEALTHCARE: So, how do you think the relationship between the health systems who employ the nurses and the nurses themselves have changed over the course of the pandemic? Do you think expectations are more aligned? Is there more inconsistency? How do you think this relationship has changed?

DR. ERNEST GRANT: I think there’s a lot more inconsistency. The early part of last year, nurses were viewed as heroes. And now they don’t want to be called heroes. They feel that their voices are not being heard. They’re not being valued. With the shortage, we see that hospitals — in an effort to try to alleviate the shortage — they are bringing in travelers to help. But the problem is, is that travelers are making sometimes 10 to 15 times the hourly rate that you’re paying your regular staff nurses. That creates a work environment that’s not really very good. And what you’re doing is, you’re robbing Peter to pay Paul.

MODERN HEALTHCARE: That’s right.

DR. ERNEST GRANT: Because, if I as a nurse leave one institution and know that I can go either down the street or even to another state and make 10 times that amount, I’ve taken the knowledge that I’ve had at that institution — it’s going to benefit where I’m going. And now that institution that I just left has to try to get someone to replace me and, of course, they’re going to have to dig deep into their pockets. The problems arise in that, the people who remain loyal to the institution, they feel that they are not being rewarded very well. I mean, obviously, they are giving them shift differentials and bonuses and things like that, but that’s not helping the situation.

And I’ve heard where some governors have ordered their state’s National Guard to come and help. Well, most people who are in healthcare in the National Guard, their real job is healthcare somewhere outside of the National Guard. So, there again, you’re taking someone away from — say if I was a nurse at a hospital but also was active in the National Guard and I got activated — well, now my hospital is going to be short because my governor says I need to go and help this place. And I understand the need to do that. I’m not criticizing that, but I think we perhaps need to sit back and look at what other ways that we can try to work this out, so that there’s an even distribution of the wealth and of the workforce. So that everybody is happy.
 
I understand in some cases, it is an economic drive that is doing that. And if that’s what it’s taking hospitals to pay in order to get staff, I certainly understand that. But I think there should be some reward for those who are remaining loyal. I also think that we need to convene a conference if you will, with both government and public and private entities to begin to work on this. There’s the short-term answer and then there’s the long-term answer.

MODERN HEALTHCARE: Right. Right.

DR. ERNEST GRANT: And part of the long-term is, we need more nurses graduating from nursing programs. And in order to do that, we need to invest in nursing schools, nursing faculty, clinical sites. All these are things that we need to look at.

And also, I think nurses need to have full scope of practice. Not only the advanced practice nurses in some states — just, nurses who are at the bedside. They’re limited with what they can do; we need to free up those reins. We need to also get nursing out from under the room and board charges that a hospital has. No other profession is treated that way. We’re held accountable for patient outcomes, but we don’t get the rewards of that. It goes to the institution, not to nursing, per se.

MODERN HEALTHCARE: So, this alignment is not just among nurses and their health systems. But it’s nurses and their state governments. Nurses and their federal governments —

DR. ERNEST GRANT: Absolutely.

MODERN HEALTHCARE: Yeah.

DR. ERNEST GRANT: It’s all around. It’s all around, because nursing is everywhere. If you ask John or Jane Doe if they know a nurse, it’s probably, “Oh yes, my next door neighbor is a nurse and they work at the hospital down the street.” We’re school nurses, we’re in public and private industry. I know nurses who are, you know, who work at NASA. Nurses are everywhere. We’re not just in the acute care setting or long-term care. If it’s an industry, there’s probably a slot for a nurse to be there in some capacity.

MODERN HEALTHCARE: You mentioned talking about doing something about this, all of the strain on nurses. Can you think of any organizations that are doing a good job of it?

DR. ERNEST GRANT: There are some hospitals and some chief nursing officers that are listening to their employees. They have a wonderful open-door policy. A staff nurse may feel that hey, I feel comfortable enough going to my chief nursing officer to say, “This is what’s going on, on the floor.” I think actively listening — that’s the keyword is to actively listen to what the nurses are saying that they need, and then working to get that and keeping them informed. We hear you and this is what we’re doing. We also need to invest perhaps in our local community colleges or our local universities to do whatever we can to attract those students when they graduate — that they would want to come here to work as well.

I think also getting the chief financial officer to understand that a nurse, is not a nurse, is not a nurse. Sometimes when I’ve spoken with chief nursing officers — when they’ve made the pitch to the CFO and those who control the budget, we need more nurses — they don’t quite understand what it is that a nurse does. And so, I think bringing that chief financial officer along with them when they’re going on those trips to visit the various floors and see how things are going — I think it would be a great eye-opening experience for that individual. 

And one other thought is, I think we as nurses in this situation don’t help very well when you’re told that, “We’re sorry, we can’t send anyone to you.” OK, we tried to make the pitch for some help; we’ll just bite the bullet and do what we can. I understand that as well. I mean, I’ve been in that situation hundreds of times when I was a staff nurse and particularly when I was a charge nurse. But studies have shown, though, it’s unsafe. And we need to be more vocal in saying that this is an unsafe situation that you’re creating, and let’s see what we can do to try to work things out.

MODERN HEALTHCARE: You’re thinking about the nursing teams who know they have clear needs, know these needs are not being heard. What are your recommendations on how they can raise their hand and say, here’s what we need — and appropriately and respectfully approach leadership about their concerns? How can they say what is or is not happening in their organization that needs to happen, especially to support their mental health?

DR. ERNEST GRANT: Well, usually, in a lot of hospitals — particularly those that are Magnet facilities — each nursing floor should have a nursing staff governance team. And that’s where that starts. No one knows better your staffing needs for your floor than the nurses who work there. My background is burns and critical care. Even though we staffed for a certain level, one of the things that could change is just a phone call that says, “Hey, there’s been an explosion at such and such plant, and now you’re going to get multiple admissions.” So, how are you going to do that as opposed to a labor and delivery floor? Or a med surg floor, or maybe an orthopedic floor where you may not necessarily get those emergency situations?

So, that’s why ANA has always advocated that it’s best for staffing to be worked out between the individual floors in administrations, with the understanding of the need to sometimes flex up and sometimes to flex down. And also given the caliber of nurse that you need. Obviously nurses with multiple years experience — you have to look at that versus a floor that maybe has predominantly new nurses, or it may have nursing assistants or LPNs and etc. Again, people are sometimes seeing that as warm bodies, but they’re not looking at the level of care that could be offered or the level of expertise that could be there as well.

Actually, what is really great is if the CNOs held town halls.

MODERN HEALTHCARE: Yeah.

DR. ERNEST GRANT: Or attended staff meetings of each of the units. If you keep the staff informed, you’re going to be more likely to have people who are going to work with you because they’ve invested in the institution. And they view this as family — and when family is in trouble, we rally around family. And who knows? Maybe presenting issues to them, there may be a suggestion that may come out of the nurses there that has not been thought about from the executive-level perspective.

MODERN HEALTHCARE: Yeah. I want you to offer some take-home messages for aspiring healthcare leaders who are looking at stepping into the C-suite. And this will need to be something they address; this problem will not go away soon. What would you say are the top three lessons from the pandemic that these aspiring leaders can learn and take to heart as they try to support nurses in their forthcoming leadership positions?

DR. ERNEST GRANT: I think probably number one would be to scan your nursing staff. And those who are interested in moving up in leadership positions, give them every opportunity to do so. Even if it’s like moving from a staff nurse to a charge nurse, from a charge nurse to maybe an assistant nurse manager or nurse manager or whatever. Give them the tools and things that they need to support them. Let them know that they are supported. Don’t shut the doors, because again if I see that my institution is willing to invest in me, you’ve got my loyalty, you know?

The other thing I have asked that chief nursing officers think about doing is forming their own leadership academy, if you will, within their institutions. Get a select group of nurses, and one of the things — I think it should be a diverse group of nurses. Not only people of color, but gender as well. And grow those people. Have them perhaps come and sit in at the board meetings. It gives them a taste of what the C-suite is going to be like and how they can perhaps begin to think, how would you handle this particular situation that’s being discussed? Or, you know, things of that sort. Or maybe even asking them for their opinions along that. So, it’s sort of a mentoring-type situation, but it’s a two-way street.

And I would strongly encourage that they take someone who is interested in becoming a leader and develop that. Because if they don’t develop it, trust me, someone down the street certainly will. And they’re going to be looking at, well, I can go and get my MBA or Masters in Nursing or even Doctorate in Nursing. But because I did not feel that I was included here, I’m going to take my skills that I learned here and apply them at my next job. So, who’s going to benefit? Well, it’s going to be that next job.

MODERN HEALTHCARE: Absolutely. And I want to underscore a take-home message that you said earlier for people who may not be a nurse or on the track to become a chief nursing officer, but they’re looking at a different C-suite position. Shadow a nurse for a couple of hours — if you can, without getting in their way — just to get that day-in-the-life insight of what the strains really are.

DR. ERNEST GRANT: Absolutely.

MODERN HEALTHCARE: Thank you so much for your time. Thank you so much for all of this insight. I hear your passion coming through loud and clear.

DR. ERNEST GRANT: Kadesha, thank you very much for inviting me. And I’d love to have the opportunity to perhaps come back and continue this, because I think we’re just beginning to explore some of the answers.

MODERN HEALTHCARE: That’s right. Thank you so much.

DR. ERNEST GRANT: Thank you.

OUTRO COMMENTS: Thank you, Dr. Grant, for that insight on how health systems can take care of their nurses during this challenging time. As nurses support our nation, we have to continue to support them.

Again, I’m your host, Kadesha Smith, CEO of CareContent. We help health systems reach their target audiences through digital marketing that focuses on the right content.

Look for more episodes of Next Up at modernhealthcare.com/podcasts, or subscribe at Apple Podcasts, Google Podcasts, or your preferred podcatcher. If you’ve been enjoying Next Up, please go ahead and leave us a review on your preferred podcatcher as well. Thank you again for listening.


Source: modernhealthcare.com

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