Issue link: https://beckershealthcare.uberflip.com/i/1468176
41 CMO / CARE DELIVERY was because most had personal reasons," Dr. Sanford said. She said nurses also told her monetary incentives were appre- ciated, but their decision to stay "was about being here, doing the right thing for patients and supporting co-workers." In reference to baby boomers, a nurse at a California hospital told Dr. Sanford: "I was already retired when the pandemic began, but I came out of retirement and returned to work. Why? Because I knew my patients and my fellow nurses needed me. I think baby boomers are idealistic, caring problem-solvers. I'm not the only one who couldn't stay away. There were others who came back to serve after their retirement." Support for new nurses Amid a tight labor market and challenging pandemic, experienced nurses have been tasked with supporting new- er nurses, in addition to their own responsibilities. Ms. Brewer of Trinity Health, who works mainly in sur- gery, said she would volunteer on the floor to help nurses prioritize tasks. "A lot of them on the floors are younger nurses," she said, adding that they had to manage many different tasks when caring for COVID-19 patients. "If [patients] were having trouble breathing and in and out of isolation … trying to help [nurses] get through their day and stay organized is mostly what I did — mentoring them to learn 'this is import- ant, let's work on this first and then maybe we can work on something else later.'" She also stood in as a listening ear for patients when they weren't allowed to have family members visit. "The new nurses that were actually scheduled for those pa- tients didn't actually have time to sit there and do that. So just [being] that extra person up there to assist them with their duties and say, 'Hey I can sit here a minute and just stand at the doorway even.' Sometimes, you didn't even go in because of COVID-19, but you could just stand right there at the doorway and be a listening ear," Ms. Brewer said. At Mount Carmel, added support has come partially through a centralized labor management pool. Dr. Mansfield said the pool allowed clinical and nonclinical colleagues to volunteer into the pool and receive training for a variety of tasks that could include environmental ser- vices or outpatient areas and weren't as familiar to a worker who typically works on the acute care side. "There was a real sense of camaraderie and folks working together to deal with these [COVID-19] waves, these surg- es that just kept coming when we already were short to deal with the volume we were experiencing," he said. "Our nurse managers, our clinical managers, directors of nursing stepped in to help with staffing as well. That's not ideal, but that's what we had to do to serve the patients who needed to be served." Mount Carmel is also revamping its nursing residency pro- gram to include more role-playing and simulation experi- ences so new nurses gain insights into problem-solving within the clinical setting. That process began in January. Additionally, the health system is recruiting for a critical care internship for the summer and a critical care fellowship. Dr. Mansfield said the internship is for nurses who are in nursing school between junior and senior year to spend time in the Mount Carmel critical care units, while the fellow- ship is a much more concentrated experience where nurs- es spend 24 weeks in a structured orientation. The fellow- ship, which is open to college graduates, involves didactic learning, as well as training on how to work within a professional team. "We're hopeful all programs will result in good first-year ex- perience for nurses and then they'll stay," Dr. Mansfield said. Outside of those programs, Mount Carmel is lowering its hiring age to 16 to work in either a nonclinical role or clinical support role. At CommonSpirit, experienced nurses told Dr. Sanford they always try to be supportive to new nurses, but couldn't al- ways give them the support they needed during surges be- cause of how sick the patients were and because they didn't have the staff they would have liked to have or normally would have had. Overall, the health system's turnover rate about doubled among new nurses during the pandemic. "I asked a few nurses about it, and they said the new grads because of COVID didn't get to do their clinicals in the hos- pital like they had," Dr. Sanford said. "They [new nurses] did their training in simulation labs, but that's not the same. So when they came out, they were not as prepared as new grads in the past. … Anytime you have new grads, they start as novices and it takes time for them to become an expert. We had these novice nurses coming out with the nurses on the floor taking care of patients at the height of when we had most COVID patients, so there wasn't a lot of time to spend with them." As a result, CommonSpirit is accelerating plans in its five- year nursing strategy. This includes starting a national one- year residency program that incorporates virtual preceptors for new nurses to call and get support any time of the day, Dr. Sanford said. That program is starting this spring. "We're excited about that because we also understand it's not just about getting out of school where in school you take care of one patient and have an extensive care plan for that patient," she said. "Out of school, you'll have four or five patients and you'll have people to supervise and you'll be coming into a new culture. Dr. Sanford said CommonSpirit also began virtually inte- grated care this year so more experienced nurses can help less experienced nurses on the unit. The health system is forecasting that some nurses who might have retired be- cause of being physically tired might want to stay with the health system through virtual nursing. CommonSpirit is a 140-hospital system with more than 1,000 care sites in 21 states. n