Becker's Hospital Review

24 CMO / CARE DELIVERY 'Use less, lose less, hire more': Inside the strategy that cut nurse turnover at AdventHealth By Erica Carbajal T wo years ago, AdventHealth's nurse turnover rate was 31%. In November, that figure dipped to 18.9% — progress leaders at the Altamonte Springs, Fla.-based system link to a three- pronged nurse staffing strategy: Use less, lose less, hire more. "We have seen incredible improvements in turnover," since going live with the approach two years ago, Trish Celano, MSN, RN, AdventHealth's senior vice president, associate chief clinical officer and chief nursing executive, told Becker's. e approach Contrary to what one may assume upon hearing the phrase, "use less" is not about reducing nursing staff. Instead, the goal is to leverage registered nurses effectively and ensure they're working at the top of their license through team models that incorporate more licensed practical nurses and patient care techs. Two years ago, LPNs weren't a part of nursing care models across the system's 53 hospitals. Now, 86 units operate on team models and hundreds of LPNs and patient care techs have since been hired. e "lose less" component is centered on improving retention and is based on four factors AdventHealth has identified through research as the major reasons why nurses leave: work intensity, leadership effectiveness, career growth and competitive market pay, Ms. Celano said. e health system made targeted changes and put efforts in place to make continuous improvements in each of those areas. With competitive pay, for example, the health system began analyzing market trends quarterly as opposed to annually. "e market pay piece is interesting because it really showed us that we had pockets of places where the market was moving faster than we were, and if you don't keep an eye on that, you have nurses who have an opportunity to go work in another facility with pay differentials that are compelling and would probably pull anyone," Ms. Celano said. e health system also launched a nursing clinical ladder across every facility to support nurses with career growth and, on the leadership effectiveness front, has invested in tactical leadership development training for nurse managers and assistant nurse managers. Classes as part of that training home in on practical responsibilities nurse managers oversee, such as leading unit hurdles, staffing principles and effective communication with physicians. Buckets within the "lose less" strategically overlap and link directly back to the "use less" component, Ms. Celano said. For instance, nurse managers learn about workload intensity and appropriate staffing as part of the leadership development training. "Intensity of work is not just staffing. It's three things: acuity of the patient, intensity of the work and the experience of the nurse," she said. "You can have a patient who is low acuity — they aren't a critical care patient — but they are someone who needs to be bathed, fed and walked; that's high intensity. "at was one specific element of our classes — that our assistant nurse managers understood how to make appropriate assignments and knew when they actually needed to bring another nurse in." 'Physician associate' marks a return to the past By Mackenzie Bean The term "physician associate" is not as new as some might think. In 2021, the American Academy of Physician Assistants voted to adopt "physician associate" as the official title for the profession. The organization is now called the American Academy of Physician Associates, but its name — and the new professional title — are not novel. Though PAs were first called "physician's assistants" at the advent of the profession in the 1960s, historical records show "physician's associate" was actually used in the 1970s to describe certain brackets of the profession, according to the PA History Society. The Board of Medicine of the National Academy of Sciences issued a report in 1970 classifying PAs in three different categories — types A, B or C — based on their level and depth of training. Type A PAs represented those who were formally trained and graduated from a university PA program. "The term 'physician's associate' started to be used at this time for the type A PAs to differentiate them from the rest," a spokesperson for the PA History Society told Becker's. In 1971, AAPA officially changed its name to the American Academy of Physicians' Associates and limited membership to university-trained PAs. Around this time, Durham, N.C.-based Duke University — the birthplace of the PA profession — and six other universities also changed their program names to "physician associate" programs. However, AAPA changed its name back to the American Academy of Physician's Assistants in 1973 (officially dropping the apostrophe in 1981) and expanded membership to all PAs after facing pushback from the American Medical Association, according to the PA History Society. While most universities also reverted back to the previous title, Yale University in New Haven, Conn., and the University of Oklahoma in Oklahoma City still use "physician associate" in their program titles today. n

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