July 2024 – The Journal of Healthcare Contracting
Editor’s Note: In the following interview, Regina Foley, Executive Vice President, Chief Nurse Executive and Chief Clinical Transformation and Integration Officer discussed the IDN’s strong nursing culture, importance of safety for both caregivers and patients, and recent initiatives related to those topics.
Hackensack Meridian Health’s nurse vacancy rate is much lower than the national average (6.5% vs. 16%, according to a Becker’s report). What do you attribute to the successful retention of your nursing workforce?
Hackensack Meridian has built a strong nursing culture and we have a reputation as a safe place to work, a place where nurses can work autonomously and spend their entire career.
Our hospitals have been Magnet designated for nearly 30 years, and we are one of the most recognized health systems in the country for nursing excellence with eight Magnet designations; less than 10 percent of U.S. hospitals have earned this recognition. Research consistently shows that Magnet designation leads to increased RN retention and lower nurse burnout, increased RN satisfaction, decreased vacancy and turnover rates, as well as improved patient care, safety and satisfaction. So, we have actively and intentionally created a Magnet culture focused on nursing leadership, professional development, full scope of license, evidence-based practice, and interprofessional collaboration.
We continuously invest in our team and their competencies to ensure our nurses are empowered and that we have an environment that supports the highest quality of patient care. We proudly offer educational reimbursements, including tuition for nurses who want to advance their careers. Our nurses are also reimbursed for national certification and for participating in professional development activities, including our clinical ladder program. We spend a lot of time and attention in developing our nurse leaders and giving our team opportunities to expand their skills.
Our strong relationship with higher education is another intentional step we have taken. We want our nursing students to have an exceptional experience in our clinical sites and to choose our health system as they begin their careers. We also incentivize our team members to help with recruiting as well. Employee referrals are now our third-largest source of hires. And finally, we’re investing in technology and focused on innovative ways to reduce the administrative burden that many clinicians face. One way we are doing this is by partnering with Epic to explore opportunities where we can target efficiency, wellness and burnout.
How does Hackensack strive to make the environment a safe place to work?
We are so proud to have just recently earned the most “A” grades in New Jersey from the LeapFrog Group, which is a national hospital ratings program focused exclusively on preventable medical errors, infections and injuries. The top rankings we consistently achieve from LeapFrog and U.S. News & World Report is a testament to our overarching priority of ensuring a safe and high-quality environment for our patients and team members.
As a high-reliability organization, Hackensack Meridian Health has worked to embed our safety culture and universal skills in our work environment and everyday lives. We are laser-focused on driving a culture where everyone feels comfortable and is encouraged to address safety and quality issues as we work toward a shared goal of zero preventable harm.
As part of that commitment, we have built trust within our organization through the implementation of a just culture, where every team member is treated justly and consistently when reporting errors or missteps. We recognize that protecting team members and making advances in patient safety depends on our collective ability to learn from mistakes – whether human, technical or system-induced errors. Our team feels supported and encouraged to identify, report and address issues or concerns. Hackensack Meridian is nationally recognized for our patient safety and outcomes because of our safety environment and the exceptional care our team provides to our patients each day.
What are some areas of nurse safety that Hackensack has made a priority to address or implement measures? How does this lead to improved patient safety?
Our commitment to providing a safe and healthy workplace environment for our patients and team members is paramount.
We live by our One Team for Safety adage, which speaks to the obligation we all have to look out for each other. That starts with a fair and just culture. By creating and nurturing a fair and just culture consistently throughout the health system, we have built trust within our organization and we have created an environment where everyone feels comfortable and is encouraged to address safety and quality issues. Our team knows we want them to speak up for safety, and that they have our full support when they do. We protect our team members and make advances in patient safety because we collectively learn from our mistakes and keep getting better.
Several years ago, we advanced an initiative involving the redesign of ID badges for patient-facing team members in our acute-care hospitals. These ID badges display the first name and last initial in place of the full name. We implemented this across the system after a successful pilot at three of our hospitals, which showed no reported impact on communication with patients or families, an increased feeling of safety among team members, and overwhelming support to expand the pilot.
We also recognize that hand hygiene is essential to our infection prevention and control measures, and critical to our culture of safety. While we had always consistently monitored the hand hygiene of our team members, we implemented a new electronic hand hygiene system last year that allows us to more efficiently and effectively support patient and team member safety.
Support for the emotional well-being of our team is just as important as protecting them from physical harm. The nursing practice at Hackensack Meridian is built around Watson’s Theory of Human Caring, which reflects our deeply rooted commitment to providing holistic family and patient-centered care, and our shared belief that essential to human caring is fully embracing self-care. Research shows that the Theory of Human Caring improves patient care, and reduces staff burn out. We are proud that many of our nursing teams were among the first in the nation to have been honored with Lotus Recognition from the Watson Care Science Institute – including the first in the country to ever be awarded, which went to Hackensack University Medical Center. Our practice and nursing strategic plan demonstrate a relentless commitment to fostering a culture of genuine self-care and healing.
Providing our nursing team with the knowledge and tools needed to provide extraordinary clinical care is another area of importance – one critical to patient safety and team member well-being. A recent example of this is our partnership with the Morgan Stanley Alliance for Children’s Mental Health and The Society for the Prevention of Teen Suicide to launch enhanced training to help our team better understand and manage behavioral health, particularly adolescent psychiatric challenges and at-risk pediatric patients. We launched this training last year and have a goal of training all nurses across our health system by 2025. The training covers all areas of behavioral health, from identification to treatment, and ensures our nurses have the knowledge and resources needed to deliver a wider range of behavioral health disease identification and treatment strategies.
How does Hackensack work to develop nursing leaders within the system?
As we continue to look for ways to strengthen the current and future nursing workforce, an enhanced framework was developed to support the ongoing professional development and growth of our nursing team. Through the integration of our three schools of nursing (Hackensack Meridian Health School of Nursing and Wellness at Georgian Court; JFK Muhlenberg and Snyder School of Nursing; Middlesex College Nursing Program) and the new Hackensack Meridian Health Sheila Cancro Institute for Nursing Leadership and Practice Excellence, a host of programs and initiatives have been advanced. Examples include:
- NSPIRE, a new apprentice program designed to support newly-graduated, pre-NCLEX nurses in their transition to practice. The program offers a paid practice immersion curriculum before transitioning to Hackensack Meridian’s paid nurse residency program. NSPIRE nurses complete clinical immersions, shadow and are exposed to the clinical environments in which they work.
- The New Grad Nurse Residency Program develops professionalism and independence among recently graduated nursing students and reinforces Hackensack Meridian’s commitment to educate and retain our high-quality nursing staff. Nurses within this program provide delivery of nursing practices using the outcome-based practice model by demonstrating competency in clinical judgment, technical skills and an appropriate knowledge base.
- Developed in 2023, the Beyond the Residency Program offers continued mentorship for nurse residency program graduates.
- In 2023, we also launched the new Lecture Workshop Series for nurse leader professional development. Topics covered included nursing finance and budgeting, nurse leader resilience and work/life balance, nurse onboarding, peer interviewing, team building and trust/conflict resolution.
We also support the development of nurse leaders through:
- National Certification – Nursing Policy – annual payment to help our nurses pursue national certification.
- Tuition Reimbursement
- Nursing Scholarships
- RN-Clinical Advancement Program – clinical ladder/advancement and compensation program
- New Doctoral Research Council to support a culture of continuous improvement and inspire nurses to get involved in research.
- Specialty Academies i.e. Operating Room
- Ensuring our leaders are coaches by providing tools and training to help them create a positive employee experience and workplace culture.
- Hackensack Meridian Health was certified as a Great Place to Work® in Jan. 2024 for the eighth time.