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VIDEO: Nursing Shortage Solutions

date

September 23, 2022

Nursing Shortage Solutions

Gina Tabone, MSN, has led nurse staffing for over 25 years. She talks with Stephen Dean about her article on the nurse staffing crisis, expanding on her ideas even more.

Original Article: 14 Cures for The Nurse Staffing Crisis

Read the transcript below.

 

Transcript

Stephen Dean

Hello, my name is Stephen Dean. I am COO of Keona Health. We Make Health Desk,

which is an AI-based healthcare CRM product that integrates with the largest EHRs and has a number of tools for facilitating everything from nurse triage to all sorts of contact center handling.

I'm joined today with Gina Tabone, who is, MSN has accrued over 25 years of experience advancing telehealth. During her time with the Cleveland Clinic, she was Administrator of Nurse On Call and participated in a number of cutting-edge practices at that time, including work from home and national centralized contact centers.

And then she moved on to doing consulting for telehealth for physician practices, health systems, mostly around nurse triage. And she was on the verge of retirement when COVID hit. And we were very lucky to have Gina join us at Keona Health.

Gina, you wrote an article fairly recently that we published in our blog around the shortage of nurses today. And I just wanted to ask you a few questions about that. Articles on Nursing Shortage has been published for decades and what is really different now?

 

Gina Tabone 

Great and thank you for that nice introduction, Steven. Nurse Staffing and the nursing shortage is definitely a popular topic in healthcare right now. And someone just shared with me that for the first time in 40 years, the biggest challenge that hospital CEOs are facing is not financial. It is around staffing and filling open positions.

We're at about 10% shortage of nurses within the healthcare environment, which is the highest that it has ever been. I first remember my first experience with the nursing shortage back in 1995, and we'll talk about that a little bit more.But what I think is most unique about what's going on in 2022, is the fact that some behaviors with nurses have changed.

Nurses are very quick to determine if their current employer is the best fit for them, offering them the most. And if not, they're out of there. Everybody is hiring. So, the quick and knee jerk reaction to exiting an organization is a huge problem.

We are also seeing as a result of COVID, huge burnout of nurses and, you know,  I don't want to go into COVID too much during this video because we all know that there really was not a lot of good that came out of COVID, but it did burn out and frustrate a lot of nurses. So, they either left the bedside and went to other types of jobs within the nursing profession, or they left nursing altogether.

Another reason is that we are seeing and this was as a result of COVID primarily, huge influxes of patient populations. You know, nobody knew when COVID hit in March of 2020 that we were going to be overwhelmed in every aspect of healthcare. Be it our telephone triage nurses, the nurses in the clinics, our urgent cares, EDs, and inpatient.

So, we had never experienced such an influx of patients ever. So, that you know, sort of bombing the nurses with patients, it was very overwhelming. And, you know, even almost to the point where some people experience some sort of post-traumatic stress, I'm never going back to that environment again.

And also, what is contributing to this particular nursing shortage is the fact that so much of our population in the United States is over the age of 50. So, our supply of nurses is dropping. However, the demand and eligible patients is increasing day after day after day. And a really unique phenomenon about this particular nursing shortage is where our nurses are at right now.

The average age right now in the United States of a nurse is 51 years old. So, they are retiring early at a very rapid rate and they are not being replaced as quickly as they are leaving. A lot of the reason for that is, it's not that there are not applicants to nursing schools to become registered nurses. They are applying in great numbers. But what we are seeing is that we don't have enough nurse educators in place at nursing schools to admit these students put them through the curriculum, make sure they're capable of passing the NCLEX, and then getting them onboarded and at the bedside.

 

Stephen Dean 

Oh, wow. So, that's not even just a shortage of supply. It's a shortage of training.

 

Gina Tabone 

I first became a nurse via a hospital-based nursing program. So, it's sort of paired with a community college. Yeah. And you got your associate degree from the community college, but you actually got your associate nursing degree from a hospital-based nursing program. Okay?

20 years ago, everybody had hospital  based nursing programs. And for some reason, I really don't know the reason, a lot of hospitals decided to move away from them and closed their nursing programs. Cleveland Clinic was the nursing program

that I graduated from and I haven't verified this, but I bet any money they could kick themselves for closing it because not only did it provide a supply of nurses, you know, you could reward with tuition credits or even pay the tuition for nurses. You know, you could offer that.

So, you knew that down the pipeline, you did have some nurses coming. But also being in a hospital-based program, as crazy as this sounds, doing clinicals, we were also part of the hands-on labor force. So, you know, maybe not in our first couple of months of nursing school, but in time we were taking patient loads. We certainly had preceptors.

So, I'm curious, I haven't, I looked to see if I you know, could find anything but I didn’t. But that idea just popped in my head as I was preparing for this. I bet they wish that they had some of their hospital-based nursing programs.

 

Stephen Dean 

Yeah, well, I mean, and that’s quite the list, too, you know, higher shortage. We've got population changes, retiring early, you know, with lack of education and training. We're just in a position that we've never really been in before. So, when did you first run into issues of nurse staffing in your own experience?

 

Gina Tabone 

Well, I would say I experienced it firsthand in or about 1995. I was working for a satellite hospital of Cleveland Clinic at the time, and there was a drastic nursing shortage. I cannot tell you at that time exactly what the impetus of it was. But what I do recall is that they began in other hospitals within my local northeastern Ohio area began to recruit internationally. So, they recruited different English speaking nurses from around the world.

And predominantly the nurses that came to Cleveland Clinic were either from the Philippines or somewhere in South Africa. The Cleveland Clinic was very involved in I don't know if it was sponsoring these nurses but I know that they help them with immigration needs and housing.

You know, they help them prepare to take the NCLEX exam, which probably everybody was watching this knows, The NCLEX exam is the standard certification test to become a registered nurse. It's the same test no matter what state you're in.

The nurses that came over that had international licenses still had to take the NCLEX within the United States. So, a lot of preparation was gone into preparing these nurses to become part of the nurse staffing rubric for the clinic.

I will say from experience and having worked side by side with a lot of these nurses, it was a very wise decision. They came with great skills and they came  with a phenomenal work ethic, and also an appreciation for the advances that Cleveland Clinic had made up until that point that perhaps they hadn't experienced in the Philippines.

So, it was really a very smart move. A lot of the nurses stayed on and made those local hospitals where they first started working. They made it their place to stay and some of them are still there today. I have one friend who I used to work with who has risen up the career ladder and is in a leadership position and she's phenomenal. It was probably up close to 30 years ago, Stephen. So, again, not something new, but the causes are different and it it certainly is more of a critical problem then I've ever experienced in the past.

 

Stephen Dean 

Yeah, well, I mean, but your experience with that is interesting. Enlightening too, for a number of reasons. Now we're responding to And we're talking about the article

that you wrote called Nursing Shortage Solutions: 14 Cures for the Nurse Staffing Crisis. And for those of us watching, the link will be down to the description. You could also go there to keonahealth.com/resources to see Gina's article on nursing shortage solutions.

You know, you're giving 14 tips to address the nursing shortage, And we've just heard some. And I noticed that, you know, similar to what you just mentioned. The first three of these tips all relate to the recruitment process.

 

Gina Tabone

Let's face it. I mean, we want to retain, but we want to recruit a nurse who is a good fit for our department and our organization. We want to do a lot of vetting in the recruitment process of who would be a good match for us. So, for example, Stephen, we, and Keona are involved in telehealth and telephone triage. So, we want to make sure very early on in the interview process that we make sure that we're hiring someone who understands the exact scope of our work.

And just a very simple example is, you know, you bring someone in for the interview process and you are asking questions and the candidate is not very good or does not demonstrate very good listening habits. You know, as soon as you stop talking, you can tell that they have spent their time not so much listening to you, but formulating a response to what you were saying without really  listening to the whole question.

 

So, a big thing that we want to evaluate is that, you know, does the nurse have good listening skills? Does she realize that by listening to the patient, we are allowing them to help us so that we in turn can help them. Okay. So, we want to make sure that they're good listeners.

We want to do some vetting of our candidates with our HR partners.  You know, we want to make sure before we even bring anybody in for an interview that they are capable of navigating technology. You know, and it's different today in 2022 then it was when I started in 1990. You know, we want to make sure that our nurses can navigate, and if we're toggling back and forth through different applications, or if we're using something like our  health desk, where everything is seamlessly on one screen, whatever our technology is, we want to make sure that our nurses are capable of navigating it.

We also want to make sure that our nurses can type. You know, we need simple typing classes and it sounds so simple and crazy, but I brought in nurses and hired nurses and didn't realize until it was too late, that they couldn't type. So, I'm a great hunter and packer. I type with my two index fingers, but I'm pretty good at it. So, we want to make sure before we  even bring them in that they can type.

And also another strategy, Stephen, that I learned the hard way is that our job description. We want to really make sure that we are putting a relevant job description out there. Don't misrepresent the job. You know, if there are some things that may be not so pleasant or well received, put them out there. In the information that you're posting. At the clinic, we have our nurses They had to work every other weekend. We want to put that in the job description.

Say the organization had six legal holidays. Well, of course, that's when we're most busy because all the clinics are closed. So, we required our nurses to work four out of six holidays. So, we didn't have any straight day shifts. We had day-night rotators. So, you want to sort of put all of that information out there so that you are not misrepresenting the job and that when you bring people in and they don't know this, you're wasting their time and you're wasting your own time, which most nurse leaders don't have time for.

We also want to make sure that we are able to identify qualities or try to identify qualities in nurses that would be valuable in the job or what our expectations of the job are. For example, qualities like, how do you feel about attendance? You know, where the buck stops here with telephone triage, everything else is closed call us. But you know, if we're not staffed because we had so many call-offs, that is a problem.

That puts patient safety at risk.

So, we want to test, we want to evaluate things like attendance. How do you feel about working and asking for advice when you don't know, you know, know something? Is it easy for you to ask questions. Show us examples or give us examples of where you had to go the distance for a patient. Tell us about a time when you had to stay and work after it was time to punch out because you wanted to finish up your work for the patient.

So, we want to reevaluate and try to identify qualities that we are looking for in our new candidates.  Along with recruiting, a big important thing is that we want to evaluate and really make sure that where we are getting our candidates from is a reliable source. And we have gotten good candidates from there before.

I think one of the greatest things is a nurse referral. You know, and you ask your nurses, Hey, we're going to give you a $500 bonus if you refer somebody to us, we hire them and then we'll give you another $500 after they're with us for six months. We want to do that. Reward our nurses, approach nurses who have the qualities we want to see in our new hires.

And also, Stephen, a very innovative thing and maybe it's taking a little bit of advantage of our new candidates, but on the first day our new hires start working, you know, one of the first questions or statements could be, "We're so happy to have you guys. You're such a good fit for us. Do us a favor real quick. Write down five people that you work with that might be a good fit for us. And if they work out, we'll give you a $500 bonus.” And does it kind of put your new people on the spot? Yes, it does.

But you get you know, you're hiring four people. It gives you 20 names to start out with, "Hey, Suzy Jones who just started nurse on call, mentioned you'd be a good candidate for us.  Why do you think you think? You know, come in we're having a pizza, social" or whatever. I learned a long time ago, Steven, Hey, Pride is not my sin. I'll do just about anything to get a new nurse on board and come into my department. It's great.

 

And one more thing about the recruitment process, Steven, and just how we don't want to misrepresent ourselves and really show what the job is going to be like.

When we would be going through the interview process and we deem this candidate good. You know, we'd like to move on with this, a big part of our recruitment process was our busiest hour of the week was always Friday evenings from five till six, because no matter who we were covering for at Cleveland Clinic, which we're almost 2,500 physicians, every single office and clinic at Cleveland Clinic closes at 5:00 on Friday.

So, you know, we saw a huge influx of calls come in, and that would be the time that we would have the potential new hires sit and listen in, and observe the nurses. Again, we didn't want to misrepresent it. It's not going to get any worse than this. So, and that was useful. And a lot of times we put them with such skilled nurses and either the recruit thought, "Oh my gosh, there's no way I can do that."

But the recruits that we ended up  going on to hire thought, "Okay, they're going to you know, they had faith, they're going to train me. This is how it's done,  it's organized.” So, that was a good tactic. So, those are just some of the  probably more personal experiences  I've had with recruiting. So, hopefully, somebody else will get some ideas from them after they watch this.

 

Stephen Dean 

Yeah, well, I'm seeing a theme with a lot of those. And it goes back to a statement that you said earlier about recruit to retain. Right? Setting of expectations, showing them the hard stuff early, getting the right fit so that they're going to be around because you know that turnover gets so expensive.

 

Gina Tabone

Yeah. And Stephen, you know, for myself, when I was the Administrator at nurse on call,  at one point, we had well over 100 nurses. And, you know, the bigger you get with an organization, the more scrutiny you come under. So, there was there was nothing that gave me more of a sick feeling then someone who was in the training process, especially if they had moved on a little bit and they, you know, something came up that was really challenging to them and they couldn't overcome it.

They couldn't perform at the standard that we wanted. So, either we had to let them go or someone that just comes in or calls in and doesn’t even come in and says, "You know, I quit. This is not for me.” I mean, it's like, you see, it's terrible. You know, not only did you invest all this time, but the money, you know, because a lot of these preceptor programs and training programs, there was a certain amount of time when training can be one on one.

I know it's luxurious in this day and age and so much is done remotely, but there still is always an investment in training. You know, finance pointed out to us that every nurse we lose to onboard a new nurse costs us $60,000. That would have like equated to an average salary of $30 an hour or 2,000 some hours a year. So, you know, I just heard of someone, a new grad working at a Cincinnati hospital got hired at $35 an hour. I mean, if I had better knees, hips, back, I would consider going back to the bedside. But it is isn't in my stars.

 

Stephen Dean 

Well one of the things I like about your tips is a number of them relate to thinking outside the box. And you mentioned things like working with restricted licensed nurses, reaching out to the recently retired, some of the avenues kind of like your write down your five friends things that are you know, just not standard.

 

Gina Tabone 

When I think of nurses that I want to hire, it's hard to sort of evaluate or qualify some qualities. But, man, being innovative, it's paramount Being able to think out of the box and turn on a dime when you're faced with a situation that perhaps you haven't dealt with before, You know, solutions. Solutions are where it's at. Come to me with a problem, but have a suggestion for how it can be solved.

So, thinking out of the box and prime example was when I was with Cleveland Clinic, one day someone from Human Resources reached out to me and she was involved with the program and I'm going to refer to my notes, so I get it right. She was involved with Cleveland Clinic's Employee Assistance Plan, and unbeknownst to me, there was a program at Cleveland Clinic called Professional Health Recovery Caring for Caregivers.

So, if any of Cleveland Clinic's employees and especially the professional staff, physicians, nurses, therapists, things like that, were to have been involved in some sort of infraction that would involve recovery and any sort of addiction, substance abuse, things like that. The Cleveland Clinic made the investment to treat them and treat their problem as an addiction.

When there were nurses that were involved  in this program, a lot of times the nurses, when they were in the process of getting back on their feet and in recovery. And also, let me add a very important feature of this. Not only does it involve Cleveland Clinic Employee Assistance Plan, but we worked on this with the Ohio Board of Nursing.

So, it's the Ohio State University that restricted the license, not the Cleveland Clinic. So, we worked along with the Ohio Board of Nursing. We came up with a program for these nurses to actually work as a nurse, and be paid nurses' wages. Because prior to this program going live at nurse on call, nurses were brought back to work, but they worked and at that time it was like a remotely located control center where mostly they did telemetry.

So, in the telemetry units at all of the hospitals, nurses sat along with non-nurses and technicians monitoring the monitors and then reporting any abnormal findings back to the floor. So, this was a job say, you know, the nurse would be making, say, $13 an hour or something. And again, not that that's the most important thing, but she was not functioning as a nurse at the top of her licensure.

So, Nicole reached out to us and we, along with our Cleveland Clinic HR And the board of nursing developed a program for these nurses on restricted licenses. It worked out very well for us and we had the same success rate no better, no worse as we did with any other hire.

The difference was that, a couple of things. We had to go along with State Board of Nursing Regulations and asks of us for these nurses and for example, random drug testing. So, a nurse say, one of these nurses may punch in at 7 a.m. for her 7:00 to 3:30 shift, and at 10:00 she'll come and tell me, "Gina, I got a notice from the Ohio Board of Nursing, I've got to go for a test.” She was done. She left, signed out, went and had her test, and if there was enough  time to come back to work, she came back to work.

So, we had to accommodate some requirements of the board, but we were more than happy to do that.

Workforce management issues there.

Yes. And we really appreciated those nurses and really found them very satisfying and rewarding. And, you know, the patients, of course, knew no difference. Now, we did have certain requirements on them as dictated by the Ohio Board of Nursing. They had to go for their random drug testing, they had no involvement with any sort of prescriptive calls.

So, Cleveland Clinic had a public line for  anyone to call in for advice. So, we were not obligated or we did not have any preexisting arrangements with their providers. So, the triage was straight triage. You know, if the guideline suggested be seen within 4 hours at the emergency room, that was it. So, we were not paging any physicians,

We did not call any prescriptions in for them So, we were always referring either to call 911, go to the ED, go to an urgent care, always offering some source of care to them.

So, they had no prescriptive rights and just some other requirements and I can't remember them all. But, one thing that was interesting was, you know, a lot of nurses had some issues and weaknesses around the medication when they were caring for patients on the floor. And a lot of those were in the high acuity areas. The ED, the units, intensive care, Things like that. Where you see some of your you know, fentanyl, your morphine, things like that were drugs that were accessed.

So, a lot of times working remotely, and having technology be your tools, these nurses were used to being in the trenches. So, a lot of times when they did gain  their full licensure back, a lot of times they did leave us and go to more traditional nursing positions. But we had a great experience with them and I hope they're still doing it. In consulting, I have suggested that to different organizations and actually, help them set up programs and sort of talked it through with some of their boards of nursing.

That was a very satisfying experience. COVID really like we said, it was a high surge in healthcare work. Everybody was overworked and understaffed. And when we started vaccinating, you know, who the heck is going to vaccinate all these patients? We certainly don't want to take our patients off the bedside or out of the clinics. So, different organizations came up with different strategies.

And I can say this from myself, I work for Keona now, but technically I'm retired from Cleveland Clinic. So, I was approached by Cleveland Clinic as a retired nurse. Are you interested in working some of our clinics? You know, we have short four-hour shifts, so, you know, our more mature patients don't worry about your knees, your back, only 4 hours. Premium pay, you know, we'll train you. We'll give you a free gym membership to Curves.

It was a very, very desirable opportunity for retired nurses. And I'm proud to say that a lot of people I know really flocked for those opportunities to help out and do something at a time of crisis and also to make a little more money. Another innovative response to COVID which I saw all over Cleveland was the ability to bring in the National Guard.

I cannot tell you how much the medical personnel of the National Guard helped out Cleveland Clinic. When they brought the Navy medic ship into the port of New York to treat patients, vaccinate, have COVID clinics. So, you know, innovation and thinking out of the box are traits and qualities that I think are hard to quantify. But man, they sure do come in handy when you need them.

 

Stephen Dean 

While we're thinking of some of these themes and creativity is is one of them, some other of your tips are what I would call treating your nurses like professionals. And so why are so many of your tips like that? And why do you think that's important today?

 

Gina Tabone 

You know, nurses are the most prominent profession, employee, group, whatever you want to call it, in healthcare. In the United States, there are 4.4 million nurses. Okay? They compromise close to 20% of the total health care workforce. And I don't know what it is. I don't know if for decades physicians were on pedestals and primarily men, okay?

And nurses were sort of like the labor force down here emptying the bedpans, and giving bed baths, and primarily women. And I think that, you know, culturally

that's where we were at for a long time. However, that has changed. I'm not so sure that nurses have been  elevated quite to where they should be, but they  are somewhat elevated. Right now,  They're extremely elevated because healthcare has to they have to retain every nurse.

So, I think that a couple of things cause this. I think that you know, like I mentioned my  hospital-based nursing program, nurses can take the NCLEX with any type of education. They can take the NCLEX with a two-year community college nursing education, they can be prepared for the NCLEX with a four-year  Baccalaureate Degree, and then some places even have a five or six-year DNP program. Doctorate of Nurse Practice.

Everybody sits for the same NCLEX. So, I think that because we were not always or all of us are not always or weren’t always degreed like everybody has to be if you want to call yourself a lawyer, or an accountant,  or more comparable, a physician. So, I think that some of that led to sort of, you know, oh you just went to Community College.

 

Stephen Dean 

Not really treating them as knowledge workers, right?

 

Gina Tabone 

Exactly. Yeah. Laborers, laborers. You know, running back and forth.  And so I think that led to a lot of the confusion and sort of to not treating nurses as professional. To me, treating a nurse as a professional, you know, first and foremost is assuring that we are doing what we had to go to school for. We are caring for patients so that we are contributing to the most positive outcome for the patients. Okay?

So, we want to make sure that any nonclinical non-duties that we did not have to go to nursing school to learn are sort of turfed off to another member of the  healthcare team who first and foremost, you know, is not paid the wages that a nurse is paid. And I don't mean to be insensitive when I talk about money, but it's a very big reality.

So, I mean, why should we have a nurse taking normal every shift, vital signs when we're paying her $35 an hour when she could be passing meds, or hanging blood on a patient and monitoring it for the 50 minutes, they have to. 

So, transferring any nonessential duties to subordinate people is a big thing that allows nurses to perform duties and practice of a clinician that they are  prepared for and licensed for.

 

Stephen Dean 

Well, and I think it's kind of interesting, indicative of where the culture has been that you have to apologize about talking about money before you say that. Because the lawyer does not apologize about money before he assigns something. Your physician does not apologize about money before he gives his MA a task, right? 

 

Gina Tabone 

It's true. I mean it's true.  And it goes back to, you know, like sort of the Florence

Nightingale nurses are handmaidens, you know. And I've got to just say one thing. So many times when we're working with clients, I'll have an opportunity to listen in on calls. And if a nurse puts out a page to a physician because you know, she's triaged the patient, this is the disposition. But using her critical thinking skills, something's just not right.

I'm going to reach out to my partner physician and review this with him. Nine times out of ten, when I hear those nurses when the physician calls and the first thing they say is, "Doctor I'm sorry to page you.” When we answer the phone and we're on duty,

the patient doesn't say, "Oh, I'm so sorry to call you. I'm so sorry to bother you.” We're working, the physician is working. And so just that little behavior still reminds me that some of this is still going on.

I think that that probably will start going the way of those 51-year-old nurses who are taking early retirement. We're not necessarily seeing that with our newer, younger nurses. So, that's good. That's good. Not that we don't respect physicians and the role that they play for us as nurses, as supporting us and in the continuum of care. But to apologize to someone for calling on them to do their job, it's not necessary. 

And also with professionalism, you know, I think that organizations really have to get in there and reevaluate  their clinical ladders, you know? How do nurses advance?  You know, make sure that they know we're hiring you as a triage nurses. But here's our plan. You know, we like to have triaged nurses. We're going to start you out. We're going to evaluate you every six months, see how you're doing, see what your quality scores are, see what your performance metrics are.

And if this is this, then we will advance you to tier two. And with tier two comes a little more responsibility, but also a little more compensation. And really put it out there for them, just like we did with the job description, Lay it on the line. You know, we're going to share the bad news, but let's share the good news. And let's have them spend time with nurses who are a little bit newer on our team and who are advancing well and consider with them, this is how the fruits of your labor could benefit you.

And you know, there's no better representative for what you do then your own nurses. And, you know, ones  that talk positive about you, but you want to give them evidence that you perform for us Here is what we'll do for you.

 

Stephen Dean 

Well, and with turnover being so expensive, right? And with retention being so important, you want to make sure that there’s the motivation for growth and a compensation that not only is going to keep them from going elsewhere, but reflects the time and expense that you would have to undergo to replace them.

 

Gina Tabone 

Exactly. Reward longevity. Because I think you know we can Google anywhere,

you know, whatever you want to call them, Gen X’s, millennials, you know, in my opinion, anyone under 40-years-old, it doesn't seem to me and maybe I’m wrong, I don't know. But there doesn't seem to be any hesitation to move from one job to another. Either within the same organization or a lot of times out of the organization.

And now, you know,  we are seeing all  sorts of incentives. You know, we'll help pay off your loans, we'll pay moving costs, sign on bonus. You know, we want to make sure that our nurses that we have feel valued by us and not easily replaced. And this is kind of jumping ahead.

But, you know, we read a lot about travel nurses. And and travel nursing is a great gig and it is really popular right now and it's really expensive. And in my mind, I couldn't really wrap around  how organizations were able to afford paying for these  expensive travel nurses. I have a friend and her daughter's a nurse. She graduated two years ago, and she moved back home with her parents and she's doing travel nurse gigs.

This girl is making close as a traveler to $75 an hour. That's great. That puts you at $150,000 a year nursing job. Again, if my knees were good, I'd go back to the bedside. I could not for the life of me, figure out how can they pay people this much money? The vacancies within the organization are so great that what they would spend for wages and add in the benefit package really and truly puts the in-house nurse complete benefits package pretty close to what the traveler is.

So, we want to make sure that, first of all, our nurses don't leave us and travel, take on you know, these jobs in other cities or  even their own state.  For some travel companies, you could look 50 miles from your house and still, be considered a traveler. You just need some sort of address that is this distance from an organization. So, most of the travel nurse companies, I would say just about all of them are owned by for-profit organizations and they have been innovative and figured out angles to get their nurses and their client's jobs.

You know, the health care itself has to be equally aggressive and creative. And right now, I do believe that CEOs are  sick to their stomach thinking about staffing because if you don't  have enough staffing, you can't give a nurse seven patients. If you don't have staffing, there is the possibility that you may have to close a unit. And if you're closing a unit, those are beds not filled, that's revenue not coming in, that daily hospital charge that Medicare or your private insurance is being billed.

So, people really are working hard to fill these position and make sure that they are keeping it competitive and rewarding for their nurses and and proving to their nurses that we value you just as much as kind of like and I'm not going to say it, but fly by night nurses, they're not really fly by night, but they're in and out. They go all over the country. 

I have a nephew, he's a traveler. In the winter, he's out in Reno, and in the summer, he's in northern Michigan traveling.  Who knew you'd be a 27-year-old snowbird? 

We just want to make sure when we you know, are talking about the revenue that the compensation is not fair anymore but more than fair.

 

Stephen Dean 

Well and then you end on an optimistic note and you say the situation is curable. Right? So, I mean, we've discussed a ton of hurdles so far. How are you optimistic that the nursing shortage is solvable for organizations?

 

Gina Tabone 

That's an interesting question, Steven, because I have to have faith that it is. Let's face it, at one point there was not even penicillin.

 

Stephen Dean 

Yeah, right.

 

Gina Tabone 

I mean, so every year there's advances and advances. I mean, now what they're doing with stem cells and healthcare sort of behind-the-scenes has not stopped working. Okay? Research and things like that and also, people such as ourselves, key owner health care has very, very eagerly embraced technology partners.

And let's just talk about it from our perspective. You know, we're remotely caring for patients. We have a technology platform that started out as just a triage platform for nurses. We put the tools that nurses needed to do their nursing job on a software platform so it'd help them care for patients by asking symptom-specific questions and identifying symptoms-specific criteria that would determine what the patient needs to do right now based on what they've told us.

So, we're a technology company. We created a resource for nurses to refer to when a patient calls in to report a symptom, okay? So, we worked with that, and Keona, yourself, O car, Jimmy those are all our partners, began to realize and listen to your clients and hear as a result of a shortage of nursing, what we once saw is a nurse answer model, meaning that nurses were answering the phone when the patient called in.

It was quickly becoming a model where we had a nonclinical person answering the phone. Sort of gathering demographic information, verifying demographics, your address,  best phone number to reach you at, do you still have Blue Cross and Blue Shield.  Doing that work, that nonessential work that we did not  learn in nursing school, we began to realize that, "Wow, what can we do that will help the nurses using this model of having a nonclinical person involved?"

So we sort of came up with that administrative model and sort of the symptom checker. You know, “Gosh, what's going on with you right now? Mr. Jones, I'm having the worst chest pain of my life. It feels like an elephant is sitting on my chest.” Oh, my gosh. That's a 911. We sort of responded to what we were hearing from our clients, and we added a component to our platform that assists with the onboarding of the patient in preparation for the nurse, so that when the patient reaches the nurse, the transfer occurs between the  non-clinical person and the nurse.

All she has to do is hear, "what's going on with you right now, Mr. Jones? Okay, you're having chest pain? I want you to hang up the phone right now and call 911.” So, we allow the nurse to do what  she went to school for. Provide care remotely, virtual care. So, that's just an example of coming up with some solutions to problems or situations that we're encountering. They're not always perceived as problems, but what we do in technology at Keona and other companies is we put on our thinking caps and we sort of, you know what, you don't even know what you don't know yet.

But when we show you what you have and show you that you can shave 85 seconds off of a call, that's a big deal in remote care.  So, I have faith that behind the scenes is working on things that are going  to make providing care for patients easier, be it lab work, radiology work, you know, medications, things like that. I believe that we're doing that.

I believe that we have as I said, actively embraced our technology partners who are making sure that we're practicing at the top of our license in only doing truly nursing work. And then again, we had such good luck with nurses that came from other areas of the world. Perhaps we need to be able to explore that again.

And I'm not sure what is going on in the United States with immigration parameters and things like that. But perhaps it's time to consider that again. We know that we're a global world.  I live in Cleveland, but we talk to people  in Romania every week and India,  we're a global world. So, let's of ourselves as global and universal and perhaps consider bringing over some of our international peers and helping us through this crisis.

So, and Stephen, those are not very scientific reasons for why I feel comfortable.  Maybe not this cold and flu season, but let's say within the next five years.

 

Stephen Dean 

And you've seen so much progress over the course of your life. Right? And now with the advent of A.I. and new models so that nurses can take work that is not really leveraging their specific training and knowledge off of their plates, and making it more effective. The international community. I mean, that is that is phenomenal. I mean, there's so many good reasons to have people immigrating who have the hard work, mental capacity, and desire to grow in their skills and immigrate to the U.S. to do this right?

 

Gina Tabone 

We've proven in the past 30 years ago how well it worked out. So, you know, learn, and repeat.

 

Stephen Dean 

That's right. Okay. Well, you can find more 14 tips and we’ve not covered all of them that go into in-depth. The link will be at the bottom. But you can also go to keonahealth.com/learning resources to see the article Nursing Shortage Solutions 14 Cures For the Nurse Staffing Crisis. Thank you so much for joining us today, Gina. We'll see you next time. 

 

Gina Tabone

Thank you, Stephen, take care.

Posted By

Stephen Dean

Stephen first built his career in information technology, working as a developer for Hewlett-Packard and several start-ups. He received his MBA from Duke before co-founding Keona Health, where manages all facets of finance, marketing, and operations.

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