Q&A
Questions: Brandon Atikinson, CEO, CareRev
Answers: Jacklynn Lesniak, DNP, M.S., R.N., NEA-BC, Chief Nursing Officer, FirstHealth of the Carolinas
Brandon: The healthcare industry is working through a significant labor shortage, especially in the supply of nurses. Can you share some insights on how FirstHealth has adapted to overcome the nursing shortage?
Jacklynn: This has been at the forefront of my priorities since I assumed the position of chief nursing officer for FirstHealth of the Carolinas. North Carolina is projected to be short nearly 13,000 acute care nurses by 2033 and having a strategy to proactively lead through this is critical. The start of the strategy for nursing at FirstHealth is to improve the pipeline of the clinical team. To support this, we started a full year and a summer nurse extern program. This brings nursing students into our system in the last year of their nursing program and pairs them with an experienced nurse mentor. They gain great experience and can move right into an RN role after graduating. We’ve also started an academy to train our own certified nursing assistants. Right now, if someone wants to become a CNA, they likely need to quit their day job to pursue education, which might not be possible. To remove this barrier, we have worked with the Foundation of FirstHealth to provide financial support for enrollees as they go through the program. And, like most health care organizations, we started an internal agency to combat the use of true external contract nurses. That, along with our weekend program, job share and float pool, is part of our work to establish a flexible workforce. Nurses are looking for that flexibility, especially in acute care.
Brandon: Why do you believe CareRev is best equipped to help FirstHealth overcome some of these challenges? How do we fit into your overall labor strategy?
Jacklynn: CareRev fits seamlessly into our flexible workforce strategy. We need to be able to staff up and down based on census and acuity in our system. CareRev’s on-demand workforce works to that effect and will help us cover unexpected gaps like sick calls and leaves of absence. We can’t do that with traditional contract nursing. It doesn’t matter what your census or acuity is in that model – you have the nurses you’ve contracted with for 13 weeks regardless. CareRev will help with short-term and spontaneous staffing needs.
Brandon: How do you anticipate this partnership benefitting your full-time nursing staff and nurse managers? Your patients?
Jacklynn: There is nothing more stressful for a nurse than walking into work and worrying if they have all the resources they’d like during their shift. Nurse managers are always feeling the pressure to make sure this isn’t the case. We’re fortunate that our staffing is in good shape at FirstHealth. Our organization has continued to be nationally recognized for outstanding patient experience. It takes a high-quality staff to be able to achieve that. CareRev will help us get into an even better position to support our nursing staff and nurse managers to provide the level of experience and quality our patients have come to expect.
Brandon: What are some of the challenges of organizing and mobilizing staff in acute care? I’d love to hear your thoughts on why acute care is unique in this regard.
Jacklynn: The biggest differentiator is that acute care is 24/7. There are no breaks, and no stopping the flow of patients. In a clinic setting, nurses have much more control over workflow. Acute doesn’t have that benefit, and that stress largely falls upon nursing staff. We serve a large population at FirstHealth and are frequently at capacity, so there are not the ebbs and flows other hospitals experience. We’re doing a great deal of proactive work on the transformation of our care delivery model to be prepared for the future. In this work, we have really leaned into the virtual nursing model as well as reintegrating the LPN into the care team and upskilling our CNAs. CareRev staff will play a critical role in supporting that shift.
Brandon: Resiliency has been increasingly important for health systems over the past few years. In your opinion, what do health systems need to do to improve the resiliency of their workforce? What does a modern clinical workforce strategy look like for hospitals and health systems?
Jacklynn: Coming out of the pandemic, resiliency has become a major point of focus for every hospital. There was no such thing as a resilience strategy when I was a bedside nurse. It didn’t matter if you had a bad day – you were thrown into the fire and had to hope you could manage it. Health systems have realized that doesn’t work anymore. It’s crucially important here at FirstHealth, and we’ve developed a number of initiatives to build resiliency within our workforce. We’ve expanded our Center for Well-being, which supports our workforce’s overall well-being with community, emotional, financial, fitness and spiritual resources. CareRev’s on-demand workforce will play a significant role in supporting our resiliency moving forward. If members of our staff are having a tough day, we have the ability to lower the intensity of their work and backfill their role until they’ve recovered.
Brandon: One thing I’ve learned in my time at CareRev is the truthfulness of the old saying, “Once you’ve seen one health system, you’ve seen one health system.” It’s a huge challenge for a lot of platforms, but I’m curious about your perspective and experience with workforce platforms in particular and their ability to integrate with your existing systems.
Jacklynn: I’ve worked with a lot of vendors who will provide a package, and it doesn’t matter if it fits or not – it’s what they offer. That’s not been our experience with CareRev. As you know, your team met with everyone under the sun to learn about FirstHealth’s payroll and scheduling systems and understand the best way to integrate with them. From an implementation standpoint, that groundwork has allowed us to get going quickly. It’s removed a lot of concerns for our nurse managers.
Brandon: FirstHealth is renowned for excellence in culture. Beyond filling immediate staffing needs, how do you envision CareRev contributing to your long-term retention strategy?
Jacklynn: Culture integration is exceptionally important. When you bring any external workforce into your hospital, there’s always a lack of familiarity with culture. Our orientation plan leads with cultural expectations, not clinical skills. We know that nurses working through CareRev will bring the technical skill sets we need, because the platform screens for that. Our job is to make sure they have the soft skills necessary to work comfortably beside our full-time nursing staff. Having an eye out for immediate staffing needs is critical, but it needs to be with an eye toward culture and patient experience. All of that contributes to long-term retention.
Brandon: As a CNO of a major health system, where do you see opportunities for innovation in staffing?
Jacklynn: We’ve always been on the cutting edge in this regard. Our staffing plans are data-driven. The traditional approach – methods like offering bonuses to your staff on their days off when you’re down six positions – doesn’t work anymore. CareRev allows us to meet the needs of our health system, the needs of our staff, and ultimately, the needs of our patients.
Brandon: As always, Jacklynn, thank you for your time.
Jacklynn: Thank you, Brandon.
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