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We interviewed CNOs from across the nation to find out the secrets to their success. Dr. Sherrill Sorensen, CNO at SageWest Healthcare in Wyoming, discusses facing the unique challenges in rural healthcare, meeting staffing shortages head-on, and effecting long-lasting change.

What are your top day-to-day challenges you’re facing today?

We’re in a rural area and have two small community hospitals, so our biggest challenge is staffing. We struggle with nurse staffing, retention, turnover, and recruiting.

Overall, it’s hard to have the right staff in the right place. For example, we normally do labor and delivery in both community hospitals. But we’ve had to combine the two departments, to temporarily take OB out of one community because we don’t have enough trained nursing staff.

It’s nearly impossible to get experienced nurses out here. And it’s hard to get our nurses to stay once we get them. When we are understaffed, our nurses work a lot of overtime to fill in the gaps. But, in that case, we risk burnout. We work to give them PTO to prevent it, but then units are short-staffed, so it’s really a hard cycle to break.

We use a variety of supplemental staffing agencies to get contract staff and to help fill the gaps. But it’s hard to recruit nurses to come to rural areas. It’s not as bad here in the summer — we live in a very outdoorsy area and we’re close to the mountains, so there’s a lot to do in the summer. But in the winter, when the wind starts blowing, it’s hard to get nurses who want to stay here year round.

What unique strategies do you use to tackle these challenges?

Our approach to recruiting and developing staff is multi-pronged. We work on solid shared governance so that staff really feel that their voices are heard and that they’re participating in the decisions that impact their practice.

We also work to develop our staff by making sure they have good learning opportunities. In a rural community, we look both to the resources our community offers and to those we can bring in remotely, such as through online courses and distance learning to supplement local education initiatives.

For example, we have two air flight companies in town and they come in and perform a simulation for our nursing students and new graduates. We also have a partnership with the local community college to use their nursing simulation lab. That helps us make sure we are offering constant opportunities for our nurse and nurse leaders to learn and grow.

We also work to have an ongoing partnership with our pipeline of nurses. These are nurses that live in the area and go to nursing school in our town. We try to work with them as they come through their clinical program and to have a good relationship with them throughout their schooling so that when they graduate, they’ll come on board. We give a presentation as they get close to graduation, explaining our salary package, our benefits, and our orientation process so that they will know from the get-go all we have to offer them.

We also have a solid 12-week new graduate orientation for them. That’s another evidence-based tool that we know helps to retain new nurses past their first year and helps them through the transition into practice.

We also do the AACN Healthy Workplace program with our nurses to really tease out if there are any issues or areas we need to work on. We did one at the beginning of the year and more than problems, we really identified areas where there were opportunities for reward and recognition. It’s crucial to recognize good leadership from your staff and really show them you appreciate them and the hard work they do.

We also work on tactics and tools — from basic thank-you notes to more formal awards — to promote regular staff recognition and provide constant, immediate feedback to the staff to show them that they’re appreciated.

What’s your biggest career accomplishment?

When I think about big accomplishments in healthcare, I always think about the change that has the biggest impact on patient outcomes. Those are the changes that have widespread and long-term impact and can affect many lives.

For example, at another organization, I worked on a maternal early warning system for hospitals that do 6,000 births per year in an academic setting. That’s a complex work environment — with physicians, nurses, aides, and residence at various stages in their education — and everyone’s interpretation of issues is slightly different. We had several bad outcomes because things were missed. It was difficult, in that environment, to come to a consensus on the source of the problem or even if there was a problem on a systemic level.

So, we started to collect data. It showed a clear picture of how the adverse effects were related to aspects of the current system. We drilled into key events to pinpoint where, exactly, things started to fall apart. But physician leaders were unconvinced.

So, we dove even deeper into the data — a lot of times it comes down to the data. We looked at more cases, over a longer period of time. We showed the physician leaders the commonalities to prove that the same things were happening over and over again and leading to poor results. Their jaws fell to the floor.

But, now that we agreed there was a problem, the key was agreeing on a solution. We were advocating for changing nursing workflow, changing the data collected. We were advocating for a huge change, and at first, the physicians were unconvinced this was the way to go. We brought in more data and tapped celebrated physician experts in the field to help us make our case.

And once our physician leaders really saw the light, there was no stopping them, or the program. We were one of the first hospitals to institute maternal early warning protocols in EPIC. Once we had full buy-in, the program became even more widely adopted, more impactful than we ever anticipated.

This is really the process that I apply with problem-solving on the executive level. I establish why there’s a problem. I compile the complete data to argue the existence of the problem and how it ties to current systems. And I outline the proposed solution, backing that up with evidence as well. I give other leaders the tools they need to take a solution initiative, tweak it, make it theirs, and run with it.

Want to read more about what makes hospitals succeed? Check out our case study on how one hospital saved time and money with Total MSP.

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