Nursing Update

headshot of Ellen Leone

Chief Nursing Officer Ellen Leone, RN, MSN

State of Nursing Practice Q & A with Chief Nursing Officer Ellen Leone, RN, MSN

Looking back on 2023, what were the biggest nursing challenges?

We were challenged by many things this year. We have continued to have a high vacancy rate in several departments, and therefore have continued to rely heavily on travelers to cover staffing needs.  January started out with a bang!  We saw a tremendous surge from what I refer to as “the triple respiratory virus threat,” referring to an increase in COVID cases, coupled with a really bad seasonal flu as well as RSV.  This was occurring across the country, but it really hit us hard here locally as well. I was actually out on a medical leave when this happened.  I was very proud of my team who rallied together to figure out creative ways to continue to take care of our patients.

In particular, we had patients whose elective surgical cases had been deferred for a long time during COVID. Many of these patients were scheduled to have total joint replacement surgeries. The thought of having to postpone that again after so long, and all the preparations you have to make physically as well as mentally and personally, so you have support in your home, was just daunting to us.  The nurse leaders got together, and really rose to the occasion.

Tara Boynton, who was made director of perioperative services later this year, really led the initiative to stand up a temporary short stay unit within the PACU at Pen Bay.  She organized volunteers from the OR and the PACU who rotated to the night shift in order to care for these patients without admitting them to the hospital.  She also collaborated with our colleagues in PT because they had to see patients prior to discharge. It was a whole different way of doing business for us at Pen Bay, but very innovative. The team did this for about three weeks and we saved about 15 people from having to be rescheduled for surgery.

What were some other highlights of 2023?

There was a lot of pressure in the early spring to reduce our number of travelers. We were successful in our approach, and part of that was a result of standing up our transitional care unit at Pen Bay to care for our long-term patients. Most, but not all of these patients are elderly, and they are literally stuck here in the hospital with no definitive disposition. We are still feeling the impact of not being able to move people to long-term care or other places in the community, and although these patients do not require the same level of care, they still need to be cared for physically and emotionally. Standing up the transitional care unit allowed us to do that in a creative way with a heavier CNA and less acute RN staffing model. We were able to shift our acute care staff to open up additional beds to take care of our sick patients coming through the ED as well as our surgical patients. It was another real innovation.

The other really special thing that happened this year was the wedding of a hospice patient at Waldo. We could not do anything more physically for that patient, but it was so important to her and to her husband and family to have this ceremony. I particularly love what she said to her nurses when they put her in bed that night, following the ceremony. She said, “This is the best day of my life.”

To me, this is who we are.  This is our connection to the community and what we want to be known for.

Historically, the nursing teams at Pen Bay and Waldo have stood alone. Have you seen more collaboration this year?

I would say there is much more collaboration across the system. We saw it during the surge at the beginning of the year, and with standing up the transitional care unit. But we’re also seeing it on a regular basis, just managing patient flow. We have our daily bed huddles three times a day, led by nursing supervisors and attended by charge nurses. We do this to increase situational awareness and collaboration related to patient flow and sharing of resources among the units within each hospital. The house supervisors then confer with each other on a daily basis to see if there are any patients that need to be moved between sites. That’s another example of how we’re collaborating. When I first got here, both hospitals were still very much running independently.  We have really come together as a nursing leadership team, and the nurse leaders will tell you that they feel much stronger as a team and that they feel really good about working together to care for our patients.

Our Shared Governance Council is starting year three in our work together and those team members are committed to working together across CHA to enhance the practice environment as well as the patient experience.  We accomplish a lot of work together but always find a way to balance that with having fun.  The members are continually looking for ways to connect with their colleagues out on the nursing units.

Now that the year is winding down, do you think nurses are more or less engaged?

Well, it’s still not perfect, of course, and there is always more work to do.  I do feel that overall engagement among nurses has improved and there is a lot of comradery among the units. There is a different feel when I round or attend staff meetings. There have been changes with some of the nurse leaders, and it seems that, for the most part, new leaders have been well received. Sometimes these changes bring new energy and a new approach to meeting with the teams, giving different work groups a voice, those kinds of things. There’s a lot of pride and teamwork among those teams as well.

I think we had a wonderful Nurses Week celebration, which always leaves me with a sense of renewed passion for my profession.  There was an incredible number of people being recognized and celebrated, and the participation by the nursing teams at both places was impressive.

The ANA Nurses Week theme was, You Make a Difference. I decided to change that locally to I Make a Difference, because I wanted each person that’s either a nurse or one of our partners who works with us as part of our nursing team to reflect on how they individually make a difference every day. “I make a difference in the lives of my patients. I make a difference for my colleagues.”

What other work has been done to increase engagement?

When I started here, which was right at the beginning of COVID, a lot of nurses shared with me that they really weren’t feeling like we were doing a lot of investment in their professional development. There is a big difference between mandatory education and developing people. One of the things that I have been working on is to build out a structure across our hospitals with clinical nurse educators to support that work. This new role has given some of our current nurses an opportunity for professional advancement.  We have also hired some external candidates who bring a wealth of educational experience as well.  There is a lot of collaboration among them, and they are extremely creative in putting together educational programs and supporting nurses who are new to practice, new to a specialty, or in achieving certification in their specialty. We are really just getting started in this work and I only see a brighter future for us under their direction.

Have we made other investments in education and training?

This year, thanks to generous philanthropic support, we were able to award close to $50,000 in scholarships to support 17 different individuals who work for us currently and are either in their initial nursing programs or are already nurses working to achieve advanced degrees. We hope to continue to build this support every year. An important part of workforce development is supporting our own team members.

We enjoy a strong academic partnership with UMA-Augusta and through this relationship, we have been able to offer a summer nursing student externship opportunity here at Pen Bay and Waldo for the past three summers. For our community setting, we also host a large number of senior practicum nursing students who are in their final semester of nursing school.  The students can request to work in different specialties and as long as the faculty person feels that the request is a match for what they need to finish out their program, we try and accommodate every request. We get upwards of 25-plus requests each year.

With both the externs who get introduced to us, and our practicum student nurses, the experience that they’re having here as students is really making them take jobs with us, which is wonderful. That’s the whole goal of that program. We hired the largest number of new grads this year in the time that I’ve been here.

What do you see looking ahead to 2024?

I have undertaken an important system-level project with the regional float pool, and I’m determined that that’s going to be successful. This has opened up rewarding opportunities for our existing staff as well as hopefully attracting others with experience to join us. The overall goal is that we are successful in filling and meeting our staffing needs utilizing the float pool, so that we are less dependent on temporary agency staffing.  Based on that success, the plan is for the float pool concept to expand to the whole Coastal Region initially and potentially to the other regions as well.

That’s one goal. I would say solidifying some of our workforce initiatives would be a huge area of focus, as well as continuing the work related to ongoing professional development for the existing team members. This would include the way we are welcoming new employees, the way we are approaching true professional development, and finalizing our distance learning program with Eastern Maine Community College, which we hope to have fully stood up a year from now.

Finally, the collaborative work across the coastal region.  The three CNOs from the region are really working together to elevate practice and to determine what we want to bring to our teams universally, and we have some shared goals around these initiatives as well.

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