Episode 14:
Transforming the Nursing Workforce
Mary Ann Fuchs, VP of Patient Care and Chief Nurse Executive, Duke Health
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In this episode, Mary Ann Fuchs, vice president of patient care and Chief Nurse Executive, joins Renee at The Table. They discuss current nursing workforce challenges, restoring joy and meaning to a clinical environment, and partnering with the rest of your executive team.

Mary Ann Fuchs, DNP, RN, NEA-BC, FAAN, is the Vice President of Patient Care and System Chief Nurse Executive for Duke University Health System and the Associate Dean of Clinical Affairs for Duke University School of Nursing. As a member of the health system executive team, Fuchs supports and facilitates an interdisciplinary team approach to the delivery of care. This includes creating a nursing environment in which collaboration is valued and excellence in clinical care education and research is promoted and achieved.

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Renee DeSilva 0:07
Welcome back to the academy table. I’m Renee DeSilva, CEO of the academy and your host. This week I spoke with Mary Ann Fuchs, the VP of patient care and Chief Nurse executive at Duke Health. Mary Ann is one of the leading voices in nursing, having recently served as the president of the American organization for nursing leadership. And as a trustee with the HA, it was an honor to have her as the first nursing executive to join us at the table.

Our conversation was a wonderful opportunity to learn from her about the workforce challenges that keep her up at night, and how executive teams should support nurse leaders. Here are a few of my takeaways from the conversation.

First, I appreciated Mary Ann’s framing of the current nursing workforce challenges. Recent years, we’ve seen an exodus of tenured nurses paired with a dearth of new nurses who envision spending their career at the bedside. It’s really unhealthy system to build a culture that supports new nurses from day one and provides the opportunity for them to grow within the organization.

And that leads me to the second reflection that Mary Ann is clearly laser-focused on restoring joy and meaning to a clinical environment. And perhaps unsurprisingly, we’ve heard this theme come up in a few episodes this year. For Mary Ann, this has meant removing friction and non-value-added tasks wherever possible, ensuring frontline staff has every opportunity to build relationships with each other and also with their patients.

And lastly, listen to how Mary Ann has partnered with and coached the rest of the executive team. She shared that what became clear in recent years was the critical nature of C suite investment in frontline nursing leaders, they have been a significant part of workforce plans that truly unlock better outcomes. And so with that, join me at the table.

Mary Ann, welcome to the table. Delighted to have you with me today.

Mary Ann Fuchs 2:09
Well, thank you.

Renee DeSilva 2:11
So Mary Ann, as I said, when we were getting to know each other a bit, I have been excited to chat with a new nurse executive just given all of the issues that are centered around some of the NERC, the nursing workforce challenges. And I’d love to get from your perspective of all the things that we hear about facing the nursing workforce, what are the one or two that you feel like are the most acute?

Mary Ann Fuchs 2:37
It is clear that complex care needs of patients continue to grow. And we’re working with a much younger workforce today who are perhaps not as experienced, that causes some challenges. That along with just staffing in general become, I think, major causes of concern and what keep me up at night.

Renee DeSilva 3:02
And when you think about—just contextualizing that for our audience a bit—do you think that those issues were quite as challenging before 2020? Or do you feel like they really sort of more come to life more recently?

Mary Ann Fuchs 3:19
Well, here’s what I’ll say. So I have some data that has just been recently published by the American Hospital Association. Prior to the pandemic, we’re now living in this world that was pre-pandemic and post-pandemic, if you would. So, prior to the pandemic, hospitals actually faced workforce challenges in 2017, for example, more than half of the nurse workforce were age 50, or older, and actually, nearly 30% were 60 or older. So we’ve lost a lot of the tenure in our workforce. At the same time, more than 80,000 nurses are, quote, qualified candidates for schools were turned away because of faculty shortages. Those issues were occurring prior to the pandemic. And now today as we have navigated through the pandemic, with all of the challenges of the pandemic, the impacts of a changing workforce, this has continued to just exacerbate our ability to have a workforce available to care for people.

Renee DeSilva 4:28
Yeah, and I appreciate you mentioning that because I think we have and healthcare men talking about the ageing nature of the nursing workforce. And I think we all know that we’re seeing a total decline in the talent pool available. So when you think about levers there that we could pull, are there things that you see working as it relates to maybe slowing down that Exodus? How do you think about really trying to get to ways to try to stem that a bit?

Mary Ann Fuchs 4:58
You will hear people say there are plenty of nurses. It’s just the environment they work in, I think the environment is, which I don’t agree with, necessarily, but I think our environments within our organization are really important. And we have to make sure that nurses are doing the work that they’re trained and educated to do. And to make sure that there’s adequate support staff to do those non that to do the or to provide care in a way that is non-value added from a nursing perspective. So being able to focus on that, I think is really important. And to be able to provide our younger workforce with additional support in education for the complex care needs are very, very important. And then from the standpoint, our, our nurses today, when they are graduating from school, they don’t necessarily have, well, they hit let’s just say they have bigger, broader bolder career goals. And I think when you have an environment in an organization that helps identify that, where the staff want to go and what they want to do in their career, and you can help them. They will perhaps move on to a new role, but they may move on to a new role within your organization, but they continually grow and development develop is if the organization can invest in their people, they’re much more likely to retain them.

Renee DeSilva 6:29
I love that. Let’s just maybe go a little bit deeper there. You mentioned part of the challenge and creating or adding to the pool of available nurses is around mentors and preceptors. And faculty. Have you seen any interesting models? You have the benefit of being attached to Duke University, and so I’m wondering, are you seeing approaches, maybe even from your AOL position, where we are being more innovative around how we think about our ability to graduate and train the next crop up workers maybe more effectively than we did 20 years ago.

Mary Ann Fuchs 7:07
There are probably a bunch of examples out there, I’ll give you a couple, where an organization can partner with their academic organizations, whether it be an associate degree program, on bachelors program, etc. And actually, when the students are in the clinical environment, pair them with preceptors, that will help them achieve, let’s say, in their last rotation of their clinical program, and opportunity to take on and to learn more about that actual clinical area, become socialized with the team and the staff and actually use that as the opportunity to recruit that student, we’re actually seeing a lot more success, because then in addition, not only does the student achieve their clinical goals for their program, but they’re also becoming a member of a team and a particular unit, there are models out there that are helping build pipelines from that perspective. And I think those are really innovative ways to be able to help staff and join organizations and to be able to recruit.

Renee DeSilva 8:21
Yeah, I spent some of my career in the higher education industry and I think that is another industry that is sort of under a just reimagining of itself in terms of sort of being more student-centered. And we’re like finding ways to like build greater connection between what you’re studying, and then how that’s applied.

So it’s great to hear that come through in a clinical setting as well. So earlier on this podcast, one of the topics that we talked about was just this notion of bringing joy and meaning back into work. And you’ve touched on this a bit in terms of how the environment matters and how that can oftentimes unlock an organization’s ability to retain the best talent. Maybe bring that to life a bit. How do you approach that in your work in terms of finding ways to make sure that the joy and meaning is really centered on the experience?

Mary Ann Fuchs 9:05
As nurses, as healthcare providers, we’re really focused on our being our purpose. As nurses, we go into nursing because we want to care for people and caring for people, whether they’re our patients, whether they’re family members of patients, whether they’re our staff, whatever level of nursing, that you are, that caring relationship is really important. And being able to establish that relationship becomes even more important. So in the environment, for example, feeling like you belong, and that you belong to a team that is a striving, striving for excellence and to provide great service becomes really important. And to people and if people find joy in that, to be able to help patients achieve their care goals, it is extremely important. I mentioned this before, that making sure that you can deliver what it is that you’re trained and educated to do, is really important. And people find meaning in that. And they find satisfaction in that work. So removing, if you would, from the environment, any of the non-value added work, that is often a part of what it has to do, right there many, many circumstances that I’ve worked in that extra things are added to the nurses work. And they’re not done. They’re not value-added. And it takes away from the time that people can actually build relationships with our patients provide extra care to their patients or their team members, those items, I think, bring joy. And the ability for the nurse to be able to continue to establish those relationships provide the excellent care that they’re trained to be able to do that and provide that expertise, use their expertise, and to be able to do that in an environment where they work collaboratively with their peers, not just nurses. But all healthcare team members around striving for goals that are important to their team become really important.

Renee DeSilva 11:33
So I appreciate that I want to one of the notes that you mentioned was on this notion of the importance of finding innovative ways to remove friction from the experience and to find things that are working that sort of take out that the nonvalue add, that was a big impetus for us at the Academy in launching our nursing catalyst program, which is really about meeting the need of nurse leaders who want to find ways to talk about real examples of innovation impacting care delivery and the experience of their teams. From your perspective, talk a little bit about where you feel like there is the most need around collaboration that really gets to some of these real case studies around change.

Mary Ann Fuchs 12:23
I am very excited about the Academy’s nursing catalyst program. It is an investment in nurse leaders across our country that I think is going to be really, it’s going to provide some great opportunities moving forward. And our nurse leaders really need a space to have a conversation with colleagues across the country, building that network and learning from each other is so important. And so I think that the ability to share to innovative projects, to understand what people have experienced, what barriers you can perhaps prevent what successes and what helps to be able to achieve a successful implementation becomes really, really valuable for people. And so, I really think that program is going to be really helpful. So when I think about what we learned during the pandemic, for example, the use of telehealth and being able to provide virtual care in different ways is really one of the great learnings from the pandemic, I think has such untapped opportunity and nurse leaders to be able to talk about that. And to be able to collaborate around that will help us to advance various care models that become even more important today, right? Because we’re struggling with the numbers of staff that we need, we’re struggling to be able to provide care in a way that we would like to. And that’s just one example of how you use technology in a different way to advance excellence into dance care. And I think there are many, many other thoughts and ideas of different types of programs, that the nurse leaders through the nursing catalyst program can enhance how we provide service.

Renee DeSilva 14:21
Yeah, I appreciate that. I think we’ve all really witnessed firsthand how the pandemic cleared some of these maybe self-imposed obstacles and really put a turbo charge on innovation. And so we really do hope that there are opportunities that surface in that category of just moving fast and clearing obstacles. I wonder, do you note that do you feel like we’re able to move at a faster clip sort of maybe buoyed by just seeing how fast we were, we were able to move in certain contexts throughout the pandemic? Do you get excited about what feels feasible today that maybe wasn’t before?

Mary Ann Fuchs 14:57
Absolutely. And I’ll tell you, right in the pandemic, we had to make so many quick decisions. And we didn’t know what was going to work each time. But what we learned is when we made a decision, if it didn’t work, we reconvened. And we made a different decision. And so it actually sped up our ability to be able to impact change. And again, I think this is part of the value add from the catalyst program because people will be able to share these different innovations and be able to perhaps prevent going through and having a particular barrier pop up. But I think that yes, indeed, the ability to expedite and to make quicker decision-making will be very, very important.

Renee DeSilva 15:45
I appreciate that. So I want to zoom back and maybe go into a little bit of a different direction, which is just talk about leadership more broadly. So you have been a leading voice on nursing and on sort of centering around the experience of nurse leaders in your role with AOL. And I chat with many C-suite executives. And I think we all know that workforce is sort of the top strategic priority. So with that lens, how do you coach your nursing leaders to work with their executive teams to more effectively communicate the needs of the nursing workforce?

Mary Ann Fuchs 16:19
That’s a great question. And well, I’ll tell you, what a wonderful opportunity, right, because all of our executives perhaps do not understand the value of what’s brought to the table by a nurse. And I don’t mean that in a negative way, they just don’t know they’re not trained from that perspective. So I think really the opportunity to partner and for nurses to be able to discuss with their leaders, the impact of the actual care that’s provided by the nurse, and providing that understanding is really, really important when you think about what’s important, not just in preparing the workforce, but what the workforce is actually doing to deliver care and to provide positive care outcomes for patients extremely important. I would say, the workforce has always has to be on the agenda, if you would they, and I think it is on everyone’s agenda today. Right? The pandemic has really caused some real challenges here, I would coach my team to partner with their chief HR officer to make sure that they have a clear strategic plan for their workforce, right? How are they building a pipeline? What are they doing to change recruitment? How are they retaining staff? How are they using their own internal data, and data analytics to inform the decisions that need to make around that workforce plan? Do they have a systematic process for review of all of the processes they use to determine how they staff and, and how they make changes to care that needs to be delivered for different patient populations, this whole process around the workforce has to be dynamic, it’s not static, it’s it should be a constant reminder in your partner in your chief HR officer is really key here. Next in line really is the relationship with the CFO, CFO, CFO has to understand that care, not delivered or care by a nurse, for example, registered nurse is going to impact outcomes. And so understanding that value becomes even more important and through this process, and as a leader, in lnl, we actually did a longitudinal study of nurse leaders during this time. We tried to understand the changing role of the nurse leader the experiences over time. What became really clear, is that, to support our workforce in general, that our major focus had to be our nurse leaders. So the investment of the C suite in their nurse leaders and their frontline leaders becomes even more important as part of the workforce plan is part of making sure that you have a workforce because the frontline team members trust their local leader to be able to advocate for them to make sure they have resources, etcetera. And so that next step, and that investment in nurse leaders to be able to be re-energized to be able to feel they have the support that they need to help their staff becomes even more important. And again, this is I would, I would say that this also then ties back into that nursing catalyst program, that investment in that frontline leader is going to pay off dividends. I know that and understand that. And so that’s what I would say the other thing I think lnl has done and worked with colleagues. It’s not just local within entities but partnerships across professional organizations to be able to understand the bigger and bolder issues in partnership with like the American College and American Association of Colleges, nursing, National League for Nursing, the State Council Boards of Nursing and other organizations AMA, really to look at the bigger broader workforce issues that are out there and to be able to gather to partner to advocate through policy and or process also becomes a continuing need and I encourage nurse leaders to be able to broaden their focus, not just their internal to the organization, but external and to be engaged in those other areas that are going to really impact our ability to provide care through a great workforce.

Renee DeSilva 20:41
Yes, I’m going to ask you this question, but I’m wondering, what does this all imply in terms of the next five to 10 years around nursing workforce transformation? I guess I would just note that I do think one of the positives has been the elevation of the nursing function on CEO and CFO radar is at an all-time high. So I do think there’s an opportunity. I also hope, when I do I spend a lot of my time with our system CEOs, and I think there may be one or two, maybe just one that has a nursing background. So I do wonder if in three to five years, if we sort of see a rise of the Chief Nurse Executive, maybe ascending into CEO ranks as we put more emphasis on such an important part of the talent pool?

Mary Ann Fuchs 21:30
I think that would be a wonderful opportunity, I think the opportunities are endless to be as a nurse. And that’s how I see it. And I think the pandemic as you have stated, as his has advanced that opportunity. I would say, though, as we continue to look at the transformation of the workforce and an elevation of the nursing function, we have to understand the data related to the care outcomes of our patients. And we have to be able to really articulate that value of the nurse more globally, I think we have a differing opinion or differing potential. Anytime when there may be a continued crisis to try to substitute the care that might be provided by a professional, I’m worried about that. And so I think it is really, really important for us as nurse leaders to be able to work both internal to organizations, with professional organizations, with our national leaders or governments, federal state to make sure that the role of the nurse is clearly articulated and implemented.

Renee DeSilva 22:36
I agree. All right. So with that backdrop, then if there’s one thing that we need to get right in the next five to 10 years to really achieve that transformation, is there one thing that comes to mind for you?

Mary Ann Fuchs 22:51
Yeah, the one thing is the role and the value of the nurse and the understanding of the education, the knowledge and the expertise that they bring to the table to provide care, care across the continuum at whether it might be episodic, for different areas, but what is the value, the true value of the nurse, that is what we really have to I think, continue to articulate.

Renee DeSilva 23:17
I love that. All right, here’s my final question. It’s one that I ask every guest, regardless of topic, which is, so much of the really reason why we call this the academy tables because we really do believe that the power of conversation to move ideas forward. And we spend a lot of time internally just curating the right groups to have conversations that we think will be provocative. So my question for you would be if you could invite two people for a conversation at your table? Who would they be? And why?

Mary Ann Fuchs 23:49
Oh, I don’t know if you’re gonna like my answer, and it’s selfish. I think the foundation of who you are as a person is has got a lot to do about how you were raised and who raised you. And so when I think I have access to my professional colleagues all the time, that I feel is such a blessing, but what I don’t have is access to my parents. Boy, I’d love to be able to have a conversation about how they would guide me in today’s environment. I miss that and I really would value hearing from them. They know you the best, I believe, and they know me the best and I think they would help guide me forward and perhaps point out things that I might not hear otherwise.

Renee DeSilva 24:43
Yes. That’s so powerful. It’s funny, I answered this question on a wrap-up that we did last year. And that was my answer was, it’d be my dad, really, because he died when I think I was maybe 25. That sort of collective body of work that he didn’t get a chance to witness See me with my children. And so I totally I think that’s a perfect answer. And you are right. No one will tell you the truth or your blind spots like your parents will fortunately, my mom does that for me on a regular basis. So I do appreciate that. But I think that’s a perfect response. Well, we will land there. Mary Ann, thank you so much for joining us today. It was really great to connect.

Mary Ann Fuchs 25:19
It has been such an honor. Thank you so much for the opportunity.

Renee DeSilva 25:22
My best to you as well.

Thanks again for joining me at the table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website, TheAcademyTable.com, or by subscribing on the podcast platform of your choice, and if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at renee@hmacademy.com. I look forward to talking with you soon.