Careers for nurses include a multitude of opportunities, roles and settings where nurses have made and continue to make major contributions to our greater society.
Fun fact: Most people know of Florence Nightingale as the founder of modern nursing, but did you know she also had brilliant mathematical and data analytics skills, making her not only a pioneer in the field of nursing but also in early clinical informatics?
Throughout history, nurses have often been reformers, innovators and advocates working to improve the lives of others.
Some, like Nightingale, are primarily recognized for their work in nursing. Others are better known for other works but also served as nurses—Walt Whitman, Martha Jane Cannary and Isabella Baumfree to name just a few. (Famous writer-poet Whitman cared for wounded Civil War soldiers. Cannary, AKA Calamity Jane, nursed a group of small pox victims on the frontier. Baumfree changed her name to Sojourner Truth and became an advocate for race and gender rights, and she also served as a nurse for the Union Party.)
Whether offering care and comfort to sick individuals and families or solving problems on a public/population health level, the nursing profession excels at making the world a better place.
During National Nurse’s Week, The HealthSearch Group sends our appreciation to our nursing colleagues everywhere.
When it comes to our healthcare, we all desire clinical competence—and we all hope that competence is accompanied by compassion.
Within any institution, investments of time, talent and monetary resources must be vetted against other competing priorities.
When it comes to the culture and business of compassionate care, there is an emerging realization that what is good for the spirit is also good for the body and mind. For health care executives who constantly have to balance money and mission, it is becoming clear that what is good for the spirit may also be good for the bottom line.
The Patient as the Customer
The Centers for Medicare and Medicaid Services now measures patient experiences in various care settings and publishes some of those results on their websites for public viewing.[i] In addition to influencing public perception, these scores can also directly affect an organization’s reimbursement.
For instance, the results of a Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS survey,[ii] accounts for almost a third of a hospital’s financial outcomes under its Medicare Hospital Value Based Purchasing (VBP) Program.
Patient experience scores and compassionate care are not synonymous, but neither are they mutually exclusive. Among other factors, surveys incorporate questions that can be seen as surrogates for compassion and empathy: those of listening and communication.
The HCAHPS survey asks “During this hospital stay, how often did nurses/doctors listen carefully to you?” “During this hospital stay, how often did nurse/doctors explain things in a way you could understand?” The home health survey also inquires whether practitioners treated the patient “as gently as possible.”[iii]
On an increasing basis, consumers expect transparent and honest communication with caregivers. Although today’s patients may be more confident in their own level of medical knowledge and choices, they still rely on professional care givers to guide decision-making, especially around critical matters.
Patients’ perceptions about whether professionals truly care about them may influence their perception of the care they receive and, in turn, affect how receptive they are to following treatment recommendations.
Discussing weighty concerns like—Will I be able to walk again?; Can I have children?; What are my chances of survival?—not only demands listening skills and honest explanations, but most certainly, compassion.
The Employee Experience
A core mission of caring for the sick is sufficient to foster a compassionate workforce and the financial rewards for positive patient experiences represent a bonus; but there is another powerful reason: care for the workforce itself.
Erosion of compassion goes hand-in-hand with employee burnout, an “experience of physical, emotional, and mental exhaustion, caused by long-term involvement in situations that are emotionally draining.”[i]
In fact, a large EAP reported that health care workers as an industry had the highest rates of anxiety and stress related calls with outreach from one in nine employees.[ii]
About 25 percent of health care workers experience burnout.[iii] Good leaders recognize the value in mitigating burnout, as it can transform caring workers into callous ones, lead to negative patient experiences, and can cause workers to opt out of the profession entirely.
Beyond switching jobs or leaving the field, burnout can have more devastating effects. About 400 physicians kill themselves each year, a number comparable to an entire medical school and roughly twice that of their non-physician counterparts.[iv]
Community hospital CEO’s ranked personnel shortages as their fourth highest concern, up from the tenth spot in executive worries just the year before.[v]
Employee turnover is costly. For example, each percentage change in RN turnover will either cost, or save, an average hospital almost $373,000.[vi] And with about two-thirds of U.S. physicians now working as employees,[vii] the financial cost of clinical turnover to an organization becomes even higher.
A Culture of Compassion
Many health care institutions incorporate compassion, or similar sentiments like empathy, acts of kindness, sensitivity, and person-centered care, in their corporate mission or core values statement.
While compassion is both expressed and felt at an individual level, it can flourish or flounder as a result of corporate culture.
In 2016, we had a series of discussion interviews with several leading health care executives to learn how working to support a compassionate workforce and provide compassionate care influences their practices in employee recruitment, retention and training[x].
We asked their opinions about inherent threats to compassion that exist in today’s environment.
Time constraints and work compression,[xi] caring for more complex patients in an increasingly complex work environment in the same amount or less time, was a frequently cited concern. Other threats that were mentioned included:
- Employees can face personal pressures when they come to work to care for others: their own illness or that of loved ones, divorce, financial distress and burdens that can make rendering compassionate care to others more challenging.
- There is a trend to communicate electronically and this can diminish our personal interactions—our ability to talk and listen to people.
- We sometimes see patients only as patients, and forget that they are people who have lives and loves; they are not their diagnoses or conditions.
- In some areas, the labor market shortage creates a talent vacuum; you need to guarantee staffing ratios to be in compliance, but those needs may conflict with the goals of hiring for compassion.
- The starting wages for nurses has risen and now rivals other white collar positions. While that is a good thing on one hand, if people enter the profession with money as their primary motivator and not for the calling, or stay in the profession for the money, this may not make a very compassionate caregiver.
New and smaller companies may have the advantage of building an expectation for compassion into their culture than larger, well-established organizations, which may require them to reshape their priorities or processes.
It would be naïve to think that there is any silver bullet to eliminate threats or that they can all be reduced at once but screening and recruiting for compassion and empathy as core competencies for new hires and cultivating an environment to help maintain those traits, are key human resource agendas.
The majority of those we spoke with said they use behavioral interviewing techniques when screening new candidates to help evaluate their relevant experiences and behaviors, motivation, and cultural fit for their organization. Other responses included:
- Screen for compassion first and then for the technical expertise.
- It is important to establish hiring practices and screen for people who love to work in a service environment. I look for a human connection and if I find nice people, I am half-way there. Do they have an easy smile? Are they warm? How did they treat the front office or reception staff? I ask myself, “Would I want this person taking care of me or my mother?”
- It may be difficult to teach soft skills like compassion and empathy but you can model them and set the expectation during the pre-hire process. Do role playing, walk the candidate through “a day in the life of…”
- We seek high customer service traits among all employees (not only caregivers.) Everyone goes through a shadow interview with a peer to assess for cultural fit. We found that an interview with a peer may yield nuanced insights that the interview with the potential supervisor does not.
Companies use various methods to help facilitate compassion and empathy among existing employees.
The Schwartz Center Rounds™ are a noted source of support for employee compassion. These structured programs offer an environment and time where caregivers can candidly discuss social and emotional issues that arise in the course of patient care.
The one-hour voluntary sessions are generally held a few times a year (six-to-eleven times a year). Despite a nominal investment of time, employees often report feeling rejuvenated after the sessions. (For more information, see “The Compassion Quotient”).[xii]
Several cited initiatives in which employees can nominate colleagues who go “above and beyond the call of duty”–either for their patient care or through their teamwork, with varying types and frequency of rewards (some financial, some not) for exemplary performance.
Other initiatives that were shared include:
- Use department and unit specific patient experience scores, comments, and outcomes to open the door for conversations about patient perception, process improvement, and as an opportunity to raise the overall performance bar.
- It is important to remember what we are in the business of doing–providing health care. We begin all business and all team meetings with a patient story to help ground us and to help us remember this.
- We have a “no pass” rule. Anyone who is walking past a patient’s room and a call light is on, goes in and checks on the patient.
- We want people to operate in a no blame culture and an atmosphere of trust. In promoting a culture of safety, our mantra is “If you see something, say something.”
- It is important for employees not only to demonstrate compassion toward patients but toward each other. How will they treat patients if they don’t treat each other well?
- We hold weekly interdisciplinary team rounds that include an “in memoriam” time where we take the time to remember and honor any of our patients who have passed away.
The Road Forward
Education, awareness are an imperative part of the systematic solution as is finding fundamental ways to remove threats to compassion.
The American Academy on Communication in Healthcare has a series of training films including a multiple resources on compassion and empathy.[xiii] One poignant video created by the Cleveland Clinic entitled, “Empathy: The Human Connection to Patient Care,”[xiv] went viral and has had over three million views.
Many organizations have created new roles of the Patient Experience Officer or a similar designation to oversee and champion the cause.
Companies are adopting new tools, including electronic technologies, to help capture, synthesize and report how well employees engage with patients.
The presence of healthcare chaplains can add to the compassion quotient of a facility.[xv] Beyond patient spiritual assessments and guidance,[xvi] these trained professionals may have time to listen to patients or families when direct caregivers cannot, especially during rapid response situations, and also serve as a source of support to other care givers.
Designations from Planetree[xvii] to the ANCC’s Magnet Recognition Program®[xviii] are deemed to improve both patient and caregiver outcomes by changing a variety of factors from environmental design to nursing education and staffing ratios.
There is a growing understanding of the unquantified, Midas-like, value of compassion—value to patients, employees, and even as a possible measuring stick for the cultural health of an organization.
A business adage asks, “What if we invest in our workers and they leave?” only to be answered by the better question, “What if we don’t and they stay?” A philosophy that is never truer than when it comes to compassion and care giving.
The HealthSearch Group would like to gratefully acknowledge individuals who shared their insights and experience, listed here in alphabetical order:
- Elliot Brooks, (retired) Senior Vice-President, Human Resources, MJHS, Brooklyn, NY
- Carol DeVol, Chief Operating Officer, Landmark Health, Los Angeles, CA
- Peter Q. Fraser, Regional Vice President, Human Resources, Acute Care Operations, Hartford HealthCare, Hartford, CT
- Niyum Gandhi, Executive Vice President and Chief Population Health Officer at Mount Sinai Health System, New York, NY
- Judy Holding, Staff Chaplain, Greenwich Hospital, Greenwich, CT
- Spike Lipschutz, Senior Vice President, Medical Staff/Chief Medical Officer, Greenwich Hospital, Greenwich, CT
- Sal Mancino, Director, Human Resources, Stamford Hospital, Stamford, CT
- Jonathan Schiller, Chief Operating Officer, Orange Regional Medical Center, Middletown, NY
Sherrie Dulworth, RN, is the Chief Marketing Officer for the HealthSearch Group, a national company dedicated to helping clients recruit, retain and develop top talent.
[i] Centers for Medicare & Medicaid Services. (2016). Consumer Assessment of Healthcare Providers & Systems (CAHPS). Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/
[ii] Centers for Medicare & Medicaid Services. (2015). Hospital CAHPS (HCAHPS). Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/CAHPS/hcahps1.html
[iii] Agency for Healthcare Research and Quality. (2014). Home Health Care CAHPS Survey. Retrieved from https://homehealthcahps.org/SurveyandProtocols/SurveyMaterials.aspx#catid2
[iv] Mateen F.J., Dorji C. (2009). Health-care worker burnout and the mental health imperative. Lancet. 374 (9690), 595-7.
[v] CompPsych Corporation. (2013). eReport: EAP and Work-Life Call Trends. Retrieved from http://www.compsych.com/resources/featured-resources/780-eap-work-life-outcomes-report
[vi] Mateen F.J., Dorji C. (2009). Health-care worker burnout and the mental health imperative. Lancet. 374 (9690), 595-7.
[vii] Andrew, L.B., (2016). Physician Suicide. MedScape. Retrieved from http://emedicine.medscape.com/article/806779-overview
[viii] American College of Healthcare Executives. (2016). Top Issues Confronting Hospitals in 2015.Retrieved from https://www.ache.org/pubs/research/ceoissues.cfm
[ix] Nursing Solutions, Inc. (2016). 2016 National Healthcare Retention and RN Staffing Report. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf
[x] Accenture. (2015). Many U.S. Doctors will Leave Private Practice for Hospital Employment, Accenture Reports. Retrieved from https://newsroom.accenture.com/news/many-us-doctors-will-leave-private-practice-for-hospital-employment-accenture-reports.htm
[xi] Grant, R. (2016, February 3). The U.S. Is Running Out Of Nurses. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/
[xii] American Academy of Family Physicians. (2015). Significant Primary Care, Overall Physician Shortage Predicted by 2025. Retrieved from http://www.aafp.org/news/practice-professional-issues/20150303aamcwkforce.html
[xiii] See Acknowledgements
[xiv] Shin, A., Gandhi, T., Herzig, S. (2016). Make The Clinician Burnout Epidemic A National Priority. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2016/04/21/make-the-clinician-burnout-epidemic-a-national-priority/
[xv] LinkedIn_The Healthsearch Group. (2016). The Compassion Quotient. Retrieved from https://www.slideshare.net/slideshow/embed_code/key/HF7VRZIGWw94Iw
[xvi] American Academy on Communication in Healthcare. (2016). Resources/Videos. Retrieved from http://www.aachonline.org/dnn/Resources/Videos
[xvii] The Cleveland Clinic. (2013). Empathy: The Human Connection to Patient Care. Retrieved from https://www.youtube.com/watch?v=cDDWvj_q-o8 Last accessed November 16, 2016.
[xviii] Puchalski, C. (2001, October 14). The role of spirituality in health care. Baylor University Medical Center Proceedings. (4): 352–357. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305900/
[xix] The Joint Commission. (2016). Provision of Care, Treatment, and Services (PC) (Hospital and Hospital Clinics / Hospitals). Medical Record – Spiritual Assessment. Retrieved from
[xx] Planetree. (2014). Person-Centered Care Designation. Retrieved from http://planetree.org/designation-2/ Last Accessed November 16, 2016.
[xxi] American Nurses Credentialing Center. (2016). Magnet Recognition Program® Overview. Retrieved from http://www.nursecredentialing.org/Magnet/ProgramOverview
Healthcare is in a boom phase: the industry tops the labor charts in job growth and is expected to occupy almost 14 percent of the labor market by 2024. Roles have emerged in areas that were black swans a decade ago but that are now commonplace, like patient experience, telemedicine, and data analytics. But it is the need for direct caregivers, registered nurses, nursing assistants and others, that still makes up the lion’s share of the jobs and job growth.
As much as the growth represents opportunity, it also can represent a challenge for employers to find and retain experienced front-line staff.
Healthcare employees leave their jobs for similar reasons as other professionals, like retirement, relocation or better opportunities, but a more specific factor that drives turnover among caregivers is feeling overworked and overwhelmed. And while service workers in other fast-paced and demanding environments often feel harried, a key difference in healthcare is that the patient is in the center of the encounter, one who by their very nature may be in a fragile state.
The delivery of compassionate care is as intrinsic to most healthcare workers’ role as their technical skills; but compassion can erode when workers feel consistently besieged by the workload or from too frequently confronting the suffering of others—a condition known as compassion fatigue.
Healthcare is about caring, but who cares for the caregivers?
The mission of the Schwartz Center for Compassionate Healthcare is to help with just that. This Boston-based non-profit had a poignant genesis in 1994 when Kenneth Schwartz, a 40-year old attorney, husband and new father and a non-smoker was diagnosed with advanced lung cancer.
Despite the fact that Mr. Schwartz specialized in healthcare law, he gained new insights with his perspective as a patient. “I came to know a lot about health-care policy and management, government regulations and contracts. But I knew little about the delivery of care,” he wrote in A Patient’s Story, a moving first-person account, published in The Boston Globe Magazine a few months before his death in 1995.
In the midst of his fears, apprehensions and burdensome treatment, Mr. Schwartz described moments of respite, “It has been a harrowing experience for me and for my family. And yet, the ordeal has been punctuated by moments of exquisite compassion. I have been the recipient of an extraordinary array of human and humane responses to my plight. These acts of kindness – the simple human touch from my caregivers—have made the unbearable bearable.”
Just days before he died, Mr. Schwartz founded the Schwartz Center for Compassionate Healthcare, his vision being to “nurture the compassion in healthcare, encouraging the sorts of caregiver-patient relationships that made all the difference to him.” Twenty years later, his organizational legacy provides robust educational and structured programs, including the Schwartz Center Rounds® program, now taking place in more than 525 health care organizations in the U.S., U.K. and Canada, which offers caregivers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss social and emotional issues that arise when caring for patients. In contrast to traditional medical rounds, the focus is on the human dimension of medicine.
An internal planning committee chooses among topics to present, a panel of caregivers offers 3-5 minute case or theme overviews, and the bulk of the time is dedicated to active attendee participation.
The topics are as varied as the different organizations and the patients they serve but with familiar themes that are common within the caregiving environment: dealing with broken families or those trying to rekindle relationships; employees as patients; death before the birth of a child; an angry family member who lashes out at staff; traumatic loss of an entire family; patients who are non-compliant with their medical regimen and frequently relapse; holidays spent in the hospital.
It is not so much the cases that make the Schwartz Center Rounds a unique forum as the discussion and exploration of the psychosocial impact of patient care, interactions with colleagues and support from the larger organization that is the emphasis.
“It’s the other side of the professional coin,” said Dr. Steven Thau, a physician leader for the Schwartz Center Rounds at Connecticut’s Stamford Hospital. Dr. Thau explained, “Issues exist. It’s better than bottling up emotions or keeping blinders on and trying to ignore the issues entirely.” Stamford has enthusiastic attendance of 100 or more at their semimonthly sessions with employees, students, and volunteers welcome to participate, knowing that the topics have wide-spread relevance and benefit everyone.
Dr. Andrew Epstein helped introduce the Schwartz Center Rounds at New York’s Memorial Sloan Kettering Cancer Center and said that while other activities, like medical rounds, or ethics committee rounds, can thematically overlap with some of the Schwartz Center Rounds discussion themes, they are not the same. He noted, “The Rounds are designed to be an open forum for staff to discuss feelings and perspectives rather than hospital policies or solutions to problems per se.”
When the Reverend Dr. Carole Johannsen, Coordinator of Pastoral Care, recommended implementing the Schwartz Center Rounds at Phelps Memorial Hospital located in northern Westchester County, N.Y., she was excited about how the sessions could support the staff and give them a structured process where they could openly and honestly discuss their feelings about a particular event, patient or issue. “We tackle difficult situations that have impacted staff members but also celebrate some special success stories,” she said.
According to Dr. Daniel O’Hare, a consultant ethicist to Stamford and other hospitals, another benefit of these sessions is that they offer staff a non-hierarchical forum in which to share and express themselves. Studies have indicated that these forums enhance attendees’ appreciation of their colleagues’ roles in their common effort of providing health care and help them to demonstrate greater empathy for their tensions and struggles.
About ten percent of the U.S. hospitals with more than 100 beds are Schwartz Center members with a growing number of other healthcare disciplines, such as nursing homes, hospices, home health agencies, and a health plan that has incorporated the program for their case management department, signing on.
Member organizations pay an initiation fee, which covers training, support and materials necessary to launch the program then a nominal annual fee for ongoing consultative support, education, resources and access to the greater member community. They also agree to commit personnel and time resources for planning the sessions and attendees complete evaluations following each session.
Pamela Mann, Schwartz Center director of programs and Rounds training, noted that, “Participants often leave the session renewed and reminded about why they went into healthcare in the first place.”
The program offers caregivers a safe place to discuss the human side of health care, and thus improves teamwork and reduces health professional stress and isolation.
Ken Schwartz’s experiences made him cognizant of the potential for the healthcare workers to feel overwhelmed and fatigued by the work environment. Perhaps he intuited the value of future Schwartz Center Rounds to healthcare workers and the subsequent positive patient impact when he wrote, “Looking back, I realize that in a high-volume setting, the high-pressure atmosphere tends to stifle a caregiver’s inherent compassion and humanity. But the briefest pause in the frenetic pace can bring out the best in a caregiver and do much for a terrified patient.”
Coming Next, Part II: “Compassion, Culture and Business”
Sherrie Dulworth, RN, is the Chief Marketing Officer for The Healthsearch Group, a national company dedicated to helping clients recruit, retain and develop top talent.
In the early months of 2014, the impending ICD-10 deadline resulted in healthcare providers scrambling to prepare for new coding standards. Most providers had not invested sufficiently into making the necessary updates and feared massive reimbursement losses. In April, Congress and President Obama agreed to delay implementation of the ICD-10 standard for medical diagnosis and billing codes to Oct. 1, 2015. This controversial move was met with mixed feelings; unprepared providers were relieved while those that had made massive investments to get up to date felt misled into taking action.
Early in 2014, The Healthsearch Group partnered with a leading health system in the New York Tri-State area to assist in the recruitment of a large number of Coder openings. After filling numerous senior roles, the deadline reprieve enabled the health system to re-engineer their short term and long term strategic plan. We have since filled several positions and continue to partner with them as they prepare for the future.
While some Healthcare organizations are taking advantage of the delay in a variety of ways, such as training staff, improving documentation integrity and conducting more robust testing, others remain weary and fear that their large financial investment into this change will once again go wasted if the date is yet again pushed back. The lack of a firm and clear path has led to much division within strategic efforts.
A recent study conducted in May and June found that most healthcare providers are using the 12-month ICD-10 reprieve to prepare for the new coding standard. To mitigate productivity loss, 68% of survey respondents plan to conduct extra training and practice, and 31% expect to hire more coders to help with the eventual transition. This will lead to an even tougher market as the Oct. 1, 2015 deadline approaches. “Is it worth hiring coders before the market turns desperate and fierce competition for experienced coders causes salaries to skyrocket? Many recruitment strategies are ‘on the table’ but being proactive is a must. As partners and advisors, we are confident that together we can find solutions.”
–Simon Gordon, Manager of Search Operations and Business Development
Global competition for talent is a daunting challenge faced by HR Organizations today. While unemployment rates are at a five year low, healthcare executives are requiring Human Resources Departments to be more agile and deliver more with less. In an effort to build and sustain a competitive edge, restructuring is more likely than not at the forefront. Managing this process is an art-form requiring in-depth expertise on the impact of loss of knowledge and capacity while at that same time harnessing the next generation HR delivery model (Shared Service, Business Partner, Centers of Expertise).
During this era, it is critical HR professionals remember the one size fits all approach does not work. Today’s HR Leaders must exhibit an ability to maximize their value to the business by driving innovation and performance, understanding workforce analytics, achieving better ROI’s, and implementing leaner processes. It is important to follow industry trends, and have a strategy around workplace mobile apps, social media & blogging, the emergence of private insurance exchanges, outsourcing HR, managing millennials, and employee perception of work life balance.
Finally, it is truly essential to leverage organizational diversity; diversity as a business strategy; diversity goes further than the conception of a diverse workforce, it entails bringing a diversity of thought to issues such as budget & fiscal management, risk management & liability, internal controls, resource planning, etc.
In the face of an improved economy, the HR landscape continues to change. Remember that the road map to success is not easy; by delaying taking action, you often adversely affect outcomes. Crystal Taylor, Vice President of Managed Care
Crystal Taylor, VP of Managed Care
Branding visibility is important for professional development, whether the brand is yourself or the organization that employs you.
Creating a consistent branding image whether for yourself or your organization is critical. It is important to maintain a consistent professional image including on social media platforms. I’m confident that your brand will yield positive results in any arena of business if you smile, engage your staff, and promote a positive work environment
. Alan Katz, Manager of Marketing and Social Media
One of my best clients approached me about a search that was “impossible to fill.” The Metabolic Clinical Nutritionist for their Pediatric Genetic Service line position had very specialized requirements. After sourcing, sourcing, and more sourcing, I finally got a referral from a networking call to a great candidate. She had just hit the 20-year mark at her company and
felt this opening could be the right career move. After the candidate accepted the position, my client stated “You found a needle in a haystack, great job!” This was an example of why I believe there are no impossible searches, some are just more difficult. Two years later the candidate continues to be excited by her role and in our most recent conversation told me “I still learn something new on the job every day and love it here, thank you Joanne.” An impossible search may not be so impossible after all.
Joanne Brandt, Manager of Recruitment