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Join Karlene Kerfoot, a nurse executive, as we delve into the nurse and clinician workforce crisis in the United States. Discover the factors contributing to this crisis, the impact of administrative tasks on health care professionals, and innovative solutions that can enhance patient care while alleviating the burden on nurses.

Karlene Kerfoot is a nurse executive.

She discusses the KevinMD article, “Post-pandemic nursing workforce challenges continue to mount.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Karlene Kerfoot. She’s a nurse executive, and today’s KevinMD article is “Post-pandemic nursing workforce challenges continue to mount.” Karlene, welcome back to the show.

Karlene Kerfoot: Thank you, good to be here.

Kevin Pho: So for those who didn’t listen to your first episode, just briefly share your story and journey.

Karlene Kerfoot: Sure. I’m Karlene Kerfoot, I’m the chief nursing officer for symplr. And I began this professional life intending to go into political science, and discovered that there weren’t many options there for women, so decided to go into nursing instead. Which is really a very interesting pathway, because in political science you learn all about the structures in politics, and obviously in health care there’s plenty of that.

So as I moved into nursing, I found it to be quite fulfilling, a wonderful opportunity. I’m kind of that accidental leader, because I haven’t ever applied for a job. People just come and tap me on the shoulder and say, don’t you want to do this? I say, what, I don’t know if I can do that, but I end up doing it.

So it’s been a very interesting career, and I think all that has come together to really be able to have a big picture about what health care could be, can be, and must be, to be able to retain and attract people in the future and do the best for patients.

Kevin Pho: So one thing caught my ear, is that you’ve never applied for a job, people always promoted you or tapped you for leadership roles. What are some of the qualities and characteristics that stand out that would make a nurse most prepared for leadership roles?

Karlene Kerfoot: Well, I think as a nurse you learn to work in groups, and you learn to pull groups together, because you can’t do anything by yourself. You have to work through others.

And of course, in leadership that’s exactly what you have to do. You have to work through others, you have to find very competent people who can do the work that you can’t do, and be able to get them to work together in a team, and get them really around a mission that they can all believe in, and they can just say, oh my God, this is where we’re going.

And that’s what you do as a nurse, as a team leader, as a nurse manager or whatever it happens to be. You’ve got to get the team working together, or else nothing works.

Kevin Pho: Your KevinMD article focuses on post-pandemic nursing, the challenges continue to mount. So tell us what this article is about.

Karlene Kerfoot: Well, the post-pandemic challenges really aren’t much of a surprise, because we’ve had those challenges before. They just haven’t been as accentuated, because they were kind of under the radar. But here comes the pandemic, oh my goodness, they become very accentuated.

So for example, we know that there has been a lot of turnover because of technology burden. It became very, very bad in technology because you didn’t have any time. We know that people left because they couldn’t be the kind of nurse that they were born to be, and they ended up nursing the computer rather than nursing the patient, and people said, I’m out of here. And physicians said, this is not what I went into medical practice for. So it just accentuated everything.

So the whole point is, in a way that’s good, because it’s brought attention to many of the facts that were just kind of lingering there under the radar. And now we have the opportunity to bring them up and fix them once and for all, and really get busy in making health care the healthy environment that it needs to be.

Kevin Pho: Tell us some of the challenges that nurses face today post pandemic.

Karlene Kerfoot: Well, I think one of the biggest challenges is time. Because we have the technology burden, we have the lack of resources, we have the inability to get enough people there at the right time and the right place. So it’s time. The more we can look at how we can take work out of the system, the better off we’re going to be, and the more retention we’ll have.

But above and beyond that also, you can have time, but if you don’t have a compassionate environment that really recognizes you and appreciates you, it doesn’t make any difference. So in addition to having the infrastructure to get things done, we also have to have a compassionate environment that really recognizes people, appreciates people, and that people can then be appreciated and then appreciate their patients. It’s the old trickle down thing. If you’re not appreciated, you don’t appreciate your patients. It’s as simple as that.

Kevin Pho: You wrote an article about a McKinsey and Company report that highlights nurses spend only seven hours of a 12-hour shift on direct patient care. So for those other five hours, talk about some of the administrative burdens that they have to deal with.

Karlene Kerfoot: Yeah, isn’t that silly? People go into nursing to be able to take care of patients, people go into medicine to be able to take care of patients, and then we keep them away from that.

So we sometimes joke about the fact, that’s not funny, but we joke about it, that you go into nursing and then you nurse the computer and you really don’t nurse the patient. So if you look at the time it takes to nurse the computer and get all the data in, and the other question is, how much of that data is ever used? Is there a way of streamlining that data so the documentation process is much less? And then also, how can we do things like, for example with technology, dictation and so on like that, so you don’t have to take the time to do that?

And then there’s all kinds of disparate systems. You can’t just go in there and be able to get a patient from this unit to that unit, you’ve got to go into a different system.

And the sad thing is, when nurse managers are doing their work, much of the time that it takes them to do their work is negotiating all these disparate systems. For example, there’s a staffing scheduling system, there’s a quality system, there’s a financial system, and it all doesn’t go together. You’ve got to go from one to another and then be able to access the data, sometimes download it, sometimes work with it. That takes a lot of time, and it shouldn’t be that way. We don’t have to do it that way.

If you can have a self-driving car like the Teslas and so on like that, why can’t you have a self-driving staffing scheduling system? Why can’t you have all this connected so three quarters of the work can be done automatically, and then the human person can come in and use the human intelligence to make things better? It’s possible. We just got to think that way.

Kevin Pho: Now, are we seeing specific examples where patient care is compromised because of these overwhelming administrative burdens?

Karlene Kerfoot: Oh, absolutely. If you’re nursing the computer and the patient is on the other side of the computer and is not doing well, you don’t even see the patient because you’re seeing the screen.

I wrote an article, I think a year or so ago, about leaders from the other side of the screen. And what we often do is we look to see what’s on the screen and we take that as fact. But you have to get away from that screen, go talk to people, go watch people, be able to get out there on the front line to really understand what’s going on, because that’s where the real truth is.

Kevin Pho: Now, you mentioned one of the reasons we got to this place was that there are just so many disparate systems that nurses and other health care professionals have to log into. How did this come to be? Why did it get like this?

Karlene Kerfoot: Well, if you look at it, nurses are nowhere to be found lots of times when you do the acquisition. And so oftentimes it’s HR, it’s the IT people or whatever, but the users on the front line aren’t there. And so the user can’t say, wait, this is not our workflow, this is not the way we do it. Wait, that’s one more system to go through. Wait, that’s going to take a whole lot more people to run this system. But of course you don’t get more people.

So in order to be able to do effective acquisition, you’ve got to have a team of users who can look at it and say, ah, this is the greatest thing since sliced bread, or, oh my God, no, that’s going to take two more people.

So it’s the old thing about, you can’t operate in silos. And when you operate in silos, then the outcomes are really bad. If you can operate in invested teams and heterogeneous teams, that everybody has a piece of the action, then you can get much better outcomes. Much better.

Kevin Pho: So tell us some solutions. What do you propose to fix this problem?

Karlene Kerfoot: Well, I think the solution is, first of all, let’s start at the top. If you look at the leaders, there’s some leaders who are very credentialed in terms of technology and this kind of stuff, there are some that aren’t.

I look at some of the chief nursing informatics officers who have become CNOs, and oh my goodness, they are amazing. Or you look at some of the physicians who have taken CIO positions, oh my goodness, it just makes such a difference.

So we’ve got to get people at the top who have a lot of cross divisional skills. And if they don’t have those skills, then they’ve got to hire paired partners to work with them, as, you know, another head, they can work together. And then all that trickles down to make sure that we’ve got people out there on the front lines who can talk the talk and do this kind of stuff.

If you don’t have the skill set, then you can’t sit at the table to talk about acquisitions, because people aren’t going to listen to you. So we’ve got to have people better prepared to understand what it’s like to have a connected enterprise, and be able to speak up and say, this doesn’t fit with this, this is just going to take more time and effort, and so on like that.

So it’s all about getting rid of those silos and getting people to work together in coordinated teams, heterogeneous teams that listen to each other and respect each other just as much as they do their own people.

Kevin Pho: So do you have a success story of that solution in action, where before you would just have a lot of disparate systems and administrative burden and nurse burnout, and implemented some of your ideas and really moved the needle?

Karlene Kerfoot: Yeah, well, two thoughts. Number one, we have a great cadre of chief nursing informatics officers now. Sometimes they are aligned over to IT and the clinical people never see them. If we can get those people integrated in the shared governance structures and the nursing structures and the patient care structures, so they’re there every day talking their talk and listening, that works. And there are people who are doing that now, who are pulling them in, and you really can’t tell who they report to, do they report to nursing or IT or whatever, but they are there on the front line working and spreading information and so on like that.

And then the second thing is establishing the structures, so that when you think about acquisition, when you think about strategic planning, when you think about budgeting, you’ve got everybody there at the table. And more and more we’re seeing that happen in a lot of very enlightened organizations.

It used to be you did your budget and then it went to the top and it went somewhere, but now what we’re doing is being able to develop the budget together, so it’s not that solo approach and then we fight about it at the end. So many organizations are going that way and having much better outcomes than what they had before. It’s all about eliminating the silos and getting people to work together as partners.

Kevin Pho: How hard is that for ingrained and entrenched medical institutions?

Karlene Kerfoot: It’s kind of hard, because we haven’t been doing that, and oftentimes it’s like, well, you’re intruding on my territory, or no, you know that. But we can do it, and especially if people get to know each other much better, they say, oh wow, this is really helpful, really helpful. So it’s a matter of time and exposure and talking and so on like that. If you don’t have the opportunity to be together and talk and be exposed, it’s never going to happen.

Kevin Pho: So I asked you earlier for a success story. Well, give me the opposite of the spectrum. Tell me a story of failure, where a medical system or hospital didn’t implement that. Did it lead to continual nurse turnover? Tell us about a scenario like that.

Karlene Kerfoot: Oh, absolutely. One of the reasons that physicians and nurses and everybody else leaves is they’re not listened to. And they feel like they have all this information, all this ability to help, in their head, and they’re not listened to. So they say, I’m out of here, I’m going to go start my own business and I’m going to do this. And then the people left behind say, my gosh, they started their own business, I didn’t know they could do that. Well, yes, they can.

So if you’re not listened to and you’re not respected, then there’s no reason to stay, because you want to go somewhere where you can actually make a difference.

And then of course, much of the patient safety problems are because of lack of communication, lack of partnership. So the nurse does one thing but can’t get a hold of the physician, because we’ve got disparate systems and paging systems and so on, and two hours later it’s too late.

And then also, if we don’t have a way of really talking to each other so each other hears, then that becomes a problem. So a lot of patient safety issues are because of the disparate systems that we have, that one group, the respiratory therapists, don’t know what the nursing group is doing, don’t know what the physician group is doing, so they go out and do their own thing. And of course the patients are caught right in the middle of that. The patients feel that, they know that, they say, don’t you people ever talk to each other? And the answer is no, in some cases.

Kevin Pho: Realistically, how difficult is it to completely overhaul all these disparate technical systems and replace it with a more unified approach?

Karlene Kerfoot: Well, it’s not that hard. Number one, if you’ve got the mission that first of all you want to be able to really get into patient safety and financial issues and all the chaos, because the number two or three reason that physicians and nurses leave is because of the technical burden. If you say, we have to change that, then we can do it. So the first thing is just making the commitment.

The second thing is really pushing, pushing, pushing, pushing the vendors, the technical operations, to say, we’ve got to make this more simple, got to make it more simple.

And the third thing is, don’t ever buy anything unless it’s been vetted by the users and the users say, yeah, this is great, it works. Because oftentimes people come to you and say this is great, and you go, OK, fine, here we go, that’s great.

But the other, probably most important thing, is involve the clinicians when you’re developing things, involve the clinicians when you’re upgrading the technology, involve them, because they are your best source of truth and they’re the content experts. They can help you look really good and make things happen really fast. If you don’t involve them, then you’ll hear nurses or physicians say, this was not built by a clinician, this was built by an engineer. We don’t work that way, we don’t think that way. This is just causing all kinds of problems.

Kevin Pho: How often are nurses involved in that decision-making process when it comes to selecting health IT solutions?

Karlene Kerfoot: Not enough. Because unfortunately in health care we have this thing about, if you’re not doing something with your hands at the bedside, then you’re not productive.

So if we say, OK, nurse, or a bunch of nurses, every week we’re going to pull you out of patient care for four hours and we’re going to have you sit down with these engineers and talk to them about what’s going on, then people will say, oh, they’re not being productive. You have to have direct patient care time to be productive.

Well, that’s not true. The whole point is, we want to be able to use their minds productively in addition to their hands. But if you’re only using their hands and they’re only doing patient care, you’re not really tapping into all that stuff that they have learned.

So the good news is, in some of the shared governance structures, and in some of the structures where you have interdisciplinary people, you take time for that and you say, talk to us, we need to know, give us some feedback, let us know what’s going on. And then you can really get things moving fast.

Kevin Pho: We’re talking to Karlene Kerfoot. She’s a nurse executive, and today’s KevinMD article is “Post-pandemic nursing workforce challenges continue to mount.” Karlene, let’s end with some of your take-home messages to the KevinMD audience.

Karlene Kerfoot: Well, I think some of the take-home measures: lead. Just get out there and lead. The clinical people need to be able to step up, get prepared, and say, we want to be a part of that. For sure, for sure, for sure.

The second thing is, push for integrated structures. Make sure that everything you do, with every bone in your body, is really pushing for integrated structures.

And third, a sense of urgency. The more we procrastinate, the less we get this done, then the more patient safety issues we’re going to have, the more doctors and nurses are going to leave, and the more patients are going to say health care is crazy. We’ve got to have that sense of urgency.

And finally, we have to have a mission that, it’s the moments that matter. Physicians go into being a physician so they can have those magical moments with patients that just rev you up and, man, you can do anything. Those are the ones we have to make more and more frequent. And we can do that by streamlining things, by dealing with the technology burden, and also setting up the compassionate cultures that really recognize people for how good they are, and do a lot of gratitude for the fact that they could be doing a lot of other things, but here they are taking care of patients. Simple, right?

Kevin Pho: Karlene, thanks again for coming back on the show and sharing your time and insight.

Karlene Kerfoot: Thank you.