Chapter 16: Challenges in Nursing Today: Building an Expert Workforce
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Description
In this Chapter, Dr. Summers lists challenges she must address as Chief Nursing Officer. First she explains how she had addressed the lack of leadership succession planning when she took on the CNO role. Next she talks about establishing the “Launch into Nursing” program to provide orientation for newly graduated .
Next Dr. Summers talks about the current nursing shortage and the challenge this presents to building a qualified and expert workforce for the future. Dr. Summers describes her job as creating an environment for nursing practice that will attract the best and the brightest and also retain senior women. She also explains efforts underway to ensure that nurses perform at the top of their license.
At the end of this session, Dr. Summers speaks about the future of nursing.
Identifier
SummersB_02_20140401_C16
Publication Date
4-1-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, April 01, 2014
Topics Covered
The Interview Subject's Story - The AdministratorThe Administrator The Leader Professional Values, Ethics, Purpose Contributions to MD Anderson MD Anderson History Research, Care, and Education in Transition The History of Health Care, Patient Care Women and Diverse Populations in Healthcare and Institutions
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Barbara Summers, PhD:
I mean, Primary Team Nursing is something we’ve been working very diligently on for the past two and a half years, but we have been planning for it for four years. But other issues that we had included we had no succession planning, leadership succession planning, at all, and we had zero bench strength for leadership positions. So if a nursing leader left because their husband got transferred across the country, we had no choice but to externally recruit, because there were no people inside who were prepared to move into the position. So that was a key area of focus, and I wanted to ensure that we put together a pipeline for future leader in nursing, and we did that in a very intentional and deliberate way by creating what we called academic cohorts for individual nurses with the talent and the passion to move into leadership positions. We supported them in obtaining their master’s degree in a leadership role. It could be an MBA or an MHA or a master’s degree in nursing with a focus on leadership. And through that program, we were able to just significantly strengthen our bench strength so that we have been able to, by and large, recruit internally for promotion, although not exclusively, because you don’t want an organization to become entirely inbred. There’s always benefit in bringing in external individuals as well, but at least we have internal candidates that we can interview and consider for these opportunities. The other major area that I addressed very early on in my tenure as the CNO is that when we brought new graduate nurses into the organization, we had no formal orientation program for them. They were treated just like any other experienced nurse coming into the institution. And I mean, that was just not a good practice, because it’s well identified that when nurses graduate from their basic education, they need to have a clinical training period just like physicians do. When physicians graduate medical school, they go to a residency. We don’t turn them loose and let them start practicing medicine, because they can’t safely do that. Nurses can’t safely do that either. So we created a graduate nurse residency program that we call Launch Into Nursing. It’s a one-year program. And at that same time, we made the decision to only hire baccalaureate-prepared nurses, no longer to hire associate-degree nurses. And as the nursing shortage has become more real with each passing year, as we have more nurses reaching retirement age than we do have nurses coming out of nursing programs, we have to rely heavily on recruiting new graduate nurses. So we recruit them by the busload. And this year in the spring graduates, I think we’re hiring eighty new graduate nurses, and we pretty much hire no fewer than fifty with each graduating class. So we have graduates who come out in the spring and then come out in December. So we hire fifty and sometimes we’ll hire two groups of fifty and stagger them, and that’s how we’re building the workforce of the future. Now, that presents challenges because we have to have senior nurses to mentor these new nurses, and we can’t underestimate the importance of that mentoring and taking the wisdom of our senior nurses and leveraging that to develop our junior nurses. But it has transformed the picture of the kind of face of nursing, particularly in the hospital setting.
Tacey Ann Rosolowski, PhD:
The nursing shortage, a topic that comes up over and over again, what are the factors that are combining to create that?
Barbara Summers, PhD:
There are a number of factors. First of all, the demand for nurses is going to continue to grow up because of the aging demographic of the United States of America. All of the baby boomers are getting older and they are consuming more nursing care. And as the baby boomers get increasingly older, they are going to require more healthcare, and healthcare involves nurses. So there’s a greater demand by virtue of the aging population. At the same time, the individuals who are in nursing, if you were to look at the demographic profile of registered nurses in the United States, the average age of a registered nurse is still probably forty-five years of age or north of that, and that’s come down a bit in the last few years because of new graduates, but we are going to have an increasing demand for nurses at the same time that we have a lot of nurses who are baby boomers retiring, and we do not have graduates from nursing programs coming out at the same pace as we have retiring nurses. acey Ann Rosolowski, PhD Why is that?
Barbara Summers, PhD:
There are a couple of factors. One is that after the baby-boom generation made their career decisions, the next generation of individuals, particularly women, had multitudes of career options open to them, not just nursing. You know, when I was in high school, of course, you know, my parents would have been very supportive of me pursuing whatever I wanted to, but it was somehow understood that smart young women would go to college and they would become nurses or they would become teachers. That’s changed. I mean, smart young women become engineers, they become attorneys, they do all kinds of things, so nursing was no longer one of the few professional opportunities available. And then the profession of nursing went through cycles of having an excess of nurses, and when you have an excess of nurses and nurses start getting laid off, it becomes a less attractive career option. And in my time in nursing leadership positions beginning back in the 1980s, nursing has gone through cycles of shortages and then abundance and then shortages and then abundance. But we are now definitely in a shortage phase that’s going to get worse over time. So we have more people retiring at the same time we have greater demand for nursing and nursing care and nurses, and we have Schools of Nursing that can’t keep up the pace of graduating nurses to replace those leaving the workforce, never mind add additional nurses to the workforce. So my job at MD Anderson is to make sure that we have a practice environment that is highly attractive to the best and the brightest young nurses, one that encourages our senior nurses to remain engaged in practice so that we can leverage that wisdom, and providing an environment where we can nurture and develop our young nurses to become experts in their practice. And then also designing models of nursing-care delivery that leverage the unique knowledge, skill, and ability of a professional registered nurse and that we eliminate non-nursing responsibilities from our professional nursing. Because nurses are very capable and very flexible, they often end up taking on responsibilities that they don’t need—
Tacey Ann Rosolowski, PhD:
How interesting.
Barbara Summers, PhD:
—and that are not part of their practice, but they do it because they’re kind of all-purpose. They can do that, so why not have them do that? Well, the reason not to have them do that is because every task a nurse takes on that does not require the expertise of a professional nurse, that reduces the time the professional nurse can give to the patient. So you have to do that kind of risk-reward evaluation. Is it so important that the nurse take on this responsibility which is not in the realm of professional nursing practice, is it so important that we are willing to give the patient less nursing care?
Tacey Ann Rosolowski, PhD:
Is that discussion about refining the role of the professional nurse, did that fall on receptive ears when you first presented it here at MD Anderson? Because it meant, obviously, that other individuals were going to have to pick up those roles.
Barbara Summers, PhD:
You know, it’s not an edict, and it’s not a conversation that has a “by this date, we are going to.” It’s really an evolutionary process, and we have been working on the evolution most intently on the inpatient side, but I’m embarking upon the conversation with the ambulatory nursing leaders as well. But we have had the luxury of having an almost unlimited pool of registered nurses in the ambulatory clinics, which are doctors’ office practices, and the consequence of that has been that because we had so many professional nurses, they’d do all kinds of things that did not necessarily require a professional nurse. So now that we are having to address the very unpleasant reality that there are not as many of these professional nurses available now and certainly not in the future, we have to say, What are the most important contributions of a professional nurse in ambulatory care? And for those things that do not require a professional nurse, let’s identify is that a medical assistant? If so, then let’s shift our focus and let’s bring in medical assistance to perform those roles, and let’s reconfigure the role of the professional nurse to focus on nursing so that the doctors don’t feel that they’re getting less support, the patients don’t feel that they’re getting shortchanged in terms of their care experience. but we’re very clear about how we are spending the dollars we’re investing in nursing.
Tacey Ann Rosolowski, PhD:
It’s just about noon, and would you like to close off for today?
Barbara Summers, PhD:
Yeah.
Tacey Ann Rosolowski, PhD:
And I’m hoping you can open up your schedule, because we certainly have a lot more things to talk about.
Barbara Summers, PhD:
Absolutely.
Tacey Ann Rosolowski, PhD:
Okay, great. Thank you.
Barbara Summers, PhD:
Yeah. So, you know, the whole issue of the future of nursing, it’s a challenging time that is filled with tremendous opportunity but tremendous risk as well, and I believe that in my thirty-some years in nursing practice, we are at a unique inflection point where nursing will either blossom into its true potential to influence the health of the community-at-large or there is the risk of it becoming irrelevant if it doesn’t transform.
Tacey Ann Rosolowski, PhD:
Interesting.
Barbara Summers, PhD:
So we can kind of pick up after that and spend some time—I want to focus a bit on new knowledge, innovation, research. I want to talk about the development of the Department of Nursing with the faculty appointments. I want to talk about nurse scientists and the research that nurses are conducting. So, lots of things still to talk about.
Tacey Ann Rosolowski, PhD:
Yeah. I look forward to it. Thank you.
Barbara Summers, PhD:
Thank you very much.
Tacey Ann Rosolowski, PhD:
And I’m turning off the recorder at about one minute after noon. (end of session two)
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 16: Challenges in Nursing Today: Building an Expert Workforce" (2014). Interview Chapters. 1253.
https://openworks.mdanderson.org/mchv_interviewchapters/1253
Conditions Governing Access
Open
