All About Nursing (31)

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Welcome to All About Nursing with your host Dr. Joyce Bachelor, executive nurse advisor Dr. Bachelor, who will present the significant role nurses play in providing healthcare in a multitude of healthcare settings. Listen to some of today's key nurses who work and practice in academia settings and talk about the challenges they face in today's modern medical world.

So please welcome the host of All About Nursing, Dr. Joyce Bachelor. Good evening. I'm your host Dr.

Joyce Bachelor on All About Nursing and we're live on the BBM Global Network in Tuning Radio. I'm really excited to have a very prestigious colleague of mine on the show this evening and I'd like to introduce her by just giving you a bit of background about her role and some of her accomplishments. So the guest I have this evening is Dr. Jane Englebright.

She is the Chief Nurse Executive and Senior Vice President for HCA Healthcare. She leads 90,000 nurses across 177 hospitals and 120 ambulatory surgical centers in the United States and the United Kingdom. For over 20 years Dr. Englebright has advanced clinical nursing practice through her unique leadership approach that combines knowledge of technological solutions, nursing theories and research with change management strategies.

She has initiated numerous knowledge-driven initiatives which have advanced patient safety and nursing practice including bar coding, enabling safety technologies, and electronic documentation using a standard taxonomy to generate a data warehouse. Dr. Englebright is recognized for her innovation in applying big data to nursing care. She currently is driving a multi-baccident nursing agenda across the HCA enterprise that you'll be hearing more about this evening.

She is internationally and nationally known for her executive leadership with numerous presentations at National Conferences, Publications, and Invitations to Serve on National and International Committees that address patient safety and other executive issues. She currently serves as the Vice Chair of the Board of Commissioners for the Joint Commission and is the past chair of the Informatics and Technology Expert Panel for the American Academy of Nursing. Dr. Englebright is an adjunct faculty member as well for the Vanderbilt University School of Nursing.

So I'm thrilled to have you on the show. Welcome, Dr. Englebright. Thank you.

It's great to be with you. So I think it'd be great if we could start off by having you just tell a little bit more about what is HCA healthcare? Thanks. I'd love to you.

So we are a collaborative healthcare network. We're based in Nashville, Tennessee. So for some of you, you have to forgive my southern twang tonight. But we have about 2,000 sites of care total 185 hospitals in 21 states and as you mentioned, the United Kingdom.

So last year we had the privilege of serving about 30 million patients. So it's quite a large geography and a large possibility that we have for caring for our communities. So as describing your background on the role that you have, you know, having the responsibility for nursing when you've got over 90,000 nurses, sounds like it's a lot of challenges. So maybe you could share a little bit with the audience about what does your role as a chief of nurse executive entail?

Well, formally I'm a member of the senior leadership team for the Enterprise. And my main job is to set the strategy for nursing and tend to design programs and tactics on how to implement and advance that strategy across all of our facilities. And of course I am the advocate for nursing at the corporate level. Clearly I don't advance the strategy or do the work myself.

We have a small, but very mighty team here at the corporate office. But more importantly, we have a great team out in our different areas. We organize ourselves geographically into what we call divisions. And I have a chief nurse executive in each one of those divisions who oversees anywhere from 10 to 20 facilities or 20 hospitals.

And then we have a chief nurse executive in each hospital who actually has the responsibility for overseeing the care that was delivered to our patients. So I'm proud to say that we now have as a part of our nursing strategy a nurse executive in every level of management in the company. That's wonderful. And that must not have been a small thing to get support for.

So congratulations on being able to do that. So I was curious, how do you really get the work done when you've got such a broad places to be able to really get feedback from a lot of different people? That's a huge footprint for you guys to really be pulling all these things together. How do you do that?

You don't mind sharing? Yeah, it's a combination of things. As I mentioned, we have this cascading leadership team. And a big part of my work is getting that team all in alignment around the same strategy.

So we do that by a couple of different mechanisms. Number one, getting involved in defining the strategy and setting the priorities. We have design sessions and strategic planning sessions. We have advisory boards where we get their input and then we get their feedback through a lot of our data and information systems.

So once we get all lined up, then I tell people watch out and look and see what 90,000 nurses all pulling in the same direction can do. And last year was our first year to really have that cascade agenda with everyone working toward the same goals. And we really did see a tremendous amount of improvement last year. That's pretty exciting.

And I was curious too, because I've had other guests on private shows. We've talked about sometimes the challenges in nursing and the need for our pipeline to be populated with people that are ready to take over as people look to retire or act or move into other roles. So what are you doing to really make sure that you continue to have a mighty team? Because it sounds like that's definitely a secret sauce kind of part of your recipe.

It is. It is. And as you know, Joyce, you've been helping us with a lot of our leadership development through your work with the AA. We have a long history of developing executive leaders.

We have our own executive development program that is several years long. So we had a way to help people get ready for that CNO role. What we have been working on over the last several years is all the other layers of nursing leadership. We started with our directors.

Then we went to our charge nurses and we have a 32-hour charge nurse certificate program that we have for all of our charge nurses to complete over a period of two years to advance their skills and their effectiveness. And then we are kind of expanded our director program this year. And then we added the program that you and Rose Sherman have helped us with, which is our ACNO. So our assistant chief nursing officers needed their own development program.

And so we just implemented that. We just kicked off our second cohort in that program. So we're trying to create sort of a seamless pathway for nurses who want to have a career in leadership to start small, start with getting their toe in the water and then continue as far as they want. We do have a voracious appetite for leadership.

And we have a mechanism for leaders of all types to move around the company. I transferred three times with the company. I started in Louisville, Texas. Moved to San Antonio as a chief nursing officer of one of our hospitals there and then made the move to corporate.

So that is a big focus of ours. And we're just now starting to pivot to that career pathway work from our leadership pathways into our clinical pathways. That's wonderful. I was very excited to hear a lot about the charge nurse development that you all have really been very intentional about because I think that is so critical given the fact that many of our managers have multiple units.

But you want them to have a good experience in leadership so that they'll stay on that leadership track. So thank you so much for sharing that. Right now this is all about nursing and I'm Dr. Joyce Bachelor, relied on the people who have been working in radio and it's time for us to take a short break.

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It isn't a time to sell your property today. Learn the My Short Sale Guru way. Welcome back everyone. You are listening to all about nursing live from the Vegan Global Network and Tune in Radio.

I'm Dr. Joyce Bachelor, the host of the show. Prior to our break, Dr. Jane Englebright was telling us about her role as Assistant Chief Nursing Executive for the HCA Healthcare.

And the way that she's able to really be able to impact and know and get involvement from her nursing leaders and staff across over two thousand facilities, which is pretty impressive. So one of the things that might be really interesting for our audience to hear about is how did you get into this role? What kind of preparation did you need to do and where to be successful? Well, my background is very similar to how I think most of us started nursing.

I was a clinical nurse for many years and began being a charge nurse and was kind of asked to step into leadership. It was not a planned career goal, but from that very first assistant nurse manager position, I found that I just absolutely loved it. I loved being able to make a difference to be able to solve problems for the staff and the patients and discover that I was getting as much reward out of being a leader as I was out of being a direct caregiver. So I had a path of promotion's movement from Kentucky to Texas.

And then while I was really not working, I was back, I'm working on my doctorate, I got into that predicament that many doctoral students do, which is called running out of money. I took a part-time job at a small hospital near my home, working PRN on the night shift in the ICU. Another topic for another time, maybe, that is really scary going back and being a clinical nurse when you've been out there for a while. And as I was going back and forth between my home and Texas Women's University, I found this hospital that at the time was pretty small.

It's called Lewisville Medical Center, and it was part of the HBI network. And I fell in love with the management team there, the style in which they did it the way they were involved in their community, and taking on special projects within, including helping to install their EHR system for them. And I found that they were right open to this branch student coming in and saying, hey, I don't know, thank you about computers. I would love to leave this project for you.

And they let me do that. So when I finished my doctoral degree and was ready for a full-time job, I looked around HCA Healthcare and moved with them to San Antonio as a chief nursing officer at what was then called San Antonio Community Hospital. And after about three years, I transferred up to the corporate office and did kind of a variety of roles here. And patients they did, as you mentioned, in my introduction, education and quality, until we finally decided to create this chief nursing executive role at the corporate office.

So how did I prepare? I think by doing a good job at all the roles that were building blocks for coming up here. And I'd say volunteering for some of those tough projects and things that were a little bit out of my comfort zone that got me great experience, great skill building, and also a lot of visibility within the company. That's great.

That's very impressive. And it seems like the other piece that I heard you too is sometimes just not being afraid to ask your involvement with the clinical electronic world when you were in school. I mean, that's something that I think sometimes people hesitate. And we shouldn't.

Because I think, you know, the voice you can have is somebody saying, no, but a lot of times people are really excited about you taking things on. So I'd really like to have you share with us a little bit more about the nursing strategy at HCA Healthcare, because I know you've been working on this very diligently. Yeah, we have. This is about year three of what we would call a formalized strategy, trying to advance our practice and improve patient outcomes.

I still think we're in the very beginning stages. As you mentioned, we've got over 90,000 nurses. I'm quite sure you could walk up to several of them right now, and they would tell you the whole thing about it. Communication is one of our big challenges in trying to get the word out to everyone.

But we've organized the strategy around three areas of focus that were identified through that strategic planning process I mentioned. The first is advocacy and leadership. The second is consistency and practice and operations. And the third we call leveraging scale.

We specifically designed goals and tactics across these domains that address the nursing work environment, career development as we talked about, and a lot of patient care processes and outcomes. We are big. And that scale gives us an opportunity to do some things a little differently and is one of our unique advantages. And so we particularly called out that leveraging scale as a way to think about how do we work together and how do we do things that are different than how you would do it if you were in a hospital kind of by yourself.

We think we have done a good job of harnessing a lot of our knowledge and our energy and resources as we try to orient all of our nurses toward our mission, which is about all else we're committed to the care and improvement of human life. Yeah, and I think that you said earlier too, having 94,000 nurses become really aligned across your organization. There's just amazing opportunities and possibilities when that happens. So congratulations on that.

So how did you just go ahead? It is. I'll be remiss if I didn't mention that as we put this strategy together, we were clear that it's an enterprise strategy. It's about nurses, it's for nurses and service of our patients.

But we invited all of our other what we call strategic partners to the table, not just to be on advisory board actually co-lead parts of the strategy. People like our human resources department, our IT group, our performance management group, our physicians, finance, and a lot of our service line leaders actually serve and help to co-lead and drive at the corporate, the division and the facility level. That's wonderful. I would think too the power of quantification of data across your multiple sites is also something that when you're looking at scale would be real opportunities that could pop up with that.

So that's exciting. But it sounds like it's a huge job. So how did you decide to undertake such a massive agenda? Well, we started small.

And again, the advice of our CNO Council, they really told us we needed to focus on medical surgical nursing. And our initial goal was to really have medical surgical nursing be seen as a specialty. We began by sponsoring certification programs, encouraging nurses to get certified in meds, search nursing, and to really take pride in the fact that they are the culture carriers within our organization. So many of our nurses began their career in meds, search, and they had an opportunity to help shape the future.

That's what it added to. So right now we are coming to you live from the VPN Global Network and Tune in Radio. We're all about nursing about your choice and we'll continue this conversation when we come back. So I mentioned the focus on certification and being beginning to see medical surgical nursing at the specialty that it is.

We also realized that nurses need equipment and they need to do their job. So we worked with our meds, search directors through a survey process that had them tell us what they needed in terms of capital equipment. And we dedicated a portion of our capital budget to the meds, search, care environments for three years and really did a lot of bed upgrades, chairs, ladder scanners, all kinds of things that the nursing directors needed to great care in our patients. Then we created what we call the unit of distinction because we realized we hadn't really defined well for the meds, search director.

What does a good unit look like? If you're running a great unit and you're delivering great outcomes, what would we expect to see? We modeled this program a lot after halfway to excellence and the PRISM award with the American Med Search Nursing Association and began to work toward these different areas of performance around the work environment that has outcomes you're doing in certain practices and processes we need to see. When we got such great feedback and response from our med search nurses, that's when we really made the decision, hey, let's try to take this enterprise wide.

Let's try to expand this to all of our different special teams. And so that's what we have been about for the last three years. That's exciting. And I'm just seeing a lot of outcomes that are improving as a result of the kind of investments you're describing because I would just think that nurses would have so much pride and ownership and energy and want to be with your organizations.

We have seen great improvement in our nursing engagement scores and our turnover for RNs, our patient experience scores have shown improvement, our hospital acquired infection rates have been declining, and we're doing great participation in our development programs that we talked about. That's wonderful. So maybe you could share a little bit more about your strategy around the three primary pillars of advocacy and leadership, consistency and practice and operations and leveraging scale. Sure.

I'm happy to. Advocacy and leadership is both the leader development that we talked about, but it's also our governance structure. So we really required as a part of the unit of distinction that their professional practice councils organize and how and every way they want to in all of our facilities. And the nurses have a way to have an active role in defining the practice and setting practice standards.

And then I mentioned we have started now working on the career paths. So we have our HDA, healthcare residency, nurse residency that graduated 2,600 new nurses last year. We've added preceptor training in order to support those nurses. And then now we're working on an app that has been designed by our nurses that will allow them to chart their career path across HDA.

They can start with specialty. They want to move to next, what part of the country they want to move to next. They can go through a little match.com kind of features to find themselves a mentor, whatever they want. But we really believe there's just a huge wealth of opportunity for whichever way a nurse wants to take their career within the organization.

We're trying to make it easy for them to find that next step and make that transition. That's exciting. Practice and office. What you talked about is we're trying to leverage our scale with over 1,500 different nursing units out there.

We have just a natural experiment happening all the time where we can go out and harvest best practices. We have focused, as I mentioned, on clinical care bundles around hospital acquired infections. And of course, we use the ones coming out of the evidence. But in terms of how they went about getting those implemented in their units, we use a lot of peer learning across the different units.

Similar process for our patient experience tactics. And then we've really looked at operational excellence around things around supply management equipment, standardization. And then, as you mentioned, a big focus on technology. Our leveraging scale this year, we've totally dedicated to clinical education.

So we are implementing a whole new model for how we support nurses and all of our clinicians and clinical education centers that we're building across our footprint and moving a lot of our education into the simulation and learning centers and having our educators in the facilities be focused more on Appie, Elbow, and just in time training for our new staff and our experience staff. Can you say a bit more about simulation labs for our people that are listening that may not be familiar with what that is? So, yeah, we're building simulation centers that have several rooms of both locality and high fidelity mannequins. Where we can do things as simple as your BCLS CPR check-offs and as complicated as running a simulation of how to manage a postpartum hemorrhage with a high fidelity mannequin.

So, that's a hard skill to have in every one of our hospitals. But by centralizing it in these simulation and learning centers, we are able to put some concentrated expertise there and really deliver a very impactful learning experience. It's pretty amazing how the mannequins can talk to you. They can have airways block off.

You can have them do everything that real humans do. So it's been incredible to see the kind of learning that can go on in a safe area, which really does prepare our nurses before they're out there taking care of real patients. So that's very exciting that Joel are doing that. So, I was curious if you wanted to tell us a bit more about the kind of technology that you're really focusing on and things that you're trying to do for communications with the number of nurses that you need to be keeping in touch with.

Yeah. So, I mentioned one with our Career Pathway app that we're developing. We just finished last year rewriting our clinical documentation system and through that process we did two things. We saved the nurses about 30 minutes per 12-hour shifts for each and every nurse by streamlining the documentation and how it's built.

And then we standardized and coded all of the data elements that nurses are entering. So, we created that data warehouse that you mentioned where we're able to go in and mine for those best practices and what's working well and what would we like to spread across the entire enterprise. The other area we've been working on is team communications. So, we have almost fully deployed, not quite done yet, an iPhone-based secure text messaging for the entire clinical team to use to coordinate care.

That's exciting and we will talk about more about that in just a little bit. So, we're coming to you live from the Viva and Global Network in Tune in Radio. This is all about nursing. I'm Dr.

Joyce Bachelor and we will be right back. Mike Zorick, a three-time California stage champion in Greco, Roman wrestling at 114 pounds. Mike, blinds its birth, was born in Hartford, Connecticut. He was a six-time national place-er, including two seconds, two-thirds and two-fourths.

He also won the veteran's folk style wrestling twice at 152 pounds. In all these tournaments, he was the only blind competitor. Thank you for listening to all about nursing live from the Viva and Global Network in Tune in Radio. I'm Dr.

Joyce Bachelor, the host of the show. And my guest this evening is Dr. Jane Englebright, who is the System Chief Nursing Executive for the HCA Healthcare System. And prior to the break, Jane had started sharing with us.

I think some very exciting things that are happening to really try to, with technology, try to improve communication and the work environment in patient care in general. So, maybe you could continue to share a little bit more about that with us. Sure. In addition to these clinical technologies that we are trying to put in the hands of our our nurses to make them more effective and efficient and take some of the burden out of their work, we are doing the same thing for our nurse leaders.

A big part of getting everyone pulling in the same direction is transparency in the data around current performance. So, we are able to take that standardized coded data that the nurses are inputting as they give care and pull that up into some interactive dashboards to what we call nursing insights. So, we can actually look at how each nurse is doing on the key performance indicators of a classy bundle, for example. And then we can aggregate that up to the unit level, to the hospital level, and then all the way up to the division and corporate to look at how and why we are doing on our actions and the interventions we need to take, and then how is that related to infection rates, for example.

And we do that across several different domains of care, as we call them, the clinical domain, the patient experience domain, the nursing efficiency domain, and the nurse engagement domain. And so, as we look at those and how we are moving our performance in each one of those, what we want is that balanced scorecard approach. So, we use that review of the data in those systems in a very thoughtful and methodical process. I sit down with each one of our division chief nurse executives and review the progress of that division using these tools.

And then that division chief nurse executive sits down with each facility CNO and reviews the hospital performance on that same tool. And then the hospital chief nurse chief nursing officer has that same review using that same tool with each one of the directors in the hospital. So, it keeps us aligned all the way up and down this organization that we are working on the same things. We know how well we are progressing and we know how well everyone else in the organization is progressing.

So, if we need some help, we have plenty of friends that we can call on to help with. So, you try to pull up the best practices and showcase them for others. We used to call that this is when you want to steal shamelessly from each other. You don't have to start right.

Yeah. So, that's great. And so, I was curious. You were talking a little bit about the role with the technology and the beginning, even like you're in-packed with working on electronic healthcare record and your experience being associated with the Joint Commission and for our audience that may not know.

This is a primary organization that comes in to look at organizations at different hospitals having to make sure that they're meeting different standards to assure that the kind of care organizations are providing is safe and efficient and effective. And so, many times people feel like there's too many regulations. So, I was curious how you are able to use your experiences and bring that back to the Joint Commission to give feedback on sometimes standards that seem to be a little cumbersome to be polite or needing to be revised. And so, I was just curious because I was excited actually to see that you did that because I thought, wow, this is a huge role because I know people are just feeling burdened with the amount of regulations and documentation that goes along with that.

Yeah. I'm thoroughly enjoying my time on the Joint Commission. I've been there for about six years now on the board and this year and next year I'll be the vice chair of the board. So, I learned a lot.

The board actually does it make the regulations. But we did oversee a process at the Joint Commission undertook, they called Project Refresh, where they went back through a lot of their standards and looked at which ones were maybe a little outdated, which ones were duplicative, which ones everybody had nailed and weren't really adding much value. And so, they did undertake a massive reduction in the number of standards and elements of performance that they have had last year. Certainly, you know, never missed the opportunity to advocate for good, meaningful standards that actually help keep our patients safer and don't add a tremendous amount of unnecessary burden.

And we did our documentation rewrite, probably one of the biggest learnings we had, is that what we thought was required really wasn't. And we came up with a group, we called them the Mythbusters, but they were our regulatory compliance experts, our attorneys, our risk managers. And I didn't let them meet and talk because they wanted to talk like nurse systems. But I really just need your regulatory expertise.

As we come across these questions of does CMS require this? Does Joint Commission require this? Do we have to have this management perspective or billing perspective? I want you to put in the spreadsheet the actual reg and rule that says we have to collect this data.

And we got, we found that most of the time it wasn't a requirement. Some of it was outdated. The people who were telling us we had to do it used to be required, but it wasn't anymore. Or we had way over interpreted what was being asked for.

So that is where really a lot of our reduction in the nursing time came from was going back and questioning every single one of those things we thought was required and moving the ones that were no longer required. That's wonderful because I think that sometimes when you do that, you find that it's the organization that's created the policy that everybody's complaining about, but it's not a regulatory standard. And so we sometimes are worse enemies when it comes to that. So that's very exciting.

You've been able to do that. You had started to share a little bit earlier about the kind of results that you're having. And I think that for people listening, the reason that we're talking about the work environment and the kinds of things you're doing for nurses is that when nurses are happy, nurses are engaged and nurses have a voice. Patient care, we know, will become much more greatly improved.

And that's what it's all about. So I was just curious, since you have such a wonderful way of cascading and tracking, you know what sorts of improvements are you seeing that you're most proud of? Well, I think you nailed it. You know, we're most proud of our nurse engagement and our reduction in turnover.

We invest a lot in the nursing nurses as they come to work with us and so keeping them challenged, engaged and satisfied with their work is real important. And we have been a focus for our nurse leaders. And then we're seeing improvement on our patients outcomes as well. And I think you're right.

It's a direct correlation to how well the nurses are performing. So this is all about nursing. I'm your host, Dr. Joyce Bachelon, we're live on the BBN Global Network and Tune in Radio.

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You're listening to all about nursing, life and the BBN Global Network in Tune and Radio. I'm Dr. Joyce Bachelor, the host of the show. And I have Dr.

Jane Anglbright on the show with me this evening. She is the current chief nursing executive for the HCA Healthcare System. And she's been giving us just wonderful information around the great work that the nursing leaders and nurses in general are all doing within their organization. And you were talking about the kind of results that you're starting to see with the cascading and the connecting the dots.

I call it from the boardroom to the bedside and now beyond to the communities. What kind of improvements you've been seeing? You had to tell us about the nursing engagement, which I always is very intriguing because I think that's okay. So maybe you could share a little bit more about the outcomes that you're really seeing that are making a difference.

Yeah. I think another one that is related to the engagement is our time to fill on nursing leadership positions, particularly our chief nursing officer positions. And I attribute a lot of that to our regional division chief nursing executives. They know their teams.

They know each of their C&Os and their assistants C&Os and even down into their director ranks. And so when we had an opening come available, they are very quick to identify where we've got rising talent, where we've got people that are ready for the next step in their career. So we have done a great job of that with our executive ranks. And this year we're focusing on our director ranks.

Because we all know the director, the nursing unit is really where all the magic happens. And the directors are the ones who run those units, who create the work environment for the staff, who manage the patient flow, who manage the physician flow, and who are the actual where the rubber meets the road for all of the improvement work that we want to do. So we are focusing on that position this year. And I mentioned increasing our development opportunities for directors and really focusing on making sure we've got a pipeline of people ready for the director position.

That's very exciting because there's a lot of concern, I think, nationally that there are a lot of chief nursing officers that will retire within the next few years. And do we have an adequate pipeline? And I know that there's work going on right now with AO&L. We're now called the Meriborization Leadership to repeat the turnover study around chief nursing officers.

So I think that's very exciting that you have been able to see that kind of improvement there. How do you sustain all these improvements? Because it seems like there's a lot of things to be looking at comprehensively with all the areas of focus. It is.

And it's one of the things that we worry about as we go through this, making improvement is easier than keeping that improvement in place and continuing to advance it. So a lot of what we do is through our accountability structure that I mentioned, our nursing performance reviews that we have at each level of the organization. Today we have not retired any of our metrics. We have kept them on our dashboard and we continue to look at what we have added a few this year, but we really are trying to stay the course.

The other thing we've done is we've created a sort of a cycle. So what we put on our list to accomplish this year that we work on implementation, next year we cascade that into our unit of distinction program. So what was an implementation project in year one in year two becomes a performance criteria in order to achieve unit of distinction status. Until we think that that two year focus on any individual improvement will help us with sustaining it.

That's wonderful. And I would imagine that all of that also is things that you have to then figure out how do you tell new people when they come into your organizations. And I would imagine you have a process that's in place to kind of help them know what's expected when they begin. And is that something that's reinforced through the residency program and things that you were sharing earlier?

It is. You know, it's great having the residency we say with all of our brand new nurses for a full year in that residency program. And it does give us an opportunity to make sure they're starting off on the right foot with the practice of the stuff that we want. That's awesome.

So is there something that has been like your biggest accomplishment that you're like just so proud of that you would like to share with people? Oh, I think it's accomplishment. You know, I really do think it is this nursing strategy. We've had some individual projects like you mentioned of our coding administration, the documentation rewrite that have been very impactful as individual projects.

But when I think it's something that's going to have a long term impact on many, many lives of the nurses who work for us and the patients that we care for, it has to be the strategy where we have really organized and harnessed the full strength of HCA to come to the service of nurses and patient care. It's been an exciting thing to see. And the fact that we were able to deliver great results in the very first year, I think is really reinforcing to the leadership at every level of this organization that nursing is not too big. It's not too complicated that we really can get in there and make meaningful change.

And it sounds like, because I know that the people sometimes are finding it challenging to talk about the value of nursing. And I sort of smile because I think you've just been describing the value of nursing through the kind of outcomes that nurses impact. And so I was just curious, does that help to really give you more credibility within the organization when you're asking for more things in order to keep the investments coming that you want to do? I mean, I can't imagine that you walk in and get everything you want the first time.

So I was just curious how that works for you. Well, absolutely. We do have a pretty stringent resource allocation. There's no shortage of great projects and great ideas within the company that just need funding.

And so it does help when you've got a track record when you win the nursing leaders and the nurses at the beds, I really deliver after we make an investment. It definitely makes the next ask. Get looked at a little more favorably. That's wonderful.

So I was curious too. You were talking about some of the things that you were doing with the Joint Commission. But I know that you're also extremely active in other professional organizations. You know, maybe because you're a little bit about what you're currently doing and how you make that time for that because I think that you're also trying to manage and have some balance to your life because you still have a home to go to.

Right. Yeah. And part of how we do that is among my leadership team here, we kind of divide and conquer about the different organizations that we feel like it's really important to stay and touch with and be a part of. So obviously with A&A, we're members and we're working with you and Rose on the ACNO development program and staying in touch with policy moves that they make.

We're also very involved with A&E for the last several years. I sponsor a workshop for some of our nurse executives prior to every A&E meeting trying to encourage their involvement in that organization. And then I'm very involved personally with American Academy of Nursing. I've been on the information and technology panel really since I became a fellow and feel like that's just a great voice for nurses at the national level.

And then I work with the Nursing Knowledge and Big Data Science Group. It's probably where I'm the most active right now. Okay. So we'll come back to that right now.

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And I have my guest on the show with me this evening, Dr. Jane Angibrite, who is the system nurse executive for HCA Healthcare. And Jane, you've been telling us just amazing work that's going on in your organization. And we just started talking about some of the activities that you're also involved in outside of your workplace.

And you were begun to tell us a bit more about nursing knowledge, big data science, which I think sounds very interesting. So maybe you could share a little bit more about what that is. So yes, this is a very interesting meet once a year at the University of Minnesota. And I can't even remember, well, I guess it was because of my work with the Academy.

We agreed to have a committee meeting at this a few years back. And I found myself really being one of only two nurse executives that were in the group of a lot of academics, a lot of researchers. And they were so welcoming to me and so appreciated having the folks going on with the data, what's going on with our systems. And so I have been back every year since then.

I've gotten very involved with their work groups and serve on the steering committee for the conference again this year. Shameless plug, if you haven't been and you're interested in data, it is absolutely great. But fair warning, it's a working conference, not a sit and listen conference. So you have to be prepared to work.

What I'm working on right now with them is defining the minimum content for nursing admission history for the adult acute patient. And it has been great working collaboratively with nurse leaders and nurse informatics from across several organizations who've been collaborating and contributing and debating what's in and what's out. And so I'm looking forward to a great design session to wrap up that work when we get together. That's wonderful.

Now, where does that committee come from? Like, I was just curious, where it got formed? Is it just in terms of everyone who comes, if anyone who comes to the conference, you kind of divide up and decide what work you're going to be on and what work you want to contribute to? That's interesting.

So very exciting. You know, you've shared so many wonderful things this evening about the work that you're doing across your organization, the cascading of goals, the nursing performance review process, the improvements is there. Something that you would really want to make sure the audience is aware of or thinks of as we get ready to close up our show here. I think it might be what I said a little earlier.

I think a lot of times, no matter what the size of your organization, nursing is a huge piece of it. And it's often the biggest piece of it. And it can be a little intimidating to take on a big change effort that involves that much of your organization. And so if you take anything away from this, it would be that it can be done and it could have a really huge impact and that is really worth the effort.

And it sounds like you've been doing that by really getting nurses engaged and being very proud of their accomplishments. And I was curious, like the Unit of Distinction Awards, how many awards do you give out? Is it like on a quarterly basis or monthly or how does that work? That's an annual award.

And we give it because we didn't know how to score it. When we first started, we just said the top 5% are called units of distinction and they get a $20,000 education grant for their unit. The next 5% are called honorable mention and they get three scholarships to go to their national meeting. So it's definitely a carrot approach of the work hard to get to meet.

And then we raise the bar every single year so that the next year, the criteria are a little harder. Well, I really want to thank you for being on our show this evening and you have shared just so many wonderful things that I would hope that those that are listening can also feel confident that nurses really are on top of things, trying to make sure that the care they deliver to everyone that may come into the organizations is really well done. So thank you so much. You are listening to all about nursing live in the BBM Global Network and TuneIn Radio.

I'm Dr. Joyce Batch, the host of the show and tune in next week. Thank you. You've been listening to All About Nursing with your host, Dr.

Joyce Batchler. Tune in each week and get a daily dose of nursing and the healthcare services they provide and how nurses are finding innovative ways to address the key healthcare issues they're facing today. Here on Dr. Joyce Batchler's All About Nursing.

You've been listening to the BBM Global Network. The ideas, views and opinions of this broadcast are those of the participants of the program and are not necessarily the ideas, views and opinions of the BBM Global Network Company.