Retaining A Rural Nursing Workforce: It Takes A Village

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Tom Haederle
Imagine you're a new hire and on your very first day of work, your new boss throws a big party and invites all of your new colleagues to welcome you. Pretty nice hello huh? That's just one strategy that a creative hospital administrator uses to attract and retain great medical talent in a rural health care setting. This demonstrated and genuine concern for the workforce seems to do the trick.

00;00;27;25 - 00;00;56;00
Tom Haederle
Welcome to Community Cornerstones Conversations with Rural Hospitals in America. A new series from the American Hospital Association. I'm Tom Haederle with AHA Communications. Middlebury, Vermont has its charms, but as with any rural health care setting, it faces challenges in attracting and keeping great care providers. In this podcast, a senior University of Vermont Health Network administrator explains how she took a fresh look at the problem and said to herself, I can do something about this.

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Tom Haederle
And so she has. Now let's go to our moderator, the AHA’s Elisa Arespacochaga.

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Elisa Arespacochaga
Good morning. This is Elisa Arespacochaga with the American Hospital Association. And I'm thrilled today to be joined by Tiffany Love, associate vice president and chief nursing officer, the University of Vermont Health Network. Porter Medical Center in Middlebury, Vermont. Welcome, Tiffany.

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Tiffany Love
Thank you. Thank you for having me.

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Elisa Arespacochaga
So let's get started. Take me back a little bit. What brought you to health care?

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Tiffany Love
So I have actually been working at a hospital since I was 15 years old. My father did not want me to work at a fast food restaurant, so he got me a job in dietary and then years later, he said he regretted getting me into health care because he felt like I grew up so fast. I went from working in dietary to being a nurse's assistant.

00;01;43;14 - 00;02;01;17
Tiffany Love
I had a really pivotal moment with a patient, and I decided I want to be a nurse. And that was all it took. And I went to school to become a nurse and before you know it, I went on to become a nurse practitioner and pursue my Ph.D. and then I decided to get into management and became a chief nursing officer.

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Tiffany Love
So it wasn’t your usual path to health care leadership.

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Elisa Arespacochaga
But it's a wonderful one. And I think almost every nurse leader I've spoken with has one of those moments with a patient that is said to them, This is what I'm really good at and this is where I need to be. So as now a nursing leader who is responsible for making sure you have the right numbers of nurses and in your organization and others, how are you starting to get creative with the whole process?

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Elisa Arespacochaga
Let's start with the recruitment efforts to bring those nurses in, to get that next generation of you coming in the door.

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Tiffany Love
Well, I asked myself, why would you ever want to be a nurse? And as a chief nursing officer, I have to have the answer. I have to be the one to create a place where people want to work. So I start with recruitment. I go out to the career technical schools, community colleges and universities. I introduce myself to the students.

00;02;58;00 - 00;03;17;03
Tiffany Love
I tell them my story, and then I ask them, there's. And then I tell them about the opportunities at my organization. And I also have had the opportunity to break down some barriers. Some of the students said, Well, you have to be 18 years old to get a job at the hospital. So I worked with Human Resources to get rid of those barriers.

00;03;17;16 - 00;03;40;22
Tiffany Love
And then when they come to do clinicals, I make sure to visit with them right away and offer them an early hire opportunity. So before they're even finished with school, they know they have a home and I think that makes a difference. They want to feel welcome. And then when we hire them, I throw them a big graduation party and invite the entire hospital to welcome them to our organization.

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Elisa Arespacochaga
Wow.

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Elisa Arespacochaga
It sounds like you really build a family.

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Tiffany Love
Absolutely. You know, that's the difference in rural health care. They tend to be small organizations. People do feel like extended family. And so from day one, I am having luncheons with them. I'm rounding with them and making sure that I know the nurses by name.

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Elisa Arespacochaga
That's great. So part of that work, once you get to the point of bringing them in the door, you then have to think about how do you retain them, how do you keep them, how do you make those connections that make that job connect to what they came into health care for?

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Tiffany Love
Well, I like to make sure that the nurses have the resources they need to get the job done. I can tell you when I started my role with the Health Network, I was working with a dedicated long tenured group of people, but they were weary. I could see it on their face that every day, as they gave report and huddle, you could tell they felt like it was such a high hill to climb just with staffing shortages, maybe with having patients in the hospital longer than usual.

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Tiffany Love
So we started with a gratitude huddle. They would come in to report and then they would say what they're thankful for and it has to be something new every day. And there's a lot of research out there. I use the research by Shawn Achor from the book Big Potential, and I found that this changed our huddle into starting the day, feeling kind of, Oh my gosh, how will we accomplish this?

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Tiffany Love
To starting the day with Yeah, it might be rough a week got each other and we can do this. And before you know it, that turned around. Another thing that I focused on was making sure that if someone's working too many hours, find a way to get them time off. Also addressing pay inequities. There was some research done by the National Academies published in 2021 about the impacts of COVID 19 and the reason that people were leaving health care were due to pay inequities, feelings of moral injury, unsafe workloads, lack of child care, lack of adult care.

00;05;46;10 - 00;06;08;17
Tiffany Love
And I thought to myself, I can fix this. So I got the nurses to pay raises in one year, I got the nurse leaders pay raises. I got them retention bonuses, which the research doesn't really support. Retention bonuses, but retention bonuses, signing bonuses, preceptor pay, doing everything I could think to do, to say I value you, I'm so happy you're here.

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Elisa Arespacochaga
That's great. And it sounds like a lot of the work you've done is really focused on the culture of your organization, really keeping that family feeling that you start with going along the way. So how do you get to that point where people really do feel like they're thriving? Because there's there's almost nothing I can imagine better than that feeling when you can help a family or a patient.

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Elisa Arespacochaga
And I'm sure, as we've heard in various sessions at the rural Conference that you have people who run into former patients in the grocery store and so forth who, you know, will come up and give them hugs. And that's got to be a piece of this work. But how do you keep your teams thriving in the day to day in the ongoing challenges, both with the pandemic and just with the difficulties of health care?

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Tiffany Love
It's been really hard to work in health care recently because in general, our communities are under a tremendous amount of stress. That means that people are not always nice. So it is my job to make sure that we are having a psychologically safe culture, that when someone is displaying disruptive behavior, whether it's an employee or a patient, that we are addressing, that that we are creating a safe work environment for our nurses as well as for our patients.

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Tiffany Love
And also a trend that I was starting to see is that nurses were working so many hours and nurse leaders were working 24 hour shifts and sleeping in their offices. Their families were suffering and their families were starting to make plans without them. And so I know that pushes people in to the post-traumatic growth phase. And I did not want my nurses to leave me or my nurse leaders.

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Tiffany Love
So I started to do wellness leadership coaching, which was six months of coaching with someone. And I participated where we sat together, we talked about why we came to nursing in the first place, and then we started to provide or the coach started to provide us with resources to help us be more resilient or even to step away and take a break and recharge when we needed to.

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Elisa Arespacochaga
That's wonderful. And I know we've talked about this a little bit before we started, but burnout and well-being are different. In rural health care. There's a different set of challenges that you face than maybe some of our your urban counterparts. Can you talk a little bit about that?

00;08;29;24 - 00;08;52;21
Tiffany Love
Absolutely. The first thing that I would say is oftentimes we are taking care of not just our community, but each other. I can't tell you how many times I've walked past the room and I heard a nurse's voice from the bedside and I thought to myself, okay, we have to make sure that our nurses are prioritizing their community by putting their own health first.

00;08;52;22 - 00;09;34;23
Tiffany Love
They were missing their doctor's appointments. They were missing vacation time because they were so committed to being there for the community. So we had to hit a reset button so that the nurses prioritized self-care. And I am taking it one step further to use a program called Nurse Happy, which I will bring in a team that will do an assessment on my nurses and nurse leaders, identify the specific root causes of their burnout, and then we will use some evidence based strategies from the Department of Veterans Affairs, from their Center for Post-Traumatic Stress Disorder, to use evidence based strategies on how we can address the stress for health care workers.

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Tiffany Love
And so this work will be ongoing so that no one gets left behind.

00;09;39;05 - 00;09;57;09
Elisa Arespacochaga
That sounds amazing. So as you think about this, what advice would you give if a colleague came up to you during either the rural conference or afterwards and said, I really want to do more on well-being and resilience and address burnout in my team, How can I do that? Tiffany, What would you tell me to do?

00;09;57;13 - 00;10;29;21
Tiffany Love
I would say focus on building the relationships. It means so much to a nurse or a nurse leader. When you say, I'm so happy you're here. Or if they were a way to say, Wow, I missed you, I'm so glad you're back. And most importantly, when you see that they are troubled, asking them, Are you okay and doing everything that you can to help give them the resources so that they can either take a step away or find another way to recharge and recover from the very important work that we have to do?

00;10;30;00 - 00;10;37;09
Elisa Arespacochaga
It's wonderful. Thank you so much for taking the time to share some of your strategies with us and good luck with continuing your work.

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Tiffany Love
Thank you. Thank you for having.