Leadership Dialogue Series: Sustaining the Nursing Workforce with Joy Parchment, R.N.

00;00;00;12 - 00;00;26;28
Tom Haederle
If there is such a thing as a sure career bet in the U.S. economy, nursing is certainly on the list. As retirement, burnout and other stressors like an increase in workplace violence are compelling many nurses to leave their jobs, America already faces and is projected to continue to face an alarming shortage of nurses. Where will the next generation of nurses come from, and how can they be persuaded to commit to a demanding and rewarding career path?

00;00;27;00 - 00;00;39;24
Tom Haederle
Some thoughts on that today from two experts.

00;00;39;26 - 00;01;12;00
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this month's Leadership Dialog series podcast, Dr. Joanne Conroy, CEO and president of Dartmouth Health and the 2024 board chair of the American Hospital Association, examines ways that care providers can build and sustain the talent pipeline for future nurses. Her guest is Joy Parchment, an assistant professor of nursing at the University of Central Florida and a board member of the American Organization for Nursing Leadership.

00;01;12;02 - 00;01;13;14
Tom Haederle
Let's join them.

00;01;13;16 - 00;01;38;09
Joanne M. Conroy, M.D.
Thank you for joining us today for another deep dive into an important topic on the AHA Leadership Dialogue series. It's great to be with you. I'm Joanne Conroy, CEO and president of Dartmouth Health and currently the chair of the American Hospital Association Board of Trustees. I look forward to our conversation today as we talk about one of the most pressing issues in health care today:

00;01;38;11 - 00;02;04;17
Joanne M. Conroy, M.D.
the sustainability and evolution of our nursing workforce. When I speak with colleagues across the country, workforce continues to be one of their top priorities. And increasingly, health systems are looking for innovative partnerships to help make an impact on their own local nursing pipeline. At Dartmouth Health, we're working to build a stronger, more robust workforce for the future through partnerships.

00;02;04;19 - 00;02;39;04
Joanne M. Conroy, M.D.
One that we have with Colby Sawyer College, and we have many other ones with regional nursing schools to provide exceptional clinical training and educational pathways for those that are pursuing a nursing career. In the last year, our team welcomed over 250 new grad nurses and established a nurse residency program at Dartmouth-Hitchcock Medical Center that provides a structured and supportive orientation to help early career ADN and BSN nurses transition to practice and begin their nursing careers with confidence.

00;02;39;06 - 00;03;12;24
Joanne M. Conroy, M.D.
As a rural health care system, we also recognize that retention is our best recruitment strategy and have implemented benefits that are aimed at supporting nurses long term, whether it be through continued education, loan repayment, housing subsidies as well as faculty opportunities with the Geisel School of Medicine. In addition to our shared governance structure. But I'm really eager to hear what other organizations are doing and what our guest can share with us today about the current state of nursing in our country.

00;03;12;27 - 00;03;40;16
Joanne M. Conroy, M.D.
And it gives me great pleasure to welcome Dr. Joy Parchment, who not only serves on the board of the American Organization Nurse Leaders, but also has a very impressive resume in nursing and leadership, both within health systems and within academic medicine. Most recently, Joy served as director of Nursing Strategy Implementation at Orlando Health before shifting over to her current role as assistant professor of nursing at the University of Central Florida.

00;03;40;18 - 00;03;42;22
Joanne M. Conroy, M.D.
Joy, thanks for joining us.

00;03;42;24 - 00;03;47;23
Joy Parchment, R.N.
It is my pleasure, and thank you so much for the honor of having a conversation with you.

00;03;47;25 - 00;04;03;08
Joanne M. Conroy, M.D.
Our listeners love to get to know a little bit about our speakers before we launch into the discussion questions. So can you tell us a little bit about yourself and you know how you navigated your career to where you are right now?

00;04;03;10 - 00;04;22;08
Joy Parchment, R.N.
A little bit about me would be...first, I have to say that I always wanted to be a nurse. From the time I was 3 or 4 years old, my parents told me that I was playing nurse and I had some amazing models. I had two aunts who since passed away. I was able to see how they interacted.

00;04;22;08 - 00;04;46;24
Joy Parchment, R.N.
They'd come back with their stories of what they've been able to do with patients. And I said, that sounds like something that would be intriguing for me. And so ever since I was 3 or 4 years old, I was always putting bandages on my brothers and they didn't appreciate that. But I was always putting bandages on them, you know, and trying to fix them up and trying to think about what would make a better way to to live.

00;04;46;24 - 00;05;09;13
Joy Parchment, R.N.
Because I looked at it from a prevention standpoint. And so I went to school, got a bachelor's degree, subsequently a master's, and then also a PhD. And one of the reasons why I did that, no organization made me go back and get my degree. It was something that I wanted to do. I wanted to learn more. And so I felt that I needed to continue to grow.

00;05;09;19 - 00;05;32;18
Joy Parchment, R.N.
And so that was part of the reason that I did that. I spent some time in ambulatory because I loved the prevention side. I also spent some time in acute care, and then I felt that it would be important to work on the practice environment and because of that, I was able to implement standards in an organization, a system actually to enhance -

00;05;32;21 - 00;05;56;23
Joy Parchment, R.N.
actually, it was the magnet standards - and to be able to enhance the practice environment. And because of that, we were able to then retain some nurses and also impact the community. Because when you think about it, we as health care providers are here to impact our community, not just the individuals that are in our organization. And so it was more of a broad perspective for me.

00;05;56;28 - 00;06;24;19
Joy Parchment, R.N.
And so I traveled through those sectors, ambulatory, academia, and then also the acute care environment. And then I said, I wonder if there is a possibility that I could have a different type of impact looking at it from a professional standpoint, how can I impact a profession to make things better for our nurses, of course, but then ultimately for our patients.

00;06;24;25 - 00;06;33;29
Joy Parchment, R.N.
And so I had the awesome privilege and honor to be able to serve on the AONL board and to work alongside some amazing colleagues.

00;06;34;01 - 00;06;56;13
Joanne M. Conroy, M.D.
When we think about how we make a lot of our career decisions, a lot of them are reflected in the role models that we have in our lives, as your aunts were, but also the role models that are in our professional organizations. And I'm sure you're a really important role model for a lot of young nurses that are thinking about what their career could evolve to.

00;06;56;14 - 00;07;23;14
Joanne M. Conroy, M.D.
So thank you for doing that. So let's start with some general questions about nursing trends that you've been seeing, both in academia and also in, you know, the health system in which you, you know, brought about significant change. You know, there are changes in the applicant pool. Are there expectations of the applicants that are different than they were 10 or 15 years ago?

00;07;23;14 - 00;07;24;25
Joanne M. Conroy, M.D.
What are your thoughts?

00;07;24;27 - 00;07;58;07
Joy Parchment, R.N.
Well, some of the trends you mentioned, some when we were starting and that was about workforce. And what we're seeing now is that, yes, the U.S. Bureau of Labor said that they have projected that nurses are going to have ample opportunities to be able to work because of what is actually needed. We're also seeing that there's going to be more needs for advanced practice nurses, those that are nurse practitioners, those that are midwives and some of those other roles.

00;07;58;10 - 00;08;27;24
Joy Parchment, R.N.
And we also are seeing a growth in entrepreneurship. Nurse entrepreneurs. We are definitely seeing the impact of wellbeing on clinicians and the impact of burnout on the clinicians. So there's lots of trends related to how do we really identify what is causing the issues related to burnout. So there's that piece. And then of course there is the retention aspect of that.

00;08;27;26 - 00;08;57;25
Joy Parchment, R.N.
And what I mean by that is we have identified and we see that across our population that the baby boomers who are were so prevalent in all of our organizations, they are saying, it's time for me to retire. And so because of that, we are seeing an exodus of these amazing experienced nurses who are retiring and that is impacting our profession in a huge way.

00;08;57;27 - 00;09;25;25
Joy Parchment, R.N.
So remember I started out saying that yes, we're going to have some ample, you know, more opportunities for nurses. However, what we're identifying is that that growth is not going to overtake the needs of the population. And we've identified that there's still will be a shortfall of nurses come ten years from now, 30 years from now, we don't have a lot of data, you know, 30 years out.

00;09;25;25 - 00;09;53;01
Joy Parchment, R.N.
But they're saying within 2035 we more likely will have a really challenging time recruiting nurses. One of the things I mentioned was the practice environment. That's another issue. What is actually going on in the practice environment that is contributing to nurses wanting to leave. Some of it has to do with workload. Some of it also has to do with what we're seeing now, which is an increase in workplace violence.

00;09;53;04 - 00;10;15;12
Joy Parchment, R.N.
I know I never and I know you also never signed up to get beat up when you go to work. We never signed up for that. We have been the individuals that were been there taking care of patients no matter what. And to have to experience violence is definitely challenging. The other thing that we're seeing is technology.

00;10;15;19 - 00;10;42;25
Joy Parchment, R.N.
The technology is just growing like leaps and bounds, and we're trying very hard to play catch up. You know, we right now are in the midst of trying to identify what's going on with AI. We are trying to identify how do we use all of this technology to help nurses. And then of course, we cannot forget our long term care partners. In that setting right now

00;10;42;27 - 00;11;07;24
Joy Parchment, R.N.
Congress has implemented minimum staffing ratios. And so we have to identify how are we in the acute care side going to then assist our long term care partners to be able to make some of these things happen? Taking care of patients is what I mean. And then on the academic side, I don't see that that the workforce issues are any different.

00;11;08;00 - 00;11;40;27
Joy Parchment, R.N.
Right now we have a faculty shortage. We also have the baby boomers that are retiring and the workload. When you look at it from a faculty perspective, we are expected to have increased the number of applicants coming into the university. So then what happens? You're going to end up taking more students into your classes. And of course, when you look at what's going on with the nursing programs, there's a huge expansion related to simulation.

00;11;41;02 - 00;12;05;20
Joy Parchment, R.N.
Again, how do we incorporate as educators incorporate AI into the curriculum? And obtaining clinical sites, you know, how do we do that? Because again, hospitals are challenged with staffing. And so how do we, as an academic side partner with our practice individuals to be able to say, we need your help?

00;12;05;23 - 00;12;30;03
Joanne M. Conroy, M.D.
It's interesting, though, that what you were describing are just the things that young potential nurses need to know that the opportunities actually across the nursing spectrum are huge. They can be in acute care. They can be in home care. We have our nurses in telehealth. We have our nurses in research. We have our nurses that are on administrative tracks.

00;12;30;05 - 00;13;05;22
Joanne M. Conroy, M.D.
Once you actually look under the hood of the opportunities for careers in nursing, it's just immense. I think, though, that a lot of the infrastructure that we're depending on - AI and really using computers at the interface of patient care - a lot of our young nurses are far more facile in actually adopting these new techniques. I've done at least three epic go lives, and my acute care nurses are the least of my concerns because give them 24 hours and they've already got it.

00;13;05;25 - 00;13;31;19
Joanne M. Conroy, M.D.
I guess a question I'd have for you, though, is all of us have to think about the ground work in our institutions. So how do we better support our current teams? I think every hospital CEO is really focused on violence in the workplace, and all of us are, you know, drawing a line in the sand with behaviors we'll accept and not accept and trying to support our teams.

00;13;31;21 - 00;13;41;20
Joanne M. Conroy, M.D.
What are the other things in terms of the infrastructure that we need to think about to support a robust nursing workforce for the future?

00;13;41;23 - 00;14;10;05
Joy Parchment, R.N.
And I love that question, Joanne. And I love it because it allows us to think outside of the box. I'm going to have to start with leadership, because you mentioned how the leaders are putting some things in place related to violence, but I'm also going to say, and I believe that you may have heard this quote from John Maxwell, and I heard him say one time that everything rises and falls on leadership.

00;14;10;07 - 00;14;33;25
Joy Parchment, R.N.
And if we don't have great leaders, exemplary leaders in place, we're not going to get the outcomes that we need. They're not going to be able to have the resources or think about those resources and tools that will be able to be put in place to create the robust workforce for the future that you mentioned. And so in nursing, yes, we have some exemplary leaders.

00;14;33;26 - 00;14;57;18
Joy Parchment, R.N.
However, what we have been challenged with is sometimes we take leaders in the clinical environment who are great clinicians. However, we don't give them the tools and the development that they need to be able to become those exemplary leaders. So the first thing I would say is to start with the leadership. Who are the leaders that you have around the table?

00;14;57;20 - 00;15;29;18
Joy Parchment, R.N.
What education and what support and what resources do they need? Because if they don't have those resources, they're not going to be able to build the robust workforce that you just mentioned. The other factor that I think is important to consider is that we bring them in and they leave. And they're leaving because -  and research has told us that - they're leaving because of some of the things that we mentioned, the violence in the in the workplace, the burnout that they're experiencing because of their workload.

00;15;29;22 - 00;15;53;29
Joy Parchment, R.N.
I think it's a two-pronged approach. We have to fix the environment, you know, putting in those resources, the processes that will allow nurses to have the tools to be able to create that environment. And then there also needs to be the on the other side of it, the academic side, that academic side needs to have practice ready.

00;15;54;00 - 00;16;26;06
Joy Parchment, R.N.
Their goal is to create these practice ready applicants and graduates who can come in to organizations and be just ready to go. And so it's a two-pronged approach that I'm thinking of. Definitely it starts with leadership. But to fix that practice environment and then also go in and look at it from the academic side, what is it that they need to have that will contribute to the robust workforce of the future that we want so badly?

00;16;26;08 - 00;16;56;08
Joanne M. Conroy, M.D.
So I'm going to ask you a personal question about advice that you would give to a young nurse who, just got her R.N. and is entering into probably a busy either health system or academic environment. And what we worry about the most is the wellbeing of our nurses. You know, when our nurses leave the organization, they usually leave within a year.

00;16;56;10 - 00;17;26;19
Joanne M. Conroy, M.D.
And it feels like a lost opportunity because we've invested a lot in that nurse to have them leave. And maybe be sour on medicine in general. And we don't want to do that. So what would be your advice for them to actually maintain a balance in their personal and professional life so they feel like, they have a pretty strong core in terms of wellbeing as a nurse.

00;17;26;21 - 00;17;52;29
Joy Parchment, R.N.
You've asked a question that is very dear to my heart. And the reason is sometimes these new nurses are challenged to speak up and to say what they want. So my advice would be to understand what their needs are. I'm talking about that individual nurse. Understand what you need so that you can go and have a conversation with your leader.

00;17;53;01 - 00;18;24;07
Joy Parchment, R.N.
I don't believe that it is valued to go in and make demands. So I think it's appropriate to have a professional conversation with your leader about what your needs are. And you'll be surprised at what they say. You'll be surprised at how they listen and how they want to help that individual nurse, that new nurse. I also think that it's important for new nurses to realize that there's more.

00;18;24;09 - 00;18;47;13
Joy Parchment, R.N.
There's more out there as far as that unit that you're working on now, and I'm not trying to categorize a specific unit. But if you look at it from a holistic perspective, if you look at it from a nursing profession perspective, we started out talking about, well, there's so many roles, so many settings, so many different things that nurses can go into now.

00;18;47;15 - 00;19;09;24
Joy Parchment, R.N.
And it's not a one-stop shop. And I what I mean by that is you can learn and grow in any environment. You just need to understand what your needs are and to come up with a plan that would allow you to have the resources and the support that you need. I would find a mentor right off the bat.

00;19;10;00 - 00;19;33;04
Joy Parchment, R.N.
Find a mentor. If you can't find somebody who is a mentor for you or could be for you, then go and find some books. I couldn't find people when I started out, and I went and started reading books to see how would this particular individual, what are their thoughts? How do they think? Would there be some characteristics that I would be able to utilize?

00;19;33;07 - 00;19;53;25
Joy Parchment, R.N.
I started journaling, talking, you know, just writing down in my journal about what my feelings and thoughts were. And that helped me to be able to cope with some of the things that I was seeing in the practice environment. I still do that to this day. I also think it's important to have some type of positivity.

00;19;53;29 - 00;20;22;22
Joy Parchment, R.N.
Duke University - I'm sure you're familiar with the studies from Duke University, where they looked at the positive things, or gratitude that you would have to be thankful for the small little things that you have seen or that you have done. And they've identified that if you do three things a day at the end of your day and identify a small win, then that gives you better support, meaning that you have more sleep.

00;20;22;22 - 00;20;44;28
Joy Parchment, R.N.
There were some physical responses that were beneficial for that person. So I think it's looking at what are your needs? Some people love to do yoga. That's not me. I can't do yoga. Okay. Do that if you like to get a massage, go get a massage. If you like to sit down and listen to amazing classical music. Some people like classical music because it's soothing.

00;20;45;01 - 00;21;02;03
Joy Parchment, R.N.
Find what works for you and then implement it on a consistent basis. Because if you don't look at it for a long term, meaning that if you don't do these things now, long term, you're going to burn out. And that's not what we want.

00;21;02;05 - 00;21;26;00
Joanne M. Conroy, M.D.
Yeah, that is wonderful advice. I tell a lot of leaders that you've got to restore your own energy and sense of well-being so you can lead others if you get depleted. It's difficult to be an effective leader in your organization. And, that's very similar to what you pointed out would be an important life lesson for a nurse.

00;21;26;07 - 00;21;52;07
Joanne M. Conroy, M.D.
You know, stay positive. Appreciate what keeps you centered and strong from a well-being perspective. Well, thank you for joining me today, Joy. It's really been a pleasure, and I appreciate you sharing your valuable expertise and insights. And I encourage all of our viewers to explore the workforce resource that are available through the American Hospital Association and through the American Association of Nurse Leaders

00;21;52;10 - 00;22;07;05
Joanne M. Conroy, M.D.
as you consider your own institutional workforce strategies and partnerships. So until next time, I want to thank everybody for joining us. I look forward to seeing you at next month's Leadership Dialogue. Have a wonderful day.

00;22;07;08 - 00;22;15;19
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.