In nurses' eyes, one key area where staffing agencies tend to win over hospitals is listening to feedback and having efficient processes in place to resolve concerns, according to a recent report from MIT Sloan Management Review.
Researchers analyzed 150,000 Glassdoor reviews written by U.S. nurses from the start of COVID-19 through June 2023. They identified 200 of the largest healthcare employers in the country — 146 of which were hospitals and health systems — and calculated how highly nurses rated overall job satisfaction. The five highest-ranked employers in the sample were staffing agencies, the analysis found.
"Nurses speak highly of how quickly staffing agencies respond to their questions and concerns. In contrast, nurses frequently complain that other types of employers are slow to respond to emails raising issues, if they get a reply at all. Nurses also place a high value on having multiple channels of communication with their supervisors," the report said.
Overall, nurses rated hospitals and health systems higher on areas related to learning and development, benefits, and opportunities for promotion. Meanwhile, many of the areas where staffing agencies rated higher (honest communication, resolving issues and building trust) link back to having a deep understanding of the challenges nurses face, and acting to address them.
While impractical to expect health system chief nursing officers to form personal connections with teams of thousands, the report's findings underscore the importance of healthcare organizations having different mechanisms for nurses to routinely share concerns and processes to translate feedback into change.
Becker's recently caught up with three chief nursing officers to learn more about how they stay in touch with the daily challenges their front-line nursing teams face and processes for acting on feedback.
Collecting feedback
In conversation with CNOs, one clear message stood out: There is no silver bullet or single strategy that works best. Instead, leaders need to ensure their front-line nurses are given the opportunity to share candid feedback in different ways and in a variety of formats, as team members might engage with certain formats more so than others.
"We have a lot of touch points with our staff. You've got to be intentional about communicating," Tommye Austin, PhD, MSN, senior vice president of patient care systems and chief nursing executive at St. Louis-based BJC HealthCare, told Becker's.
In addition to surveys, BJC HealthCare recently began hosting monthly town hall-style meetings for nursing teams across its facilities. More than 1,000 nurses have attended the first three town halls live, which are also recorded so they can be accessed online later by anyone unable to attend. The first town hall was structured as an introduction to get a feel for what nurses want to get out of them and how often they want to participate, Dr. Austin said.
Subsequent sessions are tailored, based on what nurses want to focus on. For instance, BJC HealthCare's first nursing town hall was focused on workplace violence, and the latest on professional development for nursing staff and Magnet designations.
Karen Doyle, DNP, RN, senior vice president of patient care services and CNO at University of Maryland Medical Center in Baltimore also hosts monthly town halls open to all nursing staff. Breakfast with the CNO is another call out Dr. Doyle mentioned as a way to connect with nurses on a more personal level. Those breakfasts are intentionally kept small, with about 25 nurses at each event, to ensure one-on-one engagement is occurring.
And nothing replaces rounding. Being on the ground and seeing issues in action is often what nurse leaders say can connect the dots in spotting potentially deeper-rooted challenges.
"There's no possible way to stay connected to a team of thousands, but you can connect to nurses at the bedside by being present to walk a day in their shoes," said Betty Jo Rocchio, DNP, RN, CRNA, senior vice president and chief nurse executive at St. Louis-based Mercy. "While my daily work is about serving all our nurses, clinician teams and patients, I still practice clinically as a nurse anesthetist in our hospitals, [which] helps me stay connected to what our nurses experience."
At UMMC, Dr. Doyle rounds weekly with directors of nursing, who choose the units they want to visit.
"Most people who report directly to me are VPs, but then I'll round with the directors of nursing and they usually have a scope of about 10-15 nursing departments and [can] choose where they want to take me and invite me to staff meetings."
Transparency and action
It's one thing to hear nurses out and encourage them to share their concerns, but ultimately, nurses are relying on leaders to take action.
At BJC HealthCare, focusing a town hall on workplace violence was the result of nurse input on safety incidents that occurred at different facilities, Dr. Austin said. Before the town hall, leaders met with risk management to look at data on recent incidents that have occurred and determined how the health system can better disseminate information to nursing staff regarding safety and security measures. During the town hall, leaders acknowledged recent incidents, shared employee resources and data to demonstrate the value of prevention measures, such as how many weapons metal detectors have prevented from entering facilities. The health system is also looking to expand the use of behavioral response teams across its hospitals and safety officers, which was also discussed, Dr. Austin said.
For town halls to be successful and actually elicit participation from nurses, there's an understanding among leaders that uncomfortable topics need to be addressed.
"If you're experiencing something, it's our responsibility as leaders to address it," Dr. Austin said. "Taking action when someone tells you something is happening and being in constant communication with your staff about what you said you were going to do — that's the number one thing; keeping your word."
In the spring of 2022, Mercy rolled out Mercy Works on Demand, a gig-model app and online platform that allows the health system's full and part-time nurses — and other experienced nurses in the area — to pick up shifts. A few weeks ago when Dr. Rocchio was rounding, a charge nurse showed her the app and suggested providing more flexibility on the lengths of shifts as a way to entice nurses to pick up more hours.
"I went back to our labor strategy team, they pulled the data to show me a macro view of what was expressed and we are prepared to make that change this week," she said. "When the team evaluated it, the nurse was spot on. It's going to help Mercy with more hours at the bedside and our nurses will have great flexibility."
Recent scores from employee surveys at UMMC demonstrated staff continue to experience fatigue and burnout. So, about a month ago, Dr. Doyle hired a wellness manager to focus on nursing and patient care services, "so that we could really understand the burnout and put mechanisms in place to reduce that," she said. The wellness manager will focus on developing a menu of nurse-specific wellness initiatives.
Already, UMMC offers a suite of initiatives, though organizing and promoting them effectively has been a challenge. "This person's role will be to really promote initiatives that we have, study them, and understand who uses what and what matters most to individuals."
UMMC is also putting together a team to study how to reduce or eliminate rotating shifts, which came up as a concern among nurses at the most recent breakfast meeting Dr. Doyle hosted.
'No bad feedback'
Undoubtedly, there will be times when feedback is uncomfortable to hear or to address, but to maintain a strong culture of transparency and open communication, leaders must lean into a mindset where "there is no bad feedback," Dr. Rocchio said. "Everything that reaches me at the system level is worth acting upon. There may be feedback that is hard to hear, but each comment or question gives you a piece of the puzzle those at the bedside are experiencing."