1st Year Nurse Turnover is High – Is Your Organization Actually Contributing to It?

Hospitals are struggling to hold on to all nurses, but especially the new ones. Eighteen percent of new nurses will change jobs, or even professions, within the first year after graduation. An additional one-third leave their organizations within 2 years. Nursing turnover can be extremely costly for health systems. Besides just the hard cost of recruiting and onboarding, it is hard to build a nurse leader pipeline when there is fluctuating talent being brought up within the system.

1st year nurses may be talking to their nursing school peers, and hearing about better opportunities at other hospitals. Or 1st year nurses may have no ties to a city/region which makes them more likely to interview other places. But even worse, your organization itself may be contributing to young nurses are leaving the organization. It could be creating a reputation among young nurses to avoid your hospital and go elsewhere.

How can your health system leadership, or your more seasoned nurses, actually contribute to 1st year nurse turnover?

  • Not valuing 1st year nurses, or at least are not showing it. Older nurses may make comments about Millennial workers or work ethics/work styles.
  • 1st year nurses could feel they are stuck picking up the slack for other nurses, or doing work other nurses do not want to do.
  • 1st year nurses may be given little role clarity. They may feel like goals are ambiguous, and that more experienced nurses are not helping to prepare them.
  • 1st year nurses may see little opportunity for growth or leadership development.

How can your organization turn this phenomenon around?

Offer better role clarity, which can also help alleviate stress

First year nurses have just had 14-16 years of schooling or more, where curriculums are clear from the first day. Then they begin working and realize work and life are messy and there is role ambiguity. This can lead to a low sense of control over job performance, and ultimately stress. What can nurse leaders do to stop this? For starters, make sure role expectations and performance is communicated well and across multiple channels. Have periodic check-ins with your new nurses. Let them know how their performance is contributing, and offer support.

Offer better communication; a 1st year nurse needs management to communicate about critical issues

Most surveys and studies show that Millennial workers want more communication and feedback, or at least more than other generations have. While older generations value a big paycheck or advancement opportunities, Millennial workers are more likely to aim for career or organization purpose. Show your 1st year nurses how their contributions help the larger health system at a macro level, and how they contribute to your team at a micro level. Management and supervisors should be available, or at least visible to nurses who are finding their way early in careers. Solicit input from young nurses on critical work issues. Incent your team to share 360-feedback to improve how critical issues are handled. This could show 1st year nurses that you value communication, and show they are a part of critical issues and decisions.

Offer rewards or recognitions for accomplishments

Nurses who feel valued, appreciated, and respected—and who enjoy professional communication and working relationships—will stay at an organization and remain engaged in their profession. This is especially true for nurses newly out of school.  Offer recognition for accomplishments to show young nurses they are valued. Recognizing and rewarding nurses does not have to be complicated or time-consuming. It could be on-the-spot recognition, maximizing staff meetings, fun activities, feedback surveys, or general retention activities.

It’s not uncommon to forget to show associates that they are highly valued. Sometimes a shout out will do; other times an offer of lunch with the boss or an invite to attend an off-site training will help demonstrate that you are indeed happy to have this young nurse on your team.

Offer support from more experienced nurses

Young nurses are not looking for authoritarian leadership, they want coaching to help them learn and grow as professionals. Retaining nurses requires adjusting to adapt to this generation, so make sure the right older nurse is coaching. The right coach/mentor can help a young nurse to see how their contributions are valued. It can also help encourage continuous learning, can help young nurses to build networks/join professional organizations, and can even help teach young nurses about emotional intelligence. For example, Franciscan St. Francis Hospital in Indianapolis implemented a preceptor and mentor program to help new graduate nurses during their first year of employment. This decreased the organization’s 1st year turnover rate from 31% to 10% in 2 years. There is nothing in a textbook that can replace real-life experience of a seasoned nurse who has navigated a full career. If your health system doesn’t already have a young nurse mentor program, maybe it is time to start.  

Offer opportunities for growth for high-performing young nurses

1st year nurses want to see that their health system is willing to invest in them and prepare them for future leadership roles. Actively supporting career development through online and in-person training courses can help maximize skills, growth potential and professional opportunities. For a young nurse, the first opportunity for team leadership is generally the Charge Nurse role. Leading and delegating to peers, especially to older peers, is stressful. As a manager or director, you may see that offering these roles to young nurses without leadership development and preparation may lead to stress for young nurses. So offer Charge Nurse leadership development.

East Alabama Medical Center (EAMC) is a 340-bed hospital in a rural area. Because it is an area where there is a smaller talent pool than larger metro areas, EAMC really prioritizes growing its talent from within. Rosemary Cummings is the Director of Medical Surgical Services at EAMC, and recently implemented NCharge to prepare young nurses for leadership roles. She commented “We take a lot of pride in how we do things from a quality and cost perspective. It <NCharge> helps our frontline nurse supervisors to see we’re investing in them. Development at this organization is an important piece of who we are. I think that’s why people stay.”

NCharge: “Nurses Learning to Lead” is an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. Courses are delivered either classroom-based or virtually. NCharge is for nurses who desire to build management and leadership skills and/or want to learn about the business-related aspects of nursing. Health systems use NCharge to build a nurse leader pipeline, ensure a smooth transition from peer to leader, and to increase nurse engagement and retention.

Feel free to read our related articles!

“Preparing Millennial Charge Nurses to be Successful Leaders”

“Encouraging Your Nurses’ Career Path?”

“What Your Nurses Didn’t Learn in Nursing School”


“Millennial Workers Want More than a Paycheck. So What Exactly do They Want?” Monster Inc, Roberta Matuson

“Nurse Retention Toolkit: Everyday Ways to Recognize and Reward Nurses,” HC Marketplace, Lydia Ostermeier MSN, RN, CHCR and Bonnie Clair, BSN, RN

“Strategies to reduce nursing turnover,” Nursing Made Incredibly Easy, Lisa Lockhart MHA, MSN, RN, NE-BC, April 2020

“7 Things That Cause Nurse Turnover (and 8 Things That Stop It)” ita group

Sign Up For Our Monthly Newsletter:

Cincinnati Children’s Commitment to Diversity & Inclusion through Frontline Employee Career Development

“I believe there’s a whole world of untapped potential buried within me, hoping that I’ll be brave enough to unearth it. I also believe there’s a whole world of untapped potential within you. And it’s hoping, waiting to see if you’re willing to set it free.”

Cincinnati Children’s Hospital and Medical Center (CCHMC) is recognized by U.S. News and World Report as one of the best children’s hospitals in the U.S. It is nationally ranked in 10 pediatric specialties. It is a teaching hospital, medical and surgical, and operates Level 1 pediatric trauma and surgery, within downtown Cincinnati and throughout the southern Ohio region.

While patients are referred from all over the world for CCHMC’s care capabilities, it has a mission to be a vital resource to the health of the local community, focusing on efforts to impact obesity, asthma, preventable injuries and infant mortality. The hospital strategically uses resources and partnerships with local organizations to address health issues that are prevalent in the community.

Commitment to Diversity, Equity & Inclusion. Walking the Talk… at All Levels

Cincinnati Children’s values and regards diversity as an organizational asset, utilizing the strengths and benefits diversity and inclusion bring to patients, families, visitors, employees, volunteers, suppliers and the community. The organization was ranked #40 in Forbes list “America’s Best Employers for Diversity 2020.” This isn’t an accident. The recognition represents intentional progress and alignment with strategic goals, set from the apex of the health system.

Putting this belief and strategy into workforce development practice, CCHMC offers a suite of programs that serve as a catalyst for building pathways for the next generation of diverse healthcare professionals.

  • The “Job Coach program connects employees with appropriate mentors who can help with professional development and help make connections in the Patient Service Division.
  • CCHMC’s William K Schubert Minority Nursing Scholarship seeks to increase the diversity of registered nurses at CCHMC and to assist with economic barriers that prevent some students from pursuing nursing careers.
  • CCHMC offers minority scholarships for medical imaging, to promote the entrance of minorities into the high need field of radiology.
  • Raising minimum wage to $15/hour across the board
  • Career Pathways program which increases the transparency for employees of what education and experience is needed to advance to another role
  • CCHMC augmenting our tuition reimbursement program to also offer a tuition assistance program which makes tuition payments directly to approved educational programs/colleges/universities reducing the burden of employees have to pay for tuition and then wait for reimbursement after completion course

Frontline employees are a significant and diverse part of the total healthcare workforce, yet are often underserved by leadership development and career development programs. CCHMC continues to ensure that the programs they offer are inclusive, intentional, and tailor-made to support this essential group.

CCHMC’s first-ever vice president of Diversity, Inclusion and Community Relations, Bobby Rodriguez, will help continue to change the outcome on these important fronts.

“It’s our responsibility to champion and advocate for diversity, equity and inclusion—within the walls of the medical center and well beyond. My goals are to build a vibrant, culturally sensitive and inclusive environment,” Mr. Rodriguez shares. “Listening and celebrating the differences and similarities of each other will make us a stronger organization.”

Maintaining a Focus on Workforce Development, Despite a Pandemic

One of CCHMC’s goals has been to build career pathways and upward mobility for ethnically diverse entry and mid-level professionals.

For entry level healthcare associates, CCHMC began working with Catalyst Learning in 2010 to implement School At Work® (SAW®), a curriculum and career planning system that promotes upward mobility. SAW® sharpens key behavioral skills to optimize employee performance and puts student associates on a path for career advancement in healthcare. Subjects include Life Management Skills, Communication in the Workplace, Medical Terminology, and Planning For Your Future.

Karen Powers is a Facilitation Consultant at CCHMC, and serves as a SAW® coach. Karen recently commented that “At CCHMC, we want to leverage and lift each other up for success. We need to be able to give our entry-level employees the tools they need to thrive at our organization and see their importance. We want to retain our associates, and show that we value making investments in them.”

Karen tells us that supervisors have reached out to her on multiple occasions to note the changes they’re seeing in their employees. Supervisors have told Karen,

“My SAW® employee is showing up so differently, with increased confidence, interest in responsibility, and is focused on growth and development. They’ve gone from listening to actively participating. SAW is giving a sense of accomplishment that is helping associates reach the next step.”

Danette Fields is a Patient Rep II at CCHMC who graduated from SAW® in 2014. She recently said that SAW® helped her to learn how to interact with co-workers better and to diffuse conflict and difficult situations better. She said it taught her how to keep patients and families in mind as she communicates, and to be accurate and accountable in her work and patient interaction.

Expanding Career Opportunities for Mid-Level Employees

Recognizing that many mid-level associates in roles such as Patient Care Tech, Administrative Assistant, or Health Information Tech also had more upward mobility potential, CCHMC began offering Expanding Your Career and Healthcare Opportunities (ECHO®) to its employees in 2019.

CCHMC SAW and ECHO 2020 Virtual Graduation Celebration

Liz Keith is a Facilitation Consultant at CCHMC, and is also an ECHO® coach. Liz recently commented that “ECHO reaches a different group of employees, those looking for help with career development and professional aspirations at CCHMC.” Liz works with students on resumés, networking and other skills. Liz says, “We love the cohort aspect of it. Learning about other roles from students in the cohort with them. Advancement is of interest. They’re looking for something more and want to remain with Cincinnati Children’s.”

CCHMC has seen career advancements from SAW and ECHO graduates. Students take a customized Career Interest Survey providing them with ideas for career avenues. There have been 8 promotional moves from the last 2 SAW® and ECHO® classes.

Tiffany Puska, a Health Unit Coordinator II at CCHMC is a recent ECHO® graduate. She applied for the programs because she had wanted to further her education, but had been out of school since 2002 so was a little apprehensive at first.  Tiffany said the course on Medical Terminology helped her communicate with both patients and clinical staff better. After her ECHO® graduation, Tiffany felt so confident that created SMART goals to help long-term plan a little better, then applied to college and was accepted! She is now in her 3rd collegiate semester and will attain her Associates Degree in 2022.

Helping Associates Gain Skills, Move to Career Roles with Family-Sustaining Wages

Plans in the coming year call for expanding the network of leaders involved with the program, to help make student-mentor connections and to help participants infuse the workforce with knowledge and skills learned in SAW® and take it back to their respective worksites and teams.

Graduations, always a joyful occasion, were held in a special in-person ceremony prior to the COVID-19 pandemic and have been done virtually in 2020 and 2021. Sandy Puthoff, Rep III – Patient Scheduling Center and SAW® 2021 graduate, summed up the impact when she quoted Joanna Gaines of Fixer Upper,

“I believe there’s a whole world of untapped potential buried within me, hoping that I’ll be brave enough to unearth it. I also believe there’s a whole world of untapped potential within you. And it’s hoping, waiting to see if you’re willing to set it free.”

Sign Up For Our Monthly Newsletter:

9 Ways Hospitals can Support Frontline Healthcare Workers, and Create a Winning Culture!

Most healthcare leaders agree that a productive culture is a pillar of hospital success. But there are many organizations with lofty-sounding “corporate missions” that have less-than-stellar work environments for frontline employees. Frontline employees can sometimes be an afterthought in culture development, but they are often the voice and the heart of the hospital to patients and families.

To improve culture, ask yourself – are we supporting our frontline employees’ career and life goals? Is there a sense of belonging and shared commitment among employees about how they serve patient’s needs? Do we have employee programs that are accessible and build support for our organization’s culture?

Here are some nationally recognized hospitals that are super-serious about maintaining a winning Frontline Healthcare Employee culture and some of the steps they have taken:


With focus on patient experience and reduced costs, employers are making a business case for building talent by aligning workforce training and education programs with strategic areas of business impact. Developing talent needs to go further than just a “feel good” public relations objective, so it’s important to measure the success in numbers. Quantitative metrics examples are recruitment costs, reduced turnover, or preventable re-admissions. Qualitative metric examples are new employee competencies in taking care of patients, and improved team climate relationships in a unit.

Yale New Haven Hospital is a 1,541-bed facility that serves the entire state of Connecticut, ranked by U.S. News & World Report as one of the top 50 hospitals in the country in 11 different specialties. YNHH offers a wide range of career development services to its frontline workers; its basic skill development programs include entry-level employee communication effectiveness workshops, conflict management, and effective presentation skills.

With 4,000 trainees annually, these trainings help prepare entry-level hospital employees to meet high quality and safety standards and perform in their roles more effectively.

Read more about Yale New Haven Hospital and their efforts.


When hiring, make an effort to recruit underrepresented members of the local community and demographics that mirror patient populations. This could include a focus on improving lives of local community members facing barriers to employment, or disabilities. Be a part of local workforce boards and other organizations with local outreach.

University Health System, in San Antonio Texas, is an organization committed to equitable talent development. It hires many community members who do not speak fluent English. Their career development programs have expanded to keep pace with the evolving language and literacy needs of their employees, including offering onsite English for non-native speakers.

With their community hires, University Health Systems executes on-the-job learning and career development system through the ECHO (Expanding your Career and Health Opportunity) program, to give mid-level healthcare workers the chance to move into more advanced roles in the organization.

Read more about University Health System and their hiring.


Advancing frontline hospital workers, or “growing your own” will help with obvious staffing and orientation costs. But it will also help maintain organizational knowledge and culture. And now with the economy closer to full employment, a commitment to advancing your own workers instead of looking outside is even more important. Apprenticeships and training opportunities may be a way to turn frontline workers into prime candidates to fill mid-level positions that are open.

At Mercy, the country’s fifth-largest Catholic healthcare system, frontline healthcare employee development is at the core of business strategy. To reach its goals, Mercy operates a Lowest Paid Worker Committee to bring together senior leaders to develop and implement strategies to improve wages and opportunity for frontline workers. Lynn Britton, Mercy’s President and CEO, leads the Lowest Paid Worker Committee. “We invest in the development of frontline workers to help them realize their talents and to support their professional and financial advancement.” Mercy tracks and reports participation in their employee advancement programs yearly, monitoring scholarship programs, tuition advance programs, School at Work® (SAW) graduations, and transportation programs. Mercy measures business impact, citing that 32.5% of School at Work® graduates have advanced into new roles and 9% have enrolled in higher education.

Read more about Mercy and their commitment to advancing frontline workers.


Supportive workforce practices require both qualitative and quantitative data, necessitating the capacity for data collection and analysis. HR should use workforce data to track programs, assess impacts, and analyze future needs. Forecasting tools focus on specific occupational groups, and includes head count, turnover info, recruitment metrics, vacancy rates, employee engagement, and required skills. Using workforce planning and analytics to anticipate future need is especially important when a community is reaching full employment levels.

Norton Healthcare, Louisville KY’s leading healthcare provider, is a healthcare pioneer in integrating workforce investments with business impact. Investing over $11 million a year in staff education and development, Norton’s transformational approach to workforce development integrates with its strategic staffing priorities. Norton monitors future staffing needs, patient data analysis, internal and external partnership impact, and the impact of its investments on bottom line ROI measures. In 2017, Norton Healthcare did an exhaustive study on ways leading  healthcare organizations in the U.S. use frontline investments to improve six key business metrics: Workforce Availability, Employee Competency and Advancement, Employee Engagement, Patient Experience, Community Impact and Quality, and Safety.

Read more about Norton and their analytics.


When a healthcare organization is committed to supporting entry-level hospital staff, they may offer benefits and initiatives designed to ease employee burden, through EAP or HR-direct initiatives.

These could include personal counseling, medical premium assistance, financial coaching, affordable child care, tuition programs, onsite clinics, low-interest loans, transportation subsidies, or employee crisis funds.

UnityPoint Health in Iowa is a leader in providing services to advance frontline employees and help with life events. In fact, UnityPoint’s mission is “Come for a job, stay for a career.” UnityPoint offers a menu of supportive HR options such as tuition assist programs, career coaching,  free transportation, and flexible scheduling.

Read more about UnityPoint and their efforts.


Career exploration, coaching, and mentoring are steps that should be integrated with building talent and advancing frontline workers. Once frontline health workers have developed skills and see opportunity that is available in the organization, have HR or a professional mentor show where they can go to learn more about new positions. Have a commitment to employee coaching, and promoting talent from within.

UC-Davis Health offers career coaching and an array of educational opportunities designed to help employees develop skills and advance careers. UC-Davis Health uses School at Work® as a combination of career exploration and skill coaching, working with employees to define goals and connect them to internal and external services. UC-Davis Health has found this has reduced recruitment and on-boarding costs. UC-Davis Health was also interested in developing Administrative Assistants and has invested in this employee group.

Read more about UC-Davis and their coaching programs.


A great way to support a top-notch frontline employee culture is to invest in programs that promote diversity, foster collaboration, and participation and respect in the organization. Frontline employees are the largest group of workers in most hospitals, so be intentional about achieving more diversity at the apex of the health system.

Main Line Health in metro Philadelphia has been recognized by U.S. News & World Report as one of the top health systems in the country. Main Line organized a Diversity, Respect, & Inclusion Strategy Team to make sure it was developing leaders in the organization who mirror the demographics of metro Philadelphia. This team works to break HR obstacles, tracks entry-level employment patterns, and measures impact of employee advancement strategies like SAW, ECHO, and its internal Career Advisor program.

Read more about Main Line Health and their mission to increase diversity at the top of the apex.


Many C-Suite hospital leaders still view learning and development as cost centers instead of strategic investments. When the strategic apex of any organization looks at low-wage associate investment this way, expectations and leader involvement stay low, leading to little or mixed clarity of how enabling talent fits in with company goals. This is a mistake, because when learning happens throughout the entire organizational chart, all associates start to see themselves as “owners;” and when HCAHPS surveys are taken, you want employees who see themselves as imperative

East Alabama Medical Center (EAMC) has a longstanding tradition of growing their own associates to carry out the organization’s mission of “high quality, compassionate healthcare.” In fact, a V.P. started as an orderly 35 years ago, proof that senior leadership has walked the walk. EAMC is in a small metro market, so hanging onto their best employees is especially important. EAMC invests in skill and education assessments and frontline worker learning programs, building these tactics into the mission. EAMC has built a nationally recognized culture of internal talent growth. Learn more about EAMC.


TriHealth has done the best job of measuring RoI that we’ve seen in 14 years of working in the healthcare workforce development space. The importance of measuring results sounds obvious, but this types of analysis is usually not done. If HR leaders do not show ROI and value, programs can be terminated in later years when budgets get tighter. If you’ve worked to advance turnover/retention rates, days required to fill vacant positions, overtime costs, and Temp agency costs, show it!

TriHealth Inc is Cincinnati’s fifth largest employer, with two acute care hospitals and more than 120 locations. TriHealth was recently recognized by Working Mother magazine as one of the “100 Best Companies for Working Moms,” a designation it has received 9 times. TriHealth uses CareerCare, a web-based career exploration tool for entry-level worker participants, and School at Work® to provide on-site learning opportunities to increase basic literacy, mathematics, and interviewing skills. In 2013, TriHealth did a large 4 year ROI study to show how these investments in entry-level workers had paid off. TriHealth saw huge increases in promotions and employee wage gains, plus savings from turnover costs during the four years of the study. TriHealth also had better job satisfaction scores during that time. Read more about TriHealth.

Building a great culture and support for Frontline Health Employees will not happen overnight, but paying attention to what industry leaders are doing can be a great source of ideas and inspiration! Investing in entry and mid-level nonclinical employees who interact with your patients will pay off, so be sure to measure and communicate results.

With these types of tactics, your hospital could see gains in workforce availability metrics, employee, engagement, improved patient experience, and community impact. Set your organization up for success with a winning and supportive Frontline employee culture!

To see case studies on any of these health systems, please email and we will gladly send you further details. Thank you to the National Fund For Workforce Solutions and its CareerSTAT Frontline Employer Champion program for recognizing these institutions who invest in their entry-level healthcare employees.

Nursing Trends to Watch in 2021

First off, take the 2020 nursing trends article we wrote back in January of 2020, and throw it in the shredder. Whew, no one saw 2020 coming, and hopefully we’re soon to see it leaving. But there are some trends for 2021 and onwards that we see bubbling up from American Nurse Today, American Nurse Journal, AMN Healthcare, the Bureau of Labor Statistics, plus some respected nurse leadership bloggers who we follow. Here are several high-level trends to prepare for as we head into a new and hopefully more optimistic year:

Shake-Ups in the Traditional Demographics and Backgrounds of Nurses

According to the U.S. Bureau of Labor Statistics, there will be an additional 735,000 nursing jobs by 2024. With this increased demand, future wage growth, and revived interest in nursing after 2020 was the Year of the Nurse, nurse recruiting will expand to non-traditional labor pools. For one, male nurses will become more common. Already 12% of RNs are now men, up from 2% in 1970.

Nurse recruitment will also focus on nurses from different countries, or bilingual RNs. There are 60-65 million people in the U.S. whose native language is something other than English, so patient safety can be a risk factor with language barriers.

The field of nursing is becoming more accessible, with great pay and flexible hours, making it a workforce that is ever changing and growing.

Increased Focus and Awareness on the Obstacles that Nurses Face

Nurses faced unprecedented challenges in 2020. Extreme stress led to burnout. Nurses are subject to substantially higher rates of workplace violence injuries than other professions. They’re more likely to experience incidents of hitting, kicking and beating in inpatient facilities, and these injuries often go unreported. Bullying and harassment are also issues that nurses have faced. In 2020 especially, nurses unexpectedly dealt with limited PPE supplies and elevated risk of personal illness, so all around it’s a tough job in a really tough year.

There is some good news. In the 2020 Nursing Trends and Salary Survey organized by the American Nurse Journal (ANJ), 85% of nurses surveyed said the pandemic hasn’t changed their career plans, and they intend to stay with the nursing profession. With more organizations emphasizing the importance of self-care, and with increased national and legislative attention, nurses should expect working conditions to improve and access to more resources to address these workplace challenges . Health leaders will need to provide nurses with the resources and tools they need to care for patients without sacrificing their own health along the way. COVID-19 has brought this issue into the spotlight, so expect increased awareness this year.

Technology Enhances How Nurses and Patients Interact and Communicate

We have already seen that telehealth and chatbot services are making it easier for patients to access care. 2020 has accelerated usage of virtual health, perhaps faster than many of us are comfortable with. Relaxation of rules around reimbursement for telehealth visits in the wake of COVID-19 has shown health care providers and patients alike how effectively virtual communication tools can work. These telecommunication services will continue to be the norm, and blend into nurse job descriptions and care administering tactics.

Telehealth is moving past just being a window for patients with minor complaints. It is becoming a boon for nurses, plus therapists and providers using technology to manage patients with mobility challenges or who are considered high-risk for the virus. Nurses and healthcare providers will need to continually improve their communication skills via virtual platforms, just as their patient population has needed to.

Besides just using technology for direct communications, the field of health informatics will grow. Using IT systems to create more collaboration between and patient and providers will change nursing roles in 2021 and beyond. Expect some nurses to fully buy-in to the use of informatics and move to the discipline as a full-time specialty in 2021.

Technology in nursing-to-patient communication is here to stay, and nurses will need to become confident and comfortable with it. Privacy concerns and compliance with HIPAA will have to adjust of course, making sure platforms being used are secure for communication of sensitive data. But it’s a new world we’re adjusting to. Technology can bring better communication and collaboration, and nurses have to be smart in how they use it.

Addressing Gaps in Health Equity – and Nurses Could Lead the Way

Health equity and disparities in healthcare became a large focus area during the pandemic. While health system leaders, politicians, and community leaders increased their focus on the social determinants of health and diversity during the pandemic, there will be an even greater focus in 2021. Payers, providers, and the entire health ecosystem will boost efforts to address these issues going forward. As corporate and community leaders are well intentioned, leadership should be from nurses. Finding where the gaps in care are will ultimately be tasked to nursing staff. Nurses can find actual combative steps for these inequities and recommend tactics to fill in care gaps.

Nurses may be able to help bridge social gaps, finding deficiencies in care for certain populations. From the ground level, nurses can make sure patients have a voice and that families (and even communities) are incorporated into the design and operations of their community health systems.

Recognizing, Respecting, and Investing in Nurses to Grow into Transformative Leadership Roles

Investing in growing nurse leadership and management skills translates into increased productivity and even improved patient outcomes. Growing nurse leadership is even more important during high stress times and times of change. Organizations investing in nurse leadership development will see benefits of efficiency in team management, organization, and delivery of care. With the global shortage of nurses, it is critical to focus on building up the competencies of our existing nursing workforce to ensure nurses are performing to their full potential.

Leadership development may be done in person, or it can be virtual. A curriculum like NCharge: “Nurses Learning to Lead” may be a program for your staff to consider, with a variety of flexible delivery methods. Courses like Charge Nurse Fundamentals enhance individual and unit performance by helping nurses understand the business aspects of Value Based Purchasing, as well as the various roles of an effective charge nurse. It also helps nurses create an individual action plan to identify challenges and maximize opportunities faced in today’s complex hospital environment. Other NCharge courses include “Critical Thinking for Charge Nurses,” “Leading Change in a Dynamic Climate,” and “Supervisory Skills for Positive Outcomes.” Organizations like Nemours Children’s Hospital offer NCharge to help communicate financial performance indicators for example. Learn more by reading our related article on Nemours Children’s Hospital.


  • “2021 Nursing Trends We Expect to See in 2021,” Carson-Newman University Online, January 19, 2021
  • “Trends Transforming The Nursing Industry Outlook in 2021,” Team Linchpin,, February 13, 2021
  • “Our future through my rearview mirror: Turn the troubling events of 2020 into opportunities in 2021,” Lillee Gelinas, MSN, RN, CPPS, FAAN, Editor-in-Chief, My American Nurse, January 8 2021
  • “Top 10 Nursing Trends for 2021,” Purdue University Global
  • “Top 7 Healthcare Technology Trends in 2021,” Nikita Shumov, MindStudios
  • “Top Nursing Trends for 2021: Paving the Way for Better Care in the Future,” Tiger Connect

Sign Up for Our Monthly Newsletter:

Mosaic Life Care Supports its Employee Caregivers with Skill Development and Opportunity

Even in a Tumultuous 2020, Mosaic Life Care Supports its Employee Caregivers with Skill Development and Opportunity

Sees Tremendous Impact on Retention, Internal Advancement

Mosaic Life Care (Mosaic) operates medical centers in St. Joseph and Maryville, MO, and has 60+ clinical facilities offering urgent, specialty, and primary care within Missouri and Nebraska. Mosaic offers a life-care model which combines traditional acute health delivery with a focus on key life elements which affect overall wellness. Mosaic has a commitment to health, well-being and the vitality of the community that it serves.

Being part of the Mayo Clinic Care Network, Mosaic is very focused on high-quality, data-driven, evidence-based medical care. It also takes care of its employees (called caregivers).  In 2020, Forbes magazine ranked Mosaic in the top 15 among 2,500 employers in Missouri for best state employer. Mosaic believes in its mission to serve the community through opportunity, workforce development, and employee career growth. It stresses that whatever employees choose to do in the organization, that each role is important and vital to patient care.

In 2009, seeing that environmental, admin, and nutrition caregivers were sometimes overlooked for leadership development opportunities, Mosaic began looking for ways to increase career growth and opportunity for its frontline entry-level team members. Mosaic also wanted to reduce turnover within these groups. To help with all these issues, the HR education staff found a program offered by Catalyst Learning called School at Work (SAW).

SAW is a comprehensive education and career planning experience that strengthens communication, core education skills, and medical terminology. It also helps entry-level caregivers understand the key role they play in patient care and impact on the HCAHPS rating. SAW helps health systems reduce turnover, increase employee engagement, and prepare employees for the next level of learning.

Micah Robison is a Workforce Development Specialist at Mosaic and also a SAW coach/facilitator.  Ms. Robison believes that sometimes a confidence builder is just what an associate needs. She states that,

“Many of the SAW participants didn’t have the best education background or have not had much opportunity.  But after SAW graduation, I hear things like ‘we can’t believe the change we have seen in her’ and the term ‘go getters’ when managers beam about employee work level. Managers are letting me know when ex-SAW graduates are applying for promotions. As a SAW coach, this gives me pride to know that my students are improving job performance and pursuing more job responsibility.”

Mosaic Life Care School at Work, 2019 Graduates.  15 people are standing clustered together holding flowers and certificates. They are standing in front of three projection screens showing "SAW Guest Speakers" at their graduation ceremony.
Mosaic Life Care School at Work Graduates

A SAW student at Mosaic felt so confident after her graduation that she entered nursing school. Another student working as a 3rd shift housekeeper used SAW to propel her to a job she had dearly wanted and  became an Access Rep. SAW coaches keep hearing about these “light bulb” moments when employee caregivers realize that their role within Mosaic is just beginning, and that there are growth opportunities within the health system.

To leverage SAW and promote career and responsibility expansion, Mosaic partners with local Missouri Western State University. This university offers 3 hours of elective credit for students that complete the 6-month SAW experience. This encourages SAW graduates to get back to school to take advantage of the credit.

Mosaic Life Care School at Work, 2018 Graduates (16 women shown in two rows with the back row standing. There are 10 in the back row and 6 seated in the front row. The group is smiling and are posed toward the camera
Mosaic Life Care School at Work Graduates

One of Mosaic’s SAW graduates who enrolled at MWSU is Aron Battreall. Ms. Battreal had been thinking about going back to school when she heard about the SAW program from a co-caregiver. She enrolled in SAW to get comfortable with assignments and to build confidence. She mentioned that Medical Terminology was particularly beneficial for her role. As a Medical Biller II, the terminology improved Ms Battreal’s efficiency and helped her expand the questions she asks insurance companies. She also has a better understanding of patients’ medical records.

Aron noted that “SAW boosted my confidence enough to go to my management team and express interest in taking on more responsibility. It also gave me confidence to enroll at Missouri Western State University and I will graduate with a BS in Population Health in December 2021.” Ms. Battreall also expressed the impact of the SAW opportunity on her loyalty to Mosaic.

Mosaic Life Care School at Work, 2017 Graduates. 11 people (7 women standing in the back, three women and 1 man sitting in a row in front, the man is on the right). Everyone is smiling and looking into the camera
Mosaic Life Care School at Work Graduates

“By investing in us, it makes my fellow caregivers and I feel appreciated, and I know my classmates and I work harder to be able to give back to the hospital.”

Aron Battreall, Medical Biller II, Mosaic Life Care

Mosaic has offered SAW since 2009 – that is 12 years of commitment to entry-level caregivers!  2020 was a particularly tough year because of COVID, but it did not stop progress. Mosaic offered two classes in March before the nationwide shutdowns.  It resumed class in May started offering hybrid learning models.  Mosaic even continued to have guest speakers from within the hospital present opportunities to the class via Skype. With a combination of outside-the-box thinking, flexibility with staffing issues, some IT support, and with open communication lines, SAW was able to proceed.

Experiences like this, even without a pandemic, aren’t available to entry-level caregivers without strong executive support.  Janelle Lee, Vice President of HR and OD, championed the extension of L&OD to include non-clinical caregivers from its beginning.  She describes Mosaic leadership’s cultural desire to “teach caregivers to fish”, its commitment to community development, and School at Work as “a backbone.” The health system’s goal for skill growth and education also means less employee turnover, and supports Mosaic’s greater goal to improve the community through health and opportunity.

Sign Up for Our Monthly Newsletter:

Frontline Healthcare Education: Building Learner Confidence & Enabling Advancement

By M. Lynn Fischer, Founder & CEO Catalyst Learning Company

This article is a continuation of the series, “Education and Career Planning for the Front-Line”, focusing on upward mobility for entry and mid-level healthcare associates. Check out the first two pieces: Support Diversity & Inclusion Initiatives by Upskilling the Front Line and Increasing Internal Support for Frontline Education Programs.

When people take advantage of training programs within the Veterans Hospital Administration (VHA), they have countless opportunities to transform their careers, according to Imon Muldrow, Chief of Environmental Management Services at the VA Health System in Pittsburg.  Muldrow is a prime example of amazing career trajectories. Over 12 years, he rocketed from housekeeper to supervisor of 250 associates who play a key role in patient satisfaction and safety. How? He enrolled in training for a fast climb in operations and eventually became a division supervisor.

Our customers are wise in the skill of understanding educational needs and converting those needs to education programs, so I am assuming readers of this series also have that kind of core L&OD knowledge. With that in mind, I’d like to share a few points that are critical to having a robust set of education offerings for front-line workers, particularly those at the entry-level. These are: access to technology; the importance of cohorts on building learner confidence; and knitting the post-secondary pieces together.

Education. Stumbling Blocks and Opportunities Unique to Entry-Level Associates

Access to Technology

Ensuring your learners have access to and comfort level with any technology required for their learning is essential and not to be taken for granted. (Think digital divide.) Having your technology-related bases effectively covered will improve confidence, completion rates, and outcomes.

As I write during the COVID-19 pandemic, the framework for education delivery has been revolutionized. The pandemic has vastly limited the ability for many to meet in traditional classroom settings. It has also extraordinarily accelerated the addition of virtual delivery options.

Given the incredibly rapid pace of change in this area, I won’t try to proscribe specific technology recommendations. My guidance is to research thoroughly your learners’ access to and comfort level with technology-delivered education. It is likely far different than your own. Be realistic about this.

For non-exempt employees, equipment is not the only issue related to “access”.  As mentioned in our last post, the single biggest barrier to providing more education for entry-level employees is the impact of labor cost on the hospital bottom line.  Health systems like Mercy (St. Louis) have crafted policies in which required training (paid) and optional self-development (unpaid) are clearly defined for non-exempt coworkers.  This separation is critical and allows your associates who want to advance themselves to be able to do so on their own time.

Plan, design and budget your proposed education and career planning offerings to remove technology-related barriers of all types. Be creative and collaborative with internal IT leaders or volunteer groups who are often willing to purchase or donate laptops for these employees. Examine your organization’s policies and work with Legal and leadership to alleviate labor cost concerns and increase access to learning for your lower-wage associates.

Building Learner Confidence – Increases Motivation to Succeed – Leads to Upward Mobility

As you attend recognition ceremonies for adult learners at programs like School at Work®, the comment you’ll hear most frequently is something like, “I never would have thought I could have accomplished — insert education, career or life goal — , but now I believe I can”. Makes sense, right? If I’ve had problems in my life experiences that cause me not to believe I have potential, my world view on future options is going to be limited.

Recent research from the Strada Education and Gallup bears out the need to improve low-skilled employee’s confidence in their ability to be successful. “Half of adults in the Public Viewpoint survey say that self-doubt would be a major impediment to their enrolling in postsecondary education, either because they fear they won’t be successful, have been out of school for too long, or a combination of the two. This lack of confidence ranks as the No. 2 challenge to enrollment, above cost (48 percent) and second only to logistics (55 percent).”

For your front-line associates to decide to go back to school to achieve a certificate or degree requires a lot of motivation! At this stage of life, those co-workers likely have family and other responsibilities that go well beyond the college student who enrolls as a single person immediately after high school. They are likely also low-income. In order have the motivation to take on the mega-goal of going back to school, these individuals must be highly confident.

Learner confidence is built by providing a supportive setting that results in program completion. An instructor/facilitator who has educational competence and treats individuals with empathy and respect is paramount. A cohort model in which other employees from similar circumstances learn together and provide moral support, through class challenges and inevitable life ups-and-downs, is also key.

Graphic depicting the progression an entry-level employee makes: first is confidence which leads to motivation. Next a career and life plan is made that is followed by employment and upward mobility.

Ken Bishop of AtlantiCare summeds up the change in confidence by describing students as nervous when one of his School at Work® classes begins. By the end of the program, they are standing in front of their classmates, making presentations and sharing newfound knowledge. “I joke that they’ve grown three inches. It’s because their posture changes. You can see it in how they carry themselves and interact with each other,” Bishop said.

“The program has made me a risk-taker and a goal setter.” said School at Work® Graduate JaQuita Newsome of Palmetto Health. I have been able to learn new ideas, make new friends, meet new people, advance my work skills and job performance, and it has made me push further towards job advancement.

Graduate JaQuita Newsome of Palmetto Health.

Enable Advancement; Knit the Postsecondary Education Pieces Together

Tuition Support. Upward mobility hinges on advanced education. Health systems spend millions supporting the continuing education of their employees. Check on a couple of structural elements to make sure there’s a level playing field for employees seeking their first credential or degree.

  • Ask, does our Tuition Reimbursement policy support community colleges and technical schools? Does it support attainment of credentials that are healthcare specific and roles that are employed within the organization? A “yes” to both of those questions is critical in your efforts to advance low-skilled. Properly credentialed certificate programs can move your colleague from a low-wage role to a family-sustaining wage job in 12-18 months. For those who wish to keep going, they can also be a confidence-building steppingstone to an associate’s or bachelor’s degree.
  • Lobby and Partner for Tuition Advancement. The cost of higher-education can be a barrier for low-income individuals, if they don’t have upfront funds to pay for school, post-program reimbursement may not solve the problem. Jenny Skinner of TriHealth in Cincinnati overcame this challenge by partnering with the System’s foundation. Jenny and her Education team identified, prepared, and mentored entry-level employees who wanted to go to college. The Foundation advanced the funds for tuition. Education then paid the Foundation from the Tuition Reimbursement budget as courses were completed. It is a creative team-solution to help low-wage employees avoid a cash outlay.

Nurture an Active Partnership with your Community & Technical College. Your organization likely already has a vibrant relationship with the local community college. If not, someone in the organization responsible for building the pipeline will want to build one. As the advocate for individuals who are likely not from a college-going background, you can foster their confidence by inviting college staff to speak to your employees, providing them a personal point of contact. Think about taking your group for a campus walk around, to improve their familiarity and comfort level. Get on-line with them and navigate around the college website. Work with them in advance of the taking placement test and if needed provide preparatory classes in Algebra and other subjects. Do whatever you can to make sure your newly motivated associate scores at a level on the placement test that puts them immediately into credit-bearing courses. Work strongly to overcome a placement test outcome that requires they go into remedial math or English classes as these are a total de-motivator and “the graveyard of student success”.

Be an Advocate!

Remember our story about Imon Muldrow?  Imon benefitted early in his VA career from the support of mentors, Elizabeth Jenkins, EEO/Diversity Program Director and Julia Gilmer, Chief of Food and Nutrition.  “Every good organization needs good people who feel like there’s an opportunity to grow, said Jenkins.  Imon had so many skills and abilities that he didn’t realize he had, a diamond in the rough.  The more we polished, the more he shined.”

Elizabeth, our team at Catalyst Learning, and the hundreds of others we have worked with at health systems throughout the US believe there is hidden gold in the often overlooked front-line employees in your organization.  Find it!  Unleash it! Watch them soar!

The lessons the Catalyst Learning team and I have learned about healthcare workforce development over the last 15 years are contained in this article series. (Check out the first two: Support Diversity & Inclusion Initiatives by Upskilling the Front Line and Increasing Internal Support for Frontline Education Programs.)

Sign Up for Our Monthly Newsletter:

Moments of Joy, and Hope, from a Challenging Year

In what has been a year unlike any other, we are reminded of the importance of taking time to celebrate hopeful moments of joy. We’ve seen just how much frontline healthcare workers are putting on the line to provide safe, compassionate care during this pandemic. We have gathered photos from dear customers across the country as the COVID-19 vaccine is administered to Frontline Heroes.

Utilizing the Pathway Framework to Thrive During the COVID Crisis

This is an executive summary of a session from the ANCC Virtual Summit 2020, “Thriving in Crisis: Utilizing the Pathway Framework.” This summary focuses on the excerpt delivered by Patience Harris, BSN, RN, Sr. Pathway Specialist at the American Nurses Association.

2020 has been a strenuous year on the healthcare system. Nurses especially have felt much of the professional strain in the year of COVID-19. This year has led to nurse anxiety, for a crisis we are not able to see, understand, or prepare for. Nurses are dealing with issues like PPE and work efficiency problems and are adjusting to modified work schedules and responsibilities.

Given this challenging situation, now may be the best time for nursing leaders to recreate and maintain a positive practice environment that will ensure nurse teams feel supported, engaged, and listened to. The ANCC Pathway to Excellence® Framework can help you create a system that will enable your teams to be better partners and even thrive. Here are the Pathway Standards and examples of how they can be used.

Shared Decision Making

As a leader, engage staff at all levels through strategic planning. Because of the pandemic, shared governance councils may not be able to meet as regularly or formally as before, so be creative in how you will continue to seek input from your frontline nurses. Connecting with nurses regularly is key to show them that they have a voice and that leadership is serious about incorporating shared decision-making. For example, consider using a virtual Zoom call for rounding on the unit to give nurses opportunities to speak with senior leaders. Ask bedside nurses to participate in these rounding sessions with the CNO, but not the direct manager for the best and most honest feedback. The CNO at Metropolitan Methodist Hospital (San Antonio), for example, invites frontline nurses to spend time with her monthly to connect on issues.

Be sure to give feedback up the ladder as well. Share input from nurses directly with your Boards or Councils! Rather than just high-level nursing reports, share individual nursing stories or internal newsletters. Your organization’s Board will probably love this sentiment.


Put strategies in place to protect, support and retain your leaders, in particular your nurse managers. At Memorial Hospital (California) for example, it was decided that meetings would be less about protocol and more about caring for the leader. By doing this, Memorial Hospital found issues and concerns that had never come up before within a larger group setting. What are other ways to support your nurse managers? Leadership could commit to being easily accessible, rounding regularly, and/or resiliency rounding in concert with pastoral care and social services that are available.


Because decisions made by Pathway organizations are shared, safety solutions often come from the frontline nurses. Nurses at Providence Hood River Memorial Hospital (Oregon) helped solved common PPE dilemmas on their unit. Nurses also helped fix ongoing issues, like the continuous ICU overflow of patients who were going to new teams, and the communication issues resulting from that. Also, at this hospital, the nurses who were in charge of supplies and workflow adjustments found that processes needed to evolve swiftly in dealing with the resuscitation of patients with COVID-19. The CNO at Providence Hood River Memorial stated that “this is a dramatic change to our usual clinical practice. We learned that our staff really are the experts when it comes to defining workflows, so they must be involved.” Staff ownership on the unit level is key, as it empowers staff to be agile and responsive as they address safety in the workplace.


In the Pathway framework, nursing participation and quality in evidence-based practice is key. Pathway organizations involve nurses in the development and implementation of quality initiatives. In 2020, many new processes, innovations, and treatments which were nurse-generated have become standards. Nurses were involved in the development of COVID-19 airway management isolation chamber (CAMIC) for example. When it comes to quality, nursing must be involved; nurses are key stakeholders for quality, innovation, and safety initiatives to be successful.


Well-being includes promotion of a culture that is civil, offers day-to-day recognition, and addresses physical and compassion fatigue, plus nurse resilience. This Pathway standard is even more vital during the coronavirus landscape we’re in now. Nurse executives need to be proactive in finding ways to combat nurse stress, burnout and even PTSD.

As nurses are working through this crisis, living the Pathways standard of Well-Being is a guide to mitigate the conditions that lead to stress and burnout. Consider Memorial Health South (Florida) which lets its staff know that they care about well-being by delivering yard signs to nurses’ homes that say “You Rock” and are actually signed by the CNO and other nurse leaders. The organization also started “Hope Huddles” where staff members read inspirational quotes and stories. Another health organization, St. Luke’s Global City Medical Center, a Pathway organization in the Philippines, has a rotating flower pod that goes from unit to unit with large flower arrangements and inspirational stories. St. Luke’s also turned its own auditorium into a free grocery store for its staff who have less time for shopping. It also offers free laundry and shuttle services, as well as hazard pay and housing accommodations for those in the most stretched units.

Professional Development

Nurses know that learning is an ongoing process, and is important even in the midst of a crisis. Pathway organizations recognize the importance of staff orientation, collaboration, and professional development in providing safe and effective patient care. In this time of COVID-19, most organizations have implemented some form of cross-training to accommodate viral testing needs and the influx of patients.

During a crisis, onboarding and orientation as we typically know it may not always be possible but can be accomplished through less traditional ways such as virtual meetings or online learning. One Texas health organization recognized the need for leadership development and implemented a professional practice transition program. What made it was that its frontline staff was encouraged to participate, without needing to commit to a leadership role in advance.

Great Communication is Key

The common factor in all of these standards is communication. Now more than ever, effective communication is critical to providing high-quality patient care and to staying engaged with all team members. In these demanding times, even giving bad news to staff is better than leaving them feeling left in the dark. But keep in mind that communication overload can cause problems too. As innovations and processes change quickly, be aware of how and when you communicate to avoid overwhelming your team.

ANCC’s Magnet Recognition Program® recognizes hospital organizations for excellence in patient care and superior nursing processes. Bristol Hospital, a small community hospital in Connecticut and Catalyst Learning customer, is extremely proud to be among the elite 7% of health care organizations with Magnet designation nationally. To uphold this high standard, Bristol has embraced dedication to one theme: developing great leaders at all levels of nursing, including charge and other first-level supervisory nurses.

“Critical thinking, decision making, effective communication, and conflict resolution all help to advance our nurses’ practice. The participants were most engaged in the communication and conflict style assessments. I believe it gave them a greater understanding of how effective communication and conflict resolution skills impact patient care. As the charge nurse, these skills are essential.”

Kerry Yeager, Clinical Informatics Specialist at Bristol.

Being a frontline nurse leader is a high-pressure role that is often assumed with little or no formal leadership training. Catalyst Learning’s NCharge: Nurses Learning to Lead is a dynamic, flexible series designed to improve the leadership, business management, and interpersonal skills of frontline nursing leaders. Critical leadership skills like communication, delegation, and conflict resolution require ample practice time. That’s one of the key reasons up to 70% of the time in NCharge courses is spent in group discussions and interactive activities. Learn more.

Sign Up for Our Monthly Newsletter:

Increasing Internal Support for Frontline Education Programs

By M. Lynn Fischer, Founder & CEO, Catalyst Learning Company

What if you’ve already launched a frontline education program and want to ensure its longevity in your organization for years to come? Likely you’ll face many challenges along the way ranging from budget changes to push-back from departments affected by short staffing. Your ability to anticipate obstacles in the future of your program will help it stand the test of time. Consider the following tips when planning for the new year:

Direct Supervisors and Hiring Managers – Central to Advancing Frontline Associates

The direct supervisors are in many ways the unsung heroes in the whole continuum of front-line employee development. Think about it. They have departments that will “work short” while employees are in training for skills. Your goal may be to get them promoted to work in another part of the organization. And often it is their best people that we’re asking them to develop; knowing they may be leaving that department!

So how to gain a direct supervisors’ support? An example would be to emphasize the near-term gains to the workgroup: a more knowledgeable, motivated, proactive employee with improved communication and initiative. Near-term skill gains can always be identified. You’ll just need to take the additional step to facilitate the connection for a direct supervisor.

Mercy (Missouri, Oklahoma, Arkansas)

Mercy has been very committed to providing learning and development opportunities for its lower paid coworkers, with goals to help compensation. It offers CLiMB, an online library of focused microlearnings for entry-level coworkers. CLiMB focuses on key healthcare work concepts like basic professionalism, communication, productivity, managing stress, and providing exceptional customer service. CLiMB’s 15-minute learning modules enable learners to practice real-world scenarios for learners to improve their performance.

During the pandemic, remote learning and development has become even more crucial for healthcare facilities. Beth Kinsey, a Senior Specialist of Talent Development at Mercy, notes that Mercy is seeing examples of how CLiMB learnings are being applied by frontline coworkers during times of COVID-19. She notes that coworkers are being more intentional about listening, taking instruction better, and diffusing team conflict. CLiMB participation is also gauged by HR as a way to see which entry-level coworkers are most interested in career advancement.

See our related articles, “Mercy Adopts New Technology to Educate & Advance Frontline Workers” and “Mercy Health: Living the Mission through Education of Frontline Coworkers.”

Now let’s consider the impact of the “Hiring Managers” that are in a position to offer a promotional opportunity. If a hiring manager knows an employee as the friendly and efficient person who takes her payment in the cafeteria or cleans her office, she is probably not thinking of that individual as the next candidate for a billing and coding or medical assistant she needs to hire. That’s where you, your internal partners in front-line development (e.g. a career advisor, recruiter, or coach) and, hopefully an organizational belief in “hire for attitude, train for skill” come in.

To change an impression a potential hiring manager has based on the front-line employee’s current role, invite her to attend graduations and other closing ceremonies for your programs. Go to bat for your higher-potential frontline team member by pitching hiring managers on motivation and persistence as valuable traits that merit giving someone a chance in a new role.

Overcoming the Impact of Labor Cost

The single biggest barrier to providing more education for front-level employees is the impact of labor cost on the hospital bottom line. Time in education classes is often categorized as “non-productive time” and carries penalties for direct supervisors who are measured and bonused on labor “productivity”.

Consider this method of compensation: “bonus upon program completion”. If employees clock out for class, there is no productivity impact to the manager and no chance that class time will create an overtime pay situation. By rewarding the employee with a bonus of equivalent amount at conclusion, there is a built-in incentive for completion.

A key element of increasing internal support is translating the needs of the often voiceless and sometimes invisible Essential Workers in our healthcare organizations to key influencers and seats of power. These leaders are busy, usually want to help, and need to quickly understand, “what do you want me to do”? Use the tools outlined here to improve your success with Direct Supervisors, Hiring Managers, and other key executives!

This article is an extension of our October post, “Support Diversity & Inclusion Initiatives by Upskilling the Front Line”, which outlined valuable tools and information needed to implement successful programs for frontline healthcare employees. Catalyst Learning’s front-line employee learning products provide a range of options tailored to different outcomes and budgets. If your target outcome is job advancement, take a look at our School at Work® or ECHO® experiences. If skill building is your focus, consider CLiMB or CAPS.

Sign Up for Our Monthly Newsletter:

Support Diversity & Inclusion Initiatives by Upskilling the Front Line

By M. Lynn Fischer, Founder & CEO Catalyst Learning Company

The American Dream, the belief that anyone, can attain their own version of success and upward mobility through sacrifice and hard work, is alive and well in the Healthcare industry. It is the largest and fastest growing sector in the US economy, has numerous entry points and a myriad of possibilities for promotion and job advancement. Entry-level employees with limited education have a variety of paths by which they can move from low-skill, low wage roles to middle-skill, family sustaining wage positions. This group of essential workers, employed in lower-wage roles, tends to be very ethnically diverse.

“Who touches and impacts the patient? It’s our frontline co-workers. Who has one of the largest impacts on patient experience? Again, it’s the frontline co-workers. When we invest in these co-workers, we enhance the learning and productivity of the organization.”

Sister Claudia Ward, Program Manager Health Leads, Mercy

So you’ve decided that the best way to achieve success through a diversity and inclusion initiative lies with the education and empowerment of your organization’s low-wage front line. Where should you go from here?

Understand How Much Executive Support You Have… and Build from There

Most human beings, and virtually all of those in healthcare, want to “help people”. At its core, that is what front-line development is all about – reaching out your hand to help associates who want to progress in their careers and need help to accomplish that goal.

In our work to advocate for front-line employee development, scare resources sometimes evaporate. Everyone enthusiastically says, “we need to do this”! But the reality is that very few health systems actually implement a system to facilitate long-term development and upward mobility for front-line employees. If nothing is in place, you may want to “start small”, unless you have a C-Suite champion and a good-sized budget.

Atlantic Health (Morristown, New Jersey)

As the only New Jersey-based health care company on the Fortune’s ‘100 Best Companies To Work For®’ List, Atlantic Health System appears alongside some of the country’s best-known and most successful organizations, such as Hilton, Wegmans and American Express.

A program that Brian Gragnolati, President and CEO of Atlantic Health System said he is proud Atlantic Health has instituted is ‘School At Work’ (SAW®):

“We have a lot of staff members who might be in a job that they might desire to progress in. It might be a housekeeper, or it might be dining service or patient transport for an example. They’re in those roles and they can’t progress because perhaps they had a bit of a stumble early on in their lives,” Gragnolati said. “Maybe something happened in their families or they got in a little bit of trouble in high school and didn’t get out of high school and maybe have a GED. Now it’s 10 to 15 years later and feel like they’re stuck.”

New Jersey Herald, “Atlantic Health again one of Top 100 best places to work in U.S.” by Joe Carlson

Gragnolati said everything the health system does for its employees is done so it can “support our staff so human beings can continue to care for human beings in remarkable ways.”

Brian Gragnolati, center, president and CEO of Atlantic Health System, and Nikki Sumpter, center left, senior vice president and chief human resources officer, stand with graduates of the “School at Work” program, which gives employees the opportunity to learn during regular work hours and learn skills needed to explore other career opportunities in health care.

Begin with Your Goal When Designing a Development Program

It sounds so obvious, but I’ve been amazed over the years how many customers proceed with a program because it feels like the right thing to do, prior to having a solid business-related justification. Examples of different types of outcomes you might discuss with your stakeholders could include:

  • identifying and upskilling people for a high-need position
  • increasing the ethnic diversity of people in middle-skill and supervisory positions, or
  • retraining loyal employees whose jobs are in jeopardy due to automation (an increasingly urgent imperative for conscientious employers).

Effective workforce development programs involve a number of different groups within the health system, and typically fall under the umbrella of Talent Acquisition, Talent Management, or Learning & Organizational Development or Effectiveness (L&OD/L&OE). Working closely with these various departments will help you achieve implementing a successful program.

Career Planning & Advising. Essential. Often Missing.

I have long been astounded by the huge dollars spent on external recruiting of new employees and the paltry sum spent on developing internal staff. Return on Investment will be demonstrated over a period of years as the percentage of “internal hires” grows. Once a career is successfully planned, the advancements can be game changing. The lives of the front-liners get a boost and their families also benefit. Helping an employee identify a middle-skilled position that is a “good fit” and attain it, can jump wages by 45-50%.

Help Associates Define Options

“If you don’t know where you are going, any road can take you there.”

The classic 4-step career planning process includes: self-exploration; job research; exploration of job options; and taking action. For front-line workers at the entry-level, this way of thinking will likely all be new and require structured support. Those who are already employed in certificate-level positions may be more autonomous once you get the right tools in their hands.

Encourage the leader of your Talent Acquisition group to dedicate at least one person to career advising. Important skills for the internal developer are nurturing talent and facilitating connections within the organization, making the position different than a typical recruiter.

You’ll want a focused area in the organizations website where employees who are able to operate autonomously can learn what tools are available to them and be provided with contact points for related activities such as job shadowing and tuition support.

Something to consider is adding a supplemental program, such as CareerCare®, that allows employees to do guided self-reflection, a career interest assessment, and learn about high-need jobs within your organization. Employees will then be able to approach HR with a well-qualified idea of what will work for them that the hospital has need for.

Think about developing a class where the goal outcomes are a completed Career & Learning Plan, confidence in the future, and motivation to act on the plan. Access to an advisor or mentor will also be essential for your entry-level employees to successfully complete a career plan.

A key element of this work is translating the needs of the often voiceless and sometimes invisible hardworking people in our country to the seats of power. Seats of power that are busy, want to help, and need to quickly understand, “what do you want me to do”? Using the tools outlined here, be ready with your answer to that question!

What Else We’re Reading:

Sign Up for Our Monthly Newsletter: