Top CNO Worries: A Fall 2020 Update

2020 sparked what will forever be looked at as the year of the nurse. Our nation’s frontline health heroes answered the call when the world started changing in early March. Chief Nurse Officers had to push aside competing internal priorities and get to the root of their leadership role: advocating for the nursing profession. As we prepare for an end to summer, what are the top concerns of our nation’s CNOs?

Gauging the Impact of COVID-19 on Nurse Staff

Even before the pandemic, healthcare organizations were facing growing challenges in finding the nurses they need to compete and provide great care. But not CNOs really need to gauge the impact on staff. How did this event affect nurse stress and resiliency? What can be done to make positive steps to coping as a system/team. Nurse Directors and CNOs will likely spend months or years helping to give emotional first-aid to nurses who were on the front lines, as they process what has happened.

Prioritizing Nurse Resiliency from the Top-Down

Nurses are stressed! With the pandemic, recent nursing furloughs that led to employee financial issues, political unrest, or stress from children not being in school, nurse stress management and resiliency is more important than ever. How will CNOs help RNs feel prepared to tackle challenges the job throws at them?

CNOs will be encouraging nurse emotional breaks and stress management techniques. When huddling with work teams, nurse leaders will worry about how to teach self-awareness and how to teach nurses to recognize what they can and cannot control. CNOs know they desperately need to prioritize nurse satisfaction, productivity, and stress management, but it is an uphill climb.

At Children’s Hospital and Medical Center in Omaha for example, managers are trained to listen and provide safe spaces for nurses to talk through work stressors. Omaha Children’s early intervention program began with a need to address secondary trauma, then saw there was also a need to reduce workplace stress. CNOs across the U.S. are looking for the right resiliency strategies for their own organizations.

Preparing Staffing Models for a COVID-19 and Influenza Surge in Fall/Winter

No one knows what will happen in late Fall or Winter, but history shows that a non-vaccinated virus can have secondary spikes, more probable in cooler weather. CNOs are figuring out how to expand the acute care workforce as much as possible before this possible surge starts. Organizations are relocating staff from a variety of other care sites such as outpatient procedural areas, ambulatory care sites, and low volume clinics. CNOs are also increasing temporary staffing options: recruiting from pools of retired nurses, independent NP’s under temp contracts, student nurses, and recruiting faculty from academic partners.

After workforce expansion actions are taken, the next priority is to optimize deployment of this expanded workforce. CNOs are figuring out how best to ensure staff are prepared and that potential learning needs are addressed, and worried about how to best deploy staff to optimize staff experience and clinical competency.

Once staffing volume for a virus resurgence is addressed, preparation evolves to figuring out the stressful details of how to support that staff. For example, is the 12-hour shift excessive while staffing this pandemic? Can staggered shifts be supported? How can nurse leaders best leverage preceptors and nurse mentors? How is hazard pay addressed? How are new nurse graduates prepared? How can leadership best prepare ICU space and equipment/supply issues? And how can emotional support and stress-mitigation strategies be put in place before any surge hits? These are all questions our nurse executives are hoping to find answers for.

There are a lot of questions that have no answers for CNOs this winter that will affect staffing models. Will it be a bad flu year? Will populations, tired of distancing and putting off leisure activities, let their guards down near the holidays and cause mass viral outbreaks? Will a COVID-19 vaccine come, and will high-risk populations have adequate access to it? Or will they even trust it? Will pent up demand for non-essential/preventive care in Spring and Summer cause spikes in care volume needed later in the year? And how will a divisive election season affect population health?

Nurse Shortages and Attrition Leading to Erosion of Patient Care and Staff Morale

Healthcare organizations are facing growing challenges in finding the nurses they need. According to the AMN Healthcare Study “Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” many CNOs cited that the nurse shortage at their organization is moderate to severe, and most say that this problem will become worse instead of better in the next five years. Some sources are showing that understaffing nurses can degrade the work environment and HCAHPS scores. Nurse recruitment is becoming more competitive now too, with salaries rising higher and higher. Nurses demand more perks, like flexible schedules. Hospitals are seeing nurses leaving for easier 9-5 shifts in outpatient settings. Read our related article, “Millennial Nurse Retention Strategies.”

 Changing Technologies/Processes, plus Training to Manage it

EHR, automated IV pumps, portable monitors, medication bar code scanning, smart beds, and centralized command centers are just a few recent tech upgrades. Besides just frustrations with scheduling constant training sessions, health IT can contribute to nurse burnout, as it demands more of nurses’ time. Work interruptions from constant alerts and alarms is challenging, and if nurses see added IT processes with no measurable impact, it leads to more frustration. Systems are looking to technology to streamline work and increase efficiency in 2020, but there are growing pains as this happens. And what new technologies or processes will arise because of the pandemic? Will some of the restrictive new rules from long-term facilities make it to acute care hospitals?

Turnover Within the C-Suite

Continuous consolidation of healthcare organizations and mass retirements of Baby Boom age leaders increase executive turnover rates. Churn in the C-suite can have a negative impact on financial performance, organizational development, and employee engagement. C-suite turnover creates a toxic environment of competing priorities that can distract organizations from providing high levels of patient care.

As the nation gets up from this gut-punch in 2020, will it lead to an even larger mass exodus in our systems’ C-Suite? That is uncertain, but we do know that hospital CEOs are taking pay cuts as COVID-19 financial losses mount, and capital projects are being terminated or postponed. With some bans on high margin non-emergency surgeries, workers being furloughed, and soon-to-come regulatory changes looming to prepare for future pandemics, it would not be unprecedented to see turnover within the C-Suite later this year.

Lack of Transformational Nurse Leaders – Young Nurses Not Pursuing Leadership

As Baby Boom nurses are retiring or cutting back hours, there is a void in leadership and experience. It makes sense that young nurses should apply and fill these leadership voids, but often times they do not. Hopefully when we look back in time, we’ll see that the COVID-19 pandemic helped CNOs identify leadership potential where they had not yet seen it in junior staff (and perhaps the converse, re-evaluate where they thought senior leadership potential was present). One way to prepare young nurses is to equip them with leadership development opportunities. Making sure a first-time Charge RN has a good leadership experience is crucial for filling future Nurse Manager roles. Managers are responsible for staff, overseeing patient care, scheduling, meetings, and personnel and budget decisions. It comes with stress and work-life balance issues. See our related article, “Why Are Many Young Nurses Not Applying For Manager Roles?”


BONUS – All About Nursing with Dr. Joyce Batcheller

Dr. Joyce Batcheller is an Executive Nurse Advisor with The Center for the Advancement of Healthcare Professionals for AMN Healthcare and is responsible for the development and delivery of two Chief Nursing Officer Academies: CNO Academy I, which was developed for new and aspiring CNOs and CNO Academy II, which was developed for experienced CNOs. Having served as a Chief Nursing Officer for more than 19 years in one of the largest healthcare providers in Central Texas, she has extensive experience in leading large system changes within a complex multi-hospital organization.

Dr. Batcheller’s podcast, “All About Nursing” explains how nurses play a significant role in providing healthcare in multiple care settings. You will be able to hear from some of these key nurses who work in practice, academia and other practice settings. You will hear about challenges nurses are engaged in as healthcare continues to experience an unprecedented need to decrease costs and improve outcomes. Recently, Dr. Batcheller interviewed Robyn Begley CEO of AONL and Kim Glassman who is leading work in NYC related to COVID-19. Listen to the podcast here.


“Dealing with COVID-19 Anxiety & Stress on the Front Lines,” Wolters Kluwer Podcast, April 13 2020

“Key actions CNOs should take now to staff for a Covid-19 surge,” Advisory Board, Carol Boston-Fleischhauser, JD, MS, BSN, CNO and Managing Director

“Healthcare News: Nurse Leaders Say Nurse Shortages Erode Patient Care and Staff Morale,” AMN Healthcare

“Hospital CEOs take pay cuts amid COVID-19,” Modern Healthcare, Stephanie Goldberg, May 11, 2020

“Working without a Playbook,” Emerging RN Leader, Rose O. Sherman, April 2, 2020

“The backbone of healthcare: 3 CNOs on what COVID-19 has taught us about nursing,” Beckers Healthcare, Mackenzie Bean, Gabrielle Masson, Anuja Vaidya, May 11 2020

“Maintaining hospital culture through C-suite leadership turnover,” Beckers Healthcare, Brian Hudson, April 23, 2018

“Second Victim Syndrome and COVID-19,” Emerging Nurse Leader, Rose O. Sherman, April 30, 2020

“Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” AMN Healthcare

“10 things keeping health system CEOs up at night,” Beckers Review, Molly Gamble/Ayla Ellison

“Top CNO Concerns,” Kristin Whitehead, HealthLinx

“Worries of the health system CEO,” Medi Leadership, September 27, 2019

“Nurse burnout? Try telehealth, clinical decision support and analytics tools, experts say,” Healthcare IT News, Bill Siwicki

“COVID-19 Hits Some Health Care Workers With Pay Cuts and Layoffs,” NPR, Martha Bebinger, April 2, 2020

Special Update

As the impact of COVID-19 on hospitals across the U.S. continues to escalate, the minds and hearts of the Catalyst Learning team are with you and your organization who are providing an invaluable service to your communities as the frontline of patient care.

Our office in Louisville, Kentucky has implemented social distancing protocols recommended by the CDC and the WHO. We are continuing to operate during our normal business hours for any questions you have or assistance you need. We are committed to supporting your teams in any way that we can.

We have asked ourselves “what can we do?” to be helpful in a situation that is beyond the bounds of anything we’ve ever experienced. We are providing a series of infographics and very simple discussion guides that you can use to share with individual team members, or in quick huddles here. Additionally, our existing SAW® and ECHO® customers will have access to applicable CLiMB microlearnings through their MyCatalystLearning online portal here.

Lynn and the Catalyst Learning team


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Tips to BOOST your Nurses’ Confidence

No one said nursing was easy. There are days when your nurses will be stressed out and possibly feel hesitant about their own abilities. Nurses may ask themselves “Is this something I can handle?” or “Can I really do this my entire career?” New nurses straight out of school may acknowledge that they have the clinical know-how, but don’t feel ready to face real life challenges or high acuity patients.

While executives are working on higher-level system initiatives like nurse retention planning and staff development, are there simpler ways to keep nurses happy and engaged? Here are some tips to help boost your nurses’ confidence:

Teach Personal Boundaries

Encourage your nurses to have personal boundaries; this is code for you cannot please everyone. Teach nurses, especially young ones, to be selective about what personal information they share with other nurses and staff. Teach your nursing staff the fundamentals of Emotional Intelligence, most notably keeping emotions professional. Boundaries are important in successful nurse-patient relationships as well. Teach your nurses where their responsibilities begin and end and how to assert those boundaries when tested.

See our related article, “Emotional Intelligence in Nursing – Six Key Traits.”

Build Bully-Proof Nurses

Lateral violence is no longer the hidden secret of the profession, and being bully repellant is sadly necessary. Physicians can also bully nurses; nasty workplace behavioral practices exist. But if nurses have a strong sense of self and know what they stand for, they can make themselves less likely to be a target for a bully. Bullies are attracted to low self-confidence and nurses with timid communication styles, so teach nurses to be assertive. Also teach your nurses the more subtle forms of bullying to watch out for. While physical violence is an obvious form of workplace bullying, there are other bullying techniques: peers setting peers up for failure, sabotaging work, gossip, or giving misleading/false information. If your nurses know these patterns, they can better prepare themselves to deal with it and possibly even combat it.

See our related article, “The Nurse Bullying Phenomenon.”

Teach Nurses NOT to Compare Themselves to Others

Unfortunately, we live in a culture where everyone seems to care about what others are up to. But there is little that can shatter confidence faster than comparing oneself to others. It is good for young nurses to have senior nurses/administrators to serve as inspiration for a career path, but teach your staff not to look down on their own abilities by comparing to others. You can also teach senior nurses not to inflate their own ego just because they are superior in some competencies. Even very experienced nurses can see their confidence get shaken at times.

Set Your Nurses Up with a Mentor

A career mentor is important in any career, but especially in nursing. A mentor can encourage nurses when frustration sets in, and give new perspectives. Start a nurse mentor program at your facility, whether formal or informal. For nurses, knowing that they have someone in their corner can give confidence. If a mentor program isn’t possible, encourage your supervisors, instructors, and directors to build stronger relationships with nursing staff. Have these senior staff members take nurses out for coffee or get some 1×1 moments in a judgment free mindset.

If there is anyone who knows the ins and outs of a facility, it’s the people who have been there the longest. Teach your nurses to model their work ethic after someone who is excelling in their role.

Teach Nurses that Perfection Isn’t Real

When in small groups with nurse staff or at 1×1’s, remind your staff that no one is perfect. It is better to admit a mistake or flaw than it is to make an excuse for it. Confident nurses are able to admit when they are wrong. By acting defensively after a mistake, it hurts confidence instead of boosting it. Possibly share mistakes or flaws that you had as a bedside nurse, and assure staff that all great nurses had moments they wish could be taken back.

Let your nurses know they do not have to personally know everything. Giving great care doesn’t mean nurses are on an island; teach nurses to flip the script. For example, when they don’t know what to do with a patient in distress, teach them to leverage the collective knowledge of the nursing team around them. Let the group figure out next steps. Having the ability to gather information and consensus is more important than the personal clinical knowledge to figure it out solo.

Help Your Nursing Staff to Engage in Lifelong Learning

Learning new skills and acquiring new experience contributes to both confidence and competence. As your nurses learn and develop, they will become more effective nurses. They will also be more confident nurses and better leaders. While knowledge is power and well-educated nurses will naturally be more confident, tell your nurse staff not to limit education to just clinical learning. “Soft Skills” like communication, conflict resolution, and leadership can help nurses stand out on the team and boost confidence.

NCharge®: “Nurses Learning to Lead” is a set of leadership courses built for the first-level supervisory nurse, the Charge RN. NCharge is an evidence-based curriculum that gives nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. NCharge helps U.S. health systems to build a nurse leader pipeline, impact financial awareness and results, and increase nurse engagement and retention. For instance, the Supervisory Skills For Positive Outcomes course teaches communication strategies to confidently communicate practice concerns, conflict management, time management strategies, and appropriate delegation while maintaining accountability.

Click Here to have one of our team members reach out to you about NCharge. Give us the opportunity to hear your skill gaps in nurse confidence and allow us to make a course recommendation!



“4 Ways to Build Confidence as a Nurse,” AHS Nurse Stat, Cade Webb, January 24 2019

“Boost your confidence to reach the stars,” The Nursing Times

“7 Things Nurses Can Do to Feel More Confident at Work,” Nursing CE, Keith Carlson, RN, BSN, NC-BC, March 20, 2019

“How Nurses Can Build Their Confidence,” The Gypsy Nurse, February 20, 2018

“Tips Nurses Can Use To Build Confidence,” Diversity Nurse Blog, Erica Bettencourt, July 26 2019

3 Ways NCharge® Supports Magnet Applications

Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. Gradually, a transformational mindset should take root in the organization and become even stronger as other leaders adopt this way of thinking. Nurses in charge need to be developed, directed, and empowered to find the best way to accomplish the organizational goals and achieve desired outcomes. Where Transformational Leadership meets the Structural Empowerment domain is where Magnet nurses will shape dynamic change in healthcare and the nursing profession as a whole.

Magnet requires dedication of the entire nursing staff; it is almost 2020, and it is time to think about developing the first-level supervisory nurse, the nurse at the beginning of her career path. NCharge®: “Nurses Learning to Lead” can assist organizations either considering the Journey to Magnet Excellence, or in a re-application for Magnet status, within these application sections:


The CNO advocates for organizational support for ongoing leadership development for all nurses, with a focus on mentoring and succession planning. TL6 (pg. 32)

How does NCharge® support?

  • Partners with CNO to assure content delivery is aligned with priorities of the organization.
  • Introduces first-level nurse leaders to Value-Based Purchasing principles and financial implications of their work. It raises awareness of the importance of adopting evidence-based care standards, eliminating occurrences of untoward outcomes and adverse events, and improving patients’ experience of care. For a reference case study, read “Nemours Children’s Hospital Teaches Charge Nurses Financial Implications of Success.”
  • Supports the development of an adequate pipeline of future leaders who understand the CNO’s vision and how to drive to positive outcomes.
  • Demonstrates the organization’s investment in helping to assure that staff have a positive leadership experience, and pursue further leadership roles.

Provide an example, with supporting evidence, of mentoring or succession planning activities for clinical nurses.

How does NCharge® support?

  • Provides education on how to be a first-level nurse supervisor; it provides education to assist an organization’s future leaders to think critically, supervise, and lead change.
  • Assists with clinical nurses transitioning from a peer to leader.
  • Assists with creation of multiple Personal Action Plans and topics, to aid in creation of ways to use information learned when back in the unit.
  • Reinforces exercises like the 5 Rights of Delegation Model to help prepare first-level nurses for planning to lead a team, which is key for succession planning. Classes prepare leaders for qualities they will need, like teamwork and collaboration, ego management towards self/staff, innovative thinking, adapting to rapidly evolving roles, and confidence with compassion. For a reference case study, read “East Alabama Medical Center Develops a Nurse Succession Plan.”


2) STRUCTURAL EMPOWERMENT DOMAIN – Commitment to Professional Leaders
Structural Empowerment processes developed by influential leadership to create an environment where professional practice flourishes. Staff need to be developed and empowered to find the best way to accomplish goals, and reference the Forces of Magnetism for pillars like the image of nursing and professional development.

How does NCharge® support?

  • It includes the development of the trainers and builds the pipeline of future leaders. Professional development includes:
    • Transitioning from peer to leader
    • Leading quality initiatives
    • Critical thinking integrated with the Charge Nurse role in driving process improvement
    • Change leadership integrated with the Charge Nurse role in leading compliance and other quality initiatives
    • Confident communication, conflict management, and delegation
    • Employee engagement strategies, led by nurses, integrated with patients’ experience of care


Resources, such as professional literature, are readily available to support decision-making in autonomous nursing practice. How does your organization provide a dynamic learning environment that enhances the professional practice environment skills to build confidence and competence to manage common challenges Charge Nurses encounter?

How does NCharge® support?

  • NCharge® teaches keys of critical thinking for Charge Nurses. Courses teach evaluation and building initial analysis of making decisions, determining merit of information, and placing a judgment. It teaches deductive reasoning, inductive reasoning, and using these tools to apply towards decision-making and critical thinking concepts. One course, Critical Thinking for Charge Nurses, teaches essential traits of critical thinkers with situations that Charge Nurses encounter.


For more information on how NCharge supports the Magnet Application or Reapplication, CLICK HERE.

Are you attending the Annual ANCC Conference in Orlando in October? CLICK HERE to set up a quick meet and greet with our team.

6 Reasons to Budget for Charge Nurse Development in 2020

If 2020 has taught us anything about the nursing profession, it’s that nurses have to be leaders for our country to make it through a pandemic. While often called “soft skills” of leadership, the COVID-19 pandemic has shown us that the hardest skills for nurses to master are navigating conflict, promoting resilience, engaging a team, communicating, and reducing negativity. These skills are all crucial for the Charge RN. As the C-suite is now acknowledging the valuable role that first-level supervisory nurses play, nurse executives should put this thinking into action by budgeting for Charge RN development. More than ever, there should be intention around preparing less experienced nurses for future leadership roles.

The truth is, the Charge RN role is a position that many nurses may not proactively seek. Clinical nursing education typically does not prepare bedside nurses for supervisory responsibilities. Many hospitals still have no formal program to prepare nurses for this “promotion.” But now there is increased awareness within health systems that a lack of role clarity and management skill leads to inefficiency and job dissatisfaction. And when a nurse is frustrated with a first leadership experience, it is possible she stops pursuing those roles, at a time when we need nurse leaders more than ever.

Here are 6 reasons to budget for Charge Nurse development:

It will show Charge Nurses how their Leadership, Morale, and Team Communication Contribute to Organization Success – Especially During Times of COVID-19, and possibly a bad Flu Season

Obviously the COVID-19 pandemic has brought challenges and uncertainty. But it has also presented unexpected opportunities, showing nurses that they can and must lead, for our nation to heal. Charge RNs need to be taught to maintain leadership presence and communicate frequent, transparent, and informative messages to their bedside nursing teams. Leadership development is one way to prepare them for this. During these uncertain times, Charge RNs should have L&D that encourages suggesting new ideas, how to consider alternate plans of action, provide on-the-fly feedback on new work processes, and rapidly help their team adjust to new tactics.

Learning communication is especially key for frontline supervisory nurses right now, as large group in-person large team meetings are not happening because of COVID-19. Front-line supervisory nurses must decipher system-wide phone briefings for their teams, communicate policy updates, discuss COVID-19 topics with their team, communicate equipment and supply chain issues, and share staffing issues as they arise.

Dealing with nurse team morale, while not a new issue for Charge Nurses, is a tougher challenge than it has been in recent history. Morale is down because some younger nurses feel like “it will always be like this,” and some units experience PPE body heat and general fatigue with wearing it which contributes to low morale. There may be team incivility caused by news and events, plus a fear nurses have of taking the virus home, and a general feeling that the COVID-19 sprint has now become a marathon. Given all this, Charge RNs need preparation to deal with morale and negativity that creep into the workplace.

Leadership development is key for job morale. As a Charge Nurse serves as a resource to other nurses for clinical direction, preparing them helps job morale of the entire staff. Organizations need Charge RNs who can be calm in emergency situations, and can keep an eye on the entire unit. This winter may be a viral nightmare in the U.S. – so now is the best time for your Charge Nurse to feel prepared and excited to lead with Charge RN leadership development.

Make sure the role is clear, and has clear expectations

The initial step when preparing the first-level supervisory nurse is to define the role of the Charge RN inside the organization, then be consistent. Success is achieved when new Charge Nurses have a clear understanding of their goals and obligations. For example, determine whether the Charge Nurse will take on a full patient load. It should also be clear how the Charge Nurse should act in terms of delegating work to staff members and how he or she will be using computer systems and other technology. Development and planning for Charge Nurse leadership development helps establish expectations and gets nurses to buy in.


As the baby boom generation heads for the door and younger nurses take charge, preparing staff members for these open leadership roles is time consuming. But this step in succession planning is necessary and highly beneficial. Many larger systems have an official nurse succession plan in place and Charge Nurse development is starting to become a part of those plans at U.S. hospitals. East Alabama Medical Center (EAMC) has an official nurse succession plan which compliments its overall organization goals to develop employees from within. Read More – An Official Nurse Succession Plan at EAMC.

Alternative job perk

As the labor market is already near full employment and a nursing shortage looms, organizations are getting creative in offering non-traditional perks. Usually alternative perks are thought to just include lifestyle assistance programs/EAP’s, financial assistance programs, or free daycare, but investing in development of nurses shows how the hospital values their contributions and sees promise in potential, and becomes an alternative job perk. Be sure to communicate how Charge Nurse training shows organization excitement in the career path of its nurses.

More informed financial discussions with Nurse Managers and other Senior Leaders

Nursing executives generally agree that financial indicators of hospital success and reimbursement are often not understood by bedside nurses. This may be intentional, because nurse executives may not want to inundate nurses with too much information or bureaucracy. But there are several reasons to teach Charge RNs about financial issues they impact. It will prepare them for future leadership roles, allow them to have more informed conversations with Nurse Managers and other senior leaders, allows them to take an ownership stake in VBP, it improves nurse communication and can help save money. To learn more, refer to our related blog article, Why Teach Charge Nurses About Financial Success Indicators.

Positive first leadership experience produces a pipeline of future Nurse Managers

Setting expectations for the responsibilities and characteristics of a successful Charge Nurse by having an official orientation helps new nurse leaders embrace their role. Much research shows that nurses who have a bad experience in a first leadership role are more reluctant to pursue further leadership roles. If this promotion reluctance happens, filling Nurse Manager roles with qualified internal candidates becomes tougher than it already is. When a nurse is successful in leadership early, it is a benefit to your organization and fills the pipeline for future Nurse Managers.


“When the Soft Skills Become the Hard Skills,” Emerging RN Leader, Rose O. Sherman, August 27 2020

“COVID-19: The Nurse Leader Perspective 6 Months Later (Thoughts from Cleveland Clinic’s Chief Caregiver Officer), Consult QD, K. Kelly Hancock, DNP, RN, NE-BC, FAAN, September 3, 2020

“Nursing leadership during COVID-19: Enhancing patient, family and workforce experience,” Patient Experience Journal, article 27;  Anne Aquilia (Yale New Haven Health), Karen Grimley (UCLA Health), Barbara Jacobs (Anne Arundel Medical Center), Maryellen Kosturko (Yale New Haven Health), Jerry Mansfield (Mount Carmel Health System/Trinity Health)


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