UH Nursing Adopts Bold Vision, Innovates in a Post-COVID World

UH Clinical Update | February 2023

Michelle D. Hereford, MSHA, RN, FACHE

By Michelle D. Hereford, MSHA, RN, FACHE, Chief Nursing Executive, Ethel Morikis Endowed Chair in Nursing Leadership

It will be two years in April since I joined University Hospitals as Chief Nursing Executive. Despite the challenges of those two years, from the ongoing pandemic, to workforce staffing concerns and myriad other items faced by healthcare organizations throughout the nation, one thing stands out: I am thrilled to see the continued support, dedication and commitment of our caregivers. It’s quite evident that we have some truly outstanding professionals within this organization. Hearing our caregivers and leaders speak to our long-standing history within the Northeast Ohio community really seems to set UH apart. I repeatedly see evidence of it, not only in discussing our outcomes, but also in the compelling stories of our patients and their UH caregivers that surface almost daily.

We in UH nursing are always striving to improve the care we provide. To understand what we’re trying to achieve here, it’s helpful to be knowledgeable about our vision and goals. As Chief Nursing Executive, I’m working with the teams to create and further enhance our clinical environment so that UH is the preferred organization to practice, care for others, pursue your dreams and advance your career. Making that preference a reality for people relies on the experience everyone has walking through our organization, whether you're a patient, a caregiver, a visitor or a family member. Your experience as a UH caregiver should not only help patients heal and family members feel comforted, it should also motivate you and help create a place where you enjoy coming to work.

How will we accomplish that? Through intense focus in three areas: (1) Retaining our dedicated caregivers and recruiting new members into our family; (2) Redesigning the way we care for others and ourselves; and (3) Incorporating technology into our practice. The focus and the results of our efforts will be shared.

One important initiative the teams and I are very excited about is the Care Team of Tomorrow. It’s our approach to redesigning how we streamline workflows and deliver care within our organization. It redefines the roles of our caregivers and further confirms the contribution that everyone has to make in the delivery of high-quality, safe patient care. The best way to articulate it is for everyone to operate at the top of his or her ability, whether it’s nurses, pharmacists, Patient Care Nursing Assistants (PCNAs), environmental services or food and nutrition professionals. Everyone contributes to the outcome for the patient.

How we define and divide the work at hand in the Care Team of Tomorrow model depends on the skill. For example, we’ve developed a role called the multi-skilled technician, where our PCNAs with advanced skills can  perform phelbotomy. Currently, this role is the greatest need within the model.

We continue to revise the pilots within the Care Team of Tomorrow model at UH Cleveland, UH Ahuja and UH Parma medical centers, and will expand this pilot to UH Geauga and UH St. John medical centers. The creativity of our caregivers and the suggested improvements are key to the success of this model. As enhancements to increase its potential effectiveness become evident, we will implement them. We are also embarking on research through the UH Institutional Review Board (IRB) to further confirm outcomes associated with this model.

These and other innovative ideas will help us succeed in nursing at UH in a post-COVID world. We must be nimble, flexible and creative, and we must realize that the way things were is not the way they are today, and perhaps will never be again. While the pandemic has revealed a genuine caring in people – something we never lost, even amid the toughest times we've ever experienced – its challenging effects are still being felt. We work every day, for example, on nurse retention in the wake of a national workforce shortage. It’s at the forefront. It's not helpful to continue to recruit, but not be able to retain our dedicated caregivers. We will continue to listen and learn, as we’ve listened and learned in the past, to address this ongoing issue. We’re also confronted with the thorny issue of contract labor. The utilization of contract labor has been something that we needed in order to deliver care within our community, and we will continue to appropriately provide the necessary resources to ensure we’re able to provide high-quality patient care. However, we would much rather dedicate our financial resources to our own caregivers versus outside agencies and are actively seeking ways to do just that. 

I believe we will meet these challenges and others by continuing to provide the excellent care for which we are known at UH, building the confidence that we are the “preferred organization” I mentioned earlier; and, telling others about it perhaps a little more loudly and a little more often. We are our best recruiters. The thing we can all do more of is speak to others about the wonderful outcomes and care that's delivered at UH and actively seek to have others join our family. When the whole organization is engaged in creating a sustainable and highly skilled nursing workforce, everyone wins.