HCA Healthcare Chief Nurse Executive shares 5 key learnings from year one in her role

In December 2021, amid a national nursing shortage, supply chain challenges and an ongoing pandemic, Dr. Sammie Mosier assumed her new role as Chief Nurse Executive at HCA Healthcare, one of the nation’s leading providers of healthcare. Today, she shares key learnings from year one leading more than 93,000 nurses to deliver safe, quality care, as well as recommendations to help other leaders shape the future of nursing practice.

When I began my career 26 years ago as a medical-surgical nurse at HCA Healthcare’s Frankfort Regional Medical Center in Kentucky, I never imagined I was on the road to leading one of the nation’s largest nursing workforces. And like other healthcare leaders today, I certainly could not have predicted I would play a part in helping the healthcare industry navigate a global pandemic.

While we cannot always anticipate what lies ahead, we can do our best to respond to known challenges and prepare for future opportunities. A little more than one year ago, I took the helm as Chief Nurse Executive at HCA Healthcare to continue doing just that, leading more than 93,000 nurses through an ongoing pandemic, a national nursing shortage and numerous industry headwinds. While my tenure with HCA Healthcare and experience in healthcare generally has informed my vision for the future of nursing, my seat at this particular leadership table and related learnings over the past year have solidified it.

Knowing that nurses are the cornerstone to any healthcare organization’s ability to provide safe, high-quality, compassionate care, I offer five recommendations to help other leaders ensure they continue doing so by elevating nursing practice in the years to come.

1.  Advocate for and develop nurses at every level

Throughout my career, I have consistently focused on advocating for nurses, to support their professional development and drive clinical excellence. This has become more important than ever over the past few years, as the aforementioned challenges have contributed to a “Care Complexity Gap” due to:

• Workforce shortage: rising demand and increasing turnover
• Workforce experience: increasing reliance on new nurses to fill vacancies
• Care complexity: rising patient acuity and complex treatment plans

As we work to provide great care to sicker patients in the face of current circumstances, we must develop extraordinary nursing leaders and provide opportunities for career advancement, which can help improve nurse engagement and retention. I believe we can accomplish this by ensuring nurses have a seat at the leadership table, bringing nursing experience into the sphere of influence.

We need programs and clear pathways to support aspiring nurse leaders. And while historically across the healthcare industry, we have seen a shortage of nurses in executive roles, at HCA Healthcare we’re proud to have many nurses in CEO, CNO and other leadership positions. I credit this to the visibility into professional development programs that help nurses advance their careers at every level, such as:

• Charge Nurse Leadership Certificate: a training curriculum that helps participants develop skills, language and experience necessary for success.
• Director Development Program: a 7- to 10-month cohort program to prepare aspiring nurse leaders to assume director positions.
• Chief Nursing Officer (CNO) Executive Development Program: a year-long program that provides aspiring CNOs with executive exposure, best-in-class curriculum, applied experience projects and peer networking to help prepare for executive roles.
• Assistant Chief Nursing Officer (ACNO) Advanced Leadership Program: a nominations-based program equipping ACNOs with leadership and operational skills to move into CNO roles.
• Leadership Institute Academy (for Directors): equips leaders to execute strategy, drive operational excellence and lead others to effective action.
• Leadership Essentials (for Supervisors and Managers): a 9-month cohort-based, interactive development program for managers and supervisors

2.  Leverage full care teams in patient care delivery

With global nursing shortages expected to increase in the next several years, as an industry we must embrace new models of care that leverage other team members to reduce the staffing crisis burden. This allows nurses to work at the top of their licenses, which can improve nurse and patient experience as well as outcomes.

At HCA Healthcare, we are creating innovative and effective care delivery models to support care teams and meet patient needs through our efforts to:

• Diversify and expand care teams to include Licensed Practical/Vocational Nurses (LPN/LVNs), allowing RNs and LPN/LVNs to work at top of their licenses
• Create other new or expanded roles to help support the nursing workload, including Patient Care Technicians (PCTs), Nurse Externs and Paramedics

Diversifying care models will continue to be an important part of labor and resiliency plans that are responsive to market dynamics today and for the foreseeable future, as we work to deliver care through the pandemic and beyond.

3.  Foster clinical education and academic partnerships

A primary way we are addressing the national nursing shortage is by creating a pipeline of new nurses through work with our Galen College of Nursing, as well as other academic organizations.

In 2020, HCA Healthcare became a majority owner of Galen College of Nursing, one of the largest academic practice partnerships in U.S. healthcare, which allows us to offer nurses increased education and development opportunities. Since then, we have opened 12 new campuses across the country.

Importantly, our HCA Healthcare-Galen College of Nursing Grant provides a tuition-free, online RN to BSN degree for nurses with direct billing, so nurses pay no tuition upfront. The program allows nurses to learn on their schedules, with mobile-friendly coursework built with nationally recognized subject matter experts and aligned with our quality measures.

Galen also offers an online MSN option in Healthcare Leadership developed in collaboration with our nurse leaders, to develop new leaders who will shape the future of nursing practice in complex systems through innovation, advanced critical thinking and care transformation.

Other initiatives to help build the nurse talent pipeline and develop nurse colleagues include:

• Certification Reimbursement: encourages colleagues to grow by acquiring and or recertifying nationally recognized certifications
• Nurse Residency and StaRN Program:
  • Nurse Residency supports graduates as they transition to practice
  • Year-long program begins with StaRN (Specialty Training Apprenticeship for Registered Nurses), a 10-12 week onboarding program
  • Includes 500+ hours of clinical education in the classroom and at the bedside, with skills and simulation training, clinical preceptorship and specialty development
• Centers for Clinical Advancement
  • Bridge a gap between classroom and bedside with practice-based instruction
  • Caregivers learn patient safety and quality of care in a safe, realistic environment
  • Simulation scenarios / educational curriculum standardized across all facilities

While not all healthcare providers can offer degree programs through their own nursing schools, they can encourage ongoing education and career development through partner organizations. As an industry, we should prioritize this work together. Our ability to collectively provide care to our nation depends on it.

4.  Embrace technology to elevate nursing practice

Ownership of evidence-based practice is a baseline for building a culture of excellence in nursing and healthcare generally. At HCA Healthcare, we are laser-focused on support and accountability for ensuring that best practices are developed, implemented and scaled across our organization. That said, in such a large organization — and even in small systems — you will find variations in how care is delivered.  Technology can help us bridge that gap.

Through initiatives like our department of Care Transformation and Innovation, a dedicated team working with leaders and frontline clinicians to improve workflow and care, we are using technology to help reduce nurse administrative burden and staffing challenges…and create the hospital of the future.

We learn from colleagues what is working, what is not…and where we have opportunities.  While the healthcare industry has a long way to go in terms of innovation, we are striving to understand and address building blocks that will lead to big picture healthcare transformation to improve efficiency, quality and experience for healthcare providers and patients. 

Two new CT&I solutions that are helping nurses improve efficiency and spend more time focused on clinical care include:

• Staff Scheduler
  • Automated scheduling solution to address patient demand
  • Address staff preferences and daily volume variation
  • Optimize care team to reflect actual volume, matching nurse skill set and competencies with patient needs and risk profiles
  • Use volume forecast algorithm, combined with business rules and nurse leader knowledge, to improve the forecast of productive hours based on national standards
  • Significantly reduce the time for staff scheduling while improving satisfaction and results and resulting in a more balanced, equitable nursing schedule
• Clinical Documentation
  • Automation-driven solutions to optimize the documentation process
  • Ensure documentation is timely, accurate, consistent, more efficient
  • Leverage technology to enable caregivers to spend more time with patients while improving nurse satisfaction

In addition to CT&I’s rapidly growing book of work, we invest in many other technologies to deliver the best outcomes for our patients and improve efficiencies for our nurses, including:

• Mobile
  • Deploying nearly 100,000 secure smartphones to give nurses a mobile experience
  • Using voice and text among care teams to improve efficiency and communication
  • Receives important notifications and easily takes photos for documentation
• Virtual Nurse
  • Utilizes an RN remoting into the patient room through a video camera to interact with the patient
  • Encompasses activities that don’t need hands-on from the nurse, such as admission history, patient teaching, reassessing for pain or discharge planning
  • Seasoned nurses as virtual RNs to help mentor new grads
• Coding for Caregivers
  • A fast-track technology development event leveraging cross-functional teams (importantly, nursing and Information Technology teams)
  • Goal of the event is to design technology to give nurses more time at the bedside, less redundant work and more opportunities to apply expertise

We always are looking to the future to design solutions for opportunities today, embodying HCA Healthcare’s mission commitment to the care and improvement of human life.

5.  Prioritize collaboration and “Voice of the Nurse”

Today more than ever, leadership in healthcare requires educating hospital operators on the realities and needs of nurses. Advocacy skills and establishing key partnerships are important abilities for all leaders — and especially in the nursing environment. We must prioritize collaboration and listen to the “Voice of the Nurse” in order to transform nursing practice.

At HCA Healthcare, we listen to nurses through councils and many other initiatives, leveraging partnerships to drive efficiencies and nurse engagement (e.g. through Resource Councils that influence focus areas to support nursing workload). We know that nurses are more engaged when they feel heard and supported, which can translate to better experiences for providers and patients.

We listen to our nurses and collaborate with partners on their behalf through:

• Professional Practice Councils, where nurses make decisions about how we provide care
• Advisory Councils that govern how best practices are shared across the enterprise
• Resource Councils at divisions/facilities bring together key stakeholders to solve operational challenges, drive engagement and elevate resources needed
• Walk in Your World initiative, where corporate and division executives shadow nurses
• Vital Voices, a continuous listening approach through which colleagues actively seek to solve problems and generate ideas
• Unit of Distinction Awards, which recognize units of excellence and best practices

Every tier of HCA Healthcare’s organizational structure includes nursing leaders, and employee rounding provides nurses with a stronger voice in nursing practice and how we operate. By coming together, our shared voices accomplish more.

Related, equity must be foundational in all that we do in healthcare. I proudly work closely with our Diversity, Equity and Inclusion teams and councils to ensure individuals representing a diverse range of backgrounds and perspectives are included in health equity conversations, across our nursing community and beyond. Together, we work to establish continuity between community public health and healthcare delivery, working with public health and community-based organizations to address health inequities.

A diverse, inclusive workforce gives us the best chance to provide the best care at HCA Healthcare – and in healthcare generally – so we work toward creating a diverse pipeline of nurses. We advocate for all nurses and promote equity at all levels of our organization. Because we know success in healthcare requires a resilient, caring team of authentic and diverse leaders who connect to the mission of patient care…and inspire others to be part of the journey.

Dr. Sammie Mosier

HCA Healthcare Senior Vice President and Chief Nurse Executive