Hospitals In Focus

Inside the Hospital Nursing Shortage with Lisa Dolan


The pandemic poured gasoline on the health care workforce shortage. Between nurse burnout, lower immigration numbers for trained caregivers, and a growing negative narrative surrounding health care careers, it’s no wonder we are facing a shortage sooner than we imagined.

Lisa Dolan, Chief Nursing Officer at Ardent Health Services joined Chip to examine how it is using its size and scale to meet this challenge and continue to provide quality, compassionate care to all those who need it.

Want to learn more about the origin of the nursing shortage? Check out this conversation No Silver Bullet: Diagnosing Hospital Workforce Crisis with Peter Buerhaus.

Speaker 1 (00:06):

Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host Chip Kahn.


Chip Kahn (00:15):

The Omicron wave crashed into America’s hospitals right before the 2021 holiday season, just as everyone was preparing to mark the return to a normal holiday celebration. During the Omicron surge, and now as it recedes, another issue has emerged, a healthcare workforce shortage, particularly for hospital bedside nursing. These critical caregivers are in high demand across the country and without them hospital patient care cannot be sustained. A confluence of factors are affecting hospital bedside nursing. The average age of a nurse today is 52 years old. According to research published in Health Affairs, more than 1 million nurses will retire and exit the workforce by 2030. About a third of nurses and physicians are reducing their hours due to burnout, fear of exposure, or anxiety resulting from the COVID-19 pandemic. Joining me today to discuss how hospitals are meeting this challenge is Lisa Dolan, the new chief nursing officer for Ardent Health Services, a tax paying health system with 30 hospitals and 26,000 employees. Thanks so much for joining me today Lisa.


Lisa Dolan (01:25):

Thank you Chip. I’m glad to be here.


Chip Kahn (01:28):

Lisa, considering the factors I just mentioned, what are you seeing at Ardent in terms of nursing shortage on patient care and your ability to maintain patient care at the levels you see necessary?


Lisa Dolan (01:40):

Well Chip, Ardent, as with the same with most healthcare organizations has really been impacted by the nursing shortage. During the past two years, you mentioned nurse turnover, it’s been higher than usual at Ardent. We’ve seen an increase in nurses leaving the bedside for retirements, often early retirements, to work in different settings, and then also to take travel positions. In order to maintain our patient care levels, we’ve really had to increase our recruitment efforts and also have worked to contract with many travelers across our hospitals as well.


Chip Kahn (02:15):

You know, you mentioned the traveling nurses and it is one of the mitigations to the nursing shortage, at least in terms of temporary mitigations, what are the implications of having these nurses sort of come in and go? And how is that affecting patient care on the floors?


Lisa Dolan (02:32):

I can really speak to that on two different levels. One as a hospital nursing leader, and then also as a patient family member. We have had in the hospitals, the pleasure to work with many great traveling nurses, in which, by the way, we always try to recruit them and ask them to stay with us permanently. Working with traveling nurses can be difficult for the existing staff. They’re new to your facility, they’re unfamiliar and need extra support from our nurses and at times they may not be able to care for the highly specialized or the most acutely ill patients. What that does is it leaves our Ardent nurses to care for the patients, who during COVID, have been really ill, and then also to provide support to the unfamiliar travel nurse.

The Ardent nurses are working so hard and they often know that the traveling nurse is making a stronger wage. You put all this together and it can really impact the morale of the nurses that we have. As a daughter, my mother’s recently been in the hospital. She’s been a patient in her hometown hospital, which is not an Ardent facility, but I have really experienced additional anxiety and she has as well. When you sense that uncertainty about staffing levels in the hospital, there have been some holding and waiting times for her to get a bed and often it’s due to staffing. And then when your caregiver seems unfamiliar with hospital routines, it can really add additional anxiety for her and for us and I’m sure other patients and families feel the same way.


Chip Kahn (04:01):

You talk about anxiety. Let’s talk about it from the standpoint of nurses. What’s the cultural impact of having these temporary nurses? I know there’s some pay differentials and other factors, what’s the effect on the nursing morale on the floors?


Lisa Dolan (04:17):

It does really impact morale Chip. It adds an additional strain on the nurses that we do have that are … have been so dedicated and have worked with us through this COVID pandemic. They’re also working side by side with their team around them that needs their support in addition to the patients, so that adds an additional stress and strain to their day. It can be very difficult, especially when they know that they’re working so hard and the travel nurse may be making the stronger wage than they are. It does really have an impact on morale long term.


Chip Kahn (04:54):

Do you have special efforts to assimilate them into the team because the team is so important to healthcare, both in terms of its culture to assure quality and safety and also meeting the expectations of the patients?


Lisa Dolan (05:07):

We do. I think our … Ardent has a very strong commitment to patient quality and safety. In order to maintain that we’ve really tried to work with using support tactics as much as possible. What I mean that is, if there’s a piece of technology that we can put in the hands of the nurses that would support quality and safety practices, then we probably have that in place where we’re doing a pilot in one of our hospitals. Our CNOs have been really encouraged to think innovatively and look for multiple ways to really optimize the nurses time you and help support nurses who may be unfamiliar.


Chip Kahn (05:45):

This issue of temporary traveling nurses we’ve talked about is really a symptom of the shortage. From your experience considering the problems we’ve discussed with them and just sustaining appropriate levels of patient care, how do you see your hospitals turning the corner on the shortage and sustaining the teams critical for the front lines?


Lisa Dolan (06:07):

Well, we’re really taking a multi-pronged approach Chip. First and probably the most important thing is to become the employer of choice for the few nurses that we have. So, that means as leaders, we really have to remain focused on taking care of the caregivers. It may be that we’re taking non-patient care tasks off their plate and giving them great professional growth opportunities. They need to have support staff working around them that are well trained, ensuring that the culture is very supportive and healthy and then providing opportunities to help maintain emotional wellbeing is very important. The recruitment of nursing students is also key and we need to be very focused on providing strong education and onboarding for this, the new nurses that we do … are able to recruit, to help them stay and continue to be with us.


Chip Kahn (07:02):

You know, stepping back from your specific actions, one obvious longer term solution is to provide enhancements to the pipeline of those young people going into nursing. How do you see the current scene affecting that pipeline and how do you think the field can assure that the pipeline is efficient? What would you say to young people considering nursing?


Lisa Dolan (07:24):

I do think unfortunately that the pandemic really highlighted some of the most challenging parts of being a bedside nurse in a very public way. And so you put that along with maybe personal connections that students may have with family members who are nurses and maybe discouraging about that career choice right now. So any efforts that we can put forth in our communities to reframe nursing in a positive way, and just really reignite that interest in nursing as career path for high school students is critical, not only do … for the young people and young high school students, but also even adults that may be considering nursing as a second career. It’s a wonderful career choice. I would encourage anybody to consider whether that may be right for them. It’s a profession that’s full of learning and different specialties and can open many doors for a very fulfilling career.


Chip Kahn (08:20):

Public policy could help that. What do you think the federal government could do to incentivize those younger and older women and men who could have a nursing career?


Lisa Dolan (08:31):

Well, the first thing that comes to mind to me is educational assistance and support offering maybe loan forgiveness, financial assistance that could not only help a young student, but also furthering education for a working adult and making that more attainable. On a larger scale, maybe assistance with marketing campaigns. And then maybe on a state level, we could also think about using some incentives that encourage people to stay in their home state or communities. And then that would hopefully deter some of the traveling, which could help everything we’ve talked about previously and the burden that that can create.


Chip Kahn (09:07):

You made some reference to this, but, and particularly with what Ardent is doing, but support systems are really important, maybe some of the lack of support, the pressures of COVID-19 has affected nursing and is a cause for many leaving the field or wanting to reduce their hours. What are Ardent hospitals doing to create the support system? Can you elaborate, maybe give us some examples of that?


Lisa Dolan (09:33):

Sure. When I think about supports the systems, I really think about supporting two different groups of nurses, the newer nurse, and then the nurse in general. When we discussed earlier efforts that we have with various technologies that are supporting nursing in their daily work, and I think of an example for a new nurse, we’re exploring the opportunity to use tele-health as a means to support the new nurse by having experienced nurses being able to come to the bedside with the new nurse, to help evaluate a patient and give that guidance that they may need. Newer nurses, especially during the COVID pandemic, had their education really disrupted. They had a lot less clinical experience while they were in school. And so more and more, it’s going to be important to think about that when we’re bringing those new nurses on board, taking their support out through that first year, while they’re developing experience, so that would be one measure.

When I think about just in general, the support for the nurse and their daily work-life, things like giving them technology in a handheld device, that they can quickly document some of the key vital signs or scan medications, or provide them a tool that they don’t have to run back to the desk to interact with the computer, but put something in their hand that they can take to the bedside. So those are the types of things that I think we’re working very hard to pilot and trial and see what works best and offers the most support.


Chip Kahn (11:14):

You know, nursing is such a dynamic profession and offers so much opportunity, but many young people and nurses see professional advancement becoming a nurse practitioner or going into hospital management as an avenue. But it does take some off the track of the front line, what can be done to encourage more nurses to stay at the front line? And what can be done to make that aspect of the career more fulfilling and help meet their ambitions?


Lisa Dolan (11:41):

Well, our facility CNOs are all very committed to creating what I call a shared governance structure and maintaining that in their hospitals. And so through shared governance that allows the bedside nurse to actually work through that structure, to help guide and have input into patient care practice and education at their facility. We also have CNOs that either have, or are evaluating clinical ladder programs. These programs allow the nurse an opportunity to work on projects, they may be involved in research and actually receive recognition for those contributions to their unit. Promoting ongoing education certifications, cross training to multiple departments, all of those are avenues to allow the nurse to continue to grow, but remain at the bedside and keep their focus there.


Chip Kahn (12:34):

Now Lisa you mentioned that Ardent has a goal for its nurses to make them see Ardent as an employer of choice. What are you doing to meet that goal, to develop a strong nursing culture?


Lisa Dolan (12:48):

Well, many of those tactics that we just talked about, and so it’s really about optimizing the nurses’ time and letting them have time to spend with their patients at the bedside, making sure that we give them the professional growth opportunities that they desire and nurses love to learn, and so making sure that those opportunities continue to be available and that we give as much of that as possible. Then adequately supporting the nurse. So if we are creating a support team around the nurse, making sure that we have strong and well trained support staff to help them do their work. And then just staying focused on creating that supportive culture for nursing. You know, to me, that’s a culture that fosters growth and is really just committed to our purpose of caring for the patients, their families, and then one another.


Chip Kahn (13:40):

During your COVID-19 experiences and work at Ardent, many hospital organizations showed the value of being part of a system, it can bring size and scale to patient care. How do you see it affecting hospitals as learning organizations and how has it helped them more meet the needs of patients through faster dissemination and implementation of solutions across a set of hospitals?


Lisa Dolan (14:10):

Yes, Chip, I feel really fortunate to be part of a large organization where the teams are so committed to one another. We have learned through the COVID crisis. One of the greatest assets that we had was sharing information with one another and with nursing and the workforce shortages we’re in the same situation. The Ardent nurse leaders are working on solutions and then sharing them with one another. It allows us the opportunity to replicate processes, maybe tweak a few things to make it specific to a particular market or facility, but bottom line, it’s not creating the wheel, everybody trying to do things that are new and different, but learning from one another. My job in the corporate team is really to facilitate the discussions, host those discussions, make sure we’re talking about and giving the opportunity to share packaging, best practices, and toolkits and helping to get those out and then helping to manage and put technology in people’s hands to manage pilot programs and ways to learn. We’ve got a strong team that is working well together, and I feel really fortunate to be a part of that.


Chip Kahn (15:23):

Lisa, this has just been so helpful. I want to thank you for your service and for all that you and the 26,000 members of the Ardent team do for your patients. So it just was a pleasure to be with you this afternoon.


Lisa Dolan (15:34):

Thank you Chip.


Speaker 1 (15:35):

Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @FAHhospitals and follow Chip @chipkahn. Please rate, review, and subscribe to Hospitals In Focus. Join us next time for more in depth conversations with healthcare leaders.

Throughout her more than 30 years in nursing, Lisa Dolan has built a strong track record of driving positive cultural change while elevating performance across a range of quality and safety metrics. Since joining Ardent in 2020, she has served as interim CNO at Hackensack Meridian Mountainside Medical Center and interim CEO at Lovelace Women’s Hospital, where she worked closely with nursing and clinical teams to achieve critical wins. Previously, Ms. Dolan served in hospital CEO, COO and CNO positions for Community Health Systems. She began her career in cardiovascular nursing and held multiple leadership roles within Jewish Hospital and KentuckyOne Health in Louisville.

Ms. Dolan earned a bachelor of science degree in nursing (BSN) from Spalding University in Louisville, KY and a master of science degree in nursing (MSN) from Bellarmine University in Louisville, KY.  She has been the recipient of several leadership awards, including the Shelton R. Weber Award of Leadership Excellence. Ms. Dolan is also a published researcher on the topic of management style and staff nurse satisfaction.

As leaders, we really have to remain focused on taking care of the caregivers.

Lisa Dolan, RN, BSN, MSN, NEA-BC