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Nursing News HighlightsNurses Leading Innovation

One Nurse at a Time: How UCSF Health is Working to Prevent Turnover

A former bedside nurse, this Chief Nursing Executive leads by listening. Pat Patton’s data-backed, listen-first, feedback-driven approach to creating a supportive environment where nurses stay and thrive is working – and presents a blueprint for health systems everywhere. Below, find out how Pat Patton and the team at UCSF Health are approaching the nursing shortage with creativity and innovation.

Pat Patton knows what it’s like to be a beside nurse.

Now the Chief Nursing Executive at USCF Health, Patton began his career in Florida, working bedside in emergency rooms and pediatric ICUs. He didn’t know it at the time, but one of his earliest managers would be an inspirational example on which he modeled his career.

image of Pat Patton
Pat Patton (Credit: UCSF Health)

“I was very fortunate early in my career that I had a manager who listened,” he says. “I didn’t know what ‘shared governance’ was, but I knew when my colleagues and I had issues or suggestions to try something or change something, she listened.”

Later, working in a different emergency department in another state, he had a less positive managerial experience.

“It was their way or the highway,” he said. “We had to do it, because it’s regulation, or it’s policy, but we never had a voice. As I went through my career and especially there, I said, ‘This just doesn’t make sense.“

These experiences became the foundation of a simple, but powerful philosophy – good leaders listen.

When healthcare leaders listen to nurses, the results speak for themselves

Pat Patton joins nurses for rounds at USCF
Pat joins nurses for rounds. (Credit: UCSF Health)

Simple as it may sound, the practice of listening to nurses – really listening to their fears, concerns, questions and ideas – meant Patton and his team could implement strategic changes during the pandemic with urgency and agility.

The result? UCSF’s RN yearly turnover rate of 9.5% stands out in comparison to the national hospital turnover rate of 27% in 2021.

“I really take that to heart about listening to my nurses,” he says. “I give everybody my cell phone number. I give everybody my email address. Whoever it is, I need to listen to them – I need to hear their voices."

Besides phone chats or email connects, Patton also has a few formalized processes for collecting nurse feedback. He holds open office hours every other Tuesday, which any nurse can attend – and usually more than a hundred do. Patton and other chief nursing officers may give a few updates, and then the floor is open, for any nurse to share their perspective directly with system leaders.

With 5,000 nurses reporting directly or indirectly to Patton, how does he manage to stay connected with everyone?

“One nurse at a time,” he says. “To anybody that says, well, I don’t have enough time, I don’t have enough energy – one nurse at a time. That’s all you gotta do.”

Addressing the needs of nurses, with creativity and innovation

group of nurses at USCF Health
(Credit: UCSF Health)

While nursing is a big, diverse group, nurses around the world – including at UCSF Health – share some core priorities. Surveys show that nurses want to do meaningful work in a safe, flexible, positive environment. They want to advance their skills, and they want to be demonstratively valued by leaders.

A number of programs and initiatives at UCSF provide a replicable framework for health systems across the U.S. to build positive, supportive, nurse-focused workplace environments.

For example, the new UCSF Leadership Institute, a partnership between the UCSF School of Nursing and the UCSF Center for Nursing Excellence and Innovation, provides leadership development at all levels of nursing.

Staff are also encouraged and supported to seek higher education – “I am proud to say I have many DNP and PhD nurses at the bedside,” Patton says. “I have a lot of master’s prepared nurses at the bedside. I’m proud, because they feel like they can go and get their degree and then come back to the bedside.”

A clinical ladder program allows nurses to hone their skills and steer their career, as well as a career development transition program, which provides a training and transfer process for a number of nurses each year who want to work in a different area of care within the UCSF system. A critical care nurse feeling burned out in a COVID-19 ICU, for example, can apply for a transfer to UCSF’s Ambulatory and Infusion Center, and receive training to confidently make the move.

And Patton is always looking for opportunities to tap into retired nurses to remotely provide support services, like monitoring high acuity patients, and for ways to retrain those who have been out of the workforce but may be interested in coming back.

“We’ll give you the training, we’ll give you as much time as you need to get back into nursing, so you feel comfortable. And sure enough, we had more than 35 applications for nurses to come back and do a reentry program,” Patton says.

Can health systems truly become nurse-friendly?

Patton has had success garnering system-level support for nurse-focused initiatives within UCSF. It’s all about evidence – the average cost of turnover for a bedside RN is $46,100, and it takes 3 months on average to recruit an experienced RN, according to NSI Nursing Solutions.

While nurses are commonly viewed as a “cost center” in a health system, Patton is reframing the conversation to view nurses as an important investment. The data is there – and nursing leaders are leveraging it to convince decision-makers that investing in nurses is well worth the expense, paying off in quality, safety, patient satisfaction and more.

“These shortages can be solved,” Patton says. “But we have to think differently. We’re trying to do things that are creative.”

two nurses at USCF Health
(Credit: UCSF Health)

But Patton is clear about one thing – programs and initiatives that support various nursing needs are important and necessary – but the way nurses are fundamentally valued in the healthcare ecosystem must change.

“You’re not going to retain nurses for $60,000 a year,” he says. “Hospitals have to wake up. If they’re going to stop nurses leaving, they’ve got to pay their nurses more and provide development and support.”

But with many hospitals facing precarious financial situations, increasing salaries and costs is complicated, and may require an even broader evolution in healthcare reimbursement.

“Why are we not billing the payors for nursing services? We have to look from a macro level and figure it out,” Patton says. The way the current system is structured, he says, suggests that nurses are expendable. “But we know they’re not expendable, because you can’t run a hospital without them.”

At the end of the day, Patton is focused on answering two questions that have a very direct relationship to one another – does USCF have the nurses it needs? And do those nurses have what they need?

It’s another reason why listening is the foundation of Patton’s leadership. When nurses have what they need, they’ll stay. When they don’t, they’ll leave. And the only way to know is to listen.

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