Hi, everyone. Thank you so much for tuning in to this episode of the Becker's health care podcast. I'm Erica Carbajal, editor with Becker's hospital review. I'm excited today to be joined by Regina Foley, chief nursing executive, chief clinical transformation and integration officer at Hackensack Meridian Health as well as interim president of the Central Region. Regina, thank you so much for being on today. Oh, pleasure. Flattered to be asked, Erica, and really, really happy to be here. Yeah. We have lot lots to chat about. So before we get started, do you mind just sharing little bit of brief background about your role and scope of your work at Hackensack Meridian Health? So I'm a nurse by background. Greatest profession known to mankind. Would would do it again in a in a hot minute. So I've been a nurse for thirty seven years, and I've been, employed, here at Hackensack Meridian Health for my entire career. Different roles, different places, different things, but for thirty seven years, I've been within our organization from, you know, obviously, clinical, patient facing bedside care, and then multiple administrative, positions, site chief nurse, hospital president, network roles. And, again, the role that I'm in right now, you'd already shared, kind of wearing a few hats and, you know, just trying to do whatever we can on, helping to shore up, you know, any vulnerabilities that we have as well as, our continued growth within the market. And, you know, born and raised in New Jersey and studied in New Jersey, and, I'm proud, you know, proud. I'm a proud HMH er and, want only the best for the organization, and, you know, want wanna see all the great things continue to happen here, within the company. Wow. Regina, I can imagine thirty seven years, your entire career there gives you such a unique perspective, as chief nurse now. Yeah. And I and it it is somewhat unusual, because, you know, as executives, they move around. Right? They move around a lot. And, probably a good example of, promoted from within. And I I do think that our 9,000 strong nurses see that, and they see that they're although I am the chief nurse, I I I do a few other things in the company. And there is I'd certainly respect admiration, but more, you don't have to get pigeonholed in in, in roles. And certainly, nursing has a wide variety of, you know, impact to be made within our industry. And, thankfully, you know, and the latitude and the grace that I've had within our company is that, you know, that skill set has been tapped into. So our 9,000 nurses, you know, I thought for a minute, well, if I'm I'm doing a few other things like transforming the company or integrating things, you know, is that gonna be a distraction from the nursing side? And they're actually into it. They're like, no. You you know, go you go, girl, go because it's your you have the lens differently. Right? You can you're looking at the whole package and, you know, nursing is is a visceral I have a visceral connection to the practice and, our nurses feel and see that. I'm very, authentic and very honest, with them and I think whatever role that I'm in the organization, they know that I, I come from the place yes. I'm a mom and a wife, but really a nurse is the first and foremost. And I think they feel that and see that. So there's great I think a great sense of respect and appreciation for, you know, being promoted from within and tapping into that skill set and talent and then being able to be the connection. So I may be the senior executive connection to the bedside nurses and, you know what, I am at the table. You know, my role is at the table, Work in, really terrific collaboration with our CEO and the COO of the company, and then the nursing team feels and sees that. And, you know, again, I'm a good example of spending a career. Didn't that wasn't the there wasn't that it was a plan thirty seven years ago. It's just that opportunities became available. You may have a skill set. You may have a credential that's needed. The interest would be there, and I sought out those opportunities and were successful. So, I do think that there, there's a a real understanding where the nurses feel like there's loyalty, and that's part of our brand. Right? It is part of brand loyalty and that, they know that the highest level of nursing in the organization truly has their back and want only the best for them and how to take care of our patients. You know, I I often say, anyone I care, love are a come to us for care. So I want the best for every single soul, right, that that we're taking care of, and I'm not shy at saying that. So, you know, I I guess I'm a I'm a pretty good example that, there is longevity and, you know, duration. You don't necessarily have to move if you don't want to. Certainly, there's choices and options to do that. I've just had that luxury in my career that, really challenging opportunities have come up. I've sought them out or I was tapped to do them. And, you know, here we are, you know, years later and I only want the the better for the next gen, right, the next generation to, have those afforded those same opportunities. So it's it's really a it's, really, it's a pleasure, and, I I take great respect in having had had the opportunity for those roles and obviously continuing to be in them. Yeah. Sounds like you've you've certainly said yes to plenty of of challenges and and opportunities along the way. Well, Regina, what would you say is your number one must do as chief nurse of the system this year? Any one specific initiative you call out that you're really focused on or that you plan to implement to enhance nursing operations and patient care this year? Yeah. It's a really good one. So I think the the the if I were to say kind of the big bullet, the big dot is workforce. So workforce is challenging for any health care location on the globe. Right? With just workforce. We really took a hit during the pandemic. There's a lot of choices and options for nurses to practice in to be in. You know, years ago, it was the traditional acute care environment. We're not shy with developing our ambulatory footprint. So if you're developing the ambulatory footprint, there's needs for clinicians. So is that does that mean they leave the bedside? So I would say first, Erica, is a big a big priority is workforce. And then in workforce, there's a couple of different prongs. One is, do we have edge in the market and we is our brand strong enough that people, new nurses, and nurses with experience that either relocate to New Jersey or live in our markets where new nurses come to us to practice. Right? What's the reputation and, you know, on the in the you know, from a practice environment? And, we have enjoyed, really strong recruitment even in the intra and post pandemic years. Our vacancy rate right now is just below 5%. Nationally, it's in the 10 to 12 range, so we're enjoying a lower vacancy rate. Honestly, I'd love to get it even lower than that. But, so as I talk about workforce, there is the recruitment angle that you can recruit new talent to come to you to practice. You know, when I say you meaning hack and sack, right in house, that's one big one big dot. Right behind that, before talking about recruitment, we're spending a lot of energy, a lot of resources, and a lot of time in retention. So it's not only important to recruit to the company, but we want the nurses to stay. Right? We want you to be fulfilled in that practice environment that you don't have to look at some place else to work, that somebody has a better gig than we we have. Right? So we spend a lot of time on leadership development. We do a lot of leadership development of bedside or unit based nurse leaders and assistant leaders or coordinators, informal leaders in leadership, in creating that culture of care, compassion, kindness. Historically, nurses sometimes weren't really kind to one another. We've not done a good job with that from a generational perspective, and my peers and colleagues throughout the country are looking to dispel that fact is that we know we need to be kinder, gentler to, to ensure that nurses stay within well, certainly within our companies, but stay at the bedside. So I talked about, you know, the importance of re recruitment, but retention is almost like a bigger dot because once they're here, now we want them to stay. It's it's it's really beneficial because we are part of a large clinically integrated network. So nurses have the ability to move. Now I know those nurse leaders or chief nurses at the respective sites, they don't want the turnover to occur. I look at it as a win that if the nurse stays within the company, may maybe they relocate in a different part of the state. Well, you know, if you're living in the North and you relocate to the South, well, then we have a hospital that you could practice in or we have a location. So to me, that's still retaining because they are they're part of something special and they want to stay, you know, within the company. So we do a lot with leadership development and we do a lot on the, I'm gonna say, care, compassion, kindness, concern for one another. I often say to the nurses that, you know, we have we you know, very often nurses are the CEOs of their households. Right? They're they're coming to work and they're they're taking care of our patients, miraculous care of our patients, but they also are managing families. They could be the, you know, the principal salary in the in the family. They may be holding the benefits. They are managing child expectations and getting getting kids and family members where they need to go. Very often, the sandwiching of they're taking care of older parents or whether in their home or outside their home, but that oversight is happening. And then as well as they have their own children that are growing. So we wanna make sure whatever we need to do to support you, that you you have going on in the home environment so that you when you come back when you come to work, that the distractions aren't there. A lot of flexible scheduling. You know, nurses that, maybe if they have someone else who can carry the benefits, maybe they're not three twelve hour days and they, you know, they really we have fair amount of nurses that like eleven to eleven or, we we have fair amount, especially in the ERs, three p to three a. We we enjoy that because the volumes in the ERs are coming in in those evening hours. The admissions have been there. They need to get upstairs. And then the volume comes in from the community and, you know, those hours are working for them or not even twelve hours, four hours, and eight hours. So I think the flexible scheduling has helped us on the retention side, which we've certainly enjoyed. And then a third leg to that, you know, I talked about recruitment, I talked about retention is that we have a really big appetite in reducing the administrative burden for the nurse at the bedside so they can take care of our patients. And it's a mouthful when you say administrative burden is that, you know, nurse any nurse on the planet would tell you, if I didn't document it, I didn't do it. And, therefore, there's a lot of effort and time spent with documentation. Epic is our, is our platform that we use, and we have a team of, nurse informaticists that are working with our bedside nurses in reducing the burden, like, in reducing we call it click busters. You know, reducing the clicks and taking care of document or reducing the amount of narrative that they have to free text and free type. That's a time waster. Developing we call it, I don't mean to have a pun on here. It's called dump the junk. So, I mean, I'm so I'm I'm amazed with our informatics team is they they identify areas within the platform and the workflows that really just don't they're duplicative. We're documenting in the same kind of a thing just in another part of the chart, and we're dumping. We're trying to dump that junk. And we all know that the surgeon general gave us this real directive a couple years ago, reduce the burden by seventy five percent. So we have a really big appetite, and we've seen some benefits. We there's this kind of in within epics called macros. And, again, I'm not an informaticist. I'm only on the receiving end of seeing the benefits of it. Is that when you provide the nurses what they're asking for instead of putting free text in there, can I customize this for the pay I'm on a stroke unit? Can I customize my documentation for my stroke patients? I'm in a critical care unit. Can this be customizable? I'm in oncology. Different needs. Right? A telemetry unit. Different needs, different places. Dialysis, mother, baby, OR. We're developing these macros that the bedside nurse now can have almost individual individual flows that they're they're reducing the burden. They're reducing their click and their time on the computer. We're seeing it. I mean, the hours taken out are in the thousands category. And we are hearing from our nurses continue to do that because it's working. It's working for us. We're spending less time on the computer. We're spending more time with our patients and the families, and that's translating. Our patient experience scores are moving in the right direction. You know, in New Jersey, we've we've had some challenges with patient experience. I'm not gonna lie to you. And our nurses have said, I just need to spend more time. I can't just go in and hang the IV and go. I wanna talk about what's happening with the IV. But if I have to go back and make sure that I'm documenting in all these fields and duplicating efforts, it's really it's frustrating. So we have our ears are open and we have a a team of, nurses that go site to site, and, interact directly with the bedside nurses to see where the drain where the drain and the problems are. And now we're eliminating that. So whether it be the development of, these macros that I talked about, click busters, you know, we're trying to minimize those clicks, the dump the junk, and then, we're leveraging technology such as Rover that we again, you're you're getting the theme here is our our platform is epic, but then there are enhancements within technology that we're gonna continue to leverage over being one. Maybe later, if we have time, we can talk about virtual nursing. But there are different things that we are trying to do to to reduce nurses kind of attached and tethered to a desktop and a screen so they can spend more time with their patients. And no question, Our nurses are saying that to us. Like, you've gotta help me get away from this computer. I wanna get away from it. Just leverage this name for what benefits me quickly because I have other things that I I want to be doing and I should be doing. So we have, you know, I talked about the re the importance of re it's this is all under workforce, by the way. I know this will tie back, like, where are we going? All this stuff has to do with workforce because if the if we can recruit the talent, we can retain the talent. A way of retaining them is listening to them. And what they're saying is this burden on the computer is just, like, too much. So now we have a team of individuals that are looking to reduce that administrative burden and then other technologies. So the, you know, the the the one word answer to the question is workforce and then all these other things we're doing to ensure that we're keeping our nurses at the bedside, for as long as they want to be and minimizing, the burden as best we can. Yeah. Well, Regina, you touched on so many, I think, critical aspects of recruitment retention there. And it's just interesting to hear, like, how much of that really parallels just with clinicians overall, like physicians asking for the same thing when it comes to documentation burden and scheduling flexibility, leadership development. This has been interesting to hear and definitely been hearing more from chief nursing officers just around how they're focusing more on the leadership development aspect because as the the nursing workforce is more new nurses enter the workforce, like, that is the expectation. They're expecting to see their growth path right away, and they're expecting maybe some of those more flexible scheduling options and, being able to focus on patient care as much as possible, seeking out workplaces that that enable them to do that. Regina, before we we wrap up here, I wanted to ask you about virtual nursing that that you mentioned. So many hospitals and systems are beyond pilot stages now. They're navigating implementation, scalability. So can you talk about maybe an unexpected complexity or challenge that has emerged in scaling virtual nursing and how the health system has addressed this challenge? Yeah. So we, along with our peers nationally, we did pilot virtual nursing a couple of years ago. In that pilot, we saw what worked and we saw what didn't work. Piloted on one of our, one of our hospitals on a 40 bed medical surgical unit. So the learnings from that has given us pause on, you know, the benefits associated with it. So happy to share with you that the pilot was ultimately successful. To me, a couple of key deliverables, we improved retention on the unit, we decreased agency or contracted nurses, and we lowered the length of stay. The fourth was we actually moved the needle on quality. We had less patient falls. We had less CAUTIs. We had less CLABSIs. All those hospital associated conditions that none of us wanna have because you had a second set of eyes. Right? There's a second set of eyes there. So our, Hackensack Meridian Health in the year of '25, we're gonna implement virtual nursing on four units at four different hospitals within our company. And we chose those four hospitals because those four hospitals have significant capacity constraints, meaning those ERs are really busy every day, all day. We see a lot of admissions. So we chose those four locations because our pilot unit, we were able to decrease the length of stay while not actually improving the quality. And all you know, a couple of other metrics I already shared with contracted, agency as well as retention. So this year, we will bring, we're gonna go up to a 47 beds of virtual nursing, four different locations, four different units. So, again, a 47 beds total. We're gonna monitor and measure that. We're gonna implement those by June. Over a couple of months, to me, phase two, Erica, is I have other units, kind of on the back burner. If we see the same success in those 47 beds, we're gonna bring it up to about 771 in total. So it would be another unit. Right? There'll be two units then at each of those four hospitals that we would activate. So the challenge, right, the challenge on the virtual nursing side here at Hackensack Meridian Health, we're activating virtual nursing as a value add to the nurses at the bedside, A value add. We're not taking something away. Earlier on, I talked about administrative burden. This virtual nurse is gonna help with administrative burden. They can help to do the admission assessment. They do the discharge instructions. They can help educate the patients and the families with medications. They're a second set of eyes in looking at potentially a wound assessment, etcetera. So it's a financial the the how the justification was, it wasn't that we were replacing a bedside nurse. It was enhancing the nurse. And the the money shot, the value was we were decreasing length of stay. We reduced contracted agency because the nurses on those units liked being there because they had somebody helping them out. Like, they had a partner in taking care of those patients. So the value proposition wasn't the additional cost of implementing virtual nursing. It's lowering the length of stay, improving the quality. If you have one less fall, right, if a patient doesn't fall, right there is a win because the patient hopefully doesn't need to have surgery or, god forbid, you know, does any kind of litigation. Right? So we wanna improve the quality, not compromise that in any way. Any if anything, enhance it, decrease the agency utilization, and retain that staff while lowering the length of stay? It's like, how can you argue with it? So we're implementing those 47 beds, by the middle of this year. As I said, I'm hoping everything is crossed by June. And then when we see some traction and we don't see any loss and see the retention happening in the lower agency utilization, I'm hoping to activate another, several hundred beds, bring this to a total of, I think, it's seven seventy one. That won't ultimately happen into the year of '26, but we, again, earlier on, we did do the pilot '23, you know, into '23, early '20 '4, saw the benefits of that, and now we're implementing to a 47, beds this year. Oh, that's great. Some great early outcomes there, Regina. Would love to to check-in later this year and and hear more about how that's going with the virtual nursing rollout. Yeah. Well, the deliverable for us, Erica, would be continuing to decrease contracted agency retention on those units, lowering that length of stay. So for my peers that are listening and and, you're saying, should should we do it or not, we have had success. We've had success on the pilot unit. Again, we're bringing it to a modest 47 beds this year. And then, you know, again, everything crossed that we're seeing the same metrics in the right direction, and then we would look to expand it to those other beds. And then beyond that, you know, those we select two units at those very busy places, you know, the hostels with capacity constraints, and then ultimately, maybe even bring it to the other hostels that don't have capacity constraints but have higher turnover and maybe agency utilization, because, and length of stay. I mean, we all wanna decrease our length of stay, across the, you know, across the country here, and this has been a a a really good use of technology that's helped us get there. Yeah. For sure. The capacity component is so huge too. Right. To your point, I I don't know. We didn't talk about it, but ERs are just inundated across the country. Mhmm. And, you know, fair amount of those patients need to be admitted. So but they need to be able to get to a bed. So this helps us decrease that back end issue, freeing up the capacity to help the throughput in the, in the ERs and get those patients up to a bed, you know, within an hour after they're admitted. Yeah. Absolutely. Regina, thank you so much for joining us today. It's been a pleasure to have you on, and listeners, thank you all so much for tuning in to the podcast. Flattered to be asked, Erica, and, thank you very much. Again, a credit to you and Beckers. My peers, nationally look to you really as our our true north on what's happening, and I we have a a great community of one another, across the country. So this is just, you know, one medium. So I appreciate the ask, and, you know, hopefully, colleagues and those listening could get something out of it. And, I I don't think there's no shortage of being able to, reach out to me. So, appreciate the, offer to talk with the with my peers today.