Lauren Massaro

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Healthcare systems and nursing workforces across the United States are already suffering the effects of a nursing shortage, but data suggest the worst is yet to come.

As the baby boomer generation ages and their healthcare needs grow, and nursing colleges struggle to meet demand, both current and projected nursing shortages will only intensify. A projection reported in the 

United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit

, published in the May/June 2018 issue of the 

, says the nursing shortage will spread across the nation and reach more than 500,000 by 2030. The same analysis projected that the South and West will be hit hardest by the shortage, a prediction already borne out in states like Missouri and Florida.

2018 National Sample Survey of Registered Nurses

, the average age of a registered nurse is 50 years old. As nurses approach retirement, the healthcare sector faces a large wave of retirees over the next 15 years. More than 1 million registered nurses will leave the workforce by 2030, according to a 2019 

Low nursing school enrollment rates–due to a lack of nursing school faculty–may fail to replace the ranks of retiring nurses, leaving healthcare systems with staffing shortfalls. The American Association of Colleges of Nursing’s report on 

2019-2020 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing

 revealed that U.S. nursing schools rejected 80,407 applicants from baccalaureate and graduate nursing programs in 2019 due to shortages of faculty members, clinical sites, classroom space, and clinical preceptors. Lackluster enrollment rates may result in the failure to keep pace with the shifting demographics of the nursing workforce.

“The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020. Meanwhile, the dramatic growth in nursing school enrollment over the last 15 years has begun to level off,” said healthcare economist David Auerbach in a 2015 report published by 

An aging population and growing demand for healthcare services will only exacerbate the current nursing shortage. According to a 2017 report by the 

, the number of US residents that will be 65 or older by 2030 is projected to be 82 million. This number indicates there will be an increased need for geriatric care, with an emphasis on care for individuals with chronic diseases and comorbidities, as the population ages. 

 found that the prevalence of multimorbidity in adults aged 65 or older in the United States between the period of 2005 and 2012 was 67%.

As older nurses retire and younger nurses trickle in from baccalaureate and graduate nursing programs, whether the workforce will be able to meet the increased demands of healthcare is questionable.

The lack of staffing is already having substantial impacts on nurses across the country, as they experience more stress and burnout, report lower rates of job satisfaction, and consider leaving the profession. Nurses are stretched thin, proven by data reported by 

 that there are currently only 12 nurses per every 1000 people in the United States. Some states are experiencing more dire consequences than others.

Amid the COVID-19 pandemic and recent surge in cases driven by the delta variant, nurses in Florida are being hit hard by staff shortages, where they have the 

 for COVID-19 of any state. Nurses are experiencing burnout due to stressors associated with the 

Many organizations are offering enormous pay raises to nurses to stay afloat during shortages, some upwards of $70 per hour.

“Because there’s been a demand for nurses, we’re all getting offers from agencies from around the country, from different hospitals in South Florida and throughout Florida with offers for double, sometimes triple your salary,” Betsy Marville, nurse organizer with the 1199 SEIU United Healthcare Workers East in Florida, 

. “They are limited, but since the offers keep coming, you can stay pretty well employed.”

This can result in a mismatch between the number of available nurses and where they are most needed as the pandemic enters a dangerous new phase. In Mississippi, which has one of the nation’s lowest vaccination rates, the state medical school made plans to 

 in a parking garage as it ran out of hospital space. Meanwhile, state officials said there were 

 in the state than there were a year ago.

Despite promises of pay raises and safer conditions, many nurses are more likely to retire early rather than be subject to workplaces with high rates of infection from COVID-19, Marville said.

“Starting with their own full-time employees–instead of trying to lure temporary staff with high but short term pay–healthcare facilities need to provide better wages and benefits, including hazard pay, and to provide a level of staffing that is sufficient and safe for caregivers and patients. We also need elected leaders to who will take public health seriously and who will invest in the people who care for everyone else. Nurses are the backbone of care in hospitals, and we need to be protected, paid fairly and have a place in the decision-making that will ensure quality care and avoid crises like this. Our union is fighting for all of this on behalf of patients, caregivers and our communities.”

Hospitals in the Midwest are facing the consequences of staff shortages, as well. In Missouri, only one county out of 114 counties reported having enough healthcare personnel to serve its community, as reported by 

 live in areas where there is an established nursing shortage.

, conducted in 2020, that surveyed about 136,000 registered nurses in Missouri found that rural areas have about 40% less nurses than metropolitan areas. A lack of employment opportunities and smaller pay in rural areas contribute to the disparity seen among different demographic areas.

The same study also revealed that 31% of all nurses in Missouri are older than 54, suggesting that the state’s workforce might take a hit as nurses approach retirement.

Many states are implementing initiatives to address and mitigate the consequences of the nursing shortages. The University of Wisconsin announced in 2013 the Nurses for Wisconsin initiative, for instance, a program that has provided $3.2 million worth of fellowships and loan forgiveness to incoming nurse faculty who plan to teach in the state after graduation.

Similarly, the University of Minnesota partnered with the Minnesota VA Health Care System in June 2013 with the intent to increase enrollment in the school’s nursing baccalaureate program. The VA provided $5.3 million towards the program to expand clinical placement sites, fund additional faculty, and support interprofessional engagement, with an emphasis on veteran care.

Some nurses are confident they’ll find relief and comfort amid the nursing shortages as more people get vaccinated and are urging their communities to do so.

“I encourage our community, especially our community in Broward County and Miami-Dade County–we need everyone to get vaccinated,” said Juana Mejia, manager of Memorial Hospital Miramar’s COVID intensive care unit. “Not only for you. We want to save you, and we want you to save us.”

Articles

Pandemic fuels burnout, stress, and thoughts of leaving the workforce.

Nurses, Hospital Systems Stretched Thin Amid Ongoing National Nursing Shortage

 from Kaufman Hall, the nation’s hospitals and health systems experienced varied key performance metrics in June. Although these metrics generally suggest that hospitals and health systems are recovering, progress may be hindered by the rise in COVID-19 cases across the country.

Despite the variance, the report indicated that metrics are better than they were at the start of the pandemic. The improvement can be attributed to the decline in COVID-19 cases in recent months, but as the delta variant and faltering vaccination rates cause cases to climb, future metric trends remain uncertain.

Released by the CDC, COVID-19 metrics declined for most of June before increasing as July drew closer. The seven-day moving average of 

 was 16,019 on June 1, before decreasing by 29% to 11,457 on June 18, and then increasing to 13,285 by June 30. The seven-day moving average of 

 for patients with COVID-19 was 2,567 on June 1, before decreasing by 29% to 1,822 on June 25, and then increasing to 1,900 by the end of the month.

 administered peaked at nearly 1.1 million per day on June 7 and fell 48% to 553,160 per day by June 30.

Not including funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the median Kaufman Hall hospital Operating Margin Index was 2.8% in June, but with the funding, it rose to 4.3%. The median Operating Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin Index for the month, with and without CARES, was 8.8% and 7.4%, respectively.

Not including the CARES Act, operating margin increased 89.5% and Operating EBITDA Margin rose 73.5% during the first half of 2021 compared with the first half of 2020. Operating margin increased 48.7% and Operating EBITDA Margin increased 26.9% year to date (YTD), including CARES.

Operating margin decreased 10.3% and Operating EBITDA Margin decreased 10.7% YTD, not including CARES, compared with the first half of 2019. Operating margin increased 3.7% YTD and Operating EBITDA Margin decreased 0.9%, including federal aid, compared with 2019.

Although national volumes performed better than they did in 2020, they performed worse than pre-pandemic levels across key metrics. Adjusted discharges increased 10.1% YTD compared with January-June 2020 but decreased 4.4% YTD compared with January-June 2019. Emergency Department visits increased 3.2% YTD compared with 2020 but decreased 14.8% YTD compared with 2019. Operating room minutes increased 20.4% YTD compared with 2020 but decreased 2.6% YTD compared with 2019.

Increases in revenue compared with both 2019 and 2020 can be partially attributed to rising outpatient revenues. Gross operating revenue increased 18.2% YTD over 2020 and 7.9% YTD compared with 2019. Inpatient revenue increased 11.9% YTD compared with the first half of 2020 and increased 3.3 percent YTD compared with the first half of 2019. The largest increases were seen among outpatient revenue, as metrics increased by 24.3% YTD from 2020 and 9.6% YTD from 2019.

Large-scale purchases of personal protective equipment and other items required to treat patients with COVID-19 contributed to an increase in hospital expenses. Total expense per adjusted discharge decreased 2.6% from January-June compared with the first half of 2020. Total expense per adjusted discharge increased 14.5% compared with the first half of 2019, however.

Compared with the first half of 2020, labor expense per adjusted discharge decreased 2.9% YTD, but increased 13.7% YTD compared with 2019 levels. Non-labor expense per adjusted discharge decreased 2.2% YTD below 2020 levels but increased 16.5% YTD above 2019 levels.

Inflation experienced the largest one-month change since June 2008, being a 0.9% month-over-month increase. Despite increasing inflation, the Federal Open Market Committee indicated in their June meeting that job market recovery remains the greatest concern. To address this concern, the Federal Reserve is keeping rates low and continuing monthly bond purchases of $120 billion.

Employers added 850,000 jobs in June as the U.S. economy inches toward a full recovery and more than 157.6 million Americans continue to receive their vaccine. The addition is the highest monthly gain since August 2020.

As hospitals’ and health systems’ key performance metrics begin to bounce back from the devastating effects of the pandemic, a surge in COVID-19 cases may threaten their progress.

Rise in COVID-19 Cases Could Impede Performance Recovery of Nation’s Hospitals and Health Systems

CHE welcomes Joann Anderson, CEO of UNC Health Southeastern, for this week's installment of Turning Points. Anderson has worked with the hospital for 14 years, and has led it through multiple hurricanes, the pandemic, and a recent acquisition with the larger UNC Health system. She says that enduring challenging situations throughout her career has taught her the value of human connection and the importance of managing your emotions. She will retire at the end of this year. 

This transcript is edited lightly for clarity.

You’ve led your health system through recovery from hurricanes and now the pandemic. What lessons did you gain from these experiences?

 The hurricanes have been a very interesting situation for us. Again, hurricanes are often short lived; you know they're coming; you prepare for them. Every hurricane or event like that, we learned something about where we possibly weren't as prepared as we needed to be. So, from those events, we always sit back afterwards and say, “What could we have done better?”

I think with the very first hurricane, Hurricane Matthew, which was one that we didn't necessarily expect, it took a turn at the last minute and came to us instead of going where they originally thought it was going to go. And we were prepared for a much smaller event. But what I learned during that is I have the most wonderful team to work with.

I had individuals that, when they knew the hurricane was coming, they left their homes, their families, unselfishly, and came prepared to stay as long as it took to care for the people who needed them most. They sacrificed their personal lives for the lives of others.

They did it out of the goodness of their heart. They didn't grumble and complain. They were tired during that time. But you know, watching them over particularly that first week—it was an extended timeframe for us—it was heartwarming to see how much they cared about each other and how far they were willing to go very unselfishly to make sure that people had what they needed in a great time of need. I saw people come together and the value of a community, not just individuals, but the community support. I saw doctors that were emptying bedpans or serving food trays. They forgot their title and what their job description was.

So more than anything, I learned the value of human connection, but also the resiliency of humans. You have to bounce back; when you go through situations like that, you have to come back and say, "I could do it over again if I need to." And with the hurricanes, we had them back-to-back within 19 months of each other, two major hurricanes. When the second one came around, there were still people who were still affected from the first one who hadn't fully recovered. And then we went through it again. But again, I saw the same thing: that people unselfishly left their homes again and came back in to do what they needed to do. So more than anything, I learned the value of connection, the value of compassion.

And really just resiliency. I hadn't thought a lot about resiliency in my previous job responsibilities at other organizations because we didn't have a lot of those types of things that occurred. But I've seen that here. You don't know how far you can be tested until you are. It was just really good to see the group come together, do what they needed to do, how much they care about each other, how much they care about their patients.

 What is the most important health delivery lesson from the pandemic that you believe will remain going forward?

There have been a lot of lessons that I've learned from the pandemic, both personally and professionally. I think from a professional perspective, is that when you're faced with something like a pandemic, which is totally new to not only you but to everyone in the environment, that you have to manage emotions.

Over this past year, we in healthcare have had to adjust, change quickly, pick up new ideas, learn new things, implement things, all for the right reason. That's tiring, physically. It's draining, just psychologically. Emotionally, it's taken a toll on the entire team. When you shift things too quickly, for anybody, it's hard to adjust. We as an organization have had to go through a lot of firsts since I've been here in North Carolina, and whether it's hurricanes or other related events, those are usually short lived. This has been such a long-term situation, that people have not had the opportunity to recover. That emotional toll has been a real learning experience. It's been a challenge from a leadership perspective to be able to help people navigate a situation that they just are not emotionally or intellectually prepared for.

I think learning over the past year from a pandemic is, when you're going into a situation like that, don't overlook the emotions behind it. We can take care of the technical issues. We're good at that in healthcare. But the emotional side of it we give so much of ourselves that once that bucket has drained, it's hard to fill it back up.

 If you could select one major healthcare advance that you knew would be important as soon as it happened, what would it be and why?

The first thing that came to mind was telehealth. We're sitting here today on Zoom, very geographically separated, but we're able to communicate. Very quickly at the beginning of the pandemic, we had to find a way to keep people safe and we had to find a way for people to access healthcare in a very different manner. Social distancing in an office was tough to do. So just the implementation, very rapid implementation of a telehealth platform, people being able to access it, I think, we knew immediately that it was going to work, and it was the right thing to do.

I think one of the things that was most interesting to me—I talked to a physician that has been in practice for over 30 years—he called me and said, "I need to talk to you about what you're having us do now through telehealth," and I thought, oh, here it comes, he's gonna tell me this is not working.

And he said, "I just have to tell you, I was skeptical at the beginning that, first of all, I didn't think I could do it, because from a technology perspective, I'm just not that astute. But I care about my patients, I wanted to make sure that they had access to me, so I tried it," he said. "It was amazing. I could still see my patients, I could still take care of them, which is important to me, and it was important to them. But I could do it in a safe environment and I learned to do it quickly. So, I'm a big fan, I just wanted you to know that I overcame my fears and I think this is going to be a way that we're going to be able to offer services to people in the future that I never thought was going to be possible or that I ever wanted to have anything to do with."

So, for me, telehealth is definitely the thing that is probably the biggest advancement and we're going to see that just expand more and more in the future.

 Can you think of a technological advance that was dismissed early on, but turned out to be important to the field of healthcare?

There's so many advances in healthcare from a technological perspective, and they're happening so rapidly, that I really can't think of one that was kind of dismissed at the beginning or that [wasn't] going to work, and then suddenly, we realized there's lots of applications for it.

There are a lot of things that have happened that we've seen expanded over time that may have had a very limited use at the beginning. One of the things [is] the drug Keytruda. When Keytruda was first introduced, it was for a very limited population, a very specific cancer, [and] it's now being used for all kinds of different things and being shown to be effective. 

I think that's the good thing about, whether it's technology, or whether it's just the science behind new products that are coming on the market—we might start with just being focused on a very specific small population or group, and then just find ways to advance those into other areas. Whether that's a robot that started being used for one specific type of surgical case, and now is being used in multiple surgical cases, or drugs like Keytruda, and that type of thing. I can't think of one that just got dismissed and then said, oh, now we can pick it up and try it again. But so many that have just expanded their use over time.

 UNC Health Southeastern was a separate health system that joined with the larger UNC Health system. What advantages are gained by being part of a larger health system?

The advantages have been resources available to us that we couldn't do on our own. When we went into the exploration process for a potential partner, there were things that we were looking for, and one of those things was listed as capital. Most people, when [they] think about capital, it's financial resources, financial capital available. Yes, that could be part of it, it is not part of our relationship with UNC today, but it could be. But what we really wanted was the access to intellectual capital, not that we don't have smart people working at our facility.

But in the complex world that healthcare is today, being able to have as many intellectual capital resources available to you with specific skills and knowledge is almost impossible in a rural location. So, for us, it was, could we find an organization that could help us advance our initiatives at a faster rate because of the resources they had available to them? That would allow us to access those resources when we needed them to help us move faster.

We had a lot of things that we wanted to accomplish. I have an executive team of five other members, so there were six of us who were trying to compete in a world with the mega organizations like UNC, or Novant or Atrium, who have an army of people behind them. If they need a specific issue, they've got an expert they can call upon. We didn't have that and didn't have access to that in any way. So, for us, the partnership with UNC has allowed us to tap into that intellectual capital. We have resources available to us today from an analytics perspective that we didn't have available before.

Just again, using the pandemic as an example: predictive analytics as to when the peak would occur in terms of inpatient hospitalizations, we didn't have the resources to do that. But immediately they did. Immediately they took our data, plugged it into their algorithm, and could help us plan with a certain degree of certainty what our resource needs were going to be in terms of human resources to meet the needs of the peak census. We didn't have that available.

At the beginning of the pandemic, certain drugs and certain supplies were only available to the larger institutions. And for us, since we didn't have access to that, we needed to find a resource for it. I remember we needed syringes to give vaccines and didn't have access to syringes. So, we called UNC and said, "Do you have any idea where we might find syringes?" and the next day we had syringes. It's that type of accessibility to resources that we just didn't have available.

They have clinical experts in every field, so my medical staff are so excited about the ability to tap into people who have written the textbooks, or who are doing the research, or that type of thing that they just didn't have access to before. For us on the administrative level, it's the analytical data that might be available.

I had a leader within the organization that actually left before we made the decision to go with UNC. He left because he said, "I'm one person of one. I have to be the expert. Every time there's a question about my field, I am the only person that can give that answer. That's a heavy burden to bear. When the organization may be turning to you for that expertise, and you feel the burden that 'if I make the wrong decision, or tell them the wrong thing, then I'm the one that did that,' I don't have anybody there to back me up."

The relationship with UNC has allowed us to have a peer group for everybody in the organization. They've got someone that they can call upon to just talk over a situation. We don't have to create something from scratch, there's probably someone in the organization who has experienced many of the same things that we may be getting ready to experience, they can tell us what their experience was, what they would have done different. Learning from them has been a tremendous value for us.

We're seven months into it, so I'm sure there's gonna be bumps along the road somewhere in the future. But so far, the relationship has been very, very positive, just for those reasons. Just having the resources available and to feel like you're not on an island by yourself, that you've got somebody else you can call upon who will be there to support you and to help you work through your decisions or provide resources or whatever.

The other thing we've learned through this is that we're farther advanced in some things than they are and they're learning from us. That gives my team a good sense of their value as well. We didn't want to go to an organization where we felt like we were taking everything, we needed to contribute as well. 

My team has got a sense of renewed spirit because they've gotten positive feedback from their peers at UNC who have said, "Wow, I'm glad you shared that with me because we've been dealing with that issue and you've already resolved it." Just being able to share with a peer group is a very positive thing.

 What advances will patients at UNC Health Southeastern see over the next five years?

I think our advances will actually be more in the arena of the expansion of some of the services that we're providing. Simply because we do have access to clinical experts at UNC, we're going to be able to introduce a broader array of services, go a little bit deeper into some specialty services, and what we're currently doing today.

Because we may have available to us technology that we couldn't have afforded on our own, there probably will be some technology advances as well. We've not identified all of those just yet. But again, through purchasing agreements and things like that, financially we might be able to afford some things today that we couldn't have afforded in the past simply because of that relationship with UNC. But it's going to be more about the expansion of the services that we currently have rather than introducing a lot of new types of things to the area.

 What advice do you have for someone considering a career in healthcare administration?

You need lots of stamina. You need a lot of patience.

I didn't set out to be in hospital administration, I actually started my career as a nurse. My intent was to be at the bedside taking care of people. What you find with that is there's immediate gratification because you see the fruits of your labor, you see what you've done, you can check off the tasks that you've done for the day, you get gratification from that. It's just a good feeling to know that you helped one individual or multiple individuals throughout your shift.

Administration is in many ways the same way because your patient is actually the organization of the community that you serve. My leadership role today is from the standpoint that if I were caring for this organization, or for this population, these are the things that I would need to do for it. Understanding that my outcomes are not going to be immediate, I'm not going to see an immediate reaction or a response to any action that I take, but I'm building on that for the future. It might take five years before I see a response to anything that I've done today. Or my decision making maybe about what we're looking at five years from now, not what we're doing today. Actually, what we're doing today, I needed to have thought about five years ago. If I'd known the pandemic was coming, I could have been better prepared.

In administration, you have to be able to see the future, you can't just focus on what's happening today. It's not really about what's happening today. We're planners, we're facilitators, we're conveners, we're educators. That's what you have to be prepared for in administration.

I have two sons, and they grew up on the floor of my office early in my career. My oldest son is now a healthcare administrator as well.

Early on when he wanted to go into healthcare, he said, "I want to do what you do."

And I said, "What do you think I do all day?"

He said, "You get to go to work, and you just talk to people all day long."

But those that do take it seriously. You have to mean what you say, you have to be willing to back what you say, but you also have to be willing to realize that sometimes what you say is not the right thing. And that it's okay to be vulnerable and to say, "Okay, I didn't make the right decision." You have to be able to back up and say, "Based on what you now have shared with me, or the additional information that I have received, I'm going to reverse my decision and go in a different direction."

You know, healthcare administration can be very humbling at times. And I decided that my leadership team all the time, we all have titles. Everybody has a title. Every job has a title that goes with it. I have a title, but I'm only one person in the organization. I don't believe anyone in healthcare administration needs to feel that they are so important that you know everything stops because of them.

I can be out of the office and very few people notice if I've done my job correctly because other people are doing what they need to be doing. My job is to communicate with them what the vision is, what our mission is for the day, where their guardrails are, how to stay within those guardrails. And then they do their jobs effectively. Let the people do their jobs, don't feel like you have to micromanage or dictate what's happening because you've got great people working for you in health care.

So if you're going into hospital administration, I say go for it. We're going to need some great people leading our healthcare system in the future. It's going to be complex. It's going to be fast paced. It's going to demand a lot of brainpower, flexibility, [and] analytical skill sets.

[It's] very different from when I started. Just the pace itself, because of the amount of information that's out there available to us today. The way we communicate today is very different than when I started. The internet and the advances in telecommunications are much faster than anything that I experienced early in my career. I would encourage anybody to go into healthcare administration if you're willing to be in an environment that's going to make a difference for a lot of people. That's going to be fast paced, high demand, but very high reward.

 What are you looking forward to in retirement?

I am looking forward to reconnecting with my family. I've always been at a distance, geographically, from my family and I'm looking forward to having some uninterrupted time with them. I have seven grandchildren, so I want to have a relationship with those grandchildren and get to know them as individuals over a period of time. I'm not going to be their babysitter, but I do want to have a relationship with them that sometimes I've had to forgo because of the demands of the job. I want that flexibility.

Quite honestly, I want some me-time. Over my career, I think there have been times when I've sacrificed personal issues, family time, and that type of thing in lieu of my career or in lieu of the responsibility associated with the roles that I had in the organizations. I don't regret that, I feel good about what I've done, and my family is not regretful of that either. But we're all looking forward to having time where we don't have to worry about balancing the responsibilities between the job and family. So, family time, I think is probably going to be the best.

I know a lot of people say when they retire, "I'm going to travel"—maybe I'll travel, maybe I won't. I don't think I will just quit; I still have a passion for rural healthcare in particular. So, I'm looking forward to choosing what I want to be involved in and not necessarily doing it because it's a responsibility that I have to do. It's a choice. So, there'll be some joy in making those decisions. I can make a difference here and I will do it because I choose to do it, not because I have to do it. 

Just looking forward to, for the first month, sleeping, [getting] an interrupted sleep. And just not having that burden of carrying the organization and knowing that it's my responsibility to make sure everything's okay. I think I'm ready for something different.

Videos

The fifth installment of Turning Points, a Chief Healthcare Executive™ video series in which retiring CEOs reflect on changes they've witnessed throughout their career and discuss the future of healthcare for aspiring healthcare professionals. 

TURNING POINTS: UNC Health Southeastern's Joann Anderson Says, "Don't Overlook the Emotions" Behind Challenging Situations

Poor cybersecurity hygiene within the healthcare sector leaves the field susceptible to ransomware attacks and security breaches, the prevalence of which is significant. An estimated 600 healthcare institutions and more than 18 million individual patient records were affected by ransomware attacks in 2020 alone.

Employee negligence and simple human error make it easy for hackers to compromise patient data through successful phishing attempts and other similar scams. Poor cybersecurity hygiene of doctors exacerbates the already prevalent issue of data breaches, especially in the age of telehealth and digital transformation.

“Healthcare organizations make an ideal prey for hackers, as many of them use outdated security software and continue to underinvest in cybersecurity. At the same time, they get to keep an overwhelming amount of the most sensitive data,” Oliver Noble, a cybersecurity expert at NordLocker, a data encryption solution, said in a statement.

Weak passwords leave patients’ medical records and personal information vulnerable to ransomware attacks and prove to be one of the top causes of data breaches. It is recommended that doctors use complex and unique passwords, change passwords often, and use a manager to keep track of passwords, to protect sensitive data.

Many patient records are stored as unencrypted files, which makes it easy for hackers to gain access and leverage access in exchange for a paid ransom from doctors. Patient information shared between doctors or third-party providers via email also leaves information at a risk of data leaks because email is one of the least safe methods of digital communication. Encrypting patient data and medical files using software like NordLocker offers protection from ransomware attacks, as it blocks outsiders from gaining access to sensitive content.

Using out-of-date software makes patient data vulnerable to hackers, especially if hackers are aware of known security weaknesses and vulnerabilities. Staying up to date with software updates is critical to the security of sensitive information because they typically include important fixes and patches that improve cybersecurity hygiene.

Doctors should educate themselves about cybersecurity and be proactive in recognizing and preventing potential phishing attacks, like phishing emails requesting that they download malware or share sensitive data.

Downloading a virtual private network (VPN) is another helpful way to ensure a safe internet connection and avoid data leaks. A VPN blocks the internet connection from third parties like hackers and secures an encrypted connection tunnel between a device and the internet or the organization’s server.

By improving their cybersecurity hygiene, doctors can protect sensitive medical information.

Poor Cybersecurity Hygiene Leaves Healthcare Sector Vulnerable to Hackers

This week, CHE welcomes Will Ferniany, PhD, CEO of the University of Alabama at Birmingham Health System (UABHS), for the fourth installment of Turning Points. Ferniany has led the 11-hospital, $5 billion system for 13 years. As the CEO of UABHS, Ferniany has spearheaded healthcare equity campaigns and expanded healthcare delivery throughout Alabama, including rural areas. He will retire at the end of the year. 

This transcript is lightly edited for clarity. 

 Can you describe the evolution of the health system during your tenure?

I've been here since 2008. I would say there's two major changes that have taken place. One is growth; we have grown from being a little over a $1 billion system to close to $6 billion, and we've grown from two hospitals to 11.

But that's not the main thing that I'm proud of—what I'm mostly proud of is the alignment. This is an academic health system, and as an academic health system, we have three missions. One is clinical, one is research, and one is education. When I got here, these were not very well aligned. Those three missions are very well aligned now. [They're] pretty much of equal importance, and in  just about everything we do, we consider all three of those missions.

I'm very proud to work here at this institution, and I've always been proud of the people that work here. It's a wonderful institution in the sense that it takes every patient complaint extremely [seriously], and we have one of the highest patient satisfaction [rates] in the country. That is something I'm also proud of [that we did not have] when I got here. We have strong engagement; the health system and the university together, were voted the best employer in the country by Forbes. That's of everybody, that's of General Motors, Amazon, which is pretty amazing. We take every patient complaint very seriously and respond to it and deal with it, every one of them.

We make sure we don't do things that are what I call "gray;" we're always compliant with the law. We don't do anything that we don't want to see in the newspaper. 

 UABHS oversees 11 hospitals. Can you discuss how an expanding health system balances the need for quality standards across the system with maintaining the individual character of each hospital?

The main reason [why] we have expanded into other areas, particularly in the rural areas, is [because] the University of Alabama at Birmingham, our School of Medicine, and our health system has a responsibility to the care of the state and to the health status of the state. That's hard to implement if you're just in one location, if you're just in Birmingham. So, having other facilities throughout the state allows us to implement them.

The way we've set this system up is not a very rigid system. So, part of your question is easy to answer in the sense that we maintain the individual character and boards of all of our facilities. We work together where it's to our benefit to work together, such as in maintaining quality standards. Supply chain is a classic case where we do things together. We take the advantages on our debt ratings and stuff like that, but we don't impose. We're not like a lot of systems that are cookie cutter. Let's say we're all wrestling with whether we mandate vaccines or not right now, and if we do mandate vaccines, maybe not all of our facilities will follow. They have different issues they have to deal with. We balance it by keeping the locus on the local facility. All healthcare is local, really.

Within its system, UABHS manages 4 rural hospitals. Are there policies you would like to see in place to help stabilize finances for rural healthcare delivery?

This is an area very dear to my heart. I really believe that rural healthcare, the way we finance and operate rural healthcare, does not work. We expect these rural hospitals to apply the same rules and regulations, like price transparency, [and it's] very difficult for rural hospitals to implement. What I believe needs to happen is the way we fund rural hospitals needs to change and the type of licensures and requirements for rural hospitals needs to change. Right now, rural hospitals' number one rule is do everything they can to keep the door open, regardless of whether that is the right health care they should be providing for that community. If you implemented a system like they have in Maryland, or what they're experimenting with in Pennsylvania, [like] global budgeting, or what the government now has a grant out for called the 

, [Community Health Access and Rural Transformation] if you were to do that and fund these institutions, globally, or almost like a per capita basis, they can provide the care they need to provide that's right for that community and not worry about where the next dollar comes from.

The second thing is, they should be allowed to be more flexible in what's in a hospital. Many of these communities only need an emergency room, imaging, physician offices, observation beds. In many states, Alabama included, there's no licensing for them. Supposedly, there's a new federal program that goes into effect, I think January of '22, might be January '23, that will allow those. There's a lot that can be done in rural health care.

 What is the role of the hospital in a community, and how has that changed?

It has changed radically for our main hospital, not for our community hospitals. Our community hospitals have always been integrated into their community. But UAB, the main teaching hospital—which by the way, is one of the largest hospitals in the country; I think it's the 16th largest hospital in the country—it always saw its role as tertiary care for the whole state. It's one of the reasons we are, with the years I've been here, [able to] build out to help throughout the state.

The biggest change is this issue of community health equity. Yes, we did things in many communities prior to COVID. But COVID more than put a spotlight on the need to do more. We have a senior official, our Chief for Community Health Equity. We have significant programs including a challenge, what we call our "grand challenge," which is part of the university as well as the health system, to change the health status of all the citizens in Alabama. I think the biggest change has been our focus on community health equity, number one. And second, taking on the responsibility of leadership throughout our state.

Are there any major challenges you faced early in your career that impacted your leadership? What did you learn from them?

I think the main challenge that shaped me a lot was when I was at the University of Pennsylvania, we had a significant financial challenge. We lost $180 million one year and $190 million the next year before we were able to turn it around. And, now it's one of the most successful institutions in the country. One of the reasons it's so successful is because it had that crisis, and it allowed them to make the changes they needed to make. Living through that crisis, and seeing what needed to be done and how to do it, I think had a profound impact on me in two ways. Number one, how to deal with a crisis. And number two, what good a crisis can do if you live through it. That old saying "don't let a crisis go unwasted," is a really good one.

 What are the key lessons from the pandemic?

The importance of working with competitors, I think. Matter of fact, we have a call [tomorrow morning], we stopped having them and we're gonna start again because of the delta variant in the state. The hospitals here in Birmingham worked very closely together, whether they were for-profit, not-for-profit, mental health facilities, children facilities, we coordinated extremely well, and I'm really proud of that. That did not happen in every city in Alabama or in other states. I think hospitals cooperating together was really a wonderful thing to see.

The second thing was, the importance of this I mentioned earlier, community health equity. You know, the damage done to the African American and Hispanic communities needs to be addressed and it's from years of under service.

If you could select one major healthcare advance that you knew would be important as soon as it happened, what would it be and why?

This one might surprise you—the internet. When the internet first started, when I first became aware of it in '92, and when the first search engines came in, I could realize really quickly that this was going to be important for a lot of things in healthcare and other things. There were other things I thought about that I wish I had done, I might have been going up to space like Bezos but I didn't have enough foresight to act that way. I think the internet would be one that I realized early on would have profound effects.

 (Institute of Medicine) and the importance of quality and healthcare and how we were not dealing with it. This came out around 2000, how we were not really dealing with quality the way we should [have been] and the effect that's had on the whole healthcare industry.

 Conversely, can you think of a technological or operational change that seemed less important at the time that turned out to be critical to healthcare delivery?

Telehealth, I did not recognize how important that would be. It builds on the internet, obviously. But still, I saw it mainly as an issue for helping rural healthcare, and so I did not see the broader application. We had embarked [on telehealth], again because of our responsibility to the state, [and] if the leaders in telehealth in Alabama and I had not been there, I don't think we would have had as much success during COVID as we did. We could switch real quickly to most of our visits being over telehealth.

 What is one healthcare advancement that was not as successful as you initially anticipated?

That would be EHRs, electronic health records. I really had thought they would be more beneficial than they are. They’re way short of what they could be. The interoperability, the differences in how they operate. And, we're spending a lot of money and not getting what we should be getting out of these electronic records. Their potential is far from being realized.

Well, go in it for the right reason. And the right reason is to help people. And once you get into the profession—I've lived by this, and every time I've not done this, I've made a mistake—always remember that if you put the patient first you will not make a mistake. And if you don't put the patient first, you will. 

An example of that is electronic health records. We all ran to do those because the federal government gave us money during the stimulus package after 2008. Many of us were already on that Vantage thing. But they really weren't done to improve the care of the patient and the interaction between the patient and the provider. They were done for a lot of other reasons, a lot of other good reasons. But in the end, they were distracted from that. So, I think the second thing I would tell them is to always put the patient first.

 What advances do you see at UABHS in the next five years?

I think you'll see us put, again, considerably more emphasis on health equity that we've mentioned. I think you'll see UAB Health System, both at our community hospitals and our academic center, working together to become a leader in precision medicine and genomics. I believe the future of healthcare is in precision medicine and genomics. 

I think you'll see us really focused more on our mission, we're a very mission driven organization. And again, our missions are educating the workforce for Alabama, the healthcare workforce, and research [in] improving the lives of people all around the world. And then clinical care. There are many things that the only place you can get them in Alabama, and sometimes the southeast, is here at UAB Hospital.


It was fun to think about that actually. I am looking forward to reading things I really want to read. Most of my reading now is work related. I do read pleasure material, but I would like to rebalance that to be more pleasure material and less work related. 

My wife and I are looking forward to traveling. Of course, COVID puts a big dent in that until this gets settled. We were thinking February we'd like to go to someplace, but every place we thought about [we asked] yeah, but what is it gonna be like in February for COVID? It could be gone, it could be still there, you know. So, travel would be one.

And, just the time to do the things I want to do. Basically, I want to spend six months not engaging into anything. If I engaged in everything people have asked me to engage in so far, I would be busier than I am today, but working for free. And I'm like, well I don't want to do that! I mean, if I'm gonna do that why don't I just stay here and get paid? After six months I think I'll reengage into areas that I'm passionate about and want to work on, and many of them are in the health field still. Once I retire, I plan to focus on Medicaid expansion here in Alabama because that's so important, and we're one of the 12 states that have not expanded. 


In the fourth installment of the Chief Healthcare Executive™ video series Turning Points, the retiring leader of Alabama's largest academic health system discusses the need for healthcare equity and the mission to improve the health of everyone in the state.

TURNING POINTS: UAB Health System's Will Ferniany, PhD, Says, "If You Put the Patient First You Will Not Make a Mistake"

Becton, Dickinson and Company (BD) this week announced a plan to transform the experience of the blood draw with a “One-Stick Hospital Stay,” centered on a new device designed to eliminate multiple needlesticks for blood sample collection.

The pitch for hospital and health system executives: the company’s FDA-cleared PIVO device, while initially more expensive than a traditional blood draw, will reduce levels of patient pain and discomfort, and in turn increase patient satisfaction while delivering quality outcomes. 

BD has worked towards making the process of blood collection safer and more comfortable over 70 years through their development of the BD Vacutainer family of products. Their suite of tools helps clinicians choose the right device for the right patient to achieve “first-stick success.” The implementation of the new device comes as part of the company’s recent acquisition of San Francisco-based Velano Vascular.

“As a global leader in vascular access solutions and blood collection, BD has been on the forefront of innovations that improve the patient experience and reduce additional needlesticks,” Rick Byrd, president of Medication Delivery Solutions for BD, said in a statement. “Now, with the addition of Velano and its groundbreaking technologies, we can envision a world where a ‘One-Stick Hospital Stay’ could be a reality for many by making the numerous inpatient blood draws better for everyone.”

The single-use, needle-free PIVO device draws blood from existing peripheral intravenous catheter (PIVC) lines, reducing the number of needlesticks needed for high-quality blood sample collection. The technology promises low-acuity patients will have one “stick for their entire hospital stay.”

Blood draws by venipuncture and the insertion of PIVCs are two of the most common procedures performed in hospitals and are typically met with some degree of pain and anxiety from patients, as 1 in 5 people in the United States are needle phobic. Successive needlesticks may exacerbate levels of pain and anxiety.

“By potentially removing multiple, individual needlesticks from blood draws, we can change the decades-old practice and help transform it into a better experience for patients and providers,” Anna Kiger, DNP, DSc, RN, FAONL, chief nursing officer for Sutter Health, said in a statement. “What can be an unpleasant or anxiety inducing procedure, with multiple pokes and prods throughout the day and night, is now a more compassionate one for those in our care.”

The new device may lead to a decrease in costs, although the precise amount may vary from hospital to hospital. Compared to other blood collection methods, study data have shown the device may reduce hemolysis rates and subsequently lead to cost savings by eliminating the cost of collection supplies needed for a redraw. Further, first-attempt successes of blood draw may decrease the clinical and financial impact associated with delayed care.

 that “hemolysis accounts for 40% to 70% of poor quality, rejected samples results in delayed care, additional patient discomfort and additional redraw costs of $208 for inpatients and $337 for rejected (emergency department) samples),” citing studies that say emergency departments reject between 8% and 15% of samples.

BD did not provide a precise savings estimate when requested by Chief Healthcare Executive™. In a 

 in MedCityNews, officials with Velano Vascular said pricing would depend on the “use case” at each hospital.

According to a BD spokesperson, leading US hospital systems such as Intermountain Healthcare, Sutter Health, Centura Health, Northwestern Medicine, Henry Ford Health System, Virginia Mason Medical Center, Griffin Hospital, and more are currently using PIVO in their practices.

Device would eliminate pain, anxiety associated with the blood collection process through the implementation of needle-free blood draw device.







BD Works Toward Creating ‘One-Stick Hospital Stay’ With Needle-Free Blood Draw Device

Kindred Healthcare, LLC plans to add acute inpatient rehabilitation units (ARUs) to Kindred Hospital Denver, Kindred Hospital Melbourne (Florida), and Kindred Hospital Philadelphia – Havertown, three of the company’s long-term acute care hospitals (LTACHs).

The ARUs will be able to accommodate up to 33 total patients and are expected to begin delivering care in September 2021.

The planned addition supplements five ARUs previously added within Kindred Hospital North Florida, located in Green Cove Springs; Kindred Hospital Bay Area – St. Petersburg; Kindred Hospital South Florida – Ft. Lauderdale; Kindred Hospital Houston Medical Center; and Kindred Hospital Sugar Land (Texas) in August 2020.

“Kindred’s Hospital Division and Kindred Rehabilitation are working collaboratively to meet a growing need for inpatient rehabilitation services in our communities,” Russ Bailey, President of Kindred Rehabilitation, said in a statement. “These ARUs enable us to provide greater access and enhanced capabilities, expertise, and clinical integration to patients requiring these rehabilitation services.”

The facilities will provide inpatient rehabilitation to patients recovering from conditions including stroke, brain injury, spinal cord injury, orthopedic injury, neurological conditions, amputation, and trauma. Through the provision of intensive, interdisciplinary, clinical and rehabilitation services, the new ARUs will aid in patients’ recovery and improve their levels of function and independence so that they can be discharged and return to their homes.

“The ARUs complement the care provided in our LTACHs and enable Kindred to offer a continuum of care for patients who require high-intensity rehabilitation services to continue their recovery so they can be discharged and return to their homes,” Mike Warrington, President of Kindred’s Hospital Division, said in a statement.

Under the direction of a physiatrist, a doctor specialized in rehabilitation and physical medicine, and 24/7 nursing care, patients in the ARU will undergo a minimum of three hours of therapy each day for at least five days a week. Both patients in Kindred LTACHs and patients from other healthcare providers in their communities will be eligible to receive care from Kindred ARUs.

The new ARUs add to a growing list of those managed and staffed by Kindred Rehabilitation, as approximately 100 hospitals in 30 states partner with Kindred Rehabilitation to run ARUs within their facilities. Kindred Rehabilitation delivers care to more than 118,00 patients each year and is the largest contract manager of hospital-based acute rehabilitation programs in the nation.

The nation’s leading specialty hospital company plans to expand its rehabilitation services.

Kindred Healthcare to Add Acute Inpatient Rehabilitation Units to Its Long-Term Acute Care Hospitals

CHE welcomes Gary Fulbright, CEO of Citizens Memorial Hospital, for this week’s installment of Turning Points. Fulbright has spent 39 years at Citizens Memorial and was one of the first hospital employees. In his role as CEO, he has led expansion initiatives, implemented new healthcare technologies, and introduced new specialties to the hospital, all while keeping the comfort of the community in mind. He will retire at the end of the year.

This transcript is lightly edited for clarity.

You’re retiring from Citizens Memorial Hospital at the end of the year—do you have a “to do” list of things to finish before your last day?

What I plan to do, as I prepare for retirement, is pass along the knowledge that I have gained. I've been here 39 years and was here a few months before the hospital opened. So, I do have a lot of knowledge in the organization and want to be sure to pass that along to employees that will still be here, and make sure that they can be successful.

Also, we have a construction project, and I will be working with our other leaders on planning for that, with the financial projections and also the plans for the new construction.

 You’ve been at Citizens Memorial since the beginning. What are the most important changes you have seen in your time at the hospital? 

 A lot of changes. We had around 80 employees initially, and now we have over 2,000. The 2,000 does include our clinics, long-term care and home care services in addition to the hospital. We offer a lot more services, we have a lot more buildings.

There's just a lot of changes with technology and with people. Looking at our physicians, we have many specialties now. Originally, we had just family practice. We’ve been able to offer a lot more services here and give people in our community a lot less reason to have to leave to find care.

 If you could select one major healthcare advance that you knew would be important as soon as it happened, what was it and why?

I've seen a lot of them. I've been around for quite a while, so the CAT scan was a big deal once upon a time. MRI was a big deal once upon a time. PET CT was a big deal once upon a time. We started with mobile services for those and then obtained our own equipment. That's just an example.

Third installment of Turning Points, a Chief Healthcare Executive™ video series in which retiring healthcare executives and CEOs reflect on changes they’ve witnessed over the course of their career and discuss the prospective healthcare landscape for future generations. 