Collaboration Plays Key Role in Meeting Challenges, Opportunities of Maryland’s Health

From leaders of national nursing organizations to those in state government to presidents of Maryland’s largest hospital systems to nurses themselves, everyone has their eye on the workforce — and what can be done to bolster it, in Maryland and nationwide. The 2023 Maryland Action Coalition (MDAC) Virtual Leadership Summit, hosted by the University of Maryland School of Nursing on May 22, looked to the future of the nursing profession and health care in Maryland through a lens of “Collaborating to Meet Challenges and Opportunities: The State of Maryland’s Health.”

Offered through a full day of live programming, including a poster session and roundtable discussions, to nearly 190 attendees, the summit explored new and innovative collaborations and partnerships to meet nursing’s future health care challenges and to recognize opportunities for making diversity, inclusion, and equity a reality in the workplace. 

“If you said to me what are the two to three biggest challenges, my response would be workforce, workforce, workforce,” said M. Joy Drass, MD, executive vice president and chief operating officer of MedStar Health. This came during a morning Fireside Chat on the “Health of Marylanders: Sustainable Change” with Mohan Suntha, MD, MBA, president and CEO of the University of Maryland Medical System, and Kevin Sowers, MSN, RN, FAAN, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. 

All three leaders predicted a change in the model of care in the not-too-distant future, related to staffing, electronic health record use, scheduling, mental health practices, and more. “We’re going to have to rethink our care delivery models. They will be team based, but what will they look like?” Sowers said. “Is it an NP with newly designed roles that’s overseeing a segment of the unit? Is it a nurse using telehealth to direct a team? Is it EMTs in our emergency rooms having a different scope of practice? We’re going to need to partner with schools about what our supply and demand looks like for the future.”

Suntha highlighted that work schedules and wellness play a significant role: “How do we optimize schedules that optimize quality care delivery while nurturing the health of our workforce?” he asked. Drass agreed, “Our new-to-practice nurses really want flexibility.” And Sowers reinforced that a generational shift is playing out. “This generation focuses its time on how much time do I get off vs. how much time do I work,” he said. “Maybe they have it right and we had it wrong. How do you change your perspective as a leader to support a generational shift?”

Sowers also highlighted the value of health care systems partnering to address challenges, which he said was critical during the COVID-19 pandemic. “Partnerships matter,” he said. “Mohan Suntha and I partnered very closely in the state and did a lot of good things between the University of Maryland and Hopkins. We’re stronger together than trying to work apart.”

Earlier in the morning, Jane M. Kirschling, PhD, RN, FAAN, the Bill and Joanne Conway Dean of the University of Maryland School of Nursing and co-chair of MDAC, shined a spotlight on the value of partnerships during her welcome remarks: “We will spend today exploring some of the new collaborations and partnerships that are helping us address the current challenges, including developing new care models and staffing to better support nurse retention, partnerships for preparing students for future health care needs, and exploring implementation of long-term sustainable change within Maryland’s health systems,” she said. “Threaded through each of these is the need to recognize and support the vital role of nurses in implementing strategies for academic and practice-based responses to the needs our health care system and those patients, families, and communities that we serve.”

Kirschling also presented the coalition’s annual Exemplary Service Leadership Award, which celebrates leadership and accomplishments that go beyond an individual’s day-to-day responsibilities and recognizes that individual for honoring diverse perspectives and including others while exploring new ideas and partnerships to achieve large-scale goals. The coalition has renamed the award in honor of the “incredible legacy and many contributions” of Peg E. Daw, DNP, RN-BC, CNE, FAAN, former Nurse Support Program II grant administrator at the Maryland Higher Education Commission, and bestowed the 2023 award on her posthumously, having presented it to Daw’s family members during a remembrance celebration at UMSON in May, following Daw’s death in December. “Our efforts here in Maryland have been enormously successful, in no small measure because of Peg’s deep commitment and her involvement in helping to make available the resources and support that could move a national agenda forward here in the state of Maryland,” Kirschling said.

During her remarks, Kirschling indicated that MDAC’s work has been driven recently by The Future of Nursing 2020 - 2030 report, which outlines recommendations focused on health equity. “As you may recall, a key theme of that report is the need to address the social determinants of health, reduce health disparities, and address inequities in our health system,” Kirschling said. “These were not new and novel challenges, but they were certainly brought into sharper focus given the disparate impact of the COVID-19 pandemic on selected populations.”

Health equity was the predominant theme of the morning keynote by Laura Herrera Scott, MD, MPH, the Maryland secretary of health, who discussed “Health Care Priorities for a Healthy Maryland: Leaving No One Behind.” Recently appointed to her role in January, she outlined her priorities as committing to reproductive health; creating real-time access to high-quality, equitable behavioral health care; and leaving no Marylander behind. “Across everything I’m doing, health equity is a priority,” she said.

She explained that the nursing workforce looks more like the general population than do other clinicians and that nurses who are members of underrepresented or marginalized groups are more likely to advocate for their communities. “Nurses are key partners in advancing health equity,” Scott said. “At a population level, public health nurses work to address chronic diseases and prevention. At a policy level, nurses can advocate for community interventions and government programs.” But, she said, “nurses need more autonomy to sit in leadership roles.”

This effort begins with preparing students to care for diverse populations and to address racism in health care and its roots in colonialism by “cultivating an inclusive learning environment for nursing students and giving them multiple settings for training and education,” she said. “Social justice is a core nursing value.”

Following a series of roundtable discussions on topics including workforce intervention and retention, a statewide residency initiative, violence in the workplace, and clinical simulation, the summit presented a keynote panel of American Nurses Association (ANA) Nursing Staffing Task Force members.

The panel included Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, CCTP, director of nursing programs, ANA; Cheryl Peterson, MSN, RN, vice president of nursing programs, ANA; and Sherry Perkins, PhD, RN, FAAN, president of Luminis Health Anne Arundel Medical Center. Christie Simon-Waterman, DNP '16, RN, FNP-BC, WCC, DWC, president of the Maryland Nurses Association, moderated the discussion.

Simon-Waterman kicked off the session by relaying what she called “an overarching and obvious challenge.”

“Over 100,000 registered nurses have already left the workforce due to COVID-19 in the past two to three years, and another 800,000 intend to leave by 2027, one third of them younger than 40 years of age,” she said. “Those are who we usually depend on to be the mentors and preceptors of the future. COVID-19 has ebbed and flowed. But this nursing shortage has unfortunately been constant and even gotten worse.”

The ANA and the American Association of Critical Care Nurses (AACCN) collaborated in 2018 to form the Partners to Address Nurse Staffing, Peterson explained.

“We all know nurse staffing is a perennial issue within health care and one of our greatest pain points for our direct care nurses and for all nurses,” she said.

Members of the Health Care Financial Management Association, the Institute for Health Care Improvement, and the American Organization for Nursing Leadership joined forces to create a think tank to examine nurse staffing solutions that could be implemented over 12 - 18 months.

According to Boston-Leary, the think tank’s recommendations focused on a healthy work environment; diversity, equity, and inclusion; work schedule flexibility; stress injury continuum, which refers to the range of negative consequences from stress exposure; innovative care delivery models; and total compensation.

The Nursing Staffing Task Force, formed by members of the ANA and AACCN to take a look at the issue on a national, policy-focused level, recommended reforming the work environment, developing innovative models for care delivery, establishing staffing standards that ensure quality care, and improving regulatory efficiency, Perkins said.

“I would offer to you that the task force priorities focus on retention. We can’t keep filling up the bathtub, and have the drain clog open,” Perkins said. “These Nursing Staffing Task Force priorities speak to changing the work environment, so that we’re fundamentally altering what I described as why someone becomes a nurse. This is not going to happen hospital by hospital, chief nurse by chief nurse. We need national changes, we need policy changes, we need statewide changes.”

In closing remarks, Mary Etta Mills, ScD, MS ’73, BSN ’71, RN, NEA-BC, FAAN, a retired UMSON professor and a member of the MDAC Planning Committee, thanked speakers for sharing new care models, staffing initiatives, and support services “that will cultivate the preparation and retention of a resilient, skilled, diverse nursing workforce,” she said. “I think we’ve all learned a lot throughout the day and I know we’ll be learning a whole lot more as all these wonderful programs get even more attention, more experience, more evaluation and lead to ever more innovations that will hopefully take us well into the future.”