Episode 8: Is Education the Key to Nurse Retention?

Leigh Steiner:
Welcome to the Vitals and Vision podcast. I’m your host Leigh Steiner, a Partner for Behavioral Health solutions at Relias. Today, we’re here to explore the importance of understanding individual learning styles. Through my work as a stage director, I’ve learned that when you’re coaching actors, they all respond to different things, and the key to a good director is really understanding how you can provide the right environment for an actor to really get that best work out of them, and this concept of course translates to any work setting and the relationships therein.

So, today with the brilliant Lora Sparkman, we’re going to dive into how learning styles and methodologies can really help healthcare workers learn and grow. Lora is a Partner in Acute Solutions at Relias. She provides consulting and thought leadership and strategic guidance on the use and optimization of Relias clinical solutions related to patient safety and creating reliability in some of the highest risk areas in healthcare obstetrics and emergency department care, as well as other clinical areas.

And among her other gifts, Lora is a nurse, and we know that when a nurse feels that leaders are invested in them and listen to them, they feel more connected to their organization. Welcome, Lora.

Lora Sparkman:
Thank you. Glad to be here.

Leigh Steiner:
So we’re going to dive into innovations in training and learning shortly. But first of all, I’d like to talk with you about, or I’d like you to talk with us about one of your areas of expertise, and that is maternal mortality. Because it’s always a big issue, but it’s even a bigger issue right now. Talk with us just a little bit about how that issue became important to you and maybe a little bit about some of the work that you do in that area.

Lora Sparkman:
Absolutely, thank you. Yeah, it’s maternal mortality, obviously, it’s a national focus, it’s top of mind all the way up to the Biden-Harris administration and Medicaid and CMS and HHS, et cetera, about how are we going to improve our maternal mortality rate compared to others in the world. And the U.S. has one of the worst rates. So obviously, I just being a mother myself, having family involved in that. I mean, my background in the work that I have done historically over the years has not always just been focused on OB and improving outcomes, but rather focused on how do we transform care across the acute care enterprise to improve outcomes for the patients that we serve. And OB is just very interesting to me because I am a mother, I have lots of sisters and friends who’ve all had children and I had a little stint in my career where I actually worked for a managed Medicaid, HMO, a managed care company, and we started a Medicaid managed care.

And for the first time, I really, got up close and personal to the Medicaid population and what it meant to moms struggling without the necessary resources. I think that many of us take for granted around just even having diapers and formula. And when you struggle socially and then that can affect your behavioral, you know, mental health, and just the factors of where you live. Do you have access to resources and care and even the basics of life: shelter, food, water. When you don’t have that and you’re a new mom, the stress level is just off the charts. So bad things can happen and we’ve got a chronic problem in the U.S. about that.

So that’s why I’m drawn to it, that’s why I’m very passionate about that work. But I’ve spent a big portion of my career focused on how do you influence behavior change at the bedside with healthcare leaders and what they do to influence behavior change for the best outcomes. That includes using evidence-based guidelines, what are effective education modalities, what’s the right dial of education to motivate the learner, in this case a clinician — think about a nurse or a doctor — what motivates them to stay current, to maintain competency, to even get better even though they’re licensed professionals — nurses and doctors.

You know, we all need a coach. Look at professional athletes. We talk about that comparison all the time. You could be LeBron James, but LeBron James still has coaches. And so that’s what education can be and should be to clinicians. And so those are the things that motivate me. And things I’m most proud of are the fact that I’ve been involved in some amazing projects where we were able to influence behavior change in physicians and nurses and clinical leaders. And it’s led to improved outcomes, reduced mortality and reduced morbidity.

Leigh Steiner:
Well, Lora. You said some fascinating things that really relate to our topic today in the sense of, you know, our focus here is making good things happen. How do you influence behavior change at the bedside? What motivates people to get better in their work and to stay current and how education can be a coach. So, let’s jump into your work right now with Relias in using virtual reality as a part of training and what value you think that brings to the field and how that does influence behavior change at the bedside.

Lora Sparkman:
Yeah, it’s really been an interesting journey. And I think early in my career, when I was leading patient safety improvement and high reliability, one of the things, and you go through this process of really trying to understand the problem that you’re trying to solve, and what are some of the potential solutions on how to address that. So imagine a big health system with over 130 hospitals. Each hospital has their own unique culture of how they want to do things.

And when you’re at a big system like Ascension Health or name any one of the large health systems in the country, you need to address the variation in care and variation in practice, and when you start thinking about why variation happens, you start getting to the root of the problem, which is the delivery mode often is at the core root of that, meaning people don’t have the right access to high-quality evidence-based education. But we’re so much more sophisticated, now that we understand learning science, how the brain retains information, how the brain creates long-term memory for retention of information, and we’re honing in on the science of education modalities that are most effective in transferring knowledge to the learner.

And ultimately isn’t that what we’re trying to do? We’re trying to not just check the box, right, and say, oh, you sat through my class for four hours. You’re compliant, you meet our requirement, but how we actually affected behavioral change, or moved knowledge into your conscious and subconscious, that that’s gonna change how you deliver care and you’re gonna get better at doing the things that you need to be doing for your patients. And what we’re learning is that certain education modalities have a much higher success rate of transferring knowledge and critical thinking than other learning modalities, and one of them happens to be VR, virtual reality.

So part of the work that I have been involved in, and again, this has been the culmination of years to this point, is using this notion of a blended learning model and blended learning modalities. And what does that mean? That means… Sometimes there’s a time and a need for classroom-style education. Sometimes there’s a need for, and that’s pedagogy, right? But andragogy, adult learning science, and the things that relate to the adult learner, I mean, it needs to matter to their role. It needs to be directly speaking to what they do in their role and how do they get better.

There is a compliance piece to it, but this is really about transferring the important piece of information and then that you hope it stays and retains. So the roots of that were in simulation training. We learned that even in other industries like the airline industry and early in the medical industry and now in almost every other industry there are simulations where the individual participates in a scenario and by doing that you actually have a visceral emotional reaction to that learning environment and those are the type of things, those salient points that create that memory and longer lasting retention of information.

Fast forward to today, where VR, virtual reality, is moving just out of the gaming world. All of our kids and even some adults are playing virtual reality games and environments. But now it’s becoming very topical in healthcare and we’re exploring the ways to identify what type of education would be good for VR and healthcare. And that’s part of the work that we’re doing today.

Leigh Steiner:
So Lora, wow. What you’ve just shared with us about using a blended learning modality and take a topical matter and walk us through what a state-of-the-art intervention might be that a hospital or a clinic or whoever would use in terms of using a blended learning modality.

Lora Sparkman:
In my experience and the work that I was involved in, a blended learning modality is creating some boundaries and some goals around reducing variation and creating some level of standardization and expectation around improvement. What are your goals? We want to reduce mortality. We want to reduce infections. We want to reduce morbidity. Those, and we want to standardize education because it’s more efficient and effective. It’s going to save the health system hundreds of thousands of dollars by creating that standardization if you will.

In the research that we’ve done, that immersive learning is one of the most effective learning modalities, and that includes assessment-based learning, personalized learning, simulation-type learning, and VR is part of that simulation learning modality. And so it takes it to a very personal level because you as an individual, as an example, have to immerse yourself in this virtual environment and work through clinical scenarios that emulate everyday practice. And that creates… you having to think through and engage with that environment and that clinical scenario to do well in the program, if you will, if you’re getting scored as an example.

And we’re trying to measure your compliance to a protocol, like hand washing as an example, or inserting an IV without spreading microbials on the patient or on other equipment. So again, I go back to the fact that we’re taught these basic things in our school. I’m a nurse, I worked in some very intense clinical settings and then moved over to the administrative side and been doing this kind of business side of healthcare because I’m very interested in improving, you know, education and improving the clinician at the bedside so they can be the best that they can be. But we’ve got to create that technology in order to help our, you know, fellow coworkers have access to that type of education and training. And so VR, I mean, one of the other issues we’re dealing with, you were talking about nurse retention, right? And that’s kind of this whole series.

That’s obviously a big rock we’re trying to move and improve in healthcare today. How do you, if you go back to kind of one of the original concepts that we were talking about early, which is how do you get a clinician to be competent and maintain their competency? And do it in a way that’s engaging and isn’t considered a burden or something I have to do for my job because we know as an adult learner — and I’ve been a nurse in this environment — that’s not engaging. It makes me not want to do education and training. And so time is a factor, engaging with modalities that help me learn and respect my time — that’s what I’m interested in and that’s the connection to virtual learning. Some of the other, this is really new, that early indications are already pointing to — and you alluded to this I think in your opening comments — that there is lots of work happening right now at the nurse leadership level on how do you retain and still maintain a competent nursing workforce?

And it’s actually just not nurses, right? But for the sake of this conversation, we’ll focus on nurses. It’s other clinical professionals as well, other health care workers where there are shortages. But for nurses and retention, when you, when the nurse, feels that they are listened to, that they’re part of the solution, you invest in their professional development, their growth, and you help them assure that they are competent, they are engaged, they… joy returns back to their professional desires and how they connect with their patients. And they’re less likely to leave the organization when you are hitting those levers with nurses. So there’s a lot more science and a lot more strategies out there that hospitals are working on towards effective strategies to retain nurses.

One of the things that Relias, as an education leader in this country, is focused on is to make sure that, we’re bringing science-based, evidence-based, solutions and education modalities that help these clinicians be the best that they can be and help the health systems make sure that their workforce is competent and ready to take on the challenges of really complex patient care.

Leigh Steiner:
Talking to your colleagues, what are they telling us right now about how they are being taught, about what they learn, and how that affects their allegiance to the organization, to the work, and therefore the likelihood that they are to be retained within that workforce?

Lora Sparkman:
I’ve been doing this work a long time, influencing behavior change, and I’ve learned a lot along the way around models that work. And I would advise bigger panels and bigger input sources to help feed into potential solutions. I would never just go buy a solution without having my team test and give me a view that I may be blinded by or just don’t see how it applies to a particular workforce, or a job task or a skill set or competency and I would make sure that I’m looking to incorporate that, I mean some of this, you know, assessment-based learning we know is effective.

That’s an immersive learning tool and I’ve been promoting and I’ve utilized a lot of simulation modalities in my career, and I, physicians and nurses alike, far prefer that type of education experience than what we traditionally fall to, which is classroom-style learning, flat file, education learning, e-learning. I mean, they, you know, we are a technology-forward world.

Healthcare tends to be a little bit of a laggard in that space. It takes a lot of time to get to change management and adoption of new practice sometimes. But I think the future actually looks brighter around delivering innovative education tools like virtual reality. And more common use of personalized assessment-based learning and better understanding the appropriate time and use of pedagogical type learnings, classroom style learning. Push, you know, sometimes that’s still important, but it needs to be super interactive and to maintain and hold engagement of the adult brain. And so those are the facts that we know and so we just have to make sure we’re starting to incorporate those into our learning models going forward.

I think those type of initiatives and that type of progress of implementing those educational strategies and engagement of your workforce is going to really affect a clinician’s decision to say, yeah, I really like my job. I feel important here. I feel heard. I feel invested in. We’re using, my leadership cares about making sure I’m successful and my organization is successful. The grass is not greener on the other side. I’m not gonna leave. Those are ultimately the goals we wanna try to achieve, but I think that that’s where we’re headed as a education industry and healthcare.

Leigh Steiner:
Yeah, yeah, and you just summarized there beautifully, sort of the literature on what we know about retention. What we know about that retains people in the workforce — that my leadership that I care about what I’m doing I’m invested in my work. I believe in my work, my leadership cares about me and my performance, and I have access to the kind of tools that I need in order to perform at my best. And that’s pretty much, I think, what we’ve been talking about here.

Lora Sparkman:
I’m a nurse, and I think that back in the day, you know, when I was a young nurse, it was more challenging to get a job in healthcare back then and you know, there’s a big opportunity to fill the gaps in with nursing. And so nurses in some ways, I want to say, nurse, nursing has been empowered and in many ways I think nurses look at hospitals as a commodity, that if I don’t get what I want out of hospital A, I can just go over to hospital B and they’re gonna accommodate me in ways, in meeting the needs and things that I need to be my best self as a nurse.

And so I think that’s a good thing for the profession of nursing to make sure that they’re voicing and… speaking up and out about what they need in order to be an effective and safe care provider. And that includes all the things that we talked about. And hospitals are now being held responsible, healthcare leaders being responsible for meeting these individual needs where before nobody ever asked my opinion about what kind of what I prefer, you know, and so, but that’s a different time, right? So I think we’re just, we’re also, time is evolving, technology is evolving, the demands of the profession and the field are evolving. It’s a very tough environment.

So I think leaders are actually very astute and aware that they need, they’re approaching this issue on retention very differently than they did 10 years ago. And I think we’re going to see more advancements and more tools that make it easier for them to meet the needs of their workforce.

Leigh Steiner:
As we bring this focus to a close today, what else do you want to leave the listener with? What is… the most important thing about this topic that we want to leave the listener with and to challenge the listener with today.

Lora Sparkman:
Good question, Leigh. I think it’s because I’m an older nurse and I’ve seen the profession evolve and so I kind of have a daughter who’s a young nurse. And I’ve seen the challenges that she’s gone through and the highs and lows and so some of my advice to her has always been when she’s just like, you know, nursing is really tough, and my hospital does this, or it didn’t do that. You know, at the end of the day, I’m just like, you know, hang in there. Change is coming. Um, and, and it has, it’s, um, I mean, she’s getting education resources. She’s being involved in ways that she never was before. She’s getting paid more for, um, her skills cut and her education. And all the things that we talked about, which is investment. in nursing as a profession and making that a priority. I think that’s something I am really proud to see over time, how nursing as a profession has evolved. And I try to put myself sometimes in the shoes of a nurse today.

And in some ways, I’m like, I don’t know if I could do that job today because it’s challenging and I think we’ve become, I’m obviously very educated and an expert in this space and would have to somewhat demand certain things in order for me to be optimized in my profession and that’s bringing me these tools that I need to be my best. So, if I think about it from that perspective, I’m cheering for hospital leaders to continue to lead change and be progressive. That’s really what I’m cheering for.

Leigh Steiner:
Yes, yes. Well, I love being with you because I always feel your committed passion to making healthcare a better place and helping us focus with rigor, scientific rigor, on what are we trying to affect here? How do you improve care at the bedside or and how do how do we make that better, and that you are a committed, passionate human being about that. Yes, Lora Sparkman, who has this spark that has inspired her and always inspires me when we have a conversation.

Lora Sparkman:
Well, thank you, Lee. You always make me smile. And it’s just such a joy to spend time with you anytime. So, thank you.

Leigh Steiner:
Thank you for listening to this episode of Vitals and Vision. We hope that our discussion on the connections between education, high competency, and retention has sparked curiosity and encouraged further exploration. Remember success starts with a clear vision and vital strategies. We look forward to having you join us on our future episodes.