Monday, October 1, 2012

Shortage of U.S. Doctors


Today I read an article on the Bloomberg Business Week, Politics & Policy website regarding the looming shortage of U.S. doctors by Alex Wayne. Mr. Wayne did a great job relating to his readers a real challenge ahead of us. In 2014, approximately 30 million new covered lives will be seeking medical care and who will actually take care of these new patients? We already have an issue with access to primary care in certain areas and it is largely due to the shortage of licensed independent practitioners (Physicians, Advance Practice Registered Nurses (APRNs)). Imagine what an increase of 30 million lives will do to us. It does not take an economist to quickly realize that the law of supply and demand here would alert us that we are facing a major crisis.

Sometimes what upsets me the most are the comments made by the readers. Have you noticed that for the most part, very few readers actually offer a solution? In fact, it’s all about a political rhetoric and pointing fingers at each other. Let’s forget the political polarization if you will for a second and think about the issue and not our political alliance. I feel better now, since I have said it.

The real purpose of my blog today was to offer a partial solution for a change. As a member of the healthcare team I am very worried about the increase in 30 million more lives to cover and the shortage of primary care physicians. Many new covered lives will be looking for a licensed practitioner for an annual physical and preventive care. I believe that the States should eliminate the barriers to practice for all APRNs and allow them to practice to the full extend of their training. By doing so Americans would have access to safe, evidence-based, affordable and efficient preventive care, which has been shown to be extremely beneficial in many studies. I urge all readers to familiarize themselves with a landmark report offered by the Institute of Medicine (IOM) on the Future of Nursing.

Will my proposed solution completely solve our problem? NO, it will not. I am certain of one thing, this kind of State reform is worth investing in.

Dr. Syl

Thursday, June 28, 2012

Breaking News: Affordable Care Act Upheld


Breaking news on June 28th 2012. The Supreme Court has upheld the Affordable Care Act (ACA). Some will agree and others will disagree about the decision. The decision has been made and as they say “the train has definitely left the station”. Now what? There is a lot of work ahead of us for sure. Here is a scary thought for me. In a previous post I wrote “By 2014, an estimated additional 32 million United States (U.S.) citizens will have access to health insurance, either from a private insurer or Medicaid, regardless of pre-existing conditions”. This represents a significant increase in potential consumers seeking healthcare. I am not convinced that we have the proper infrastructure to properly care for everyone. Do not misinterpret this statement that we should not offer care for everyone. My statement is not meant to be perceived from a political perspective but rather from the eyes of a nursing leader / hospital operator. I urge all nursing leaders to revisit their current model of care to ensure we are up to the challenge ahead of us. As more people will have access care in your respective institution, do we have the right quantity of nurses to meet the demand? Is the current workforce ready and prepared for the increase in demand?

I foresee a greater need to ensure Advanced Practice Registered Nurses (APRNs) are able to practice to the full extent of their education and training. This will require for many States to remove the barriers currently in place. In 2010, The Institute of Medicine offered a report on the Future of Nursing outlining a road map to remove those barriers. The Center for Medicare and Medicaid Services has already done their part by amending one of the conditions of participation allowing APRN’s to be eligible for clinical privileges, and membership of the medical staff. All nursing leaders should educate their respective colleagues to ensure the proper medical bylaws are amended (when needed) to reflect this important change. Now we need to ensure that every State Legislators work at revisiting their respective scope of practice for APRN’s to conform to the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administration Rules (Article XVIII, Chapter 18). We need our APRNs now more then ever and everyone deserve access to the excellent care they deliver.

Dr. Syl

Wednesday, May 16, 2012

Nursing Shortage vs. a Surplus of New Graduate Nurses: Simple Advice for New Graduate Nurses




Depending on what you read and where you are located in the country you may hear about the nursing shortage and at the same time the surplus of new graduate nurses. That seems hard to understand and counter intuitive at face value. According to the Bureau of Labor Statistics’ Employment Projections 2010-2020 there will be 1.2 million job opening for nurses by 2020. Meanwhile, the current state of the economy and the reluctance for baby-boomer to retire are all potential factors creating a pseudo-sense that the shortage of nurses is not a true statement. The California Institute for Nursing conducted a survey in 2011 among new graduate nurses (N=1492) and concluded that 43% of new graduate nurses were unable a suitable nursing jobs within 18 months of graduation. Of those who could not find a nursing position, 42% stated they could not because a bachelor’s degree was preferred.

So what is it, a shortage or a surplus? From my perspective I would say that we have a national shortage and regional surplus. This is what I would say to you if you aspire to be a registered nurse.


  • Nursing is a wonderful profession where you will be able to make a difference in the live of others.
  • Obtain at minimum a bachelors degree in nursing so you can be better prepared to meet the needs of your patients and a make a significant difference in patient outcomes.
  • Be prepared to relocate where your profession needs you.
  • You may very well have to work various shifts, weekends and holidays. Remember that this is a 24 hours, seven days per week operation.
  • Upon graduation be sure to find a hospital that will offer you a residency program for your transition into practice. Do not settle for less.
  • Identify a mentor that will help you transition into practice and grow professionally.

Monday, May 14, 2012

Strengths Based Leadership: Book Summary


As a nurse leader I had the privilege to read many books. Today I opted to share with you a book summary of one of my favorite leadership book: Strengths Based Leadership: Book Summary
In this book, the authors reveal the results of more than 20,000 in-depth interviews with leaders and more than 10,000 followers around the world to ask why they followed the most important leader in their life. Three key findings emerged from the research that preceded this book. First, the most effective leaders are always investing in strengths, second, they surround themselves with the right people and maximize their team and third they understand their followers’ needs. In part one of three, Rath and Conchie speak to the importance of investing in your strengths, a long term investment. In fact, they report that people who are cognizant of their strengths and build self-confidence at a young age “reap a cumulative advantage that continues to grow over a lifetime” (Rath & Conchie, 2009, p. 16). I believe this to be of great significance for nursing leaders. Hospitals are a very complex organization and the only way nurses can lead a successful organization is to ensure they surround themselves with the proper talent. I never understood why the entire human resources process and yearly evaluation processes focused on weaknesses. It appeared to be counter-productive to me and now I have found the proper resources to change and influence our practice. In fact, I believe this to be a major common concern that many are facing today that has to be addressed.
In the second part of the book, Rath and Conchie discuss the importance of maximizing a team composed of a broad grouping of strengths including four domains of leadership: executing, influencing, relationship building and strategic thinking. In other words it serves a team well to have representation of all four domains on any team. Typically leaders with dominant strength in the executing domain get the job done, those with a dominant strength in the influencing domain are always selling the team’s idea, those with a dominant strength in the relationship building domain have a unique ability to create organizations that are greater than the sum of their parts and lastly those with dominant strengths in the strategic thinking domain continually stretch our thinking way into the future. In my opinion in order to meet to needs of our patients today and tomorrow it is crucial to develop nursing leadership teams that include individuals with strengths in all 4 domains. As I reflect on the AONE Nurse Executive competency and guiding principle for future patient care delivery, aging workforce, diversity in health care organizations, and the role of the nurse executive in patient safety, it is evident to me that the only successful CNO will be the CNO who will surround himself or herself with talent from all four domains. This is not a one women or a one man show.
In a third part of the book, Rath and Conchie demonstrate how leaders have utilized their dominant strengths to drive organizational growth. They feature Wendy Kopp, founder and CEO of Teach For America, Simon Cooper, President of The Ritz-Carlton, Mervyn Davies, Chairman of Standard Chartered Bank and Brad Anderson, Chief Executive Officer of Best Buy. As you read the stories of these featured leaders, you realize as a reader how much clarity they have of who they are and who they are not. Once a leader understands the strengths of each team members and how to best leverage those same strengths, the quicker the organization finds its way to success.  Strong teams have the following things in common: conflict does not destroy them because they focus on result, they are able to prioritize what’s best for the organization and move forward, they are as committed to their personal lives as they are to their work, they embrace diversity, and they are a magnet for talent. That alone is enough to make me want to recommend this book to all nursing leaders. This book offers a key to a successful environment.
Why do people follow leaders? Gallup Poll conducted a study including a random sampling of over 10,000 followers over the years. They asked the followers: What leader has the most positive influence in your daily life? Once they identified the leader they asked this follow-up question: Now list three words that best describe what this person contributes to your life. Rath and Conchie reported that what they found is that followers have essentially four basic needs: trust, compassion, stability and hope. A serious breach in trust can destroy a leader and employees are much more engaged when they trust their leaders. Employees who feel compassion at work are significantly more likely to stay with their employer, have much more engaged customers, are more productive and they produce more profitability for the organization. Employees have a need to know that a leaders core values are stable. In addition, when employees have confidence in the financial stability of an organization, they are nine times as likely to be engaged in their job as compared to those with low confidence in the financial stability of their organization. Lastly hope gives followers something to look forward to and will act as a powerful motivator for followers.
“The most effective leaders know better than to try to be someone they are not. Whenever they spot an opportunity, they reinvest in their strengths” (Rath & Conchie, 2009, p. 93). In today’s fast-paced healthcare environment characterized by financial instability, an aging workforce and an increase acuity in the patients we serve, nursing leaders must: know their strengths, leverage them, and build a team of leaders that will possess strengths from all four domains to ensure they achieve all organizational goals.

Rath, T., Conchie, B. (2009). Strenghts based leadership; Great leaders, teams, and why people follow. New-York: New-York. Gallup Press.

Saturday, May 5, 2012

Nurses Week 2012 (May 6th - 12th)

Happy Nurses Week 2012 This year, nurse’s week is celebrated from May 6th to 12th. It’s hard to believe that I have been a nurse now for over 22 years. The most important part is that I have loved every minute of it. I decided to be a nurse because I wanted to make a difference in the life of others. As an emergency department registered nurse I contributed in maintaining and sometimes even saving lives. As a nurse leader I have influenced the practice of nursing and contributed to the wellbeing and development of bedside and nursing leaders alike.

I am very proud to be part of this incredible profession. During this week of celebration, I wish all my fellow nurses a wonderful week of celebration. Celebrate the difference you have made in the life of so many people in time of needs. Take the time to encourage others to join our profession. As equally important revisit the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) landmark report on the Future of Nursing. The report includes four key messages:

• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.
• Effective workforce planning and policy making require better data collection and an improved information infrastructure.

As you revisit the report what actions will you take to ensure a bright future for our profession? How can you make a difference and implement any of the key messages listed above? Thank you to all the nurses. If you know a nurse, share this link with them and remember to thank them for his or her contribution in improving the health of the world.

Dr. Syl Trepanier, RN, DNP, CENP
Doctor in Nursing Practice / Executive Leadership

Monday, January 2, 2012

Justifying Investment in a New Graduate RN Residency During a Tough Economy

Dear colleagues and Followers,

In October 2010, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) report, The Future of Nursing: Leading Change, Advancing Health, highlighted an urgent need for RN transition-to-practice residencies. However, justifying an investment in a new graduate RN residency remains a necessary business requirement in today’s tough economic climate.

I was recently asked to offer a free webinar on this topic and I have posted below the information should you wish to attend. Please feel free to share this information to any heatlhcare leaders as you see fit.

"During this free 90-minute webinar, you will have the opportunity to hear from two national authorities on the topic of investment justification. First, Sylvain Trepanier, DNP, RN, CENP, the Regional Senior Director of Patient Care Services for Tenet Healthcare Corporation, will discuss how a multi-hospital, for-profit publicly traded healthcare company justified the importance of investing in new graduate nurses’ onboarding. This ROI model can be directly applied to either profit and not-for-profit healthcare systems or standalone hospitals. Since 2006, Tenet has graduated over 1,000 new graduate RNs via the Versant® RN Residency".

You may access the registration by following this link: www.conferenceplus.com/confcenter/PinCode/Pin_Code.aspx?100185&o=UOcmaatQLRMGma or visit www.tenetnurse.com

I wish you and yours and Happy New Year!