Modern Healthcare reporters delve deeply into industry leaders who stand out and make a difference in their organization or field. We heard from John Nickens, president and chief executive officer of Children’s Hospital New Orleans, about how the organization has responded to staffing needs and the childhood behavioral health crisis.
What are some of the biggest challenges you’re facing right now at Children’s Hospital New Orleans?
If you look at the world today, I think most of the children’s hospitals are having a hard time, and we certainly are having a hard time with staffing. [One problem] We’re nurses, but we’ve had nursing shortages before, and we have creative solutions to that problem, sometimes including tweaking our model of care. This time, [the shortage] including respiratory technicians, laboratory technicians, imaging technicians. One crazy New Orleans story is that, when tourism returned, we opened our own little coffee shop and we couldn’t find a barista to help us.
In Louisiana we had Hurricane Ida [in 2021]. We call that timeframe “COV-Ida” because we are fighting COVID-19, [while] we had a storm with Ida. We have been without power for almost 10 days.
Lately, I think many people have heard about the triple threat of viruses with COVID, RSV, and influenza. Children were really sick. The hospitals are full.
How has the so-called “pandemic trio” affected Children’s Hospital?
In the winter, there’s always the chance that kids with complicated health problems could catch RSV and add some form of shortness of breath or the flu—only really destroying the immune system. But the fact that you have both and COVID, [increases] impact.
We typically see about 200 children in the emergency room every day. We are seeing 400 every day. We’ve never been really 100% full before, and we’ve been many times over the past few months. It forced us to reallocate resources: “Is this the right time to do a surgical procedure or should we wait?” That’s always a concern and creates anxiety because that child clearly needs surgery, but we probably can’t provide that care right now.
How do you navigate capacity issues?
There are all kinds of mechanisms that we talk about often as a children’s hospital group. One of them is that you take your operating rooms and turn them into acute inpatient care rooms. So you can have 10 operating rooms, and then you can have 20 post-operative rooms: You take those and convert them.
We have an on-site emergency center, five floors of doctor’s office clinics, about 80 rooms. We have some creative ideas in the emergency room. We categorize and if you are not in [a certain] illness level, we will bring you to our clinic after 5 hours, when the clinic is closed.
Regarding the epidemic trio, do you see any improvement in the near future?
I don’t think it will improve. We talk to our infectious disease doctors, and they try to use all the preliminary data they have from the Southern Hemisphere to help them understand how flu can spread. As an administrator, I only hesitate when I feel confident that it will get better. Children will return to school. They will spread the flu to each other. It is difficult for people who choose to wear a mask to keep a mask for a child. I think we’ve had a couple of months to navigate through this.
Can you expand on the HR challenges you’re facing at this point?
Booming generation… [made up] a large number of the nurses we see have left the workforce. And then, unfortunately, we don’t see the same number of enrollments in nursing school as we did in previous years. That’s what we feel responsible for [for] and have to keep working. We need to make nursing attractive, but as I mentioned earlier, [the need includes] more than just breastfeeding right now.
In New Orleans, we have been very active in partnering with all of our affiliated schools. The past six months have [seen] our lowest turnover rate since pre-COVID. That gives me some hope.
How many contract workers are you employing for nursing work?
We have about 800 nurses and about 25 contract nurses at the most, a pretty small number compared to our colleagues. But we were very purposeful. We asked many nurses who had left the clinical setting—maybe into a clinical trial in the research world, or maybe they moved into management—we asked them all to come back hospital bed for a period of time to help us out.
How do you stay competitive in terms of compensation and benefits?
Wage inflation is substantial. We are in a competitive environment where we need to pay the nurses or they can take to the streets right away. But we’ve tried to balance that with the types of benefits we offer. Over the past two years, we have opened our own nursery on site and made it available to our employees free of charge. We opened our own gym. We have a dry cleaner—anything you need to make your life a little easier. Our cafe offers take-home meals for the whole family.
