Quality Insights Podcast

Taking Healthcare by Storm: Industry Insights with Jennifer Nestor

Dr. Jean Storm

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Jennifer Nestor, Chief Nursing Officer at Mon Health Preston Memorial Hospital.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-PCH-021924-GK

Welcome to Taking Healthcare by Storm, Industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.
 
 In each episode, Quality Insights Medical Director, Dr.
 
 Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.
 
 Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.
 
 Subscribe now, and together, we can take healthcare by storm.
 
 Hello, everyone, and welcome back to Taking Healthcare by Storm.
 
 I am Dr.
 
 Jean Storm, the Medical Director of Quality Insights.
 
 I know we've all heard the term healthcare hero during the pandemic, and maybe some in healthcare, including me, started rolling our eyes when we heard this term.
 
 But I'm going to say that the individual that we have on the podcast today is truly a healthcare hero.
 
 We're joined with Jennifer Nestor, who's the Chief Nursing Officer at Mon Health at Preston Memorial Hospital, and I'm so delighted for her to be joining us today.
 
 Jennifer, thank you for coming on the podcast.
 
 Well, thank you for having me.
 
 Very excited to be here today.
 
 Good.
 
 So I thought we'd start out.
 
 Can you tell us about yourself and your healthcare journey to get where you are now?
 
 Sure.
 
 Sure.
 
 So as you said, I'm Jennifer Nestor and I'm the Chief Nursing Officer at Mon Health Preston Memorial Hospital, which is a critical access hospital in Kingwood, West Virginia.
 
 So, you know, it's really essential that we provide those critical services to this rural area.
 
 Otherwise, people have to drive hours to get somewhere for health care.
 
 So kind of my story of how I ended up here, I grew up in a small town called Yawkey, West Virginia.
 
 Many of people haven't heard of that.
 
 And it's in rural Lincoln County, which is home of Chuck Yeager and just southwest of Charleston.
 
 So when I was deciding my career path, I wanted to major in political science and go to law school.
 
 So I was attending Marshall my first year, and I took an EMT class to volunteer at my local community at Duval Emergency Medical Services.
 
 And I volunteered there for a couple of years.
 
 But once I took that EMT class, I was kind of hooked.
 
 I was hooked on the intricacies of the medical and nursing fields and providing that care, that direct care to patients.
 
 So I found great interest in it.
 
 I changed my majors and was accepted into the BSN program at University of Charleston.
 
 And I graduated there in 1996 and worked as an extern while I was in school at Charleston Area Medical Center at General Division in downtown Charleston.
 
 I worked on the orthopedics and trauma unit and worked there when I graduated until the end of 2000.
 
 And then at that time, I became the director of nursing at Cabell-Hunnington Health Department in Huntington.
 
 And that was a super exciting period of my life.
 
 I worked there nine years.
 
 And so I was there when 9-11 happened and everything that public health went through at that time.
 
 So, you know, we had smallpox vaccinations.
 
 We had emergency preparedness planning.
 
 We had anthrax attacks.
 
 We were investigating strategic national stockpile flu vaccine shortages.
 
 It was just a super exciting time to be in public health.
 
 And I really had a passion for that.
 
 And I was the president of the West Virginia Public Health Association at that time.
 
 So in 2009, my I had some life changes.
 
 I got remarried and I moved to Morgantown in 2009.
 
 And I accepted the position here at Preston Memorial.
 
 And at that time, it was termed the vice president of clinical operations.
 
 It's really the same job.
 
 It's now been changed to a chief nursing officer title.
 
 But still, you know, managing all of the oversight of all the clinical areas of this hospital, because in a small hospital, it's so essential that all the areas interact smoothly and work as one collective interdisciplinary team.
 
 So I oversee, you know, nursing, anesthesia, EDOR, acute care, ICU, radiology, lab, respiratory, physical therapy, and pharmacy.
 
 So it's a pretty lengthy list, but it's a great opportunity because everyone works together.
 
 So we've had a lot of accomplishments since I've been here at Preston Memorial.
 
 We built a new brand new hospital in 2015, and I was the move planner for that.
 
 We became part of Mon Health System.
 
 And now just this, you know, just a little over a year now, we've been part of Vandalia Health System, which now takes up, you know, half the state.
 
 So I also took on a side job because it sounds like I'm really not busy.
 
 But, you know, my background in public health made me want to stay in that arena.
 
 And I still have a lot of contacts in public health, and we lost our diabetic educator in Preston County.
 
 So the administrator of the health department, BJ Davis, reached out to me and asked me if I would become the diabetic educator for Preston County Health Department.
 
 So I took that on part time in 2019, and I still do that today.
 
 And I'll tell you a little bit more about that later.
 
 But, you know, I run the diabetic program here in Preston County, and I'm also currently serving as the president-elect for West Virginia Organization of Nurse Leaders.
 
 Oh, my goodness.
 
 So you've always lived in West Virginia, and it sounds like you are driven and passionate and committed to improving health care in West Virginia.
 
 Yeah, you know, I think the demographics of West Virginia is pretty unique.
 
 And I always say if you took the state and you mashed it flat, it would be huge, right?
 
 But, you know, just because all the roads are up and down, it's hard for patients to get care and get transported places.
 
 So that's kind of our mission here is to provide great quality care close to home, because if it's not close to home, people just aren't going to get the care.
 
 Yes, I agree.
 
 So can you give us a description of a day in the life of a chief nursing officer?
 
 Absolutely.
 
 So, you know, as I mentioned, you know, all the areas report to me.
 
 So I have a pretty diverse span.
 
 And because of that, pretty much anything that breaks down operationally, I end up being involved with.
 
 So my day starts off being just very accessible.
 
 Sometimes I'll restart receiving calls as early as, you know, 630, 7 o'clock when the next shift has come on in the morning.
 
 Sometimes it's an issue.
 
 Sometimes it's a staffing question.
 
 But, you know, I give people my personal cell phone.
 
 You know, I want to be contacted and I want to be there for them when they need me.
 
 So and there's also because we're part of a bigger health system and we really need to integrate provider led care teams so when providers are available is before they start in a clinic or start surgeries for the day.
 
 So sometimes we'll have system meetings that start at 6.30, 7 a.m.
 
 in the morning to get those done with so they can focus on patients later in the day.
 
 So have those early morning appointments, some calls, and then I start driving into the office because I do live in Morgantown, so it takes me about 40 minutes to get here.
 
 So sometimes I'm listening to a WebEx while I'm driving, and then once I get here, I check emails for updates to see if there's anything I missed during the evening hours.
 
 We have a safety call every morning, so one of the administrators, and I take my turn at that, is we hold a daily safety call.
 
 So it's a call where everyone calls in and just reports off department by department so we know if anything is going to be an issue for the day so we can kind of troubleshoot those.
 
 Then it's off to meetings on and off all day.
 
 Some days are better than others, but there's regulatory meetings, nurse governance committees where we give our nurses a say in their practice.
 
 So we have those meetings, strategy, plannings, and that could be for the hospital or the system.
 
 We like to be present for our staff, so we attend staff meetings of departments that report to us or do leader rounding on departments, process improvement, quality projects, operational meetings, meetings with my leaders who report to me so I can give them clear guidance and input.
 
 Then during the day, I round on departments.
 
 I think it's really important to be seen and build that culture in your organization that we're accessible and we're there in this together.
 
 I do a lot of reviewing and revising policies, have a lot of budget reviews, look at operational data, contracts, and then hopefully sometime in that day I can eat, go to the bathroom and stretch.
 
 I mean, you mentioned what I think is really important is that nurses have a say.
 
 And that leads me to my next question.
 
 I know the hospital achieved a fantastic award.
 
 So tell us about the Pathway to Excellence Program for Health, Work, Environment for Nurses.
 
 So you've, you know, most people have heard of its sister component, which is Magnet.
 
 Magnet gets a lot more press, but they're both accreditations that are kind of in the same vein.
 
 They are premier designation by the ANCC, which is the American Nurses Credentialing Center.
 
 And it's for organizations that demonstrate a commitment to a healthy work environment and positive culture.
 
 So there's a book, and you have to speak to all the standards in the book.
 
 And they all fit under like six categories.
 
 So the six categories that are within Pathways is shared decision making that we kind of discussed, nursing leadership, safety, quality, well-being and professional development.
 
 And we're actually one of only two hospitals in the state who have achieved the pathway designation.
 
 And I really think that we are reaping those rewards.
 
 You know, when you engage in quality programs, research tells you that if you do these things, you will achieve these results.
 
 And sometimes that seems so far down the road or far removed that you really don't think that's going to happen.
 
 But I'm telling you, it happened.
 
 It happened this past year.
 
 So because we were working on these things, because we were investing in our staff and committing to building a great culture, we achieved the 94th percentile on our HCAHPS results.
 
 And we reached the 95th percentile in our engagement survey.
 
 Our employee engagement survey that we just had in October, in the clinical areas, there actually were no areas of concern.
 
 And I've never seen that before on an employee engagement survey.
 
 Oh, my goodness.
 
 I mean, that's just amazing.
 
 So when you think about the pandemic, obviously, we're all kind of still recovering.
 
 How do you think that it has affected the nursing profession?
 
 Well, first of all, you know, from an administrative level, just the workforce, just having availability.
 
 So, you know, while that's an administrative nightmare, it's a nightmare for nurses.
 
 I mean, when you don't have enough colleagues, enough people to spread the work between, but we are going through very expensive and engaging routes to try to get more staff.
 
 But, you know, some nurses retired during the pandemic.
 
 You know, the physical stress was present during those years.
 
 Some found other professions, they just kind of got burned out on health care.
 
 There's a lot more work from home positions today, and those positions may never come back to the bedside.
 
 So we just lost so many bedside nurses, and we rely heavily on travelers.
 
 You know, I saw peaks in pay for travelers, you know, upwards of $150 an hour, and it's really hard to wind that back down.
 
 It's starting to, you know, the market has decreased and travelers aren't getting paid that today, but it's hard to entice people to take a regular full-time job at the bedside caring for patients when they're used to traveling and getting that high rate of pay.
 
 And, you know, even as a small hospital, we still have somewhere around 10 travelers in our hospital, and for a small facility, that's a lot.
 
 We offer a lot of incentives to recruit and attract nurses, you know, and all the facilities are doing this.
 
 You know, you're looking at high sign-on bonuses, you know, matching referral bonuses if you refer us to hire someone.
 
 We have traveler transition programs so we can kind of move people into more permanent positions.
 
 We have in-house travelers that travel between hospitals, international nurses.
 
 You know, we have a program called Mod Scholars that gives scholarships to people and will pay for your schooling if you'll come to work for us.
 
 But I think really what, you know, the biggest impact on the pandemic was the well-being of nurses.
 
 You know, it brought a spotlight on the fact that nurses and other health care workers really need to focus on their own well-being, you know.
 
 And so we try to provide support.
 
 We have a lot of programs to help staff manage stress, do self-care, self-soothing behaviors, physical well-being, you know, kind of addressing that compassion fatigue.
 
 So we have a lot of like employee assistance programs, webinars, educational series, you know, a lot of people put in place oasis rooms so you could take a break and kind of remove yourself from the stressful environments and, you know, flexible work schedules.
 
 So it really has changed the whole complexion of nursing.
 
 Oh, well, most definitely.
 
 And I think if anything good has come out of the pandemic is that focus on well-being.
 
 Do you see that these incentive programs are, how do you see them impacting the future of the nursing profession?
 
 I guess the question is, you know, will they continue long term?
 
 And I think how the workforce evolves in the next couple of years will tell us that.
 
 I think it's always going to be a desirable profession.
 
 I think enticing people to stay at the bedside and take those shifts because we have to cover all the shifts.
 
 You know, we're really having a hard time getting night shift and weekends.
 
 You know, a lot of people don't want to work nights and weekends.
 
 But, you know, I think we'll keep a lot of these programs.
 
 I think we'll have to continue to become more and more inventive and flexible in making new programs that are attractive to a changing generation.
 
 Yeah, I would agree.
 
 So what advice would you give an individual who's thinking about going into the nursing profession?
 
 So, you know, it's really funny that you should ask because just over the last couple months, I was actually asked this question.
 
 I had a few cousins that reached out to me.
 
 I have some twin girl cousins that are graduating from nursing school later this summer, and I have a cousin who's getting ready to head off to college.
 
 And they were actually asking me these questions.
 
 So I put a call together, we talked.
 
 You know, I would say, you know, look to your passion and what drives you.
 
 You know, what kind of patient population interests you?
 
 You know, do you like organized, regimented environment in the OR?
 
 Do you like the chaos of the emergency department?
 
 Do you like that one-on-one compassionate care of the patient at the bedside?
 
 You know, where are you going to find your joy?
 
 And where do you want to be in five to ten years?
 
 But I told them, you know, that the nursing profession is wide open.
 
 You know, I gave them some tips on their resume.
 
 But honestly, you know, if you're smart, intelligent, if you interview well, you're going to get hired and you're going to probably have a great sign on bonus.
 
 So, you know, I feel like we're in that recovery phase for the hospital setting.
 
 And we're kind of, you know, resetting the new health care norm.
 
 I think, you know, I tell people going into nursing or other professions, you know, study hard, always ask the question, you know.
 
 I would say as I went through my nursing career, I've kind of, and I think that's why I'm in a leadership position is I realized if I sat back and didn't ask the question, I took what was served to me, then I wasn't happy with the end result.
 
 And if you really want to be happy in your career, you know, you have to raise your hand first.
 
 You have to be, don't be afraid to speak up and advocate for your patient.
 
 You know, challenge yourself on maybe what scares you.
 
 You know, if it scares you to take care of an ICU patient, educate yourself on that until it no longer holds that power over you.
 
 So I was a bedside nurse for many years.
 
 I took care of patients.
 
 And so what I do now is I take care of patients by taking care of nurses.
 
 Am I right?
 
 Yes, I would agree.
 
 And this is still an important job.
 
 I guess on that same vein, I know we have a lot of young individuals kind of coming into the nursing profession and they're looking to be leaders.
 
 So what advice would you give an individual, say maybe any individual in leadership looking to create a work culture that nurses want to stay in?
 
 It sounds like you've excelled in that area.
 
 You know, my big word is engagement.
 
 You know, we need you to engage.
 
 You know, we've all probably had jobs at some point in our life where you come in, you do the job, and you go home at the end of the day.
 
 But if you're wanting to grow and expand to become a leader, you know, engage in your profession.
 
 And there's ways to do that from the bedside.
 
 First of all, like I mentioned, we have, like, a shared governance nursing committee where we bring issues to that committee and we solve them together.
 
 You know, it's not just them bringing it to me and I tell them what they're going to do.
 
 You know, we have committees, we have groups, they work on projects.
 
 They do evidence-based practice to find out what's the best way with the best outcomes for our patients.
 
 And then they make their own decisions.
 
 So, you know, get involved in that.
 
 Say, I want to go to a, you know, tell your manager, I want to go sit on this committee.
 
 I want to be a representative for my department.
 
 You know, they can also get engaged in their professional organizations.
 
 As I mentioned, West Virginia Organization of Nurse Leaders is a great organization.
 
 We take students as well.
 
 So if you're just, if you know you want to be a leader one day, and, you know, arguably nursing in and of itself is a leadership role, you know, become engaged in those organizations, attend some conferences, learn how to grow yourself professionally.
 
 And then, you know, one thing that WVONL, which is, you know, is a state organization based on the American Organization of Nurse Leaders, which is the national organization, is political arenas, you know, maybe that scares some nurses.
 
 But, I mean, just voting and maybe even becoming, you know, an advocate for your patients by entering that political arena.
 
 Maybe you want to take an office.
 
 Maybe it's a city, county office.
 
 Maybe it's a delegate for the state.
 
 But, you know, become engaged.
 
 Find out what's out there and how it is affecting nursing.
 
 That's great advice.
 
 So, switching gears a little bit, and I know you mentioned it earlier.
 
 So, tell us about the Diabetic Education and Support Group in partnership with Preston County Health Department, kind of your, another job that you're doing.
 
 So, as I mentioned, it kind of started at the end of 2019.
 
 The important thing that I noticed was we really needed a class schedule that was always at the same time.
 
 Some people don't know how to make an appointment.
 
 They don't know, you know, what they want to talk about.
 
 So, I thought if I gave it structure, you know, it would kind of blossom.
 
 And I think it has.
 
 So, I have a schedule that's on the third Wednesday of every month at 6 p.m.
 
 at the hospital.
 
 So, they don't need an appointment, they don't need to call ahead.
 
 And if something happens and they can't come, it's no problem.
 
 It is completely free and you don't need a physician referral.
 
 So, I maintain that schedule all the time.
 
 I have never canceled a class.
 
 Even when we've had snow, actually we had snow in January, and no one was able to physically come, but I had a couple people join via WebEx.
 
 I offer it on conference caller videos, so if people want to join that way, they can.
 
 And I think it really just kind of streamlines that.
 
 So, I cover a variety of topics.
 
 There are recommended topics through the American Diabetes Association.
 
 So, I cover those topics throughout the course of the year.
 
 So, like one week, it may be about physical activity.
 
 Another week, it may be about managing your carbs, visiting your doctor, how to monitor your glucose.
 
 They may be separate topics, but then we also cover whatever the group wants to talk about.
 
 So, I do a lot of that for the classes, but then I also do some one-on-one.
 
 So, I talk to patients.
 
 We can do phone or in-person meetings, and I kind of do case management.
 
 I kind of evaluate what their needs are on an individual basis, and maybe I consult with their physician.
 
 Maybe I help them with their appointments to see a dietician or a pharmacist.
 
 And then we also partner, you know, with other programs.
 
 Like recently we had, Mon Health System had offered a program called Pharmacy, but it was with an F for farm.
 
 So, it was a grant-funded program.
 
 It targeted diabetic patients, and we met for 15 weeks.
 
 Topics included a variety of diabetes education and healthy cooking.
 
 And then at the end of each class, they took out farm-fresh vegetables that were provided by local farmers, and they were taught how to prepare foods with the vegetables and fruits that they were given.
 
 So, that was really an exciting program.
 
 Oh, that's fantastic.
 
 So, can anyone join this group?
 
 Yes.
 
 So, the group I have, like I said, it's free.
 
 You don't even need to schedule.
 
 And I take everyone.
 
 I mean, there are some people who may be pre-diabetic.
 
 You know, their doctor has told them that, hey, you know, your blood sugars are rising or they seem a little high.
 
 And sometimes, you know, they're just recommending lifestyle changes, but they come to the class and they learn a lot.
 
 So, you know, pre-diabetes, diabetics, you know, and support people.
 
 I've had, you know, they say their husband will come, but the wives will come.
 
 And they're probably the one preparing the meals anyway.
 
 And some people just come and they bring their support person, which is great because, you know, two people hear things differently every time.
 
 Yes.
 
 Oh, absolutely.
 
 So do you think that the pandemic has adversely impacted the health of individuals in West Virginia?
 
 Oh, absolutely.
 
 You know, we didn't, in West Virginia, we didn't have great food choices to begin with.
 
 You know, our culture of eating, you know, has not been great across history.
 
 And so now, you know, people were staying in more.
 
 So when you stay inside for a couple of years and you order a lot of to-go and you don't get a lot of physical activity, you know, and then you think about social activities shutting down and how that has, you know, affected people's mental health as well.
 
 You know, so people are coming in and we see this in our emergency department all the time.
 
 Patients are coming in sicker.
 
 Maybe they haven't kept doctor appointments.
 
 They don't even know what's wrong.
 
 They may have underlying health issues and they are just sicker and really not living a healthy lifestyle.
 
 And you talked a little bit about that pharmacy with an F.
 
 So there's been a lot of work around food deserts, particularly in West Virginia, you know, areas where there are very few or no big grocery stores, so no fresh foods.
 
 Maybe they just have like small little convenience stores, you know, with, you know, maybe a lot of processed foods.
 
 So do you think that these food deserts play a role in chronic disease, such as diabetes in West Virginia?
 
 I think it can.
 
 You know, definitely our transportation system is one of the biggest challenges in West Virginia.
 
 We don't have a lot of public transport.
 
 We have a small bus system here that only runs in certain hours called the Buckweed Express in Preston County.
 
 And that's run through the Senior Center, which is a great service.
 
 But, you know, it is small.
 
 So transport is definitely a big problem, as well as a lot of low-income people.
 
 We do have, we're probably more plentiful when it comes to a lot of people growing their own food.
 
 So there's a lot of farm.
 
 There's a lot of butchers here locally.
 
 So we're kind of rich in that sense.
 
 But what I do see in my patients that come to my diabetes class is a lot of very processed foods because they don't go out to the store all the time.
 
 So they buy packaged processed foods.
 
 And they don't readily identify that.
 
 I think there's a lot of issue with health literacy.
 
 And sometimes we're not all speaking the same language.
 
 You know, I can say processed foods, and they know I'm talking about like, you know, hot dog wieners.
 
 They understand that's processed.
 
 But they don't necessarily understand that like, stovetop stuffing is also very processed.
 
 So, you know, it's kind of that health literacy.
 
 And it's really habit and culture.
 
 And I think it totally affects what we're seeing in West Virginia.
 
 Yeah, we talked, you talked a lot about some challenges.
 
 So what do you think is the biggest challenge you faced in diabetes education?
 
 I do think it's health literacy.
 
 You know, and that doesn't mean that the people aren't intelligent.
 
 Very, very intelligent people still may have low health literacy because they really don't understand how some of the activities or some of the language about how everything affects your health and the impact.
 
 I think there's a lot of cultural and social expectations.
 
 You know, sometimes people don't seek help or go to a class.
 
 You come to a diabetes education and support class.
 
 Some people feel like it's a weakness, you know, that you need support.
 
 I think some of that is starting to change over time, and younger generations are understanding that it's okay to be supportive of each other and accept that help.
 
 But, you know, attendance at my classes are definitely a challenge, and some of that is because of the transport.
 
 And, you know, 6 p.m.
 
 is kind of dark in the winter.
 
 But then, I also try to keep it at that time to make it available for people after work.
 
 So, it is quite a challenge.
 
 There's a lot of challenges.
 
 Yes, uphill battle.
 
 Well, you've shared so much wonderful information today, Jennifer.
 
 One last question.
 
 If you were in charge of healthcare in the United States, what is the first thing you would do?
 
 I think the important thing is to put those healthcare decisions in the hands of the people who understand healthcare.
 
 And that's not necessarily the politicians or the pharmaceutical companies or the insurance companies, but in the physicians and the nurses and the care providers at the bedside who are looking those patients in the eyes and deciding the healthcare needs.
 
 We actually had recently hospital day at the legislature here in West Virginia, and I had went down with some colleagues, and it's great.
 
 You know, our legislators want to know, they want to know these things from the people who are at the bedside.
 
 So, you know, the more we can educate, the better we are.
 
 So if I was in charge of healthcare, you know, I think you have to give that power and control back to the people who make the healthcare decision.
 
 So, you know, reimbursing hospitals for the care that they render, making sure it's enough to cover those rising costs and then helping patients make smarter healthcare decisions and assuring them that they can get the healthcare they need when they need it and supporting those safety net programs and facilities that work to care for the poorest and the most underserved community.
 
 I think we have to start early with kids and their healthcare literacy so we can do better for the next generation.
 
 Absolutely.
 
 That seems like that is wonderful.
 
 We can implement those things.
 
 Jennifer, thank you so much for joining us.
 
 I know you have inspired many individuals out there.
 
 You've inspired me.
 
 Thank you very much for taking time out of your day to join us.
 
 Thank you.
 
 Thank you for having me.
 
 Thank you for tuning in to Taking Healthcare by Storm, Industry Insights with Quality Insights Medical Director, Dr.
 
 Jean Storm.
 
 We hope that you enjoyed this episode.
 
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 So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.