After managing a yearslong, unprecedented pandemic, hospitals are still facing challenges like reduced staffing and how to keep workers safe. We check in with Cheryl Nester Wolfe, the president and CEO of Salem Health Hospitals and Clinics. She joins us with more on how the health system is faring and what’s top of mind for health care leaders in Oregon.
Note: This transcript was computer generated and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. We start today with the Salem Hospital. With 644 beds, it’s the largest hospital in Oregon, with the busiest emergency department in the Northwest. The years-long COVID emergency for hospitals is over. But between staffing and safety, it remains a challenging time in health care. Cheryl Nester Wolfe is the president and CEO of Salem Health Hospitals and Clinics. She joins us now. Welcome to Think Out Loud.
Cheryl Nester Wolfe: Thank you, Dave. Good afternoon.
Miller: Good afternoon to you. How would you describe the role that Salem Health plays in the region?
Nester Wolfe: Well, as you indicated, we have the largest single hospital in Oregon with 644 beds. We have a 25 bed, small hospital in the neighboring Polk County. So we service that community along with multiple clinics, urgent cares, that service both Marion and Polk County, about a half a million people that we take care of. The vast majority of those patients, because we offer extensive services here, and then we’re also a Trauma II designated trauma center. And so again, we see patients from all over this part of the state to the coast, taking care of those patients. So, pretty large geography and a large number of people for a single, large hospital to take care of. So again, just a large population, one large hospital, that we service the vast majority of the needs of the communities.
Miller: One hospital for a large area, and that’s how you get the really remarkable stat that it’s the busiest ER in the Northwest, busier than hospitals in Seattle or Portland?
Nester Wolfe: Yes. And so where you have multiple hospitals, they have a larger population. So if you look at the total number of visits and all those hospitals, they certainly have more visits than we do. But as a single hospital, we’re taking care of roughly a half a million people and see over 100,000 visits a year in our one emergency room. That’s correct.
Miller: What was staffing like before the pandemic? I mean, if we had talked in 2019, would you have said everything is fine?
Nester Wolfe: No, I wouldn’t have said everything was fine. I think the pandemic clouded the fact that we were in a shortage before the pandemic occurred. Many of the baby boomers are retiring. That was a phenomenon going on beforehand. We were actively recruiting and hiring staff. But the biggest difference that we saw between that [in] 2019 to 2021 and into 2023, is the number of contract staff that we had to bring in because of the increase in the number of people that we were seeing that were in the hospital, during that time and just trying to keep up with that to make sure we could take care of our community. So the big difference, no contract labor in 2019, 320 contracts - this is for nurses, registered nurses - throughout the pandemic. And currently we’re at about 100, as we have been able to mitigate and continue to hire people to fill our positions.
Miller: So you still have 100 contracts, meaning not on staff, but say traveling nurses or people who are hired for some short period of time. You still have 100, whereas you had zero before the pandemic?
Nester Wolfe: That’s right. And in between, 320 was our maximum number that we had. And again, partially because of the shortage that was already there. The second piece is just the increase in the number of patients and the capacity issues that we experience, specifically the last two years, during all the surges we had, and then problems getting patients out of the hospital to a safe level of care. So we were holding a lot more patients, that we needed to take care of them because they were with us. So that 320 traveling nurse number has now, we’ve been able to hire and to move ourselves to about 100. Our goal is to be back at zero.
Miller: To do that, will it mean hiring more full time staff nurses?
Nester Wolfe: Yes. And full time, part time. Also, nurses, like everybody else, have their particular lifestyles and how they choose to work, so it’s both. 100 is really what we call a full-time equivalent. So that is a full time person, but you may have hired two people that want to work part time to fill one of those full time positions. In 2022, as an example, in total for our organization of about 5,000 people, we hired 1,100, and 300 of those were nurses that we hired.
Miller: Wait, last year, you had 5,000 total employees in the entire health system and one out of five of them were hired in a single year?
Nester Wolfe: That’s correct. Yeah, again, that attrition that happened, the disruption of COVID to people’s lives, having to stay home with their children more, early retirement, people that maybe weren’t planning on retiring. We actually saw a huge increase in retirements in 2021. And so that gap just kept getting larger. So we lost, essentially… it’s loss, and also then what you’re making up for in terms of the increased busyness that you have, in the number of people you’re taking care of. We had to, we had to really hire to that level, a higher level than we’d ever had to hire before. About 1,100 people. So, yes, one in five.
Miller: I just, I imagine the HR department running around, like, I don’t know, like cartoon animals.
Nester Wolfe: Oh, it was pretty impressive, quite frankly, that my HR team was able to really hone in on what the critical needs are. We developed lots of different ways to bring people into the organization and we tried to really focus our HR staff on what we consider to be the most critical patient care positions, so that we could really expedite and get people through. But yes, they’ve been an incredible asset. I mean, I think people forget in a hospital, you think about nurses and doctors, obviously incredibly important, but all of our support teams were equally as stressed in…
Miller: Physical therapists, and pulmonary people and people who are coming to clean rooms and cook food and do everything.
Nester Wolfe: That’s right.
Miller: I’m wondering how you maintain the culture of an organization when there is that much turnover?
Nester Wolfe: Yeah, I think, pretty impressive. We have a particular approach to the culture. And we use, not to bog you down too much of this, but we use the Lane Management System in our organization in how we think and how we work on our culture. It’s constantly being reinforced. Our staff are very participative. We worked with all of our contract staff coming in to make sure they understood the culture and the expectations but yes, it was an all hands on deck to maintain the culture. It actually improved, I would say we’ve even improved the culture as we normally did before the pandemic. So, the culture keeps improving there.
Miller: It’s one thing to get closer to a sustainable staffing level. But how are you thinking about actually retaining those employees, so you don’t have to go through all this again next year?
Nester Wolfe: Actually, I would say again, we’re very deliberate about that. Obviously, it’s very important to keep your staff during the pandemic with all the downturn in hospital finances. And even of course, what we’re dealing with today. We made a decision, or I made a decision, that we would not lay anybody off. So we absorbed the reduction in revenue and the expense of staff and kept our great staff with us throughout the entire pandemic and again till today, so we haven’t laid anybody off during this entire period of time. We worked very hard with our staff before the pandemic on resiliency. It’s a big problem, in health care in particular, in terms of just the continuous trauma of working with really sick people and what that creates. So a lot of work to really strengthen people’s ability to be resilient. And that really got us pretty far through the pandemic.
What we experienced though, about halfway through those two years, is that we needed to do more. So we added resiliency advocates to each of our teams. And what those individuals do is they become part of that team. They don’t do patient care, they do staff care. So they’re there to help the staff, they’re there to hear about their concerns. They’re just part of the team, but their particular role is to make sure that we’re taking great care of our people. Again, extending their resiliency and obviously their ability to serve and continue with their passion with patient care. So that’s one of the newer things that we put in a couple of years ago that’s been really helpful.
And the other thing that people don’t talk a lot about in our industry is the harmful words and actions that patients or visitors may enact on our staff and how debilitating that is for our staff over time. And so we launched an initiative about a year ago of how we’re gonna handle any of those situations and working with our staff to create the systems of support and give them the right tools to take care of these issues when they arise in their department. So that’s just two examples. But yes, retention is top of mind because it doesn’t do you a lot of good to just have a revolving door of staff, from a culture of care perspective and it’s just not the right thing to do.
Miller: You mentioned harmful words and actions. I have to ask you about a very high profile incident that happened recently in terms of employee safety. As many of our listeners are probably aware of at this point, a security guard was shot and killed at Legacy Good Samaritan Medical Center in Portland, recently. Another employee was shot and according to the hospital is recovering. What went through your mind when you heard about that?
Nester Wolfe: Complete horror, sadness. I have to say our hearts go out to the Legacy family. We made that message out to our staff immediately and we have been doing a lot of work because we are seeing more violence. It’s just a reality of what we’re seeing, and much more than what we saw before the pandemic, but we’ve been doing a lot of work, whether it’s technology or hiring additional people in our security force. I’ve met with security this week to kind of check with them about what additional things we should do. We’ve got a lot of work we’re continuing to do and got some great suggestions from them on things that they believe will make them safer and our staff and patients safer.
So just continuing the great work we’ve already started, but also just making sure that we’ve heard from the people that are actually doing the work about what they think would improve our safety on the campus. But yeah, that’s obviously been a high topic of concern and discussion on our campus this week.
Miller: I wanna go through some specifics that I saw. The Oregon Nurses Association put out a statement after the shooting, calling for a whole series of safety measures at hospitals including making sure all patients and visitors go through a metal detector that is staffed at all times, ensuring that there is sufficient security staff for coverage in all areas of hospitals, as well as a zero tolerance policy when people make threats. Is all of that currently in place in your facilities?
Nester Wolfe: So we have a metal detector that we use. Again, we have those 100,000 people coming through our emergency room every year. So it is staffed, and manned, we don’t have any gaps in that. And so we do that 24/7. On the night shift, everybody goes through that same entrance in order to gain access to any of our buildings. And so everybody goes through that screening and what we’re looking at now is what else do we need to do to make it safe? Because like a lot of organizations, our hospitals, our buildings are separate, it’s not one building. And so how else do we make it safe for patients and visitors? And so that’s one of the measures.
Yes, in fact, we do have the metal detector and we are thinking about whether or not…what else to do, what the security people call ‘harden the environment,’ and it could be as much as making everybody go through that system regardless of what building they’re going to. So I have a team working on that right now.
Miller: Turning back to questions of staffing, what would the new nurse staffing law, which mandates minimum nurse-patient staffing ratios, mean for you if the governor does sign it?
Nester Wolfe: So, from my perspective, we are part of the hospital association. We were at the table with labor, not just the ONA, because this was a labor initiative, discussing how we would implement this and we supported the legislation. So we know it’s on the governor’s desk now and certainly are waiting for her signature on that. In our hospital, in particular, assessing the impact - and again, it’s a hospital staffing bill, it’s not just a nursing staffing bill - we believe that we have some additional work to do to have additional staffing, especially around meals and breaks. But that, by and large, we already meet those ratios, those nursing mandated ratios, for the majority of our units. So there’s some work there, but we’re, individually as an organization, I’m not speaking for all the hospitals in Oregon, we feel like we’re in pretty good shape.
We have a very high functioning nurse staffing committee that’s been in place for a long time. And part of the work is to establish these other committees, for the other staff in the organization and go through that process that we’ve been doing with nursing for a long time. But overall, it’ll add some hiring needs to our organization. But overall, we are in pretty good shape for this initiation. So we were supportive of it and we feel very confident that we’ll be in compliance with the law.
Miller: Cheryl Nester Wolfe, thanks very much for joining us.
Nester Wolfe: Thank you. Have a great day, Dave.
Miller: You too. Cheryl Nester Wolfe is the president and CEO of Salem Health Hospitals and Clinics.
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