Ep 4 - Perspectives from a lifelong nurse and CNO with Mary Jim Montgomery

Published by Hiro Kawashima on June 13, 2019

This week, our guest is Mary Jim Montgomery. Mary Jim is a lifelong nurse with extensive experience in nursing and operating leadership. She served as the Vice President of Clinical Patient Care Services at Baptist Health System, Chief Operating Officer at Bay Medical Center, Chief Operating and Nursing Officer at Crisp Regional Hospital, and most recently, the Vice President of Patient Care Services at Sacred Heart Health System on the Gulf. 

HIRO: Mary Jim, welcome to our audio blog.

MARY JIM: Thank you I'm happy to be here.

HIRO: Mary Jim, take us through your career from your nursing education to then becoming an operating and nursing executive.

MARY JIM: Oh, that's an interesting landscape. I started working for my father in his office as a teenager learning the nuances of nursing and from there, I had an opportunity to attend the University of Alabama in which I received my bachelor's science degree in nursing. And from there I actually started nursing and moved up through some leadership ranks to Chief Nursing Officer. At that time, I realized that I needed to return to school and was seeking a degree in business. And the purpose for doing that was to be able to have a seat at the table with the board members and to be able to explain nursing in a manner that would relate both to the patient care and also to the business side of healthcare.

HIRO: Got it. You're one of those few nurses that have made that transition to the leadership roles. As you know with CNO’s and Senior VPs of Clinical Care, there are few and far between, so how if any has your perspective on nursing changed as you transitioned from working directly with patients into these leadership roles?

MARY JIM: Well I think it was really important to realize that you have to blend both the business side of healthcare and the compassion, and patient care aspects of it. So, I had the opportunity to really influence not only one patient by taking this road, but also influencing the care given to nurses. So in a sense, I felt like I became the nurse that care for the nurses. And with my degree both in nursing and business, I was able to communicate in a way that would help nurses understand both sides of the business, and I think it better prepared them for the environment that we’ve been through with all of the changes in healthcare and how we have to run more as a business and not just an institution.

HIRO: That's a great point Mary Jim. I think a lot of hospitals talk about the double bottom line: patient outcomes as well as the actual business outcomes. When it comes to patient outcomes what role does optimal unit coverage play either in elevating these types of outcomes or potentially contributing to consequences in these outcomes.

MARY JIM: Well I think it plays a key role. One, you’ve got to have the right staff, the right culture, and the right resources to provide good patient care. So, one of my early focuses in my career was having the right leadership to set in a place a culture that allows nurses and patient care providers to do the best job that they can do. Setting that culture, defining what that looks like and expectations, hiring the right staff that meet and want to achieve those expectations, and then working with them to identify what resources they need. Whether it's the Staffing hours the staffing equipment, all the staffing patterns that might go with that, all those are key to ensuring that you get the right outcome. It’s not one thing that will make you successful because you’ve got to focus on the patient satisfaction, the nurse satisfaction and the quality of care you’re rendering.

HIRO: That’s certainly is important. You just mentioned nurse satisfaction. As you know nursing burnout and nursing retention is a critical issue now in our healthcare system, so similar a question, what role does optimal unit coverage play when it comes to nurse job satisfaction and retention?

MARY JIM: Key to nurse satisfaction is feeling like that you can do a good job. Everybody wants to do a good job. At the end of the day, you want to go home and feel like that you’ve made a different. That’s why nurses go into nursing and healthcare – it is to make a different and to be there for the patients that they serve. And without having the optimal resources, time and energy to put towards taking care of their patients, they often go home feeling dissatisfied and frustrated at the end of the day. And we know that when they go home in that frame of mind, that's when they consider other opportunities. In such a competitive market for nursing and quality nurses, to be able to meet their expectations, [it] is just paramount [to do] the right thing and ensur[e] that you have the right staff to take it to the next level and provide that patient care excellence.

HIRO: I think that’s certainly spot on. What challenges do hospitals face today when trying to achieve optimal unit coverage? Clearly, it's still an issue across the industry. Why do you think that it's such a problem?

MARY JIM: I think recruitment is a problem. Particularly in rural areas, you’re going to have a shortage [in] nursing. You’re going to have a very competitive market. Nurses come out of school and a lot of times they want to go into specialty departments, so Med Surg areas where it is your bread-and-butter, your core business, often is left with minimum staffing or [it is] difficult to fill those positions. I think you’ve got to have recruitment [and] you’ve got to have a culture. We still struggle dealing with change and communication and having the leadership in place that will support nurses to do the right thing and to be in the place at the right time. So, we have a lot of changes going on right now with meeting our quality standards. Years ago, everybody practiced nursing and patient care the way they wanted to. Now we have research that tells us what’s best practice and how we need to approach certain disease. That’s a challenge because nurses feel [that their] independence has been challenged. This conundrum of how to deal with both sides of the equation when you’re working with nurses in this area.

HIRO: I think that’s totally a challenge today that wasn't faced several years back. I guess my final question would be as an operational executive you've really had to look at things like staffing plans and ensuring that you […] had the right number of people, the right people, and the right culture to the serve the patients. When it comes to having and planning for the right number of people what role does forecasting or really mathematical science play into that?

MARY JIM: I think it’s critical because the healthcare landscape is changing constantly. Whether it’s due to changes in market forces, physician practices moving from one hospital to another or one setting to another, there’s just a lot of changes that are going on that you can't be stagnant in the way that you're thinking. And forecasting really helps that you’re able inject those variables into the future [and] into budgeting, and so you have to know what those changes are. Sometimes it requires meeting with the nurses and having focus groups to see what the changes are and even how the practice has changed for treating certain diseases and expectations that we have to meet the quality or the bundles, so to speak, that we have to deal with. All of those things taken into account can make a difference on how we staff and how we need to staff to get the correct outcome and the most desired outcome.

HIRO: Well great. This has been very, very insightful Mary Jim. Thank you for joining us on our audio blog.

Next post: Make-or-buy? Implementing patient demand and nurse staffing predictive analytics

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