Episode 29: Discussing the Critical Demand for Nurses with Kathleen Belmonte, Chief Nursing Officer and Senior Vice President of Clinical Services for Fresenius Kidney Care
Even before the COVID-19 pandemic, the United States was in the midst of a major health care challenge as the demand for nursing and other caregiver roles increased dramatically. Kathleen Belmonte, Chief Nursing Officer and Senior Vice President of Clinical Services for Fresenius Kidney Care joins Field Notes to discuss what is being done to retain and recruit qualified healthcare workers.  

Brad Puffer: Welcome, everyone, to this episode of Field Notes. I’m Brad Puffer on the Medical Office Communications team at Fresenius Medical Care North America and your host for this discussion today. Here we interview the experts, researchers, physicians, and caregivers who bring experienced, compassionate insight into the work we do every day. The United States is in the midst of a major health care challenge as the demand for nursing and other caregiver roles exceeds supply of qualified workers. And the COVID-19 pandemic has not helped as nurses, including those working in kidney care, have reported issues of heightened stress and exhaustion given the unrelenting nature of this pandemic. So, what can be done to ease the burden on nurses while recruiting others to join the profession? We are pleased to welcome Kathleen Belmonte to Field Notes to discuss this important issue. Kathleen is Chief Nursing Officer and Senior Vice President of Clinical Services for Fresenius Kidney Care. Kathleen, welcome to Field Notes.

Kathleen Belmonte: Hey Brad, thanks so much for having me. It's really great to be here.

Brad Puffer: Well, you've had a firsthand seat to the front lines in healthcare these past couple years. What has it been like for nurses over those past years, not just in nephrology, but in healthcare, in general? They truly have been our heroes, haven't they?

Kathleen Belmonte: Yeah, nurses have really been our heroes over the last couple of years, Brad. As you know, the COVID-19 pandemic has been difficult, and nurses are the backbone of the health care delivery systems. While the pandemic has caused this devastating loss of life and has certainly strained the health system, it also has brought into focus, really, the nurse’s pivotal role in health care. And so, as you can imagine, when we talk to our nurses and ask them how they're feeling and what it has been like, they tell us that they're feeling stressed, they're exhausted, they're burnt out. And of course, when we hear our nurses telling us that they're burnt out, we're worried that a consequence of that may be nurses choosing to leave the field, leave the profession.

Brad Puffer: And our nurses certainly have faced a lot of challenges specifically in kidney care to maintain the high quality of care that we expect amidst this pandemic. I assume COVID-19 has also impacted both the demand and the need for these great nurses because the problems with recruiting enough nurses and healthcare workers began even before the pandemic, correct?

Kathleen Belmonte: I would say that. So, pre-COVID-19, there was already a very serious concern as to whether the profession was going to be able to attract enough nurses to care for populations, and that also includes the ESRD population, the CKD population, moving into the future. And so, we were working on a broad strategy to continue to encourage more people entering the healthcare field and specifically nursing. Now, in terms of the pandemic, Brad, I think you are very well versed, as well, that the pandemic has been exceptionally difficult for both our patients and our caregivers. We saw throughout the pandemic that our patients were at a much higher risk for morbidity and mortality, and many patients were hospitalized and died during the COVID-19 pandemic, and so we have had to implement lots and lots of strict infection, infection control policies and procedures, screening processes, COVID-19 testing. We have implemented isolation shifts and isolation clinics and certainly, as we have done all of these things, thinking about our nurses and the need for more nurses to provide care frontline has been front and center. And we know that it's important for us to continue to be able to provide care in these outpatient settings, because we want to make sure we continue to relieve the burden on hospitals, and certainly the burden on nurses who are working in these acute programs.

Brad Puffer: And Kathleen working in that environment for two years definitely is a huge burden for these nurses across the entire country. We've heard of something called the Great Resignation, where people are leaving their careers to do something completely different. And that's having an effect on the entire country, but also in the nursing industry, for sure. So how can companies like ours support our nurses so that doesn't happen?

Kathleen Belmonte: Early in the pandemic, going back two years ago, say, we knew it was really important to support our nurses and thinking about compensation and implementation of things like emergency pay and childcare and eldercare. And these were things at the peak of the pandemic, when there were lots and lots of unknowns. Now, fast forward to where we are today, nearly two years later. Based on a lot of feedback from our nurses and our frontline health care workers, we have pivoted to make sure we are providing support in other ways. So, we have recently rolled out a lot of new benefits and health care options that we hope are going to show our care teams and our nurses just how much they mean to us. So, for example, we've placed a big emphasis on the development of wellness programs that support both the physical and emotional wellbeing of our nurses. And we know the pandemic is not over, you know, 2022 is bound to bring new challenges and new opportunities. And so, how are we building resilience in our frontline health care workers? Helping to achieve work-life balance and supporting a healthy person is very important, as well. So, we have really invested in tools that promote wellness because we believe that mental health is equally as important as physical health, and so, making programs available to help our nurses and other staff members to manage stress and find balance is very important.

Brad Puffer: Well, that’s great Kathleen. Hopefully those investments in wellness programs and in our nurses will pay dividends in helping retain the great nurses we've got. But there's also going to be this ongoing demand that you talked about that started even before the pandemic, where we need more healthcare workers. So, what opportunities exist within the nursing industry, and how can we attract those new applicants? Because, from what I understand too many nurses in undergraduate programs may never get introduced to a potential career in kidney care dialysis, correct? Some may not even realize just how many types of nursing jobs there are out there in this one specialized area of care.

Kathleen Belmonte: Yeah, that is absolutely correct. So, I will be dating myself, but going back a couple of decades, I did not know what nephrology nursing was. That was not something that was part of my nursing program. And it is exactly the same today, and we have spent a lot of time and a lot of effort in the last year to two years in developing university relations teams that are focused on the development of strategic partnerships with universities so that we can continue to expand access to nurses and training. And importantly, Brad, to your point, introduce them to nephrology nursing earlier in their nursing program. And so, university placement programs help us to bring students into the dialysis units to introduce them to nephrology nursing and importantly, get them excited about nephrology nursing so that they can see this as a great career option for them. And as you can imagine, tuition reimbursement programs and other college reimbursement stipends are part of this program, as well. So, importantly, making sure we are front and center in starting to shape and influence nursing and training programs to introduce nephrology nursing. Now, strong strategic partnerships with industry partners like the American Nephrology Nurses Association are also very important. Our partnership with an ANNA really is to help to raise awareness about nephrology nursing in the community. And from a retention standpoint, so looking at the 20,000 or so nurses we have currently across FMC, we also have looked at the development of nephrology nursing professional advancement pathways and lots of exciting things taking place there. The program in 2022 is going to be relaunched with some really, really nice enhancements. So, I’m excited about the professional development and professional advancement opportunities that have been put in place here at Fresenius, as well.

Brad Puffer: Yeah, 20,000 nurses you mentioned – that's a lot of nurses and that's just for our company. So, there are a ton of opportunities in this field which, unfortunately, the demand for specialized nursing care and dialysis and nephrology continues to grow. What are, though, some of the opportunities within nephrology nursing for those who may be listening and thinking about this for the first time as a potential career? What makes nephrology nursing or a dialysis nurse different and unique and special?

Kathleen Belmonte: I will tell you first and foremost, nursing is an amazing career choice, right? So, there are not a lot of jobs where you can go home at the end of the day and know that you have made a difference in someone's life and really impacted them in a meaningful way. And from a nursing perspective, you are continuously challenged every day to be better, and it is certainly never boring. So, as you know, we provide life sustaining treatment to patients. And we provide very routine dialysis treatments. So, if you work in an in-center hemodialysis unit, for example, you are seeing patients three days a week, for a minimum of four hours of therapy every day of those three days a week. So, you have the opportunity to develop beautiful relationships with your patients, with your patients’ caregivers, and you really get to have a balance of what you find in chronic care settings and community settings in terms of the relationship-building. But when you add dialysis, Brad, on top of that, it is complex, it's thought provoking. It always challenges you. So, it's interesting, right? So, sometimes people picture that the chronic care setting is boring, or maybe it's not as exciting when you think about a nursing profession. But dialysis has a beautiful blend of the relationship, with the challenge that is presented every day to be better. So, I think dialysis nursing is very unique in that way. And then if you think about where Fresenius is going in terms of the kidney care space… so, we have home therapy modality options, and if you're not working in an in-center unit, you may find excitement in a home therapy modality option and providing support and training to patients who choose a home therapy option. We have acute program nurses, so if you're a nurse who really likes the excitement of a hospital setting, that's also an option at Fresenius Medical Care.

Brad Puffer: It certainly seems like that transformation is well underway, which just provides a whole range of different opportunities for nephrology nurses. Before we wrap up, I wanted to touch upon something that has been useful in addressing this shortage, I believe, and that's the Nursing Licensure Compact. Can you describe what that is and why that's been so important? And why we're still hoping some of the states that haven't put that in place will do so?

Kathleen Belmonte: Yeah, absolutely. And this has been very, very important to us. It's been important for a long time, but especially important, Brad, over the last several years of the pandemic. So, the Nursing Licensure Compact was actually created over 20 years ago, and currently, there are about 39 states who participate who have now signed a Nurse Licensure Compact and so what does that mean? The Nurse Licensure Compact allows nurses to get a license to practice temporarily in other states. So, if I am a state that participates, a nurse can get a temporary license in the state that participates, so she can provide care to patients in that state. So, let me give you an example: I am Board Registered in Massachusetts. And Texas is a state that has adopted the Nurse Licensure Compact, so if we were to experience a nursing shortage in the Dallas market, for example, or in the Austin market, for example – because Texas is a Nurse Licensure Compact state, it allows us to mobilize nurses from Massachusetts so Kathleen can be mobilized to move from Massachusetts on a temporary basis to be licensed temporarily in Texas to provide coverage in our Texas-based acute programs and our Texas-based in-center hemodialysis program so, that we can continue to provide care throughout the nursing shortage. And this is incredibly important when we think about nationwide shortages and making sure we can continue to provide that life sustaining treatment to our patients. So, we were able to, in the pandemic, mobilize across many markets. Nurses coming in, board registered nurses in other states, coming in to provide support in markets that were really struggling from a staffing perspective. And this is, even outside of the COVID-19 pandemic, thinking about disaster situations around the country where we have to really mobilize lots of licensed nurses to provide support in communities. This becomes a really, really important avenue for us to explore. So, we have been educating legislators around the country, we have been encouraging states that have not adopted the Nurse Licensure Compact to consider it, we continue to advocate for that in states that have not adopted it, and we do believe that this is incredibly important as we think about proper staffing in our centers across the country during a nationwide nursing shortage.

Brad Puffer: Now, thanks for that explanation, Kathleen. I think we're up to 38 states, if I'm right and there are many states right now with pending legislation, so that could increase considerably over the next couple of years. I want to end just with your thoughts on how we get out of this workforce shortage. This nursing challenge we're facing right now. Once we emerge from the pandemic, are you confident that we can recruit and retain enough nurses to meet the demand in the future?

Kathleen Belmonte: Yeah, I think that is probably, Brad, a question that many, many providers in the healthcare space are asking themselves. So, I'm confident we are going to get out of this. I do believe it will take us a little while to get out of a nursing staffing shortage and to be able to manage through that, it's going to take the implementation of lots of things we talked about today. So, it’s going to take, if you think about getting upstream, we need more people to choose nursing as a career first and foremost. Then we need those people who choose nursing as a profession to choose nephrology nursing as a profession. So, a lot of the university relations and advocacy work will continue and will be instrumental, I believe, to our success. Now, thinking about encouraging nurses to choose Fresenius, continuing to be competitive from a compensation perspective, continuing to think about benefits that are important to our nurses and will be important to our nurses moving forward – so those well-rounded options that are more than just compensation. It's a lot about how can I achieve balance and how can I avoid burnout?

Brad Puffer: Well, Kathleen, we covered a lot of ground today. Thanks for joining us and talking about this really important issue.

Kathleen Belmonte: No, it has been great. Thanks so much for having me.

Brad Puffer: And to our audience, thanks also for joining us. Don't forget you can find Field Notes on the Apple Store or Google Play or right here at FMCNA.com, where you can also find our Annual Medical Report and other featured articles. If you have any questions about the COVID-19 vaccines, please contact your primary care physician or care delivery team. And please, if you're not already vaccinated, protect yourself and your loved ones by getting vaccinated today. Until next time, I'm Brad Puffer, and you've been listening to Field Notes by Fresenius Medical Care. Take care, everyone.