00:00:02:09 - 00:00:15:11 Cynda Rushton Welcome to the Resilient Nurse podcast, where we discuss the tools and practices that nurses, faculty, students and practicing nurses are using to renew and amplify their resilience and integrity. 00:00:15:13 - 00:00:54:04 Cynda Rushton This podcast is a special series within the Johns Hopkins School of Nursing’s on the Pulse podcast. Each episode will cover the complexities, the misconceptions, and the new pathways toward keeping our nursing workforce resilient throughout Maryland and beyond. Our podcast comes out of the our three Renewal, Retention, and Resilience Initiative for Maryland nurses. I'm your host, Cynda Rushton, and today our guest is Jane Krienke assistant vice president, government affairs and Policy at the Maryland Hospital Association. 00:00:54:06 - 00:01:04:02 Cynda Rushton Jane has been an incredible partner across our state, and she staffs the mayor's Chief Nursing Officer Engagement Committee 00:01:04:04 - 00:01:05:19 Cynda Rushton Jane also staffs 00:01:05:21 - 00:01:13:09 Cynda Rushton the Maryland Hospital Association's Task force on Maryland's future health workforce. Welcome, Jane. 00:01:13:11 - 00:01:15:04 Cynda Rushton Thanks Cynda, it's good to be with you today. 00:01:15:06 - 00:01:25:03 Cynda Rushton Thank you so much for joining us. Tell us a little bit about your role with the Maryland Hospital Association. What drew you to that work? 00:01:25:03 - 00:01:25:15 Jane Krienke Sure. 00:01:25:17 - 00:01:30:08 Jane Krienke So currently I am an assistant vice president on the government affairs and policy team, 00:01:30:10 - 00:01:42:08 Jane Krienke with the Maryland Hospital Association and more is the advocacy organization representing hospitals across the state about the state and federal level before legislative and regulatory bodies. 00:01:42:12 - 00:02:06:13 Jane Krienke So we are out there kind of elevating the hospital voice, in different spaces. And personally, I kind of fell into this work. So in college I studied biology, I was pre-med, I spent my nights and weekends working at the community hospital, as a patient registrar, actually, in the emergency department. In a very rural area, kind of learning the ropes of how community hospitals work. 00:02:06:15 - 00:02:32:10 Jane Krienke And after college, I spent some time in the foster care system growing up. So I wanted to give back in that way. And I found, an opportunity to come to Washington, D.C. and advocate for foster youth issues. As a as an intern with the Congressional Coalition on Adoption Institute. And so during that summer and turning in a senator's office, I learned about policy and how a single story and your voice can make such a difference. 00:02:32:12 - 00:02:51:09 Jane Krienke At a federal level. And then, I kind of got the bug. I feel like once you get into the work, you realize that there's so much opportunity for change. And that kind of hooked me. And I wanted to stay in the D.C. area and found, a job with me that kind of mirrored my interests, interests of the hospital field with policy. 00:02:51:09 - 00:02:53:06 Jane Krienke And so I've been here ever since. 00:02:53:08 - 00:03:16:05 Jane Krienke It's fabulous. It's such an interesting, journey how we all arrive and what we're doing. And it sounds like you've had quite an interesting path yourself. So you, are involved in so many things across the state. What are some of the pressing policy issues that you're monitoring for making 00:03:16:07 - 00:03:17:14 Jane Krienke sure there are a lot. 00:03:17:16 - 00:03:19:16 Jane Krienke Keeps us very busy here at MTA. 00:03:19:16 - 00:03:21:03 Jane Krienke In terms of workforce, 00:03:21:06 - 00:03:30:14 Jane Krienke we're working alongside our chief nursing officers on, several topics. So one is implementing the Joint Commission's new national performance goals are on staffing. 00:03:30:18 - 00:03:32:09 Jane Krienke As you know, the Joint Commission, 00:03:32:09 - 00:03:40:10 Jane Krienke developed a goal specific to to staffing for the first time. And so that's been a significant change that we're supporting the CNAS through. 00:03:40:12 - 00:03:44:00 Jane Krienke In addition, we just wrapped up the Maryland General Assembly legislative session. 00:03:44:03 - 00:03:50:10 Jane Krienke Several bills passed that impact the workforce, including the Safe Staffing Act that the governor, recently signed into law. 00:03:50:12 - 00:03:59:10 Jane Krienke that that requires hospitals to have, private hospitals to have staffing committees. So working with the supporting and chief nursing officers on that implementation. 00:03:59:12 - 00:04:12:20 Jane Krienke And then any time you talk about workforce issues, you hear about workplace violence. And so we keep hearing about how the severity and frequency of those events are increasing for the hospital field. So those are a few things on our radar for for the interim coming up. 00:04:13:00 - 00:04:19:05 Jane Krienke While it's a complex, set of issues, every single one of them. 00:04:19:07 - 00:04:47:21 Jane Krienke And there really aren't any easy solutions. But you mentioned the issue of violence against health care workers and certainly nurses as the largest segment of the health care workforce really are often the recipients of that violence and in the workplace. Tell us a little bit more about what's being done from a policy perspective to address some of those issues of violence and in the health care workplace. 00:04:47:23 - 00:04:52:05 Jane Krienke You know, that's a really great questions. And, and it's kind of been stumping us for a long time. 00:04:52:05 - 00:05:03:14 Jane Krienke If you look at what other states have done, I think the numbers about up to 30 that have passed legislation, making it a felony to solve a health care worker kind of looks a little different in other states, but essentially that's the crux. 00:05:03:19 - 00:05:06:05 Jane Krienke And there's been mixed reviews. You know, 00:05:06:07 - 00:05:12:06 Jane Krienke there isn't necessarily a direct correlation between passing that legislation and a decrease in the severity or frequency. 00:05:12:08 - 00:05:17:15 Jane Krienke And, there have been prior attempts in Maryland to pass something similar, but it's been they've been unsuccessful. 00:05:17:20 - 00:05:27:11 Jane Krienke There's been attempts at the, the federal level for to pass legislation. And I think that when that happens, I think that will have an impact, just like it did with the airline industries, 00:05:27:11 - 00:05:31:22 Jane Krienke versus individual states kind of putting these, these felony laws in place. 00:05:32:00 - 00:05:33:17 Jane Krienke But it's something we're definitely monitoring. 00:05:33:21 - 00:05:35:15 Jane Krienke And just this past legislative session, 00:05:35:15 - 00:05:37:05 Jane Krienke Delegate Alston introduced, 00:05:37:05 - 00:05:38:16 Jane Krienke I think for the third time, 00:05:38:16 - 00:05:46:16 Jane Krienke sacred spaces, legislation which enhances the penalty for crimes of violence in sacred spaces like hospitals, places of worship. 00:05:46:16 - 00:05:48:08 Jane Krienke that bill is unsuccessful, too. 00:05:48:08 - 00:05:52:13 Jane Krienke So we're going to have to get creative about what the policy solution is around workplace violence. 00:05:52:13 - 00:06:00:04 Jane Krienke Because it's it's hard when you're trying to change behavior and cultural change. And sometimes that has to happen before a policy change. 00:06:00:07 - 00:06:01:16 Jane Krienke So that's something we're trying to navigate. 00:06:01:20 - 00:06:14:23 Jane Krienke Yeah, it's a very, very complex issue. And it's not like there's a secret, you know, solution, magic solution that if we implemented it, it would address all the issues. 00:06:14:23 - 00:06:44:14 Jane Krienke Because certainly what we're seeing in a lot of hospitals is, you know, the, you know, violence, the anger, the the kinds of, interactions that are happening in our society are showing up in, in hospital settings where people are particularly vulnerable and we, you know, are challenged, I think, over and over again because on the one hand, you know, we are taking care of vulnerable people. 00:06:44:14 - 00:07:19:22 Jane Krienke And on the other hand, health care workers, deserve the same respect of other people and perhaps even more because they are trying to serve under these incredibly difficult, circumstances. So it is, it is an issue that I think, we need to put our heads together, nurses and policymakers and the public, to really try to see if we can solve, as you know, this year, the our three Resilient Nurses initiative is focusing on public engagement. 00:07:20:00 - 00:07:35:01 Jane Krienke And I'm just curious, where do you see opportunities for the public and nurses to align their interests, to make a difference in the way health care is delivered in our state? Well, what are your thoughts on that? 00:07:35:03 - 00:07:43:22 Jane Krienke Yeah, no, I think building off of what you had just mentioned about how we really need the public's help, you know, to address workplace violence and talk about, 00:07:44:03 - 00:07:45:00 Jane Krienke what's appropriate. 00:07:45:00 - 00:07:59:17 Jane Krienke And in the workplace, I mean, nobody shows up to their workplace and expects to be spit on or yelled at or punched or anything even worse. And so I think it's going to take that cultural change, and we need the public to understand and really humanize the health care workforce. 00:07:59:19 - 00:08:07:13 Jane Krienke the careless with police campaign was a marketing campaign that was funded through state dollars and really led by the Mid-Atlantic Patient Safety Center. 00:08:07:16 - 00:08:11:06 Jane Krienke And it was, really neat because they featured real health care workers. 00:08:11:06 - 00:08:13:14 Jane Krienke You could look up and recognize some of their faces. 00:08:13:14 - 00:08:27:04 Jane Krienke Just depending on, you know, where you are and how you engage. But I think it it reminds people that these are your neighbors. When you go to your community hospital, you're seeing your neighbors and they're caring for you. And you know that I think that makes a difference. 00:08:27:04 - 00:08:33:22 Jane Krienke And you wouldn't treat your neighbor like that necessarily as you would a stranger. And really, there's there's no excuse, 00:08:33:22 - 00:08:39:02 Jane Krienke for some of that behavior, that incivility, even in the highest stakes, most intense pressure cooker, 00:08:39:04 - 00:08:44:14 Jane Krienke environments that some of these hospital departments are especially like emergency department, ICU, ob. 00:08:44:14 - 00:08:50:05 Jane Krienke But really, we need that level of civility to deliver the highest level of care in the safest way possible. 00:08:50:07 - 00:08:51:07 Jane Krienke And so I think it's, 00:08:51:11 - 00:08:53:00 Jane Krienke having a no tolerance policy. 00:08:53:00 - 00:09:07:19 Jane Krienke And really just drawing the line in the sand to say this is inappropriate. And, you know, when I've been traveling around, I see other, like, gas stations with signs that says things like this other places. And I know some of the hospitals have similar signs, and it's really just there is no place where this is appropriate, you know. 00:09:07:19 - 00:09:24:04 Jane Krienke And so I think it will be beneficial to have more and more nurses and health care workers talking about it and not making it a part of their job like it's been in the past. Like it. You know, my mom was a nurse, and it was kind of just what you dealt with. And it's like we we got to draw the line in the sand and, and change it, you know, and lead that. 00:09:24:07 - 00:09:25:08 Jane Krienke Lead that change. 00:09:25:10 - 00:09:48:01 Jane Krienke Yeah. I think that's really an important point. There are times when nurses have been told you signed up for this, and I don't think there's any nurse who ever, signed up to be treated in a disrespectful way, especially when your commitment is really to serve, you know, serve the people in need. That's why we're here. 00:09:48:03 - 00:10:22:17 Jane Krienke And yet it's it's a really important, issue. It's one of the topics that is included in our statewide slow talk, that is going on right now through, May and hopefully by the beginning or the middle of June, we'll have a final report. But that's an opportunity for the public to get engaged in helping us to help them, because ultimately, when we have safe, environments for healing and for health care, everybody benefits. 00:10:22:17 - 00:10:55:14 Jane Krienke And so, you know, your suggestion about care goes both ways is a really important one, because we are both have a stake in how health care is delivered, and we need to work together to figure out how to improve that whole environment for everybody. So, it's interesting in, in nursing and in health care, I think sometimes policy sounds like this thing somebody else does, and it sounds kind of intimidating. 00:10:55:19 - 00:11:05:04 Jane Krienke And I wonder, given your path, what advice would you give nurses who are interested in getting involved in policy issues in our state? 00:11:05:06 - 00:11:08:01 Jane Krienke would definitely encourage them to, to pursue it. 00:11:08:07 - 00:11:16:10 Jane Krienke Because they they are the subject matter experts. You know, nobody knows more about how health care and nursing works than the nurses themselves. 00:11:16:10 - 00:11:20:16 Jane Krienke And it's interesting, you know, how intimidating that table can be when you come to testify. 00:11:20:16 - 00:11:21:01 Jane Krienke And, 00:11:21:07 - 00:11:29:04 Jane Krienke similarly, I always remind our members, like, the legislators are just people, too. Like they are also your neighbors and they represent you. They kind of work for you. 00:11:29:04 - 00:11:43:02 Jane Krienke And they're really looking to you, for guidance on the best path forward. You know, that's what legislators do. They they're kind of generalists, and they're relying on the subject matter experts to guide the decisions and to make the best policy choices. 00:11:43:02 - 00:12:04:03 Jane Krienke And so that's a perfect place for nurses to step up and, you know, to see us, you know, be concerned or a frontline staffer be concerned, you know, nobody there are no life and death situations. And the General Assembly, you know, but you deal with that every day as a health care worker nurse. And so, yeah, nothing in Annapolis is a stressful, as, as what you're dealing with on your day to day. 00:12:04:03 - 00:12:09:01 Jane Krienke So, yeah, it's definitely a more of a breeze than, what you're dealing with. 00:12:09:01 - 00:12:29:11 Jane Krienke But I would encourage, engagement with organizations like a MHA, like the Nurses Maryland Nurses Association, like the Maryland Organization of Nurse Leaders. And then some of the specialties have associations as well, like the nurse practitioners and even, like the psychiatric nurse practitioner or some of the small other groups have associations as well. 00:12:29:13 - 00:12:46:02 Jane Krienke And I do want to make a plug. There was a DNP student at University of Maryland who just created an advocacy toolkit for this purpose. And so when I give him, Jacob Carmichael a shout out because he he really took that on, there was no kind of centralized advocacy toolkit to encourage nurses to engage. 00:12:46:05 - 00:12:53:12 Jane Krienke he's working with the Maryland Nurses Association to make it more accessible for nurses to find their voice and advocate in Annapolis. 00:12:53:14 - 00:13:25:14 Jane Krienke So there are a lot of opportunities. And, I think that, as you point out, nurses have the lived experience. Nurses see firsthand the consequences of policy. And generally, I think, have a lot of good insight about what policy needs to include, what's going to work and what's not going to work. So it's a great time for nurses to think about how to raise their voice in this context. 00:13:25:14 - 00:13:41:20 Jane Krienke And, it seems like there's no shortage of opportunities when you think about the future of health care in Maryland. What what are your hopes? What what do you see as the possibilities on the horizon? 00:13:42:02 - 00:13:43:07 Jane Krienke Another great question. 00:13:43:07 - 00:13:51:04 Jane Krienke as Maryland transitions into the head model, the new, you know, way, how health care is paid and works in Maryland. 00:13:51:06 - 00:14:05:00 Jane Krienke We're going to see a lot of changes. And we don't always we it isn't clear quite what all those changes will be or what the impacts will be. I do think we'll continue to see care shift outside the hospital walls more into community settings. 00:14:05:00 - 00:14:08:11 Jane Krienke The care delivery models are going to look different. Lots of things are going to look different. 00:14:08:13 - 00:14:16:05 Jane Krienke You know, we're going to we're already seeing like an increase in AI and technology, virtual care models. It's an exciting time to be in health care. 00:14:16:05 - 00:14:20:21 Jane Krienke Even though there are a lot of unknowns, I think that opens up, doors to innovation. 00:14:21:01 - 00:14:26:19 Jane Krienke my hope is that, we continue to evolve and create care that's more equitable and accessible. 00:14:26:21 - 00:14:32:04 Jane Krienke really elevating the, the role of the health care providers. So, you know, as we're developing even these new, 00:14:32:04 - 00:14:45:08 Jane Krienke tech roles and other roles to support the health care workers, I think it gives an opportunity for nurses, nurse practitioners, advanced practice providers to really work at the top of their scope, which will hopefully help with things like retention and decreasing burnout. 00:14:45:08 - 00:14:48:12 Jane Krienke All of the these challenges we here our workforce is facing. 00:14:48:15 - 00:14:58:18 Jane Krienke Just because if you look at the data we're seeing, again, a projected shortage for nurses in the future. And so I think it would behoove us to figure out ways to really protect them and retain them and support them. 00:14:58:20 - 00:15:01:18 Jane Krienke Otherwise we'll lose them. You know, we've kind of seen that trend through Covid. 00:15:01:18 - 00:15:16:22 Jane Krienke That was really another wake up call. And over the years you've seen these waves of shortages around nursing. And so if there are more things we can do to really support them and keep them and keep them safe, most of all, I mean, we shouldn't even have to. That should be an assumption that they are safe at work. 00:15:16:22 - 00:15:33:15 Jane Krienke you know, around trainings and equipment and capital infrastructure changes to keep everyone safe. And so I think those are what I hope in the future we will have to even have this conversation. You know, it'll just be assumed that hospitals are the safest place you can possibly work. You know, a great way to especially as nursing. 00:15:33:15 - 00:15:43:02 Jane Krienke You know, there's a lot of places you can work as a nurse. So I'd love to see hospitals is kind of that gold standard place where everyone wants to work and feel safe and and really empowered, I think. 00:15:43:04 - 00:15:48:03 Jane Krienke Yeah. Well, I love that we know that, 00:15:48:05 - 00:15:59:17 Jane Krienke you know, the numbers suggest there's a shortage, but one of the things we've heard from our colleagues is there's a shortage of nurses who are willing to work in the current conditions. 00:15:59:17 - 00:16:50:00 Jane Krienke And so your point about how hospitals are really instrumental in creating healthy environments for nurses to practice is, is really very, very important. You know, there's only so much individuals can do, but it is the partnership with the hospitals that, I think really offers us, a path forward, because if we can design systems in ways that really allow nurses to serve, as you said, to the top of their license, but also to serve in a way that reflects why they chose this profession, because nurses, you know, when you when you talk to nurses, almost universally, there is a sense of service and purpose of why we're here. 00:16:50:00 - 00:17:16:04 Jane Krienke And so that is, something I don't think can be replaced by AI or robots. And we need to really nurture that scarce resource, because that is in many ways the glue in the health care system. And, nurses, provide that, that glue in so many situations. And yet they need to be treated as human beings as well. 00:17:16:06 - 00:17:29:03 Jane Krienke Absolutely. Yeah. And nurses, I mean, they make up about almost 50% of the hospital workforce. So they're a huge component, you know, an essential. And whatever we can do to support them is, you know, top of mind for us. 00:17:29:05 - 00:17:58:07 Jane Krienke Yeah. We we thank you so much, Jane, for your partnership and for all the work that you're doing across the state and, how you are really, in many ways, a person that connects all these threads together to try to help us, gather up all the, the, good ideas, but also to focus on what opportunities there are from a policy perspective. 00:17:58:07 - 00:18:01:21 Jane Krienke So thank you so much for all the work that you're doing. 00:18:01:23 - 00:18:14:07 Jane Krienke Absolutely. Yeah. It's an honor to work, alongside you and different nurse leaders and frontline nurses, across the state. It's really, really humbling. You know, the again, I, I kind of was making light of it, but, 00:18:14:12 - 00:18:21:07 Jane Krienke I'm not saving lives every day, you know, like the nursing community is making a huge impact on the individual level and systems level. 00:18:21:09 - 00:18:25:23 Jane Krienke enormous amount of respect for nurses. They're the toughest, kindest people you'll ever meet. 00:18:26:02 - 00:18:29:10 Jane Krienke yeah, it's a privilege to to engage in this work. 00:18:29:12 - 00:18:59:18 Jane Krienke The R3 website hosts over 40 resilience and ethical practice tools and resources for faculty, students, and nurses throughout Maryland. Also found on our website are beautifully designed and easy to use. Plug and play free social media graphics that are available for personal and professional distribution throughout Maryland. The R3 website address is nursing dot JHU edu forward slash R three. 00:18:59:20 - 00:19:24:02 Jane Krienke We hope you'll join us next time for the Resilient Nurse podcast. If you enjoyed today's podcast, please share it with others. Funding for our three comes from the Nurse Support Program, two grant administered by the Maryland Higher Education Commission and is funded through the Health Services Cost Review Commission. Thank you so much for joining us.