Nursing Satisfaction Up Amid Growth and Innovation

Johns Hopkins Community Physician (JHCP) nurses reported increasing satisfaction levels in FY24, a year that saw several new or expanded programs, including a switch to an electronic triage system, nurse-led Medicare wellness visits, and expansion of the medical assistant externship program.

The April 2024 pulse survey, an internal check of employee engagement, showed a satisfaction score of 80%, up from 77% in October 2023. The industry benchmark is 73%.

“We’re definitely trending up,” says Chris Rawlinson, director of education and nursing for JHCP.

Rawlinson believes one reason for the positive result is that she and Tammy Buettner, assistant director for nursing, have made a point of listening to the concerns of nurses, and taking those concerns seriously.

“I think the nurses feel like they have leaders who are advocating for them and giving them a voice and listening to them,” she says. “We can’t fix everything, but we’re listening and we’re doing what we can.”

For example, in December 2023, Rawlinson and Buettner launched once-a-month meetings that brought nurses together by region and specialty: Baltimore, the suburbs west and south of Baltimore, the National Capital Region, Gyn/Ob nurses, and specialty/heart care nurses.

The idea behind the 30-minute virtual get-togethers, says Rawlinson, is for “the nurses at the regional and specialty level to get to know each other better and connect and really talk about issues that are important to them and the communities they serve.”

Key performance indicators, such as follow-up calls within two days and follow-up appointments within seven days for patients discharged from local hospitals, also saw improvements. The follow-up call rate reached 93.97%, well above the 85% target; the emergency department follow-up within seven days was 85%, well above the 70% target; and follow-up appointments within seven days was 60.2%, exceeding the 60% target.

“Making these calls within two days contributes to the fact that we were able to get the patients in for their appointments, because if we’re waiting five days to make the call, chances of getting them in within seven days are significantly decreased,” says Rawlinson.

In other important performance indicators, the 30-day readmission rate was 13.33%, exceeding the 13.5% goal; and both emergency department visits and hospital admittances were well below targets of 286 and 129 respectively, with 155.4 ED visits per 1,000 patients and 71.76 hospital admissions. While these successes can’t be directly attributed to nursing, says Rawlinson, follow-up care and comprehensive triage did contribute.

Triage Goes Digital

Until recently, Johns Hopkins Community Physicians triage nurses paged through physical books, several-hundred pages long, to ask questions and make recommendations to patients calling in with symptoms that could be serious. On Aug. 10, 2023, this triage function went digital, becoming part of the Epic electronic medical record system. 

The shift made triage decisions more efficient, and also meant that record-keeping was automatic, says Rawlinson.

Previously, says Rawlinson, if a patient called a JHCP office and “you got one of the triage nurses on the phone and you said I’m having abdominal pain, the nurse would literally turn to page 7, abdominal pain, and it would have all the questions to ask. A lot of the nurses had been doing it for so long that they knew a lot of the protocols by heart. But if you were a new nurse coming in, you were given a book.”

The change required a financial investment to add the feature to Epic, and it required training and a learning curve for nurses.

“It makes so much sense,” says Rawlinson, noting that the change also made it easier to run reports showing where patients who called triage lines ultimately received care.

With the new system, she says, “they just type in the complaint, and the questions are right there and then the documentation is right there.”

A related improvement was development of a centralized nursing support site that provides in-basket and triage coverage when there are vacancies for vacations or other reasons. Many of the practices have just one or two nurses, so the centralized site support benefits nurses as well as providers, administrators and support staff. So far in FY25, there have been 181 requests a month, on average, filled by the central nursing team. 

Wellness Visits

Registered nurses are now conducting some of the annual wellness visits that are required for Medicare patients.

About 8,000 patients per year make JHCP appointments for these visits, which are covered by Medicare and include screenings for cancer and other health risks, preventive care like immunizations and counseling, and annual health assessments.  

“We learned that under CMS (Centers for Medicare and Medicaid Services), registered nurses can primarily conduct these visits on behalf of their primary care teams,” says Rawlinson.

Rawlinson and her team developed education programs for nurses, which are offered quarterly. The first nurse-led wellness visits took place in February 2023. During fiscal year 2024, 179 wellness visits were led by nurses, with the most taking place in November and December as the end of the calendar year approached.

“It is a small percentage of these appointments, but anecdotally what we’ve heard is that the patients really appreciate the time that the nurses are able to spend with them. On average, a nurse visit lasts 30 to 45 minutes, while doctors often have just 15 or 20 minutes to spend with each patient.

An Expanded Medical Assistant Pipeline

The medical assistant externship program, established in 2021, has grown 132% this fiscal year, with 117 students in the program — up from 61 in fiscal year 23. It now has relationships with 16 local community colleges, trade schools and universities, up from eight previously.

Medical assistants, who take vital signs, draw blood, administer vaccines and perform other essential clinical tasks, learn their craft through certificate programs at community colleges or other programs, which require 60 or more hours of on-site work under the mentorship of a preceptor.

“The turnover rate for medical assistants is higher than we would like,” Rawlinson says. “This is a great way to develop workforce pipelines and really gauge the caliber of the candidates before we think about making them an offer.”

More than 44 of those externs were hired in FY24, making up 36% of newly hired medical assistants, says Rawlinson.

The medical assistants are joining a JHCP nursing team that is poised for even more progress ahead.

JHCP nurses are recognized for their excellence and compassion. Three were honored in Baltimore magazine’s 2024 Excellence in Nursing issue: Amanda Cullison, Aysha Sajid and Catherine Davidson, who was also the JHCP Daisy Award winner for 2023.

“Receiving the Daisy Award was one of the most touching moments of my career,” says Davidson. “Nursing is an incredible profession that gives us the opportunity to connect with patients across the life span, where our compassion creates a lasting imprint on the healing journey of those who we have the honor of treating.”