The Critical Role of Nurses with Costa King Cockfield, MSN, RN, NEA-BC

Almost any time you seek out healthcare services, you will receive some form of care by nurses. This profession is often called the glue that holds a patient’s health care journey together. In this episode of Advance with MUSC Health, Costa King Cockfield, MSN, RN, NEA-BC, Chief Nursing Officer at MUSC Health's Florence Medical Center talks about the art and science of nursing and the critical role they play in healthcare.

"These days, it's critical that we keep our (patient’s) family abreast if the patient wants, just as much as we keep the patient abreast. Nurses are the patient advocate, the nurse is the voice for that patient and family"
- Costa King Cockfield, MSN, RN, NEA-BC

Topics covered in this show

• Cockfield details qualities of excellent nurses, including compassion and empathy, great communication skills, strength and stamina, being organized and lifelong learners.
• She explains how nurses are an advocate for patients and patient families and that at MUSC Health there are nurses on the front-lines and behind the scenes helping patients get the care they need to be discharged from the hospital in a timely manner and to keep them safe.
• After more than a year and half of treating COVID-19 patients, Cockfield says many nurses are tired and with a third wave expected in January 2022, they are bracing for more compassion fatigue, yet she says their team is prepared to take whatever is next.
• The nursing shortage sweeping the country as the population ages is also being felt in South Carolina. Cockfield says the pandemic caused some nurses to retire early. She also says there is a faculty nurse shortage in South Carolina. MUSC Health is working with many groups and institutions to bring more young people into the profession, even building outreach programs in high schools to entice the next generation of nurses to go into the field.
• Cockfield talks about the importance of recognizing outstanding nurses and details several award programs, including patient-nominated programs that identify and celebrate outstanding MUSC Health nurses.

Read a transcript of the episode below

Erin Spain [00:00:04] Welcome to advance with MUSC Health. I'm your host, Erin Spain. This shows the mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Almost any time you seek out health care services, you will receive some form of care by nurses. This profession is often called the glue that holds a patient's health care journey together. Today, we're talking about the role nurses play and your health with our guests. Costa Cockfield, chief nursing officer at MUSC Health's Florence Medical Center. Welcome.

Costa King Cockfield [00:00:40] Thank you. Erin, thank you so much for having me.

Erin Spain [00:00:42] Tell me a little bit about you and your career as a chief nursing officer here.

Costa King Cockfield [00:00:47] Actually, I would tell you that I started as a chief nursing officer in a very small rural hospital, and I give that a lot of credit to any success that I've had because in a small hospital, you just don't have the resources that you do in a larger system. And I just had some phenomenal people that I work with great mentors who encouraged me along the way. I was in a hospital for 12 years as a CNO and then came to the Florence facility, now 23 years ago, so I often tell people, if you look at my resume, I look extremely boring because I've been in this role for 23 years. We've had a variety of owners and with every owner, they're there different missions and and goals. And I've just been extremely blessed that I've been able to stay in the system in this Lawrence County for all these years.

Erin Spain [00:01:41] Nursing is the nation's largest health care profession. Why do you think so many people are drawn to this profession and what do you think makes an excellent nurse?

Costa King Cockfield [00:01:50] Many people say I entered nursing because I wanted to help people or I entered nursing because I wanted to make a difference. And I'll tell you that those two reasons are great reasons to enter nursing nursing is certainly a noble profession, and it's actually received the Gallup most trusted profession for 19 years straight. So obviously a great profession. I encourage anyone to enter it. What makes an excellent nurse? It goes without saying that a nurse must have the qualities of compassion and empathy. I think that's critical to make them successful. I think that nurses must be very family centered as well as patient centered. These days, it's critical that we keep our family abreast if if the patient wants just as much as we keep the patient abreast. So they are the patient advocate, the nurse is the one the voice for that patient and family. And certainly that's a critical skill. I think that a nurse must be able to think on their feet very quickly. They must have great critical thinking skills. Certainly great time management skills, its a extremely busy profession. Therefore, they must be very organized. Health care relies on a variety of individuals with a variety of skill sets, so they must be great team players and that makes a great nurse. I think that attention to detail is so valuable to make a great nurse, and I will tell you that a great nurse must embrace education because obviously we've seen so many changes over the years, and I think we have to be lifelong learners willing to accept education, embrace education. One quality that I think is very, very important for nursing is to be an effective communicator, because that really is so, so critically important to ensure that that patient has the best patient experience that he or she can have, and that we need to speak in terms that our patients can understand. Health care is confusing. We use a lot of acronyms we have to speak in terms that our patients and our families understand. And then lastly, I would say the physical demands of nursing are heavy. I mean, it's it's tough working in nursing and you're turning patients and you're on your feet. I've read a study that says a nurse averages four to five miles per shift.

Erin Spain [00:04:24] Oh my goodness. Get those steps in.

Costa King Cockfield [00:04:27] That's right. So stamina, stamina is important. Again, a very noble profession. But we want the right people in nursing. And those qualities, I think, are extremely important to be a successful nurse.

Erin Spain [00:04:41] I want to go back to that relationship you were talking about between patients and between patients families. Now, studies show a good nurse patient relationship may actually reduce the days of a hospital stay and improves the quality of care and satisfaction of patients. What do you think? You mentioned communication earlier. Compassion, but what do you think makes for an excellent nurse patient relationship?

Costa King Cockfield [00:05:04] I love that question because you mentioned two things that are so important to our facility and to our success. You mentioned the reduction in the days in the hospital. And you mentioned the nurse patient relationship. And both of those are things that we're working very, very hard at the hospital. Nurses are critical to that. The communication is absolutely key. So we actually expect our nurses on admission to begin, right then speaking about discharge. Communication is key to gear them up with this particular diagnosis. You're expected to be in the hospital these many days, and we're going to do our best for you to meet your goals and get you better or get you to the next level of care. I think back on my early career and we've learned so much about the nurse patient relationship. The old days, I'll have to tell you that we used to give report and we would actually tape report. So the on coming and off going nurse really didn't even talk about the particular shift and the particular patients. That was a taped report. Then we evolved to nurses, they would sit at the nurse's station, so the oncoming nurse and the off going nurse would sit at the nurse's station and handle off that care information. We'd whisper because we didn't want anybody to hear us and we would speak about our patients during that shift. Today, what we know is extremely successful is we involve the patient and the family in that handoff. So it's 7A and it's 7P when we change shifts. We want that nurse to give hand-off to the oncoming nurse with the patient's involvement, and we ask the patient if they want their family involved as well, because we know that that's only going to make the care better. You know, they're going to be educated. The patient's going to know the plan for the day. And something that simple has been shown to improve the patient's satisfaction, the patient's experience and to reduce the patient's length of stay and to keep the patient safe. So we know that one tactic is extremely beneficial. Also, with the nurse, we want them to round hourly and we want our leaders around. So again, that relationship with the nurse and the patient is critical.

Erin Spain [00:07:25] Tell me about some of the different types of nurses a patient might encounter at a MUSC Health.

Costa King Cockfield [00:07:30] Well, we have a robust nursing department with many, many nurses and in different roles and specialized roles. We do most of the continuum of care. We don't do transplants and burns at this particular facility. You're going to see just about every type of nurse from obviously a very skilled emergency department nurse. We have navigators, whether it's navigators, oncology, whether it's navigators, stroke, med surge nurses, ICU nurses, we have very skilled labor and delivery nurses. We have case managers, all the perioperative vascular access nurses. That's the great thing about our profession is there are so many opportunities you'll never get bored. You can stay in our system and experience different types of nurses. And then the advanced practice nurses, the nurse anesthetist, nurse practitioners. And we have a group of nurses that that help us to stay compliant with all the many, many regulations in health care and infection control practitioners in such a big, big role in nursing.

Erin Spain [00:08:37] Well, there's even nurses behind the scenes who are helping out at the administrative level. Tell me about those nurses as well.

Costa King Cockfield [00:08:44] We have a regulatory practice nurse again making sure that we meet all of the many, many regulatory standards in health care. We have clinical documentation specialists in those nurses help to manage and assess and review the patient's medical record. We want to make sure that we have accurate documentation in the medical record. We have nurse informaticists with the electronic health record it's very critical that we have experts in that area. So there are many behind the scene nurses in health care and in certainly help us to function as a high performing organization.

Erin Spain [00:09:22] I want to shift gears a little bit and talk about the COVID-19 pandemic. It has really taken a toll on health care workers. Nurses, obviously are no exception. How are your nurses doing after these many months of the pandemic

Costa King Cockfield [00:09:36] I'm going to be real honest and tell you that many are still tired. We've had two really, really big waves and it is physically and emotionally draining to take care of COVID patients. They have certainly seen a lot and if endured a lot of change, I think back on that first wave and literally, we were all just learning, how do you take care of a COVID patient? And I was just amazed every day watching them in action, their resilience, what they had to do to don on and off personal protective equipment to keep themselves safe. We were very fortunate to this hospital. MUSC spent over $6 million early on in the pandemic to ensure that our care team members would have all the PPE they needed to stay safe. But it was just it was heavy, the visitation restrictions, not having family present, that it was just very, very heavy. And then the second wave came and again now we had more vaccine. The second wave I saw was known as compassion fatigue in real life. I mean, I saw it because nurses want the community to get vaccinated. I will tell you that we've been talking about a projected third wave, which the very smart epidemiologists are telling us will probably occur in January. When you say that, you just kind of see a sigh from from nurses and not just nurses, respiratory therapists, physicians, I mean, it's just it takes a toll. It takes a toll. I will say, however, although I've been very transparent about the fact that many are tired, I will say that they have been extremely resilient, extremely resilient. It just is is so impressive every day to see them and what they do, just true troopers and and very, very well-prepared and very, very well educated.

Erin Spain [00:11:37] More than half a million RN anticipate retiring by 2022. So there is a nursing shortage happening right now really unrelated to the pandemic. Tell me about that and how you're planning to keep up with demand here at MUSC Health.

Costa King Cockfield [00:11:52] There is a shortage. I've seen shortages come and go. This one is different and people ask me all the time what is going on, why do we have a shortage? And I will say that, you know, South Carolina actually has more licensed nurses this year than we did last year. But you know, Americans are aging. We have more need for licensed nurses. I will tell you with the pandemic, you had a group of nurses that were teetering on retirement and that did cause some to make that decision that maybe it is time that I retire. I will also say that in South Carolina, there is still a faculty shortage. So we have schools that could enroll more students, but not enough faculty. The statistic is that South Carolina will have the fourth worst shortage in the nation by the year 2030. So we're doing everything we can to work with academia and even to work in the high school to encourage bright young females and males to go into nursing. So it's it's a concern. We're very innovative and we're spending a lot of time with our HR partners on recruitment and retention strategies. It's a wonderful place to work. Very, very rich benefits. If you want to have a fulfilling career, choose MUSC and you will be, I think, very, very happy. But it is definitely a concern.

Erin Spain [00:13:25] You do a lot to acknowledge these nurses. What do you do? Tell me about some of the things that you do to acknowledge their hard work.

Costa King Cockfield [00:13:32] That's one of the most favorite parts of my job is out and about with nurses and in recognizing them for the great work they do. And sometimes it's something as simple as a thank you note. We do something here called mission accomplished, and we dress up in black trench coats and a black hat and sunglasses, and we play the theme song for Mission Impossible, and we recognize care team members. We have encouraged and continue to encourage and promote national certifications. So when our nurse becomes nationally certified, we have a recognition ceremony for that. It's a traveling trophy that we present them. And I call it traveling because I tell them I hope that it's going to be taken away from you very quickly, meaning the next person is going to be receiving a national certifications. Our state has something called palmetto gold, where they recognize the top 100 nurses in our state, and we just celebrated the 20th year of doing that. And I'm proud to say that we've had nurses every year in the palmetto gold selection. We participate in what's called the Daisy Award, which is a national program where patients and family members can recognize nurses, and we select a nurse quarterly. So again, sometimes it's the little things. Sometimes it's a big recognition. But one of the things that I'll look forward to when just a thank you to our staff that excel.

Erin Spain [00:15:00] You know, last year was the 200th birth anniversary of Florence Nightingale, who is the most famous nurse in history. What do you think she would think of the profession today?

Costa King Cockfield [00:15:11] Well, I love that you you're asking that question because we do a recognition ceremony every May during National Nurses Week, May 6th through May 12th, May 12th is significant because that's Florence Nightingale's birthday. So we wear our whites and put our nursing cap and have a nursing ceremony. I think that she would be pleased with what she has seen within our profession, and I think with her being ahead of her time, I think I think she would look at us now and how we've responded to the pandemic, and I think she would be pleased. I think there's a relevance as well because, you know, she's known for her focus on hand-washing with the Crimean War and how she helped to reduce sepsis related deaths. Just focus in on hand-washing. And that has certainly been a focus with the pandemic. I think there's a correlation there and then her emphasis on epidemiological data that she used to make decisions. And more than ever, you know, we're doing that in health care. Certainly true today. So I would hope she would she would be pleased with our profession.

Erin Spain [00:16:23] The question that we ask everyone on this podcast, what do you do to optimize your health and live?

Costa King Cockfield [00:16:29] Well, I do preach that I try to stay, stay healthy, stay pretty active. I like to. I used to call it run. Now it's jog. Just decompress. That's critically important for us to stay physically and mentally sharp, that we've got to be able to decompress from work. I have a great family that I love to be around. Both of my children are in health care and we said we weren't going to talk about it, but we always do. Two grandchildren that keep me very young. So I think it's just so, so important that we do take care of ourselves. That's what we preach and we have to practice it as well.

Erin Spain [00:17:05] Thank you so much, Costa, for coming on the show and talking with me today telling me about your amazing nurses. I really appreciate it.

Costa King Cockfield [00:17:13] Thank you as well. I enjoy talking with you.

Erin Spain [00:17:19] For more information on this podcast, check out advance.muschealth.org.

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