CNO Day in the Life: Leading through Change

Phil Sobol:

Welcome to the CereCore Podcast, where we focus on the intersection of healthcare and IT. From practical conversations to strategic thought leadership, let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities.

Well, today, we're thrilled to have Judy Krupala on the CereCore podcast. Judy is Chief Nursing Officer at Cuero Regional Hospital, where she's been a cornerstone in nursing leadership since 1987. She is humble and dedicated to serving her community and has done so for the past 30 years, as a nurse educator, a retired nurse practitioner, OR nurse, and supervisor in the ER, OR, and ambulatory care. She received numerous awards including the Excellence in Nursing Practice Award and the DeWitt Lifesaver Award. And she's active in professional organizations for nurse executives and rural health in Texas. Judy, welcome to the CereCore podcast.

Judy Krupala:

Well, thank you very much. It's a pleasure to be here.

Phil Sobol:

Well, glad to have you. So we always like to start these podcasts off with is a little understanding about your nursing journey and the journey that took you to Cuero Regional Hospital. What inspired you to pursue a career in nursing? And maybe what inspires you today in your role as chief nursing officer there at Cuero?

Judy Krupala:

Well, I can tell you that I was born and reared and raised and been in Cuero my entire life.

Phil Sobol:

Wow.

Judy Krupala:

And just left for a small time to go to college. And I come from a strong Catholic background and so I went to Catholic school most of my life. And they instill in you, and it's in me today, just a strong commitment for compassion and caring. It is the power to change lives and that's what I've taken with me.

There weren't a lot of opportunities to do many things. I could have been a nurse, I could have been a nun, I could have been those kinds of things. And I, many years ago, just decided that nursing was what I wanted to do. I wanted to care for people. So that's what I continue today, the purpose of taking care of others because it truly makes a difference.

In these hospital beds and in our emergency room beds, I tell everyone, because I teach at a new employee orientation, "That's somebody's family. That's somebody's child, that's somebody's parent, it's somebody's family." And we've got to treat everybody like family. And I will forward that til the end of time.

Phil Sobol:

No, that's absolutely fantastic. So maybe share with our audience what is it like to walk in your shoes for a day or two? And tell us about all the hats that you have to wear as CNO there in rural health.

Judy Krupala:

Well, there's many hats. Many, many hats.

Phil Sobol:

I'm sure.

Judy Krupala:

I can tell you that I oversee all of the nursing units. I'm also the senior leader over our EMS because we actually have an EMS that's connected with the hospital. And I'm over grounds. So everybody says, "Why are you over grounds?" And I said, "Well, I can walk out and see the grounds and see how they look." But one time I told my administrator I didn't think the grounds looked good. I thought the plants were dead. It just didn't look good and that's not what people would want to come see -- dead plants. And he said, "Well, if you think that you can do it better, I'm giving you grounds." And I've had grounds ever since and I love it.

Phil Sobol:

That is fantastic. It's fantastic. Well, very good. You've been CNO there at Cuero for a number of years and I'm sure have witnessed just considerable change for many aspects of nursing, technology change really just being one of those. Recently, our organizations worked together to implement a new EHR. Maybe tell us a little bit about your experience to moving to MEDITECH Expanse. What were some of those big challenges that you all faced and how did you overcome those?

Judy Krupala:

Well, I've been in this role so long that I was in the first MEDITECH conversion in the '90s. And now I had the privilege of being in this conversion to Expanse. I say to everyone, "Make sure that you have the stakeholders at the table." I'm not talking about all the leaders, especially when you're building and working on everything, you've got to have that staff that are in the forefront. You've got to have that staff that did all the documentation prior. They know what they need to chart, they know how to chart it, and those are the people that have to be there for the build.

Right now, we've only been live for six months, so we are truly in our optimization phase right now. And if you talk to the staff, they've learned the basic system, but now they want more. And that's what I see right now. They're always saying, "Well, could we do this? Could we build this? Can we do that?" And I think that that is a great challenge right now, almost more than the build because they're familiar with the system. Now they want the system to work for them.

Phil Sobol:

Exactly.

Judy Krupala:

That's where we are now and that's where the CereCore staff have helped us. Now the staff can actually understand and they know what they want, so now they can tell the staff to, "Help me build this. Add this. Do these things." And I think that's kind of where we are right now.

Phil Sobol:

And honestly, I think that's an exciting place to be, right? Getting through an initial implementation, going through the go live, it's an awful lot of work. And then you begin to see, okay, wait a minute. Now we've got a system that brings more capability than we've ever had before. Now how do we use that capability to really make a difference? And that is certainly an exciting place to be and exciting part to have there.

Are there any tips that you might share with other CNOs, when they're navigating technology changes and looking to help their nurses prepare for working in a different fashion? Perhaps things that you tried to help encourage from an adoption standpoint?

Judy Krupala:

Well, I say that technology and innovation are intertwined in nursing. They are something that that is what we do now. We have to, number one, leave the patient in the center. We have to be patient focused and to just keep the clinical perspective in the forefront. The other thing is that we must have an IT specialist with us during all of that and be at the table.

I can share examples like when we were doing this, we wanted our glucometers to merge into the EMR and we were saying, "Well, we don't know if it can happen right away." And I was going, "No, we need it, we want it." So rather than come in after the go live, we got to put it in right at the beginning.

But then a story that didn't work well prior to Expanse was that we brought in these great vital sign monitors and they were supposed to integrate into the system and do everything. Well, we did not have the IT backup and technology to do all that, and it was a failure. So if you bring your IT people with you to the table for every piece of equipment that you buy, that they understand everything with the interconnectivity that nurses don't. We just want to plug it up and go.

Phil Sobol:

Exactly.

Judy Krupala:

And we don't understand all the background work that goes into it, but we know what we want it to do. So please include your IT on everything. And any, we call them our CERs, that's our capital equipment purchases, we now have a line for IT that they have to sign off on it, which makes us a complete unity when you're purchasing something. So that's what I share, please include them.

Phil Sobol:

Yeah. No, that makes... That's great advice. That's great advice. There's all sorts of articles all over the place talking a lot about just the shortage, just nationwide, that there happens to be from a nursing perspective. And certainly, one of the goals of implementing a modern EHR from a technology perspective is to help really improve the nurse workflows and patient care. What's your experience been when it comes to EHR and nursing workflow challenges? What's been the experience for you guys there at Cuero? And have you noticed where those areas of opportunity where going from an older EHR to a newer one might provide the opportunity to work more efficiently?

Judy Krupala:

Well, I think that first of all, nursing students are very, very savvy in computer and documentation now. And when they're doing all their clinicals, they're learning multiple EMRs.

I serve on the advisory councils for the Victoria College associate degree and LVN [licensed vocational nurse] programs, and so that makes a huge difference in working with them. And we have a program called UNITE, and it's actually a scholarship program that we actually bring these students in with us. And it's a new acronym. We used to call it LINC, which stands for Lateral Nursing Careers. But what we decided to do at our hospital was to, it doesn't just apply to nursing. Let's work with the shortage hospital-wide or community-wide, and let's bring them in. So it stands for, UNITE, uplifting new impactful talent everywhere. So it's easy to say UNITE.

Phil Sobol:

It is.

Judy Krupala:

But we bring those students in and they work with us their whole time that they're in school. They work 20 hours a week and we pay them for 40. So those students are with us the entire time and learn it. And then they work for us after they get out of school, so they've had that great experience to work with it.

Phil Sobol:

Oh, that's fantastic. Just developing the younger generation there, investing in them and being able to be with them through that journey and them giving them a path forward is absolutely fantastic for them and for the community there as well.

You talked at the top just about caring like their family, and certainly we talk a lot about patients, but we also I think, talk in the same context really about employees and team members as well. And I imagine that community hospitals like Cuero try to foster that family-like culture a little bit. So what are some of the practical ways in which you kind of foster a great nursing experience there at Cuero? Is it through the continued education, leadership development, retention? What are some of the secrets there?

Judy Krupala:

Well, we do all those and we grow our own. You work with them from the very beginning until they become nurses and then continue with them. We have many scholarship programs.

One of the things that has been a huge help for us is our Methodist partnership. And what we do, say, for instance, we have an OB nurse and we don't have that many deliveries. I can send my nurses to Methodist. They actually work on the floor. They're able to have all patient contact, everything, and they can do many deliveries a day compared to us doing them per month. And Methodist comes down here and does mock code training, they do stable training, they do all kinds of training for our staff, and that has helped a lot.

I have some nurses right now in the rural nurse certification program. We have leadership classes that we're bringing in right now. Our hospital actually works with our employees and we commit to them because they've committed to us and we are going to grow them.

Phil Sobol:

That's excellent. That's excellent. In so many towns and communities that the hospital really becomes almost the cornerstone of that community. What are some of perhaps your favorite traditions or ways that Cuero serves the community? Maybe a story or experience that you could share with our audience?

Judy Krupala:

Well, we are on the forefront all the time. It doesn't matter if we're with our child at a baseball team or we're with the... We are out there all the time and they see us as the community.

A funny story, when I was a nurse practitioner, patients want to talk to you all the time. And I can't tell you how many people used to pull me aside in HEB and say, "Could you please check this rash for me?" Or the last time I was there, "Could you refill this prescription?" Because they know you and you're out there with them.

I share a story about one of the... A strong community member right now, this is happening right now. He's a strong community member, and he was one of our board members. And he was actually a couple of years older than me in school and went away and got his education and came back. He's having many difficulties right now, and he's on hospice. And guess who he asked to come see him? He asked me to come see him. That is the most heartwarming thing, that we've been together our whole lives and now you're asking me to come see you. So that's what Cuero's about. Cuero's about family and friendships, and it happens every day.

Phil Sobol:

Wow. That's fantastic. That's fantastic. It's important for, and you mentioned a little bit of collaboration with Methodist early on, it's important for leaders too to collaborate. And TORCH, which for those of you who aren't in Texas listening, is the Texas Organization of Rural and Community Hospitals. And it's an organization, I believe that you're an active participant in. What's top of mind for Texas CNOs collectively? Are there examples of and successful collaboration through TORCH or other organizations that you happen to be a part of there in Texas?

Judy Krupala:

Well, I think some of the major topics for rural nurses, but it's not just rural at this time, it's patient safety and workplace safety. We've got to address those. We got to look at the workforce shortage. There's a shortage. I've been in this profession long enough to see the ebb and flows, and we are in a shortage and it's only going to get worse.

I look at things like in the small rurals, we're having low volumes. And then there's a lot of uninsured or underinsured patients that truly affects the financial viability of hospitals. And then you've got the Medicare Advantage plans that are just being difficult for patients to navigate the system. So all of those play a significant part.

One of the neat things that TORCH has done just for our small rural is they've put us on a CNO listserv. And we share policies, we share everything that we possibly can. And then monitoring this is one of the attorneys. So if we say something out of line or we start to talk about salaries or whatever, she'll get in there or she'll say, "Let me share this policy with you," and that makes a huge difference.

Phil Sobol:

Indeed. Indeed. No, that's excellent. And just having those peers to bounce ideas off of, share with is just so critical, so that's excellent. You mentioned earlier when you're out in the community, and people are coming up to you, in your professional capacity, in a personal manner.

Judy Krupala:

Absolutely.

Phil Sobol:

So how do you deal with work-life balance in a situation like that? Are there things that you can perhaps enjoy in your free time where you do get a mini break?

Judy Krupala:

Well, I tell everyone out there that work-life balance is a cycle. It's not an achievement. You just can't do it one day and you're done. And I was talking to Laura earlier, I'm a yard person, and I think that's what helps me on the grounds here. I work in my yard and I can see a sense of accomplishment, and I'm done. In the fields that we're in right now, you're never done. And there's always continuous change. So that's what I do, I do a lot of yard work.

Phil Sobol:

Well, I understand that. And now you've just reminded me that I probably need to do my spring shrubbery trimming coming up here in the next couple of weekends. So that's great.

Judy Krupala:

I did that all last week. It feels-

Phil Sobol:

There you go. It does.

Judy Krupala:

Now, if we get another freeze, I'm in trouble, but it's okay.

Phil Sobol:

That's right. Well, oh, we will most definitely have another one at some point coming up here for sure. No, that's great. Well, we always love to wrap these up, which is kind of an open call for any additional final words of wisdom that you might have for any of the healthcare leaders that are listening today.

Judy Krupala:

Well, I say to each of you, always stay connected to the why. Why are we doing this? What has this done? Why is this change? And it's all about the patient. It is always all about the patient. Stay patient focused. And like I said, it will give you your strong sense of commitment and purpose in life. And that's what it's about, we're here to serve.

Phil Sobol:

Yes.

Judy Krupala:

And that's what I share.

Phil Sobol:

Well, that is great, great words of wisdom. So Judy, thank you so much. Thank you for the work that you've done. Thank you for the career of service for the community there in Cuero and for your partnership over the past number of years.

Judy Krupala:

Well, you are very welcome.

Phil Sobol:

Thanks for listening to the CereCore podcast. We hope you enjoyed this conversation. Follow us on your favorite podcast platform for more episodes. Connect with us on LinkedIn. Visit our US website at CereCore.net. And for those abroad, visit CereCoreinternational.net. Learn more about our services and find resources. At CereCore, we are healthcare operators at heart and know the difference that the right IT partner can make in delivering quality patient care 24/7. Let's help make IT better. Here's to the journey.