A Conversation with Deborah Baker

The first senior vice president for nursing for Johns Hopkins Health System discusses how to attract and retain nurses.

Published in Dome - December 2016

As the first senior vice president for nursing for the Johns Hopkins Health System, Deborah Baker is a nursing leader for all Johns Hopkins hospitals.

Baker, who started the job July 1, works with chief nursing officers across the enterprise on strategic planning and vision related to the care of patients and the shift toward a full-service, integrated health system.  

It’s difficult to imagine someone more qualified: Not only did Baker earn her undergraduate and graduate degrees at the Johns Hopkins University School of Nursing, she has held a variety of teaching and leadership roles since joining the staff of The Johns Hopkins Hospital as a clinical nurse in 1992.

One of her greatest challenges is helping Johns Hopkins hospitals hire and retain highly qualified nurses at a time when demand outpaces supply. The Bureau of Labor Statistics anticipates 1.2 million nursing vacancies between 2014 and 2022, and the National Center for Health Workforce Analysis predicts a 12,100-nurse shortfall in Maryland by 2025.

Dome spoke with Baker recently about the challenges and rewards of Johns Hopkins nursing, and her efforts to attract and keep nurses.

Q: Recruitment and retention are ongoing issues. Why is it hard to find and then keep good nurses?

A: Some of the reasons are related to demographics. Nurses in the baby boomer generation are retiring at a faster rate than new nursing graduates are entering the workforce. Nursing schools are graduating smaller classes because there just aren’t enough faculty members. Meanwhile, an aging population means more people need health care. Nurse shortages in many care areas increase job stress and decrease job satisfaction.

The good news is that there’s more interest in the nursing profession across genders and cultures than in the past. We recently held our first-ever systemwide job fair for Johns Hopkins nurses. It attracted nearly 400 attendees, far exceeding our expectations.

Q: What changes have you seen in the profession of nursing?

A: Health care has become more competitive as hospitals work to provide innovative, high-quality care for the lowest cost. Outcomes are more transparent, and it’s easier to coordinate care across settings. Our patients and families are more informed. We partner with other clinicians to make sure we include patients and families in decision-making and have them present throughout the experience.

Nursing has led a lot of these efforts, and there is a lot more we can do. I believe job stress will decrease in health care if we allow the collaboration with patients and families to replace the top-down model of care that was prominent for many years.

Q: Is there also more partnership with the rest of the care team, including physicians?

A: At Johns Hopkins, we’ve enjoyed a professional, collaborative relationship with physicians and other members of the care team for a very long time. As I learned as a nurse who trained at Johns Hopkins, you know a Johns Hopkins nurse because he or she always asks a lot of questions. That’s what they’re expected to do, and that sense of inquiry is valued. The emphasis on evidence-based practice and self-governance are very attractive to our nurses.

Q:  You recently commissioned the Urban Institute, the nonprofit organization that studies economic and social policy, to study nurse retention at The Johns Hopkins Hospital. What did you hope to learn?

A: The question was, how do we keep what we value about Johns Hopkins nursing but make it better in the workplace and marketplace? In looking at our workforce challenges, we thought about the things that retain staff members in any profession. It’s usually feeling valued, work/life balance and salary.

We want to understand the expectations of nurses at The Johns Hopkins Hospital and how they change over the course of a career, from new nurses to veterans with decades of experience. The Urban Institute conducted surveys, interviews and focus groups. It surveyed our existing staff members, as well as staff members who had left and people who were offered but did not take positions here. It also spoke with some of our managers, executives and leadership. 

We are now engaging with our nurse managers and staff members to design solutions based on what we learned.

Q:  What did the study find were the pluses for nurses of working at Johns Hopkins? Any drawbacks?

A: The results revealed several areas of opportunity for nursing and hospital leadership, including compensation, scheduling and promotions. Nurses want support from administration and leadership, a collaborative environment, and opportunities to grow.

Job stress was consistently rated very high across all groupings of years of experience. We’re not a factory. We see challenging cases and patients who need the specialized care only Johns Hopkins can deliver. Decisions have to be made quickly and with precision. Being a nurse means coming in every day and executing critical thinking. You have to be incredibly resilient. You have to be firm and lean in on your values, while also being able to bend as needs change.

On the plus side, the employee benefits are a real strength, with a huge emphasis on education and training. You can develop and reinvent yourself if you take advantage of those opportunities. That might be important at certain stages of your career. At other times, tuition benefits for dependents might be important too. 

However, our jobs are often very task heavy, which reduces opportunities for nurses to take advantage of professional development. We’re working to fix this through creative scheduling and restructuring some of our workflows.

Beyond the benefits, people are our greatest asset. Nurses really value the expertise they see in their colleagues and the chance to develop and mentor those around them.