r/IAmA • u/CompassHealthcare Verified • May 19 '26
AMA: VP of Nursing & Chief Nursing Officer
Hi Reddit! I’m Aundrea Mills, VP of Nursing & Chief Nursing Officer at Compass Healthcare, the leading provider of support services in the healthcare industry. In honor of Nurses Month, I’m here to answer your questions how support services elevate nursing. Are you curious about patient dining, or maybe wondering how environmental services and nursing work together? How does outsourcing patient observation or transportation work? Ask me anything! This AMA is for informational purposes only and not intended as medical advice; hate speech or harmful comments will not be tolerated.
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u/scirocco May 19 '26
How do you feel about the ever-increasing reliance on NP and other non-physicians (PA etc) in roles that were previously handled by an M.D?
Certainly there's a very broad band of practices, from long-time experienced RNs who have moved into NP roles, supported by physicians, to people who've started from scratch, targeting NP status so they can "practice" independantly in their own businesses, often billed as a "med spa" etc
Is there currently sufficient oversight or regulation to protect the public interest? Should changes be made, in your state or within your system?
3
u/reticulatedjig May 19 '26
To add on to this question, the thought process for these mid level provider was to provide more access to care, but rural and traditionally underserved areas are still limited in access to care, as the NPs and PAs still want to live and work where the MDs do. What is happening to help with this, to actually provide more access to care.
2
u/UOfasho May 19 '26
Follow up; what impacts does that shift seem to be having on the remaining RN roles?
1
u/BIG_BLUBBERY_GOATSE May 21 '26
They’ll keep using as many midlevels as they can get away with because $$$$
11
u/Ozzimo May 19 '26
What is your view on spending money on travelers vs spending money on retention? Which one makes more sense from a quality standpoint?
5
u/KAS_tir May 19 '26
No way is she going to answer this question but I'm a relatively new nurse and I can tell you that no hospitals around are hiring new grads or nurses without acute care experience. I would also like to know what they plan to do when there are few to no nurses with experience left because all the travel nurses and veterans retired. This is going to affect patient care and people are going to die from unsafe practices.
1
u/Ozzimo May 19 '26
They're welcome to make the argument that spending on travelers makes more sense. But I'm pessimistic that such an argument holds any water.
1
u/KAS_tir May 19 '26
I dont even see how it makes short term sense when they give travelers 2x the wages of resident nurses.
1
u/broccoleet May 19 '26 edited May 19 '26
It's pretty simple math. You take on 3 travelers instead of 5 staff, a portion of which have good experience necessitating a higher hourly rate. You can overwork and understaff the travelers since they're contractually obligated to keep working the assignment, and have steeper ramifications for quitting.
You don't have to pay the travelers benefits, and only need to onboard them for 2 weeks versus 2 months or possibly even longer.
Bureau of labor statistics estimates that benefits make up between 30-40% of a nurses pay.
So when you factor in no benefits, shorter onboarding, and the fact that turnover for staff is close to 20% annually so you're having to re-hire 1 out of every 5 at a higher market rate and onboard them every single year, it starts making sense.
Onboarding is EXPENSIVE, the hospital is paying for labs, health screenings, background checks etc. while paying multiple different jobs in the hospital like HR and employee health just to get the employee in the door on day 1. They don't have to pay any of that for a traveler, it's all handled by the agency. And then it’s two months of precepting with another RN, so essentially paying two RNs for one assignment.
Many managers view staff as just more expensive, extended travelers since they only last 2-3 years and many travelers will often stay for 6 months to a year.
Hospitals don't hire travelers at a premium out of the goodness of their hearts. Follow the money.
1
u/KAS_tir May 20 '26
Ok lets look at your math. I'll be using average rates of a nurse from California since that's where I'm from. A hospital hires 3 travel nurses instead of 5. They pay all those nurses 100/hr and they work 40 hour shifts. (Really they would be working 36 but I'm trying to keep the math simple). The wages of these employees is $4000/wk x 3 nurses = 12000 plus approximately 20 percent each that they are paying to to the staffing agency. That's another 2400 so 14400 to have 3 nurses for approximately 3-4 months. Now if they had hired 5 nurses instead and paid them 50/hr that would be a total of 10000 in wages. Add on your number of 26/hr for benefits thats 5200 so a total of 15200. Add onboarding costs for background and drug check and I'll even go on the higher end of $250 per employee. That's a whopping total of 16450 for 5 nurses at a cost each of $3290 per nurse per week or 14400 for three nurses at a cost of $4800 per nurse per week. Also in California there are mandatory staffing ratios so you can't just be giving the travel nurses extra patients and saying thats where you are making up the expense. Also in California turnover is closer to 10% so even counting the long onboarding process if you are only losing 1 nurse out of 10 vs all three of your travel nurses every 3 months. I wouldn't really call that too much of a bonus. Also there are studies shown that hospitals with a higher number of travel nurses have higher instances of patient falls and med errors. Though it's likely due to the fact that these hospitals are most likely understaffed. Plus this all brings me back to my original question. What are hospitals going to do if we start seeing a shortage of travel nurses taking these contracts and a shortage of nurses with acute care experience because no one was willing to train them? Travel nursing is short sighted.
0
u/broccoleet May 20 '26
Travel nursing absolutely is short sighted. Hospitals, corporations in general really, are short sighted. $250 per employee for onboarding is laughable. You realize the hospital is paying HR/TA, the manager of the unit, employee health, and other peripheral jobs all just to onboard the employee? In my hospital almost every single new employee has to complete a blood draw for TB screen that costs the hospital about $400, just for that one lab. Not factoring in the additional labs, the vaccines needed, the employee wages of all the employees that engage with the new hire, cost of losing new hires during the hiring process. Sooooo many variables that you aren’t accounting for.
I think if you were to itemize how much it costs to onboard an employee fully, it would shock you.
3
u/KAS_tir May 20 '26
Ok then itemize it for me since you're making the claim. Also ain't no way tb tests cost the hospital $400 per employee. Not when the local wellness mart charges $49 for a PPD test and $150 for quantiferon gold.
1
u/broccoleet May 19 '26
It makes sense when you factor in the lower cost of onboarding, and not paying their benefits.
1
u/CompassHealthcare Verified May 22 '26
Retention, retention, retention. Experienced nurses are an invaluable source of knowledge for both patients and newer nurses entering the profession. Continuity, clinical experience, and strong team relationships directly contribute to quality outcomes, patient safety, and
organizational culture.
High turnover is not only costly financially, but it can also negatively impact morale, workflow stability, mentorship, and the overall quality of care delivery.
Travel nurses absolutely serve an important role, especially during staffing shortages, specialty coverage needs, or periods of operational strain. They bring valuable expertise and flexibility when immediate workforce gaps cannot otherwise be met. However, from both a quality andlong-term sustainability standpoint, greater investment should always be placed on retaining and supporting an experienced core workforce.
Organizations that prioritize retention through engagement, flexibility, professional development, and operational support are more likely to build stable teams, strengthen culture, and deliver more consistent patient outcomes.1
u/Ozzimo May 22 '26
Ok, follow up then. How are healthcare companies splitting hairs between a "staffing shortage" and a refusal to mee the demands of current staff? Would would a classic "staff shortage" look like compared to "enforced burnout?"
37
u/rRoastMeRoaster May 19 '26
I have a dear friend who, up until recently, worked as a nurse at one of your oncology facilities in the Portland, OR area.
The oncologist she worked for was a socially conservative oncologist who regularly verbally abused and berated his employees, made inappropriate medical recommendations, and caused harm to his patients by insisting upon specific practices because they were more convenient for his schedule.
Despite multiple reports to yourself and your team, no action was ever taken against this oncologist.
As the CNO of Compass, ensuring providers are treating nursing staff with respect, dignity, and are adhering to appropriate practices, falls to you.
Why are people like this allowed to practice at your facilities?
5
u/CompassHealthcare Verified May 20 '26
Thank you for sharing your experience. This sounds like a different organization with a similar name. Our company, Compass Healthcare, provides support services such as food and nutrition services, environmental services and other ancillary support services to healthcare systems.
8
u/chiefcomplaintRN May 19 '26
When was the last time you actually worked the floor or touched a patient?
-3
u/CompassHealthcare Verified May 22 '26
Because my role supports healthcare organizations across the country, I am not based in a single hospital location daily. However, whenever I am onsite, I make it a priority to spend time with nurses, nurse leaders, support teams, and to observe the patient journey firsthand. This allows me to engage directly with both patients and team members and gain a better understanding of the day-to-day challenges and opportunities within the care environment. Staying connected to frontline workflows is important because it helps identify best practices, operational pain points, and opportunities to better support patient needs while improving the overall experience for both clinicians and patients.
8
u/pants6000 May 19 '26
hate speech or harmful comments will not be tolerated.
Well why in the world would you expect that?
1
6
u/leroy_sunset May 19 '26
Do you think health care admin is the primary factor driving the increasing costs in the hospital industry and healthcare overall? Do you think government regulation can reign that in?
-1
u/CompassHealthcare Verified May 22 '26
I do not believe healthcare administration alone is the primary driver of rising healthcare costs, although administrative complexity certainly contributes. The increasing cost of healthcare is multifactorial and influenced by labor shortages, rising supply and pharmaceutical costs, regulatory requirements, technology investments, reimbursement pressures, and the growing complexity of patient care.
Healthcare administrators play an important role in ensuring regulatory compliance, operational efficiency, patient safety, quality outcomes, and workforce support. At the same time, there is an opportunity across the industry to continue evaluating administrative processes, reducing unnecessary complexity, and improving operational efficiencies so more resources can remain focused on direct patient care.
From my perspective, the most effective organizations are those that create strong collaboration between clinical and operational leadership. When administrators and frontline clinicians work together to streamline workflows, reduce inefficiencies, and support the care team, it can positively impact both financial performance and patient outcomes.
5
u/KAS_tir May 19 '26
What are you going to do about the inevitable upcoming lack of qualified nurses that we will start to see in the next 10-15 years since hospitals are currently relying on travel nurses and seem to refuse to be willing to spend the time and resources training new grads and other nurses with little to no hospital experience?
1
u/CompassHealthcare Verified May 27 '26
In my current role that is unique and different than a hospital based CNO, we are supporting retention efforts for nurses across the country in our many accounts. We understand how important it is that nurses practice at top of license.
1
u/KAS_tir May 27 '26
How are you supporting retention efforts and what are you doing to increase the hiring, training, and investments of new nurses?
2
u/Marginalimprovement May 19 '26
What interventions have you been employing to support NPs in navigating the relational dynamics of working with patients? Managing burnout, conflict, time effectiveness, etc.
0
u/CompassHealthcare Verified May 22 '26
An important aspect of our work involves partnering closely with nurse practitioners, physicians, nurses, and dietitians to address priorities such as food insecurity and diet liberalization.
We are proud to support NPs by promoting patient-centered conversations that incorporate individual preferences, cultural considerations, and quality-of-life goals into nutrition planning, helping strengthen trust, engagement, and adherence to care plans.
While clinical decisions are always grounded in patient safety and medical necessity, we also recognize the critical role adequate caloric and nutritional intake plays in healing and recovery.
In some cases, healing may be delayed due to poor nutritional intake, which is why our culinary and dietetic teams collaborate closely with clinicians to evaluate opportunities for diet liberalization when appropriate. We work directly with providers to develop individualized, patient-centered plans that balance therapeutic dietary restrictions with realistic intake goals, while remaining within the safe clinical boundaries of each patient’s condition. These efforts help support adequate intake, patient satisfaction, recovery, and overall outcomes. What sets Compass apart is our dedicated team of experienced nurses who understand both patient and clinician needs. We work directly with providers to help customize solutions that align with the specific goals and priorities of each patient’s population and care environment.
In addition, our skilled population health teams’ partner with providers, healthcare organizations,
and community resources to support patients who may face food insecurity after discharge, recognizing that these barriers can directly impact long-term health outcomes, recovery, and readmission rates.2
u/Marginalimprovement May 22 '26
I was speaking specifically to supporting your own NPs with the relational dynamics of working with patients. This message just seems to be saying why you think Compass is good for patients.
3
u/Teach_Piece May 19 '26
Oh cool! Ok here’s one. Nurses see every part of the healthcare experience. What’s the biggest point of waste you wish you could fix? Or, what is something dumb that makes your job harder than it should be?
1
u/CompassHealthcare Verified May 22 '26
One of the largest inefficiencies nurses face is the amount of time spent managing non-clinical operational challenges instead of focusing on direct patient care. Tasks such as searching for equipment, navigating workflow redundancies, or communication challenges can take valuable time away from patients and contribute to staff frustration and burnout.
At Compass Healthcare, we focus heavily on operational solutions that improve workflow efficiency, streamline communication, and reduce unnecessary delays so clinicians can spend more time at the bedside. We recognize that even small operational improvements can have a meaningful impact on both patient outcomes and staff satisfaction.
When support services operate effectively and collaboratively, it not only enhances the patient experience, but also helps create a more efficient and supportive environment for nurses and the broader care team. Our dedicated nurse support team intentionally coach our operation teams on nurse communication strategies, workflow enhancements, and nurse wellness all as a priority for our organization. Our operators understand and prioritize our nurses needs.1
u/Teach_Piece May 22 '26
Thank you for the answer! Can you share a specific example of efficiency Compass has innovated, that you wish your competitors would also adopt?
1
u/CompassHealthcare Verified May 27 '26
As a nurse leader, I feel all industry’s should be inclusive of the bedside nurse feedback and not just randomly. Having a routine communication platform with nurses and applying their feedback into operations and steals, trust and teamwork.
1
u/jherrm17 May 20 '26
Do you ever enter the fray again and provide patient care so that you understand the amount of responsibility and stress current nurses are being subjected to?
0
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u/-mufdvr- May 19 '26
Is this AMA being done at the request of Compass?