As the healthcare industry faces a growing workforce shortage, hospitals and acute care facilities nationwide struggle to solve the staffing puzzle. A recent study by the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers revealed approximately 800,000 registered nurses plan to leave the workforce by 2027. Despite the scope of the crisis, MedPro Healthcare Staffing Senior Vice President of Client Services, Chief Clinical Officer Rosemarie Aznavorian, DNP, RN, CENP, CCWP, CCRN-K, remains resolute and focused on putting the staffing pieces together.
Anatomy of a Career
No one person, reason, or moment inspired Aznavorian to go into health care and nursing. “There wasn’t a secret sauce as to why. It just evolved,” said Aznavorian. Her perseverance and determination, which have characterized the entirety of her career, came from home. “My Mother was a strong Italian woman, and from a very early age, she instilled a deep sense of self-reliance in me. Once I start, I keep going.” Aznavorian would get her first experience in healthcare at Humana South Broward, where she worked as a patient care assistant on the orthopedic floor but quickly shifted to critical care. “I enjoyed caring for patients and helping them through what may be their worst days.”
Aznavorian started early. She excelled in math and science at Miramar High and considered a career in healthcare. As a senior, she enrolled at Broward Community College and completed all her prerequisites for nursing. Two months after graduating, Aznavorian enrolled in the nursing program, earned her RN, and began working in an ICU when she was only 19. She was fascinated by pathophysiology, learning how disease develops and progresses, and what care we can provide to improve patient quality of life. Her curiosity and follow-through propelled her up the chain of command, expanding her influence throughout her 44 years of RN practice.
“Promotion wasn’t in the forefront of my mind; it was a progression.” She worked as a staff nurse at Broward Health Medical Center in the CCU, the open heart and medical cardiac unit, and quickly progressed to the charge nurse role. Aznavorian would take the assistant head nurse position at Broward Health Medical Center before becoming the director of ICU and PCU at Broward Health Imperial Point. She remained in leadership, moving forward, always maintaining her clinical expertise.
She worked in the CSICU at Jackson Memorial as the clinical educator for the adult, neonatal, and pediatric heart surgery and heart transplant unit. Transitioning to pediatrics, she served as Director of the Pediatric ICU, ECMO, and Apheresis teams for eight years at Miami Children’s Hospital, now Nicklaus Children’s Hospital. “These pediatric patients were so critically ill with complex comorbidities that it was challenging to balance the schedule with the specific skilled clinicians needed to care for these children consistently. We needed to develop some creative staffing that provided highly skilled clinicians but also met the operational and financial needs of the organization.” Although this strategy is common practice now, it was a new approach at the time to have staggered shift starts. An example of this included how to effectively staff the cardiac surgery or any surgical patients being admitted to the PICU post-operatively, arriving at different intervals. The routine shift started at 7 a.m., with the first open-heart patients arriving in the PICU after 11 a.m. At that time, the charge nurses were not carrying a patient assignment. The solution was “clear as day.” A strategy was trialed where the charge nurses set up the lines and prepared for the admission. A new shift was created, 11 a.m. to 8 p.m., with that RN admitting the post-operative patient. She also implemented self-scheduling, where the staff would schedule and balance the numbers, assuring that at least two of every advanced clinical specialty (ECMO, Open Heart, etc.) were working. “That’s how my interest in staffing began, and then a staffing career started.”
Aznavorian’s success would lead her to Nurse Works, a staffing company in Fort Lauderdale, where she and her team brought the startup company to profitability in less than a year. She would then lead offices across Florida through multiple buyouts, successfully completing turnarounds in less profitable branches. She also wanted to learn the physician side of staffing and worked in the Locum Tenens space for Emergency Medicine and Interventional Radiology until she received an opportunity from Texas Health.
A New Frontier
The timing was perfect. Texas Health, one of the largest non-profit health systems in the US, was looking for a president and a chief nursing officer to open their internal agency. “Having had all of my career in South Florida, I was ready to make a move, and I was interested in returning to a hospital-based position,” said Aznavorian. Initially, Texas Health partnered with one of the larger staffing companies, but she believed they could do it on their own and bring it in-house to the hospital system. Over her ten-year tenure, and with the support of her mentor and leader at that time, Executive Vice President and Chief Nurse Executive, Joan Clark, DNP, RN, CENP, NEA-BC, FACHE, FAONL, she created a team and operationalized a highly functional systemwide staffing office covering all the hospitals within a 200-mile radius. This includes hiring core clinical staff to float across the enterprise as well as managing all contracts and contract labor. To further advance the capacity of the Central Staffing Office and provide a 360 view of staffing and patient logistics across the enterprise, the Clinical and Behavioral Health Transfer Centers, Bed Control, Language Services and the Behavioral Health Call Center were added under her umbrella. With the success of the Central Staffing Office (CSO), other large hospital systems aspired to replicate the model and Aznavorian has assisted with setting up their own, as examples, Adventist West and Yale New Haven Health.
“The work there helped create a new model which led to a national presence. There are very few leaders nationally who have implemented anything close to what we accomplished, with Liz Tonkin being one of them for HCA.” One of Aznavorian’s challenges was helping the ancillary and finance departments understand the mindset of a centralized clinical staff who relished flexible schedules and assignments versus staff who wanted to be based at a specific unit with a set schedule. “It takes a special type of clinician to go into a situation they have never been in and perform at the highest level.”
Additionally, during her time at Texas Health, along with the stakeholders, Aznavorian operationalized a centralized program for a Perioperative Nursing Residency as part of her doctorate work at Texas Christian University. With a significant projected shortfall of Operating Room Nurses nationally, there was an urgent need to recruit and train new nurses in this difficult-to-fill specialty. Standardizing the training with clinical experiences across the enterprise provided the hospital-based Perioperative Directors an opportunity to hire the best fit not only clinically but culturally. She holds her Texas Health memories fondly.
Aznavorian has been published and is an invited national speaker on the topics of effective staffing strategies and optimizing facilities’ internal workforce, whether part of a standalone facility or an enterprise.
Dan Marino’s framed No. 13 jersey (a gift from Patty and Fred Jeffrey) hangs prominently in Aznavorian’s office in Sunrise along with other memorabilia and pictures of friends and family, such her father Bart and daughter Angela, a clinical psychologist, and Aznavorian’s two cockapoos Rocky Marino and Bella Swan. Rocky is turning 13 this year, and Bella, who is doing well a year after suffering cardiac failure, prefers not to disclose her age.
Aznavorian and MedPro President and CEO Liz Tonkin had known each other for over 20 years. In mid-2019, when Aznavorian was deciding whether to return to SFL due to her father’s declining health, and she knew her sister couldn’t care for him alone, she had an opportunity to talk with Liz while at a conference.
A week later, Liz invited her to the Sunrise office to spend the day and meet with the leaders. With MedPro’s growth, there was a need where Aznavorian could add value. Again, the timing was spot on as the healthcare industry would soon face one of its greatest challenges, the COVID-19 pandemic and the resulting workforce shortage.
Aznavorian’s role has evolved over the past four years, but she attributes her success at MedPro and the company’s overall success to its nurse-run perspective. But progress comes amid a growing crisis. Not only are more nurses retiring, but fewer are entering the field. The American Association of Colleges of Nursing reported more than 90 thousand qualified applicants were turned away from nursing schools in 2021 due to a lack of faculty. “We don’t have enough educators for the nursing programs, so we’re not increasing the pipeline of new nurses graduating,” Aznavorian said.
The national nursing workforce shortage involves many more pieces, but the puzzle is solvable. “The shortage is dire, but I’m optimistic.”