From Bedside Nurse to Healthcare Executive: Crystal Farmer’s Leadership Journey at Augusta Health

Anthony Codispoti : Welcome to another edition of the Inspired Stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Codispoti and today’s guest is Crystal Farmer, Senior Vice President and Chief Operating Officer at Augusta Health. They are one of the top community hospitals in America recognized for patient-centered care and membership in the Mayo Clinic Care Network. They offer a wide range of health care services focusing on operational excellence, high quality treatment and compassionate patient experiences. Now under Crystal’s leadership, the organization has earned top marks for patient outcomes and expanded its clinical services while streamlining operations. She has more than 28 years of experience in nursing and health care leadership, including roles as Chief Nursing Officer at Augusta Health and other prominent hospitals in Richmond, Virginia. She is also a member of the American College of Health Care Executives and the Virginia Organization of Nurse Executives and Leaders.

Her dedication to continuous improvement has helped Augusta Health remain a vital resource for its community, providing care with advanced technology and compassionate service. Now before we get into all that good stuff, today’s episode is brought to you by my company, Add Back Benefits Agency, where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our innovative programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies, contact us today at addbackbenefits.com. Alright, back to our guest today, the Senior VP and COO of Augusta Health, Crystal Farmer. I appreciate you making the time to share your story today.

Crystal Farmer : Oh, I’m so grateful that you asked me. This is a real honor, so thank you. Absolutely.

Anthony Codispoti : Let’s jump right in. Crystal, what was it that first drew you into the health care industry?

Crystal Farmer : You know, I don’t have the same story and journey as most people that go into health care. They’ve known since they were a child that they wanted to be a nurse or a doctor and help people. For me, it was a little bit of a different story. I had a different career path in mind and I got hit by a drunk driver. So my career path originally was going to be going into the military.

We got in a car accident and we were hit by a drunk driver and I injured my back. So it was not eligible anymore. So then I thought, this is right out of high school. Well, now what?

Because that was my plan. I took a year off, I went to a certified nursing aid school and started working as a nurse’s aide in a nursing home and just got to see health care from a different perspective. But I also remember my mom being an office manager for a doctor’s office and the two nurses in there, they always wore white and the way they talked to the patients and I knew them most of my life. So I started thinking back at, well, I want to be able to do that.

I want to be able to talk to people and help people. And so I decided to go to nursing school and my first day in nursing school, they load you up with the books and they came up to my shoulder and I thought, what am I in store for? But I have never looked back. Things happened for a reason and I think my path was not supposed to be in the military. It was exactly what I’m doing now. I’ve never looked back.

Anthony Codispoti : When did it click for you? When did it feel right?

Crystal Farmer : I think in my first semester of nursing school and actually it clicked a little bit before that because that’s what maybe want to get a nursing school is being a nursing assistant and helping patients that couldn’t help themselves and seeing them in situations where they can’t even lift a cup so they can get a drink when they want to and seeing patients in this vulnerable state and being the one that can make them more comfortable or an offer and encouraging word or just have a conversation with them. When you’re in a room, you’re very isolated and so I started seeing the power of nursing even when I was a nursing aide.

Anthony Codispoti : What was maybe the most formidable stop for you before getting to Augusta Health?

Crystal Farmer : There’s so much that’s happened over 28 years, sounds like a long time, but it doesn’t feel that long. I think when I first became a CNO, I did not think that I was CNO material necessarily and I had a leader that believed in me and really didn’t give me a choice not to be, which I have to, one day I’ll have to tell him how he’s impacted my career.

Anthony Codispoti : Do you want to offer up his name? Give him a little shout out here?

Crystal Farmer : His name is Will. He was a CEO at Henrico and I don’t think he knew what he was doing at that moment and how much it’s opened up my world, but it certainly has and so I appreciate his faith in me.

What do you think he saw? At that time, I was really at this point in my career of where do I go next? I was a director. I felt like I could do more, but my confidence was not great. I was really at probably the third or fourth crossroads in my career of what do I do now? I mean, there’s been many things over the years.

Anthony Codispoti : What is it that you think that CEO first saw in you that maybe you were having trouble seeing in yourself at that time? Results.

Crystal Farmer : When people ask me, what’s your reputation at any organization that you work in? It’s really around getting things done. I have very high expectations of myself and others, which is not always a great trait, but I do not give up and I love being able to be creative enough in my roles to problem solve and not just do things the way everybody else sees it. So if I get a no, I’m going to figure another way to do it because maybe it’s not this way, but it’s this way. And I think he had seen me take a couple of challenging areas that I was in charge of and really turn them around into a place where people wanted to work, physicians wanted to put their patients there, and that was no small feat.

And so I think he knew I was tenacious because where he put me from my first C &O role, you needed to be tenacious, you needed to be a good problem solver, and you needed to be able to connect with people. The hospital was very small. The census was around 30 a day and it was not doing well. And they had a new C &O and a new C &O as well. And so between the two of us, really, it was in the red for quite a few years. And in our first year there, we were in the black. And it’s because we did those things.

Anthony Codispoti : Did what things? What were you able to

Crystal Farmer : do to turn it around so quickly? It was connection, but the hospital was at the bottom of our, the bottom for patient experience in the ED and inpatient. We were, we did not have great employee engagement scores. So our employees were not having a great experience working there. morale was very low. Our physicians did not feel heard. They didn’t feel like they had a voice. And then our census was dropping. So patient physicians were admitting to us either. And so we had great staff, but how do we motivate?

How do we say this is different? How do we invest in them? And, you know, the best investment is time. So both her and I, you know, we met frequently with the staff. I put in quite a few tactics around patient experience.

And I can share that story about the things that, that we put in place, but it was really about connecting. Not just with our patients, but with our frontline staff and being vulnerable. Honestly, for a lot of that, you know, one of the things that, that happened in my first role as a chief nursing officer is my mother was in, was burned over 60% of her body.

And this was in my first, probably six months of being in new CNO. And I just, you know, the hospital is not, she was not in my hospital, but a hospital that was not far from me. And so in the evenings, I would go and visit and she was there for eight months. So it was a long process. And during that time, she, she had all kinds of infections. She had catheter associated infection. She had bloodstream infection. She had pneumonia. Just she had a blood clot and just all sorts of different things.

But what made a difference in that hospital visit and in that hospital time period that I take with me now to every role that I do. There, my mom was actually, she went into cardiac arrest. And while I was there and the team really rushed into the room and started working on her. And I’m, you know, even though I’m a nurse, I’m standing at the, at the bedside and you know, nurse training goes out the window when, when you see that and it’s your own family member.

And in the middle of it, the nurse manager turned over what she was doing in the code to somebody else and came out and talked to me. And, you know, she said, I know that your relationship has not been great with your mom for the last few years. I know how she got here was not something you’re proud of. My mom was addicted to narcotics, prescription medications. And she just wasn’t an easy patient. And she said, we don’t care about any of that. Right now in this moment, what I care about is are you okay? What can I help you do right now?

And we’re going to take the best care of her. None of those other things matter and you’re right here where you need to be. And, you know, it was just a few words, but it was the feeling that I was understood that, you know, people were not judging my mother for a lifestyle or judging me for our relationship.

But in the moment, it was all about taking care of her and nothing else mattered. And so I remember taking that back to my hospital as we were trying to figure out, you know, how do we improve our patient’s experience at our hospital? And I took it back to my nurse leaders and I had to be very vulnerable.

It’s still difficult to tell the story now about all the things that I saw. And the consequences of her just being in the hospital for a long time. But if I had to rate that hospital, I would have rated it great because of the human connection.

You know, bad things happen. But that nurse manager coming out to me and then calling me later to check on me and give me an update on my mom. And then she made a point every time I came to the hospital to say, how are things going and just really build that relationship. There was a human to human connection there that I knew that she understood.

And so I took that back to my team up. I think what we’re not doing for our patients is making them feel like a human, like we care about them or their families, like we care about them. You know, all healthcare providers, we go to school, we’re highly trained, we know what to do. And so we save people’s lives every day, but I don’t get letters about saving people’s lives. What I get letters about is how we made somebody feel why they were here or didn’t feel why they were here. They don’t expect to be treated like family. They don’t expect to really connect with a stranger in a hospital. And so we really worked on the leadership team and I really worked on making sure that we were rounding on the patients. They’re going to see patients every single day, the nurse leaders, asking those questions. It’s not just about how you feel today, but what’s going on in your life outside of here? Are you worried about your dog at home? How can we help that?

You know, I heard today is your birthday. It’s making connections to the human side, not just the patient or the diagnosis or the room number. And that was really the trick. I call it the secret sauce. It’s not so secret. It’s just about connections. And we saw our patient experience go to the top.

Anthony Codispoti : How quickly did that transition happen? About six months. Six months. Six months. So it’s incredible that you took this very challenging experience with your mother and the interactions that you had as a result. And it turned this light bulb on inside your head. It’s like, this is what we’re missing, you know, where I work.

How, you know, when you brought this idea to the team there, how was it received? Did everybody agree with you? Oh, yeah, absolutely. Let’s start doing this. Was there some resistance?

Crystal Farmer : There was certainly resistance in the first resistance, which is normal for everybody of your ask me to do another thing. I’m so busy. I’m trying to put out fires. You’re asking me to do another thing. And, you know, it takes a good hour or so, if not longer to see every patient on a particular unit. Round on them and have a meaningful connection. And so we practiced that. I went with them.

I wasn’t asking them to do something that I wouldn’t do. We practice rounding. You know, we did a lot of training up front because for some people that’s not a natural conversation to have.

You know, we’re so used to in the medical field of having a conversation about your health, but not necessarily a human to human conversation about just you. And so we did a lot of training up front. We did a lot of practicing up front. And I asked them, I said, can you just trust me on this? Just do it long enough.

And if it doesn’t work, then I won’t make you do it. And within that short time is less than six months when they started seeing the results of their patient experience and reading comments about how the patients felt cared about like they were family. I didn’t need to even ask them to do it anymore. I didn’t need to tell them to do it anymore because they saw that it worked. And it was the same thing with our quality metrics.

I mentioned that my mom had a lot of infections in the hospital. And when you’re in leadership and you probably see this too is sometimes you can be so metric or number driven. And I think I was starting, especially as a CNO, there’s a lot of information coming at you reports. And so then you just start thinking, okay, this number, this number’s in the red.

We need to get it to the green. And what we forget sometimes is that behind every single one of those infections is a patient that we did harm to. And that’s the way I look at it. Not intentionally did they get an infection, but they had something that they did not come in with. And so we handled, in our quality metrics also went very high in the company, top percentile. And it was because we started thinking about patients as there’s a number.

There’s a patient behind every single one of these numbers. And if it was my mom, if it was your sister, you know, would you do something differently? And my team came back and said, yes, we would probably do this differently. And so it was just a lot of those vulnerable conversations and sharing my experience.

Anthony Codispoti : And so obviously you took these learnings, these lessons, these experiences with you as you made other career stops, including to Augusta, or maybe they were already doing something like that when you got there. I don’t know.

Crystal Farmer : For Augusta, the patient experience has always been middle of the road. OK, not bad, but not always great either. It may not have stood out. And I took the same things. The first thing that I implemented here with my team was nurse leader rounding on all patients. And that was a little bit of a challenge. Again, you know, time is so hard to come by when you’re in leadership or health care in general.

Anthony Codispoti : And change is always hard.

Crystal Farmer : Yeah, there’s so many things that happen in a day to a patient. You can’t schedule those things. It’s uncontrollable. That’s why they’re in the hospital. And so anyways, you know, I did the same exact thing, created training and said, just do this for three months. Let’s see how it works. And it was the exact same story that the units and the managers that really took it seriously to go and meet every single patient and make that human connection with them. Their patient experience scores went to the top percentile. And so it was just sort of another experiment. And so others, you know, really started doing that as well. And it’s just an expectation.

Anthony Codispoti : I think this is a really great story to share with the audience. And folks that are listening, I want to encourage you to sort of think about this in the context of your own daily lives, your work life, your home life, because this really highlights the importance and the value of genuine human connection. So you might not work in health care. Maybe you’re in an office setting, but what wonders would it do to your relationships with other folks? You show it a genuine interest. You ask them how they’re doing. You listen for the answer. The next time you see them, you ask about that thing that you just talked about, right?

Crystal Farmer : And we did the same thing with our team members. So if it works with patients and we only see them, you know, this much of time of their entire life, we see their employees every day, you know, 52 weeks a year. And so we did the same thing and requested the same thing of what would happen if you sat down with all of your team members for 15 minutes a month and just asked how they were doing. You know, what’s going well? What’s not going well?

Are there challenges? What can I do to help? And again, it wasn’t necessarily about the job, but it was about making a human connection. And again, those were the areas where the leader really put the time at 15 minutes a month is not much. And the return on investment on that time investment, you can’t even measure it, but they felt cared about. So when we do employee surveys and the managers scored high, it’s because they felt cared about it. And that’s what they say in their comments.

Anthony Codispoti : That’s great. Okay, so Crystal, how did the opportunity to join Augusta first come about for you? Yeah.

Crystal Farmer : So actually, it was those recruiter email cold calls, those work. Okay. You know, sometimes it’s your I think the recruiter is like, maybe today is the day that somebody wants to look for a new job. And I wasn’t not looking for a job. I was very happy in my role. I was already a chief nursing officer at my second hospital. I’d already been with the organization that I was with for over 20 years and not planned on leaving. But there were things that, you know, I started to wonder as I got more comfortable in my own leadership style and and in the leadership team that I started to wonder, you know, I’m not sure that I feel valued here every single day. And it was really just having time and experience in there that I thought, I wonder how it’s done in different places.

So to be honest, I happened to have like probably a very challenging week. And then I got that email and I thought, where the hell is a Fisher’sville, Virginia first. I’ve been in Virginia my life.

I’ve never heard of it. And, you know, it was two hours away. And so I reached out back out to the recruiter. I said, I would love to hear more about the hospital. And so on a whim, and really probably more for my confidence that thought I’ll drive up there and interview. But I don’t plan on leaving. I’m fully invested, you know, I have my retirement. And when I came to Augusta, I fell in love.

Anthony Codispoti : Pretty quickly, like, like on that first visit.

Crystal Farmer : And yeah, I did. I hoped that I would have the second interview, make it to the second interview process. I interviewed, I tell my CEO all the time, Mary, I said, I was fully vetted. I interviewed with like 48 different people. By the time all the interviews were done. And I left here after the second round of interviews thinking, wow, I really do hope I get that.

My daughter was still a senior in high school. So again, I was not, how’s that going to work? And so Mary gave me the call. But what was different for me and where I felt like I could really do some good things here and feel supported as well, is when I interviewed with our board members, actually, it was three or four of them that interviewed me. And I had interviewed with board members before. And when these board members interviewed me, they really talked about people. So, and one question was, you know, patient experiences, you know, what are you going to do about that?

And tell me about how you did, what you did in your current role. And so we talked about that, which happened to be very passionate about. And then they said, you know, also we’re hearing the community that our nurses aren’t having a great experience here. Our turnover isn’t great. But people don’t enjoy working here all the time. And then I saw the employee, the nurses engagement survey. And it was in the 21st percentile. So 80% of other hospitals surveyed and nurses were having better experiences than they were having here.

And so we talked about that, you know, things that I would do. And they didn’t ask me about finance. You know, they didn’t ask me about all the regulations that we have to meet because they assume I’m in this role. I’ve been doing it.

I know how to do those things. But they really wanted to make sure that they were hiring someone that was focused on people. And just those questions alone, I thought, this is a different place.

It’s a different feel from top down. And then I interviewed with front line staff and they told me the same things. They were very open and honest as staff usually are when they’re interviewing a potential boss about all the things that they feel like needs to change.

And this was no different. And I said to them, you’ve been really open about the opportunities here and what’s wrong. But why do you stay? Because many of them have been in here over 15 years. And they all told me that it was because this isn’t just a job for them. This is their community. So like one of them said, you know, my mom just had a calf last week, but it was my friend taking care of her. And, you know, I see my patients in the grocery store. And so it’s really this community feel. That’s great.

Anthony Codispoti : Tell me a little bit more about Augusta itself. How many locations? How big is this breadth of services that you provide? Sure.

Crystal Farmer : I think our bed size, so we’re 255 beds. And that’s the medium sized hospital, but that’s not very indicative of the size and impact that we have on the community. So we have one hospital, but we are a health system. We have dozens of outpatient clinics, physician offices. We have a very large home health and hospice program. We have a mobile clinic. So we last year started or two years ago started taking health care to the community and it really came out of COVID. But that’s a great program. We go to 19 different locations with our mobile van and take health care to the people that need it the most.

Anthony Codispoti : We have like where are you going? Are these like homeless camps or these like churches?

Crystal Farmer : Yeah. Okay. So we look at, you know, the patients that are in our service area and where are those areas that need us the most? So they may have transportation issues. They may not have insurance and it’s beneficial to us, you know, for them to get health care early. But it’s also beneficial to them. And so we realized there’s a lot of barriers to coming to the hospital. Let’s take it to them. So it’s churches.

Anthony Codispoti : Who funds that? Who funds that? Community centers. It’s homeless shelters. Sorry. Sorry for talking over you. Who funds all of that? We do. That comes out of your pocket.

Crystal Farmer : It does. But that’s part of being a community hospital.

Anthony Codispoti : I was going to say you guys are part of the community.

Crystal Farmer : We’re part of the community. We’re non-profits. So we put much, we put 80% of what we make back into the community or into the hospital. Wow. And so we have a farm here as well. We have a working farm. We have a fitness center on site. So we have a gym and we have childcare. It’s just a huge footprint in the community.

Anthony Codispoti : So you talked about one of the first things that you tackled when you got there was the, you know, whole human connection component. Get those employee satisfaction scores, the patient satisfaction scores up. Tell us about another project that you’ve wrapped your arms around and you’re proud of.

Crystal Farmer : You know, a lot of it had to do with staffing in the beginning. If you talk to any nurse, we always feel like we don’t have enough people and there’s a nursing shortage.

So to a degree, that’s also true as well. But when I got here, you know, one of the assessments that you have to make as a nurse leader is, is that we don’t have enough bodies per se, or is it the team’s not working together or is it we’re not scheduling right? And so there’s a lot of questions and assessment that you have to do when you’re trying to figure out when people are saying staffing, we’re short staffed all the time. And so as I dug into it, I realized, well, wow, we don’t have enough bodies here. We don’t have enough nurses here. And some of the ones that we were hiring because we were so desperate, we’re not the right fit for our organization. You know, we want to hire a particular type of nurse. And so I worked with not only with my leadership team of saying, I want us to identify the type of people that want to work here, that we want to work here.

So what does that fit look like? And we stopped hiring, what I say, bodies and making sure that we hired the people who want to be here for the right reasons. And so that made a huge impact in our turnover. Some of the other things that had to do with staffing was our reputation in the community. So we have a lot of nursing schools around us and they bring their students here to do clinicals, but those students weren’t always having a great experience here. They might have been mistreated by the nurses or the physicians.

Well, that’s where we’re going to recruit from. And so, you know, we had a lot of conversations on that with all the schools, all the nursing school leaders and said, you know, I’m sorry for what’s happened. How do we move forward? How can I, you know, make these relationships stronger and support the students and what they’re doing? And so we did a lot of work about making sure that students felt good when they worked here.

And that also helped us recruit tremendously because they felt like they were part of the team, even as just being a student, so they would apply afterwards. We also started our branding campaign, a nurse branding campaign. And that really talked about if you want to be a nurse here, we have an L &D unit. We take care of you from birth all the way through your life cycle of any kind of nursing that you’d want to do until you’re deaf because we have a hospice unit.

And not every hospital can follow a patient’s journey all the way through their life. And so we talked more about what it’s like working here in the opportunities here. And so we just built a brand for nursing. And so our turnover, our recruitment numbers went up and they continued to go up every year. And our turnover during COVID was about 32%. And now we’re down to 14%. And so that’s just through hard work.

Anthony Codispoti : Once you find somebody that fits the mold, they’re there for the right reasons. How do you hold on to them? How do you keep them there?

Crystal Farmer : You know, it’s just as important. And I learned very early here because I put a lot of attention on we need to recruit, we need to recruit, we need to recruit because we just didn’t have the sheer numbers to take care of patients. But during focusing on recruit, I had a nurse that had been here, I think 25 years. And I did a lot of town halls to explain what are we doing to get the word out. And a nurse that had like 25 years experience came up to me afterwards and she said, you know, it’s great that you’re recruiting and we’re building our numbers. But what are you doing for the people that have been here?

And I thought, you know, that’s a really good question. And I was so focused on recruiting, but I’m not going to keep those people that I’m recruiting if I don’t figure out the retaining part. And so that’s when we started really talking about, again, making those human connections with leaders, making sure our leaders had the right training. You know, how do you know how to be a leader? What skills do you need?

It’s not just because you are a great nurse at the bedside. We need to make sure they have the skills and the tools to do their job. We talked about benefits and we talked about what sort of, if we were giving a sign on bonus, for example, to a new nurse, let’s say we gave them $5,000 sign on bonus, then what were we giving for our team?

And so we, if a nurse referred another nurse here, then we would give that nurse $5,000 to as incentive, you know. And so we did a lot of these little things. There’s a ton of tactics that we did, but it was really focused on meeting the needs of the people that we have. And one of the other areas is, and it’s very challenging, I think, in all areas, is all the generations working together. And so what worked for a baby boomer is not going to work for a millennial or a Gen C. And so we really had to open our eyes to it’s not a one size fits all. It’s really the things that Gen Z and millennials have wanted is career paths and growth and development and what does that look like. And that’s very different than some of the other generations of nursing. And so we also made sure that we were, we didn’t have this many of one size fits all, that there was really truly things that we could do. Yeah.

Anthony Codispoti : Crystal, during the middle of COVID, you decided to get your pathway to excellence designation. What is that and why did you pursue it?

Crystal Farmer : Pathways to excellence is similar to a magnet. It’s the same company and it really lifts up the power of nursing and the voice of nursing. And pathways to excellence is really focused on the practice environment of every nurse, no matter where they work in the hospital or in a physician’s office. And they want to know that we have the support systems and a positive environment for them to work in. And it takes a little while to build that and there’s certain areas that you have to, in order to build this positive practice environment that you really need to execute on these particular things.

And so I decided during COVID, even though we were already stretched then, you know, I think this is what we’re going to need to start moving out of crisis mode into this is normal life. And it was a way to distract from what we were doing. But it was an entire team decision because it does take a lot of time.

And it is going to take away from some of the things that they have to do. And so I set the nursing team down and also the other hospital leaders down and said, here’s what it’s going to take. Here’s the time that it’s going to take for everybody.

Can everybody get behind this? I know we have a lot to do. And every single leader in the organization had a vote. All my nursing leaders had a vote.

And they all said, yes, we want to do this. So it took us two years to really meet all the requirements to meet pathways. Once you meet the requirements and you’ve documented those, you send it to the ANCC and they accept your document. So you have to have examples of every single thing, all the requirements, and a real example about how we met this thing. It also had to be written by frontline nurses.

So it was not leaders that were writing these things. It was frontline nurses giving examples of how we’ve met this. After they accept our documents, then they do a survey of every single nurse. And it’s sort of validation.

So we got your documents, but are you really doing this? And so they anonymously survey all the nurses and we have to get a certain percentage in order to be designated as a pathway to excellence. And it was just what we needed to start coming out of COVID, focusing on the things that created that positive practice environment, like grounding, like leadership development, career pathways, all the different ways they can grow, certification, pay. Those are the things that nurses care about. And we had a laser focus on those. And it was the best thing we could have done.

Anthony Codispoti : Crystal, say more about that experience of coming out of COVID. COVID was hard on everybody, but probably no harder than it was in your environment. What was the vibe there like and how helpful was this pathway to excellence program?

Crystal Farmer : It stopped me if I’m rambling. In the middle of COVID, things were changing literally every 15 minutes. Do you wear a mask? You not wear a mask? Do you wear full protective equipment?

Do you have to have a respirator? I mean, there were just all sorts of questions coming out. And this was even before the vaccine. And a lot of healthcare people thought, you know, this is probably just a bad version of the flu. And we were all used to going through flu season.

So we really thought this would probably be over a month or two. And it wasn’t. And it got worse and patients died. And it was really hard to be a nurse at that time. Things were changing. You didn’t have all the information.

Social media didn’t help either. And all these opposing views about things. And in front of them, they were seeing patients die like they’d never seen before. And we had to set up special units.

They had to wear extra equipment. And it was just really difficult. And so when you go through something like that for an extended period of time, really start going through burnout. And I call it caregiver fatigue. Where you’re so busy taking care of everybody else that you’ve become immune to your own needs.

And sometimes not sensitive to others’ needs because you’re in this environment all the time. And so it created a lot of burnout. And so I felt like we needed to start really focusing on how we were going to prevent burnout, which also would have helped us with turnover.

And so for me personally, you know, I go back to the things that worked for me. And when a big change needed to happen, and again, I needed to get back to being vulnerable with my team. And because I also felt burnout, I also felt like, you know, I’m not sure if I’m the right leader to see them through this.

You know, is having again, you know, questioning my own abilities to lead through this, because I’ve never been through this before. And I didn’t have all the answers. And, you know, sometimes all I could do was sit and listen. But I didn’t have solutions for things. And that really bothered me. Again, at the same time, having been burnout myself.

And so I started thinking, I think that I cannot be effective here anymore. And this is my own wording. You know, no one told me that, you know, a boss never, she’s always supported me. But I started feeling like I don’t, I don’t know if I’m giving them the right things. And I started questioning, you know, maybe I should leave so someone else can do, maybe someone else can do a better job of just helping with this burnout. And I had a nursing director come to me right at the moment where I really needed to make a decision whether I was going to stay or go. And she didn’t know that I was internally dealing with this. And she put a letter on my desk. And it said, you know, I know that you focus on us and the front line so much. But, you know, I want you to know that I see you. And it still gets me emotional that I see you and that I appreciate the things that you’ve done and the time that you’ve spent with us. Even if it’s even if you don’t have the answer, the time spent in just talking through this has made me a better leader and I just, and thank you. And so after seeing that, that was sort of that I needed to hear that, you know, even leaders need, you know, that positive reinforcement every once in a while and not everything just because things aren’t great.

I mean, no one could control COVID. It doesn’t mean that we’re not doing well as a team or that we’re not close. And so I just disclose to my team, listen, I’m feeling burnout too, but this is not the way where we’re going to stay. And I had to be really open and honest with them.

Anthony Codispoti : And you chose to be open and honest with your team after you had received this letter. Yeah.

Crystal Farmer : Okay. That, you know, I was also feeling burned out and questioned my ability to lead them and to get them out of burnout. And, you know, they were afraid to express some of the things that they were feeling because I had tried to stay, you know, very professional and everything’s going to be okay. We’re going to get through this.

And, and that’s called crisis leadership. You know, you can’t fall apart. And I realized that they need to see the human side of me where I was struggling just as much as they were. And the only way that we could get out of it is if we supported each other. And the leaders really came together and we started holding each other accountable for not working late nights, not sending emails late at night and taking your vacation and just doing things to have a better work life balance, but just opening up that conversation to my leaders to say, I understand where you are because I’m there too. But how do we get out of it? I think it really impacted quite a bit of leaders.

Anthony Codispoti : I mean, it sounds like you struck a really critical balance at just the right time there, right? You can’t show up to work, you know, sobbing every day because like you said, crisis mode, like, you know, you got to show up and get stuff done. But it’s at some point, being too professional, too rock solid, you know, is making everybody else alongside of you feel like, what’s wrong with me because I don’t have that same confidence that crystal is exuding. And so then when you can kind of pull the curtain back and say, listen, here’s what’s really going on inside of me. They’re like, oh, thank goodness, me too. Let’s come together, give each other a hug. And you know, how can we make this better and move on?

Crystal Farmer : Yeah, yeah, that’s exactly how it happened. And you know, some people could move on and we mostly moved on as a group or nurse leader engagement, improved by over, by memory over 40%. You know, we were really low. And, and they took their just a nurse leader engagement survey.

And when I saw it was so low, that’s, I’m like, yeah, I’m feeling the way they are. And how do we get to it together? And so we use that as our starting point. And then we just did another survey last year, and it’s more than doubled, you know, what it was when we took that during COVID. And so I know that was incredible. Yeah.

Anthony Codispoti : Crystal, I want to hear you talk a little bit about blame culture that used to exist in the hospital system. What does that mean? Why is it no longer the problem it was?

Crystal Farmer : Yeah, I think, you know, it’s one of the reasons why I, you know, when I was called on to be a leader, it’s one of the reasons why I said yes. And, you know, when things happen to patients or to other people, so I’ll just use a fall, for example, the patient falls in the hospital, the way it used to be when I was at bedside is the first question that you would get from a leader is why’d you let your patient fall? And so immediately, one, you’re on the defense and two, you feel like you’re a terrible nurse. And those things have happened to me and I didn’t let my patient fall, but I also can’t be there 24 seven. And so you put all these things in place to try to prevent it.

But sometimes it’s still it’s not 100% foolproof that it’s not going to happen. And, and at the time that, you know, I was blamed. I felt like blamed. I thought, again, this is early in my career, I’d only been a nurse for about five or six years. I thought, okay, well, they must not think I’m a good nurse. If I let my patient fall, and maybe I should be away from the bedside and just really blame myself for a long time. And then I decided to go back to school to try to understand how maybe I don’t understand how things work.

And, and how can I not let those things happen to my patients? So I decided to go back to school thinking I would have the answers to those questions. I want to be a better nurse.

I want to I don’t want bad things to happen to my patients. And, you know, what I learned out of school was, you know, it’s all about how the organization or how this particular leader looks at errors, you know, medical errors, medication errors, things that happen. And the old school way was blame and shame and make you feel bad. And the way it should be is, okay, Crystal, your patient fell. Let’s go back to this timeline about what happened.

And are there things that we could learn from this? So for example, on my situation, the patient had what was called a bed alarm on. So it should alarm when the patient comes out of bed. It didn’t go off. So when we looked back and started doing root cause analysis, well, why didn’t they get it off?

It didn’t give me enough warning. Well, it’s because there was a weight limit on it. And my patient only weighed 90 pounds in order for it to feel pressure.

The patient needed to weigh 120 pounds. And so that’s what we should be looking at. We should go back and say, let’s go through the situation. Let’s look at our policies or what we’re doing and our policy and the thing that we’re really doing.

Let’s go looking through the equipment. Let’s figure out how this, how we can prevent this from happening again. And that’s proactive. That’s a culture of safety. That’s a no blame.

Anthony Codispoti : Nurses are much more constructive. Yeah, it is. And we’ve prevented other things from happening because nurses feel comfortable coming forward of and reporting, hey, this happened until we dig into the situation. It’s less than 1% of the time that it’s actual person issue.

Most of the time, it’s an organizational or policy issue that we haven’t dug into to find out why these things are happening. What was the catalyst over the years to sort of spark this change?

Crystal Farmer : You know, the catalyst for me really thinking about how errors at the bedside, again, just use that when there’s things that happen in healthcare, no matter if it’s a bedside or not, and how those people are treated. But as a leader, I wanted to understand that more because it does have a huge impact on somebody staying in healthcare or leaving healthcare and how they see themselves and making these errors.

You know, over the years, there’s been so many examples of when we talked about something or something that was reported and we fixed it and no more errors happened. And it was really about nurses having a voice and into the work that they do. And they know how to fix things because they’re at the bedside. Just listen to them. They’re at the bedside. They know how these things work. They know how it doesn’t work. And just listen.

Anthony Codispoti : I understand you’ve got two daughters, either in or entering the healthcare field. How do you feel about that?

Crystal Farmer : I am so incredibly proud of my daughters. My oldest, and they’ll probably both kill me for talking about them, but I talk about them a lot. They’ve influenced my career a lot as well. So my oldest is 26 and she’s a nurse. And she’s currently in an ICU unit. And she’s been a nurse for about four years. So she went to nursing school during COVID. And, you know, listening to her experiences during COVID really opened up my eyes to the experiences that my nurses might be having here. So when she would tell me about things during COVID and how she was training, also understood when people graduated during COVID, they didn’t get the same training that I did because it was very limited about what they could do during COVID. So she helped me open my eyes about some of the challenges that new grads might be having. But I would come back to my hospital and say, I just heard this from my daughter who works in a totally darker system. Is that happening here?

Could that happen here? And so again, it helped with those conversations and really being in tuned with the front lines. And so she’s, even after she became a new grad, finished nursing school, became a new grad, you know, one of the first times that she called me. And I just knew she called me crying and I thought, oh, she probably just had her first patient pass away.

And that’s not what it was. Because we all feel a certain way, especially when you’re first patient. And well, with every patient, but in particular your first one. And I said, what’s wrong? And she said, I just had a patient really talk poorly about me. And I heard, I overheard him talking to the other nurse. And I worked with him all night long, I was in his room all night.

And just the lack of appreciation, the instability to call her names, and to talk about her body style, her body type, just broke her spirit as a new grad. And so I came back to my leadership team and to my frontline nurses. And I said, is that instability happening here? And yes, it was.

And so again, it opened up a whole new world to talk about violence and work in the workplace, the instability that’s happening, and what tools and resources do we have to make them resilient, you know, to deal with these sort of things. And so my daughter has certainly taught me a lot. But I’m not going to let her know yet. And then my youngest, she is graduating from St. Louis University with her MHA. She got her MBA last year. And her dream has always been to be into healthcare leadership.

And population health. She’s had a good role model. Yeah, health equity and population health and to be in leadership. And she’s done so many things the right way to get there. So now, actually, this month, she’ll be graduating in two weeks, she’ll be looking for a job in healthcare administration. And, you know, I worry for her because just the state of things in healthcare in general right now, it feels like it’s on the shaky ground with, you know, all the policy changes, and payment changes that are having how we get reimbursed for the care that we provide. It feels really unstable right now. And so I worry about her career and the things that she’ll have to deal with that at least were a little bit more stable for me. Yeah.

Anthony Codispoti : You know, Crystal, the next question I want to tackle, I wonder if we’ve already hit the topics, you know, I always like to ask my guests about a serious challenge that they’ve overcome and how they got through it and what they learned. You’ve already touched on some. You have another one that you’d like to explore, maybe go a little bit deeper on one we’ve already mentioned.

Crystal Farmer : Yeah, there’s, you know, one of the, I’m going to answer that in a roundabout way, hopefully not rambling way. At Augusta Health, you know, one of the things that we do is a new leader orientation. And our director of organizational development about two years ago asked, hey, we’d really like to understand your career path.

And we’d like to have some of the leaders come and talk to the new leaders about how they got where they got where they are. But what were those defining moments in your career that made you think twice or something changed and the highs and the lows. So it’s on, you know, ideally you’d put a timeline together and your career progression is like this. And when you look at mine, it’s up here, I had some highs, I had some lows, and it’s just sort of like that because that’s life. And so I probably have quite a few, you know, my mom, you know, being in the burn unit, that was probably one of my lowest points. But it became the highest because that’s really what motivated me to do better for our patients. And, you know, having children was a high point. But I also realized, you know, soon after having children that I needed, I couldn’t be a nurse 24 seven, I’m always a nurse, but I also needed to make sure that I had enough reserves emotional reserves when I got home to take care of them and to be emotionally and compassionate for them. And it’s easy sometimes to give that all to your patients and not bring it home to your family. And so I had to make a career choice then of, I probably should get somewhere else that doesn’t drain me so much emotionally at the time I was working in hospice care. And so there’s been lots over the years. I think COVID, that was probably the biggest that I’ve had next to the situation with my mom.

Anthony Codispoti : What have you found as a source of strength or someone or something you can lean on during the really hard times?

Crystal Farmer : Just by the nature of who I am, I go internal. And it’s not a great coping mechanism. And you learn the older you get that you can’t do it by yourself. So my husband has been fantastic and knowing when those times where I’m really inside and through he’s really patient and waits for me to start talking about that. But I’ve really had great support systems. And that’s really, it sounds so cliche, but it’s really been those support systems and letting me figure it out in my time. And then reaching out when I need that help. My support systems have always been there.

Anthony Codispoti : Do you, are you part of any peer support groups? Some people call them masterminds or networks of, you know, folks who are in similar positions within other hospitals that you can kind of talk with and support each other?

Crystal Farmer : Yeah, that’s been, you know, a big part. And that would be advice that I would give anyone at any point in their career is build your network. Build your network. And you’ve got to have people that have similar roles to you, sometimes just as a sanity check. And to say, are you dealing with this? Or how have you dealt with this in the past?

Or is this weird? But I have a number of chief nursing officers that I’ve been very good friends with. A couple of them have been my mentors. I’ve built a really great network that I can call any of them, and we can call each other.

And during COVID, we were always on the phone with each other. But also reaching outside of nursing has been very helpful. So, you know, I have mentors that were CFOs and COOs and understanding that world. But I also think that the team that I work with and on my in my hospital right now, the administrative team, it will make you or break you.

And so we have such a great team that they really support each other in the good times and the bad times. And some people are so intuitive. Without you saying a word, they know something’s happening.

It just happened today. One of my colleagues came between and said, are you feeling okay? I’m like, oh, yes, I’m fine. I’m just tired. And she said, I wanted to check on you just to make sure, because I was reading something different.

And I’m like, oh, no, no, I’m just distracted. And I was fine and surrounding yourself with people like that. But I do have professional networks. You know, I have nursing leadership networks. I’m part of the American Academy for Healthcare Executives. I’ve built some great friendships there. But network, network.

Anthony Codispoti : What advice would you have for somebody who’s in a position of leadership? Maybe it’s, you know, within healthcare, maybe it’s not. And they’re like, yeah, like I could really use that. How do I even get started? Like, how do I build my network? How do I find that support group?

Crystal Farmer : Now, it’s lucky enough when I worked for my last company, it was a very large company. And, and so you could just pick up the phone and call another hospital that was in the same company. And coming to Augusta, we’re independent.

So we’re not part of a system. So I really had to practice on looking for those things. I think joining a nursing leadership organization is probably the first thing that you need to do. But then one of the wonderful parts about being part of the Mayo network is that now we have the resources.

And I can call Mayo and say, hey, who’s, who’s doing this right now? Which hospital? Which CNO?

Which COO? Are you that I can talk to you about this? So that’s been the fantastic thing about joining the clinical network there, because we have resources. I think the professional organizations are always where to start conferences, really taking advantage of going to your professional conferences. That’s where all the one to one connections happen. And, and if you’re in the same session, obviously, you have the same kind of interest right there. And so just start talking there.

Anthony Codispoti : What does it mean to be part of the Mayo network? What does that get you access to?

Crystal Farmer : It gives us access to all of the other organizations that are in Mayo. So, you know, Mayo has their their flagship hospitals, but they’ve opened it up to other independent hospitals joining so that we can have a clinically integrated network. And so what for us, how that’s really helped us is, you know, maybe there’s a specialty that we don’t have here.

And so we want to call someone that’s in the network to say, what do you think about this? Or sometimes our patients want a second opinion. Or Mayo is also known for their fantastic research and education that they provide. So all of our physicians have webinars and all sorts of education available right at their fingertips.

They don’t even have to get looking for it, because Mayo’s already done that. They have a lot of best practices that we can just tap into. For nursing, we’ve used their nursing network for best practice. There’s a CNO group as part of Mayo. And Mayo hosts a couple get-togethers every year for the CNOs just to talk about what are we dealing with. And so there’s lots of education, lots of opportunities for clinicians to talk and work on projects together. It’s just been a fantastic experience.

Anthony Codispoti : I want to talk a little bit more about community. You mentioned a lot about how guys are part of the community. You have these, you know, these health vans that go out to churches, homeless camps, different places to provide free healthcare for people. You know, the people who work there, they interact with their patients.

They see them at the grocery store, a church, etc. What does more formal kind of community outreach look like, aside from what you’ve already mentioned with the traveling health vans?

Crystal Farmer : So we have a whole network for community. We have a community partnership that we’ve put together. So in partnership with large employers, other community-minded businesses and organizations, and we bring that entire group together and we start talking about what would be most impactful for our community. So is it investing in this or a grant for this project for the YMCA or something for the homeless shelter? And so that I feel like we’re the of all those community groups working together. So not only is the organization itself doing things in the community like I’ve already talked about, but we’re bringing the other community partners together as well to do those things.

And one of the, there’s so many different things that we impact. Like I mentioned our farm, you know, we have our own farm. We grow produce there and we deliver that produce not only to our patients who have food insecurities. Once we’ve identified them, we make sure that they get those vegetables. We also use it for our diabetic education and we teach them how to cook healthy and you know, that’s just an offering to the community. But we also deliver food to the food pantries in the area. So someone doesn’t have to be a patient of ours to be impacted by the work that we do in the community. And so the food pantries, you know, rely on that produce as well. And that’s just one example of things that we do that, you know, it’s for the health of the community and for the benefit of the community. It’s not because we’re making a dollar off of it. I like that.

Anthony Codispoti : Crystal, I’ve just got one more question for you. But before I ask it, I want to do two things. First, I’m going to invite all of our listeners to go ahead and hit the follow button on their favorite podcast app. We want to continue to get more great interviews like we’ve had today with Crystal Farmer and Augusta Hell. Crystal, I also want to let people know the best way to get in touch with you or to follow your story. What would that be?

Crystal Farmer : Probably the best way would be on LinkedIn. It’s just Crystal Farmer, COO and Augusta Health and search for me and feel free to send me a message. I’ve done a couple presentations before and that’s the best way for people to just send me an email. And I’m happy to connect. I’d love to connect. The best part of my job is when I get to do things like that.

Anthony Codispoti : Well, and I understand that you actually made a LinkedIn post earlier this month. This is a, or actually it was last month, April 2025, that you were particularly enthused about. You want to give voice to that? Yeah.

Crystal Farmer : So I just happened to love April Fools. I have no idea why, but I just always do. And now that my kids are grown, I can’t do jokes on them anymore because now they know all my tricks. And so April Fools is coming up. We had a leadership meeting coming up and I loved to infuse fun and joy into our leadership meetings. You know, everybody hates a staff meeting because you sit there and listen and even the most interesting ones. If you’re not infusing fun and connection, if you don’t laugh in some sort of leadership meeting, really just leave feeling like now I got a whole lot more work to do.

It’s about building that connection. And so I had a partner in crime, our nutrition director. And between him and I, it took five minutes.

We used chat, GBT. We made up a new menu for our cafeteria and told our key leaders that, you know, we needed to support healthy eating and that we were going to go 100% vegetarian in our cafeteria. And our cafeteria is known. Like people come in from the outside when they’re not a patient just to eat at our cafeteria. So we have very good food. But going 100% vegetarian would definitely be a change. We have cows across the street, you know, we grow beef here. And so it was a good trick.

And people are still talking about it. And that’s the kind of connections like the shared stories that you have with your team, the shared jokes, the inside jokes. Those are great for building a team connection and purpose. But it’s all about bringing joy back to work.

Anthony Codispoti : Well, we’ll find a link to that post as well as a link to your own profile and make sure we include that in the show notes. Crystal Farmer, I want to be the first one to thank you for sharing both your time and your story with us today. I really appreciate it.

Crystal Farmer : Thank you for the opportunity. I really appreciate it.

Anthony Codispoti : Folks, that’s a wrap on another episode of the Inspired Stories podcast. Thanks for learning with us today.