Michael Charlton was recently named CEO of AtlantiCare, a healthcare organization operating across five counties in southern New Jersey and serving a region of 1 million residents. In conversation with Mr. Charlton, we learned more about AtlantiCare’s mission and his philosophy for being a transformational leader in the 21st-century healthcare space.
Meet AtlantiCare
With over 100 locations, AtlantiCare has over 100 locations, including two hospitals, 11 urgent care centers, and six federally qualified health centers (FQHCs). AtlantiCare also boasts four health parks, healthcare facility campuses, and amenities grouped in one location. These consist of multi-specialty and mixed-use spaces. For example, the Egg Harbor Township health park has multiple buildings housing its Cancer Care Institute, surgical center, urgent care, medical and corporate offices, and other services.
“We have over 6,500 team members,” Charlton shares, “and nursing makes up over 2,000 of those team members (including LPNs, RNs, and APRNs). We have 600 nurses working in ambulatory, 220 APRNs, 1000+ nurses within the hospital setting, and 150+ working in leadership or other corporate support positions. There are an additional 800+ team members working in nursing support.”
When asked about AtlantiCare’s mission, Charlton states, “Our mission is simple: we always care for our patients with kindness and excellence. Our #1 goal is to make a difference in health and healing, one person at a time.”
A CEO’s Story
Mr. Charlton’s CEO journey is an interesting one. He states, “I assumed the CEO role in June of 2023, with my appointment becoming official a few months later in October. Before my tenure as President & CEO of AtlantiCare, I was a member of the Board of Trustees for 15 years, with 7 of those years serving as Chair.””
Charlton continues, “While healthcare has long been a passion, my career started in the hospitality industry. I founded Icon Hospitality, a successful family of businesses dedicated to superior quality and service.”
When Charlton wanted to understand the intricacies and nuances of the night shift, he embarked on a learning process to truly grasp the challenges faced by employees who work those late nights.
“The night shift is a lifestyle for many team members, so it was important to me to experience it in a meaningful way,” Charlton opines. “Night shift comes with a unique set of challenges that are difficult to understand until you see them happening in real-time. It’s critical that these teams achieve the same level of excellence as other shifts, but they don’t always have the same set of resources. I wanted to see how decisions are made in that environment.”
To accomplish his goals, Charlton was on-site for many night shifts with the intent to be present, visible, and supportive. He brought food to the team and observed their workflow, needs, and interactions. Most importantly, Charlton experienced their challenges and obstacles firsthand and in real-time and was thus able to address them in meaningful ways. He still regularly stays connected to the nursing team in this manner, focusing on spending time on hospital units on nights and weekends.
Charlton reflected on the experience by saying, “It was truly an eye-opening experience that is helping to shape the design of our nursing organization.”
Lessons Learned
Charlton left with strong impressions of what happens during the night in AtlantiCare facilities.
“The lessons I learned are universal. Our hospitals run 24/7, and the care patients receive at 1 pm must be the same as the care they receive at 1 am.”
“The night shift should not be any different than any other shift, “Charlton observes. “Appropriate staffing is critical at all times, every day. That means providing the right assets to our nurses, such as housekeeping staff, security, and access to leadership. Resources must be the same regardless of shift. That is best for our team members and our patients.
“I found that the administrative ways in which we ran the night shift were an outdated model. It is distressing that weekends are staffed differently when care is required around the clock. Nursing leadership was being asked to pick up the administrative burden when others went home for the night. We need hospital administration in the building at night to provide support and direction because care doesn’t stop at 5 pm. However, like many hospitals, most of our team was not working nights.”
“We need to ensure we have the right number of team members to care for our patients. I believe that when we take good care of our team members, they can provide their patients the highest level of care.”
Charlton has a clear vision regarding the administrative burden of ensuring that AtlantiCare facilities run well at all hours of the day and night. He shared, “We must focus on reducing non-productive administrative work placed upon our nursing team. Less time at the computer and more time at the bedside providing the personalized care that called so many to this field.”
As CEO, Charlton drafted plans for solutions.
“I immediately started working on a new model of what our hospital schedule should look like. At the time of this writing, we are now 90 days away from implementation. The initial stages will be administrators placed in the hospitals on nights and weekends to support the nursing team. We will be appropriately staffed across all services needed to operate effectively and efficiently.”
Charlton adds, “Clinical quality and care are always our priority. We serve a large population, many of whom are the most vulnerable in the community. Because of this, we must put our mission ahead of anything else. We have finite resources, so we make sure the allocation of resources is a collaborative effort to meet all needs. When fiscal responsibility is framed within the context of mission and something to take on as a team, you set yourself up for success.”
Embracing Appropriate Technology
“The administrative burden placed on the healthcare industry is especially felt by nursing, and the right technology can help,” says Mr. Charlton. “At AtlantiCare, we are exploring solutions like virtual nursing, which helps balance workload by streamlining tasks such as admissions, patient education, observation, and discharge.” “We are also building our Command Center to up-end the model of care and allow us to reach out to our patients when we know they need care – even if they don’t know it yet. This is the gold standard for personalized, proactive, preventative medicine that builds long-term, trusting relationships, which our patients and our team want.”
But is technology always the right fix?
“Not all problems are solved through technology,” Charlton observes. “We have also taken a hard look at the span of control for our nurse managers to give them more administration and clinical support so they can be present with their teams.”
Finding Balance
Charlton clearly views how AtlantiCare approaches this crucial issue regarding staff work-life balance.
“I prefer to talk about work-life harmony, not just work-life balance. We have five generations working right now, and they each have different wants, needs, and desires. It’s important to understand our team as individuals whose work at AtlantiCare lends itself to the richness of their lives. Different individuals have different needs and priorities. We want to provide each team member with the tools they need to create the best balance or harmony for them.”
How can healthcare organizations and facilities recognize events like Nurses Week in a manner that goes beyond the usual tropes of tote bags, water bottles, pizza parties, and “heroes work here” banners?
Beyond Nurses Week
When asked about how healthcare organizations can move beyond the superficialities of Nurses Week, which is usually celebrated with pizza parties and free travel mugs, Charlton is clear in his response.
“My leadership philosophy is “Be visible. Be kind.” A week of recognition is great, but our leaders must be consistently present, supportive, and working with our nursing staff 52 weeks a year. True recognition, in my view, comes from meaningful interactions and acknowledgment of the hard work our nurses put in day in and day out.”
“We also make it a point to provide personalized recognition throughout the year,” he adds. “Our participation in the DAISY Awards is an excellent example of how we celebrate individual contributions. As a team, we all take pride in our national recognition as 5x Magnet, a distinction only achieved by 1% of US hospitals. This achievement speaks volumes about our nursing team and their focus on excellence.
“Nurses Week is certainly important, but to me, it’s more important to focus on creating a culture where our nursing team feels appreciated and recognized for their hard work and dedication all year long.”
A small clinical trial supported by the National Institutes of Health has found that eating during the nighttime—like many shift workers do—can increase glucose levels, while eating only during the daytime might prevent the higher glucose levels now linked with a nocturnal work life.
The findings, the study authors said, could lead to novel behavioral interventions aimed at improving the health of shift workers – grocery stockers, hotel workers, truck drivers, first responders, and others – who past studies show may be at an increased risk for diabetes, heart disease, and obesity.
The new study, which the researchers noted is the first to demonstrate the beneficial effect of this type of meal timing intervention in humans, appears online in the journal Science Advances. It was funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), part of NIH.
“This is a rigorous and highly controlled laboratory study that demonstrates a potential intervention for the adverse metabolic effects associated with shift work, which is a known public health concern,” said Marishka Brown, Ph.D., director of the NHLBI’s National Center on Sleep Disorders Research. “We look forward to additional studies that confirm the results and begin to untangle the biological underpinnings of these findings.”
For the study, the researchers enrolled 19 healthy young participants (seven women and 12 men). After a preconditioning routine, the participants were randomly assigned to a 14-day controlled laboratory protocol involving simulated night work conditions with one of two meal schedules. One group ate during the nighttime to mimic a meal schedule typical among night workers, and one group ate during the daytime.
The researchers then evaluated the effects of these meal schedules on their internal circadian rhythms. That’s the internal process that regulates not just the sleep-wake cycle, but also the 24-hour cycle of virtually all aspects of your bodily functions, including metabolism.
The researchers found that nighttime eating boosted glucose levels – a risk factor for diabetes – while restricting meals to the daytime prevented this effect. Specifically, average glucose levels for those who ate at night increased by 6.4% during the simulated night work, while those who ate during the daytime showed no significant increases.
“This is the first study in humans to demonstrate the use of meal timing as a countermeasure against the combined negative effects of impaired glucose tolerance and disrupted alignment of circadian rhythms resulting from simulated night work,” said study leader Frank A.J.L. Scheer, Ph.D., professor of medicine at Harvard Medical School and director of the Medical Chronobiology Program at Brigham & Women’s Hospital in Boston.
The researchers said that the mechanisms behind the observed effects are complex. They believe that the nighttime eating effects on glucose levels during simulated night work are caused by circadian misalignment. That corresponds to the mistiming between the central circadian “clock” (located in the brain’s hypothalamus) and behavioral sleep/wake, light/dark, and fasting/eating cycles, which can influence peripheral “clocks” throughout the body. The current study shows that, in particular, mistiming of the central circadian clock with the fasting/eating cycles plays a key role in boosting glucose levels. The work further suggests the beneficial effects of daytime eating on glucose levels during simulated night work may be driven by better alignment between these central and peripheral “clocks.”
“This study reinforces the notion that when you eat matters for determining health outcomes such as blood sugar levels, which are relevant for night workers as they typically eat at night while on shift,” said the study co-leader Sarah L. Chellappa, M.D., Ph.D., a researcher in the nuclear medicine department at the University of Cologne, Germany. Chellappa formerly worked with Scheer in Brigham & Women’s Medical Chronobiology Program.
To translate these findings into practical and effective meal timing interventions, the researchers said more study is needed, including with real-life shift workers in their typical work environment.
For the sixth year in a row, WGU Indiana delivered Night Shift Nurse Appreciation Kits to hospitals and healthcare facilities across Indiana for daylight savings time. These kits were provided to nurses who worked an extra hour during their usual, and already difficult, shifts.
In addition to the usual work challenges that all nurses tackle, night shift nurses run into problems on the job that affect more than their careers. Having their circadian rhythm thrown off by their working hours, these night shift nurses are put at risk for fatigue and other health issues.
The care packages also included information about the WGU Indiana Night Shift Nurse Scholarship. There are five $2,000 scholarships available to Indiana night shift nurses who are interested in advancing their education through WGU Indiana’s College of Health Professions.
Most nurses at some point in their career will have to work night shift. The grueling hours can take their toll on your body and your life, so it is important to focus on taking care of yourself. Here are a few suggestions for how you can be healthier (and happier) while working night shift:
1. Find a sleep schedule that works for you.
It is important to find a sleep schedule that works for you while working night shift. Some people can switch back and forth between day shift and night shift simply by taking long naps the day before they work (e.g., sleep 10 pm – 6 am and nap 3 pm – 5 pm). If you find you are unable to take naps, try sleeping in late the morning before you work (e.g., sleep 2 am – 10 am). You may also find that your body functions better with only a partial switch in your sleep schedule, so that you stay up later at night and sleep later in the day, even on your days off (e.g., sleep 4 am – 12 pm on your days off).
2. Drink caffeinated beverages (in moderation).
Many night shift workers are dependent on caffeine for survival. If you are someone who relies on caffeine to stay awake during your shift, be sure to stay away from energy drinks that are loaded with sugar and large amounts of caffeine. Instead, drink coffee or tea. Remember to stop drinking caffeinated beverages around 2 am to avoid being unable to sleep later in the morning.
3. Fuel your body with healthy foods.
It may be tempting to binge on sugary foods to feel energized, but these foods will cause your blood sugar to crash and your stomach to rumble shortly afterward. Fill your lunch box with high protein foods that will help you stay full longer, and fruits and veggies that will help your body feel refreshed instead of sluggish. Try packing items like apples with peanut butter, salad with fruit and nut toppings, or a brown rice veggie bowl.
4. Practice good sleep hygiene.
One of the most difficult parts about working night shift is having to sleep during the day. By practicing good sleep hygiene, you will be able to fall asleep faster and stay asleep longer. Try investing in a good set of blackout curtains and earplugs to simulate the quiet darkness of nighttime. Avoid watching TV or looking at your phone before you sleep, and be sure to turn your phone to silent mode to avoid notifications that will wake you up. Before you crawl into bed, take some time to unwind and relax by stretching, reading, or meditating; this will help signal your body that it is time for sleep.
5. Stay hydrated.
Staying hydrated throughout your night shift will help your mind stay alert and your body feel energized. Your body is made of over 60% water, and water fuels almost every bodily function. The average woman should drink approximately 2.7 liters of water, and the average man should drink 3.7 liters of water per day. If you’re not a fan of plain water, try adding slices of fruit to your water for some extra flavor.
6. Seek professional help if needed.
Some people experience headaches, insomnia, and nausea while working night shift. Give your body a month or so to adjust to your new lifestyle, and if you continue to struggle, talk with your doctor. A doctor may be able to advise you on how to treat and manage your symptoms.
My name is Sarah and I have been a postpartum nurse for about a year. I work on a 36-bed labor, delivery, recovery, and postpartum unit in the Seattle area. We take care of a variety of postpartum patients and babies on our unit, and see gestational diabetes, preeclampsia, small- and large-for-gestational-age babies, late pre-term babies, etc. I work three 12-hour shifts per week, and I am currently working night shift.
Typically, I have three to four couplets each night, all needing vital signs, assessments, medications, 24-hour newborn screenings and much more. I am lucky enough to work at a baby-friendly hospital where we encourage breastfeeding, so I spend about 30% of my time as a postpartum nurse educating and assisting my patients with breastfeeding. The rest of my time is spent delivering hands on nursing care (about 40%) and charting (about 30%).
It would be nearly impossible to write about the many things I do during my 12-hour shift, but I will try to describe a typical day as a postpartum nurse:
17:00: My alarm goes off. I snooze for another 15 minutes while I cuddle with my cat.
17:30: Shower time. Once I am squeaky clean, I eat a bagel and cream cheese and drink my English breakfast tea. I always make time to sit down and eat before I go to work so that I can fuel my body and mind.
18:10: I braid my hair, do my makeup, and put on my scrubs.
18:45: I say goodbye to my cat and she meows in protest. I head to my car and listen to NPR during my 10 minute drive to the hospital.
19:00: I clock in, grab a work phone, drop off my bags in my locker, fill my pockets with my essential nursing supplies, and sit in the break room to hear the unit’s announcements and safety concerns.
19:10: Out on the floor I am greeted by the day shift nurses, who are extremely happy to see the night shift nurses. I have been assigned three couplets tonight. Two are vaginal deliveries and one is a caesarean section. One of them is an experienced mom, and the other two are first-time moms. All have chosen to breastfeed their babies (yay!).
19:15: I find the day shift nurse who has my patients and we go into their rooms to get SBAR report, introduce me to the patients, and write my work phone number on their white boards. As I congratulate each set of parents and ask about their baby’s name, I scan the room and patient to make sure all my emergency supplies are available, tubes and drains are functioning properly, and the bed and bassinet are locked and safe.
19:40: After getting report, I sit down at a computer to gather additional information on my patients and plan my night. For each patient, I look at their history, orders, medications, and labs, and chart a Braden skin assessment and Morse fall scale. I plan out when vital signs, medications, and other tasks need to be done during the night.
20:15: Feeling organized and ready to take on the night, I visit each of my patients to tell them their plan of care. While I’m in the room, I restock supplies, take out trash or dirty linens, and tidy up the room.
20:30: I get a call from one of the dads. Baby pooped for the first time and they need help with the diaper change. I enter the room to find a screaming baby and panicked dad. Dad hands me the baby and I proceed to change the diaper while I educate the parents on diaper basics. The parents look at me with wide eyes as they see the sticky black meconium. I reassure them that this is completely normal as I swaddle baby and hand him to dad.
21:00: It’s time to do the first set of vital signs on my cesarean section patient and her baby. I get blood pressure, temperature, and do a full assessment on mom. Her belly is distended from the c/s and she hasn’t passed gas yet, so I talk with her about taking a medication to help relieve the gas and other alternative therapies she can try. She agrees to take the medication and try walking the halls, so I grab the gas pill, simethicone, as well as her Advil and Tylenol that are due. I assess her pain and give her the medications. I then listen to baby’s heart and lungs and do a full assessment. Baby has a wet diaper, so I quickly change it and swaddle him.
21:30: Spotting my charge nurse in the hall, I stop to give her an update on my patients and ask a few questions. She tells me there are cookies in the break room from a thankful patient, so I make a mental note to grab one later in the night.
22:00: I take my 15-minute break and scarf down an apple with peanut butter, pretzels, and cheese. I drink some jasmine green tea on my way back to the unit.
23:00: More vitals and medication administration. While in one of the rooms, I notice that baby has managed to wiggle out of his swaddle, so I wrap him up and spend a few minutes cuddling and cooing at him until mom has returned from the bathroom.
00:00: I get a phone call from one of my dads and he expresses concern about baby being fussy. I go into the room to see if I can help soothe baby. I educate the parents about the many reasons baby might be crying: hunger, wet/poopy diaper, wanting to be held, etc. The parents soak up the information like a sponge and begin to discuss what baby might want. They decide that baby needs to be re-swaddled and might want to be held. I watch and give feedback as mom swaddles the baby. It takes her two tries, but she is thrilled to have done it by herself.
01:00: It is time for the 24-hour screening, so the tech and I gather our supplies and head into the patient’s room. The baby is sleeping, so we take advantage of the quiet time to do the CCHD heart screening and jaundice check. Baby passes the CCHD test, but the jaundice level is higher than average. I explain to the parents that while I do the metabolic screening, I will also be gathering a small tube of baby’s blood to test the serum bilirubin level. The parents are asking questions about why baby’s bilirubin is higher, so I sit down to explain and educate them about newborn jaundice. While I’m discussing this with the parents, the tech is weighing baby and warming baby’s foot for the heel poke. Once the baby’s foot is warmed up, the tech holds the baby in her arms while I clean, poke, and gather blood from the heel. The baby doesn’t cry during the whole procedure and the parents proudly state that they have a brave baby.
01:30: I run the bilirubin test to the lab. I then get a phone call. One of the moms is having difficulty feeding her sleepy baby and she would like me to come help.
01:40: I enter the patient’s room and baby is sound asleep on mom’s chest. It has been almost three hours since baby’s last feeding, so I pick up baby to try to wake him. As soon as I change the diaper, baby is awake and crying…success! I help mom with her positioning of the baby and latching. It takes several tries to get baby on the breast, but after about 15 minutes, we are finally able to get him actively sucking. Mom is so excited and profusely thanks me for helping. I leave the room feeling accomplished and sweaty. Helping with breastfeeding is one of the more physically taxing parts of my job.
02:30: I sit down at the computer to do some charting and look at the baby’s bilirubin lab result. While chugging my water I see that the baby’s bilirubin level came back normal. I go tell the parents and they are noticeably relieved.
03:00: Break time! I grab a warm blanket and settle into one of the large lounge chairs in the break area. I typically try to eat healthy while I am at work to avoid feeling sluggish. Today, I have a salad with a variety of exciting toppings, rice cakes, and a La Croix sparkling water. I watch TV on my phone as I munch on my food. During the last 15 minutes of my break, I lay my blanket on the floor and do some stretching while I drink peppermint green tea.
04:00: Feeling refreshed and ready for the last few hours of my shift, I head back to the unit. I give pain medications to a patient, grab a set of vital signs on another, and help with a breastfeeding.
04:30: I get my cesarean section patient up to the bathroom with the help of my tech. While I am in the bathroom with my patient helping her with peri care and Foley catheter removal, the tech is changing the bed linens. The patient stands up from the toilet and says she is feeling dizzy, so we quickly escort her back to bed to relax. She hasn’t slept in over 24 hours, so I encourage her to get a quick nap in before the next breastfeeding.
05:00: I check in on one of my patients I haven’t heard from in a few hours. She is resting in bed with baby skin-to-skin on her chest, and she excitedly tells me she was able to get baby to latch all by herself. I congratulate her and chart about the breastfeeding and a poopy diaper.
06:00: A worried grandmother comes out in the hall seeking help for her daughter’s baby who is spitting up. I hurry into the room and help baby work up the amniotic fluid. I educate the parents on how I helped baby, clean baby up, and put the baby skin-to-skin on dad’s chest.
06:30: My tummy grumbles and I remember about the cookies. I sneak into the break room hoping there are still some left. I snag the last one and hungrily snack on it as I review my charting for the night.
07:10: Feeling a bit delirious, I give report to the day shift nurses. I say goodbye to each of my patients and introduce them to their new nurse. One of my patients gives me a big hug and expresses how much I helped her survive the night. My heart swells as I walk out of the room thinking, “This is what makes it all worth it.”
07:35: I clock out, feeling excited and relieved to have survived another shift.
07:45: Finally home. I am greeted at the door by my very-happy-to-see-me cat. I quickly shower, put on my PJs, turn on relaxing music, and read my book while I snack on nuts and berries.
08:50: Snuggled in bed, I set my alarm for 17:00 and get some much-needed rest so I can wake up and do it all over again!
