Episode 11 : The Role of Nursing in Shaping Future Care Models

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Intro/Outro:
Welcome to the Smart Care Team Spotlight presented by care.ai, the smart care facility, platform company, and leader in AI and ambient intelligence for healthcare. Join Molly McCarthy, former CNO of Microsoft, as she interviews the brightest minds in healthcare about the transformational promise of AI and ambient intelligence for care teams.

Molly McCarthy:
Too often, technology makes caregivers' lives harder, not easier. It's time for smart technology to empower care with a more human touch. I'm thrilled today to have a leading voice in nursing and healthcare. Dr. Robin Begley on the Smart Care Team Spotlight today. Dr. Begley is Chief Executive Officer of the American Organization for Nursing Leadership and Senior Vice President, and Chief Nursing Officer of the American Hospital Association. In her role at AONL, she leads a membership organization of more than 11,000 nurse leaders whose strategic focus is excellence in nursing leadership. She oversees a number of key initiatives involving workforce quality and safety, and future care delivery models. In addition, she works collaboratively with the AHA to ensure their perspective and needs of nurse leaders are heard and addressed in public policy issues related to nursing and patient care, and leads the AHA workforce initiative. Dr. Bagley previously served as Vice President of Nursing and Chief Nursing Officer in Atlantic City, New Jersey. Welcome, Robyn.

Robyn Begley:
Thank you, Molly, it's really a pleasure to be here with you today.

Molly McCarthy:
I appreciate your time. I know that you've been traveling and busy, so thank you. And I know our audience is really excited to hear from you. And so I'm going to jump right into my first question—just a little background information. Obviously, there's certainly no lack of problems that healthcare systems must address today, that goes without saying. And this podcast is really developed to bring thought leaders like yourself together to address two overarching challenges right now. One, what we ask of our bedside caregivers has become humanly impossible, and therefore we're losing so many talented and passionate nurses. And then two, even if we had all the caregivers we needed, the underlying costs of our current care delivery models are fiscally unsustainable. So my question really for you is, as the CEO of AONL and CNO of AHA, can you share with our audience today how you and your organizations are working to combat these challenges?

Robyn Begley:
Thanks, Molly. They are large challenges, but we do have lots of work in play. So let me give you a few examples of what we're doing. The American Hospital Association has been working on the workforce issues for a number of years. I am leading, along with others in our organization, a board-led task force that is comprised of AHA board members and also AONL board members as well. And so we're tackling issues on the clinical side as well as the non-clinical side. I would say that recruitment and retention, and pipeline issues are top of mind. We have work going on. I think one of the things when we think about healthcare across the country, it's not one size fits all. We have so much variation from really tiny critical access hospitals to very large academic centers and systems across the country. So there's there really is no one size fits all. So the information that we gather from our members illustrates some of, we've done a very intentional job at gathering best practices from across the country. What are organizations doing? How are they partnering with their local communities, with their educational, with their educational partners, in their communities? And we are really pleased by some of the emerging work in Virginia; for example, the Board of Nursing, the hospitals, and academia are partnering not only to make sure that nursing students get great educations, but really to support those students as they are in school with paying positions.

Robyn Begley:
And this is all vetted with the Board of Nursing. So those though some of those hours can also be counted towards their education. We're finding that there's other disciplines besides nursing for sure that are experiencing real challenges as well. And again, how can the community connect with the hospitals? We think about challenges that some challenges that are unique are not only attracting the nurses and other caregivers to the regions, but when we get them there, there are certain areas of the country that are very expensive to live in. Housing becomes an issue. That was something that when I spoke to some of our colleagues in California, I had not realized was such a major issue. And it involves traveling for hours from affordable housing. And those hospitals are doing things like subsidizing housing for employees and in some cases, actually have a very creative purchase agreement with local homeowners or property owners, where then our staff can be their staff can become part of the local community. That's just one real example, real time example rather of what's happening. I think that on the AONL side, just want to talk a little bit. Last year we and into the beginning of this year, we produced a compendium that if you go to AONL, aonl.org, you can see the compendium which was originally released in three sections, but now is all combined and takes a look at the topics we would expect to see recruitment and retention.

Robyn Begley:
But when we really drill down into that, what is that about talent acquisition? How can we really work on that? Using some tools that perhaps were found in healthcare prior to the pandemic, but we're doing using really unique tools to be able to attract people. We have a section on a positive practice environment. We could probably take another whole section and just talk about work environment and how we have to make the work setting attractive and make it a place that is welcoming to not only senior healthcare members, but also our new generation that's just joining the workforce—best practices in leadership, academic practice, partnership, the culture of inquiry. How can we really change the cultures in our healthcare system, and we can't minimize how important comp and benefit is to our staff. So we have a section on total rewards, and we just talk about some of the issues and benefits that are important, for example, to different generations. So are entering, new clinicians into the workforce might be really attracted by an organization that provides child care or has benefits that help them repay their student loans. For example, when our older and more seasoned, I like to say healthcare workers are looking for retirement benefits or maybe less aggressive scheduling. As people are getting older, there's not really a one size fits all, and we're finding that the most progressive and successful organizations are the ones that realize that there has to be, if you will, a menu of benefits.

Robyn Begley:
And how can we appeal to really the four generations that we have in the workforce? Right. Just some those are just some high level ideas. One thing, several things that we are working on in 2023 from the perspective we are partnering with IAG, who is funded by Johnson and Johnson Grant, to evaluate new models of care. We are working with IAG, rather, they have a learning collaborative that began and is underway and will finish their inquiry in January of 2024, and they've outlined the metrics, they're looking at the different models that are being evaluated. And of note, they're not just hospitals or health systems that look the same. There's a world there's actually a military hospital from the West Coast, as well as some other organizations across the country. We're monitoring that very carefully, and in collaboration with IAG, we hope to make sure that the learnings get disseminated, not just at the end of the process, but at points in time along the way. So we're very excited about that. Out of the care models work, we've also identified the importance of and some of the things that we're talking about today is really how can technology be an enabler for the new care models? Virtual nursing is something, for example, that everyone is talking about and considering. But what does that really mean? And there's we're finding that there's variations in virtual nursing, which is probably good at this point in time, because this is the time that we are doing innovation and evaluation.

Robyn Begley:
And hopefully as we move a little further, we will know what are those either common elements that are scalable or what might have sounded like a great idea, but in practice was really something that we need to move on from. And finally, the actually, the second really large initiative that AONL has underway is a really deep dive into the nurse manager role. And for anyone who's ever worked in a hospital or health system, I think it is so apparent that the role of that frontline manager is critically important to the success of really good patient care. They have those managers have such a breadth of responsibility and depth, and so things like span of control we are evaluating. We're looking at what are the rewards and recognition for the nurse manager. What are some of those tools that can really help alleviate some of the stress? Most of our nurse managers work or have responsibility for the care on their units 24/7. It's quality and safety. It's staffing, which is, I think, the bane of every nurse manager's existence. It's the well-being of their staff. It is certainly the well-being of their patients, and they have costs and financial responsibility, so they are just pretty much overwhelmed with their current responsibility and also really very tired to what's happened over the past several years.

Molly McCarthy:
All very salient points. I think one thing that I heard throughout your discussion, really, that which you led off with that one size doesn't necessarily fit all. And it's really important to look at the profile of where the care is happening and where it's given, whether it's rural or inner city, etcetera. As well as to really understand the aspects around who is giving the care. So with your nurse, I think you made a great point around, we currently have four generations in the workforce. So again, what we perhaps reward them with is going to differ based upon what's important at this stage of their lives. So all really good information. Again, you mentioned the Nurse Compendium. I know that's on your website. So I would just ask listeners to go check that out. I know it's incredibly detailed. I looked at it again yesterday. So thank you. Just to follow up question and so you talked about new models of care. And as we think about these transformations happening clinically, what role do you see nursing playing, whether it's a bedside nurse or nurse leader or CNO to ensure that the new care models best serve their patient populations as well as themselves?

Robyn Begley:
I think that's a really great question, Molly. I always believe that if a person or an entity or a profession is involved in the design, that it's better. I think we have to be very careful about not saying this is what our patients want, or this is what our community wants, or this is what our nurses want. We really need, nurse leaders need to feel comfortable enough, and they need to be aware enough and smart enough to say, we need the nurses now. We need the staff to be able to help design the solutions. We need the patients. And sometimes I think we think it's easier for us to do the work and then present it, if you will, to either the patients or to part of the team delivering the care. And it might take less time, but I don't think it's as rich a process or really gives us the real insight into care delivery. And you mentioned earlier, and I just agree with what you said about care being needs. It's happening in many different places, both in hospitals as well as really pretty much any setting across the continuum. And in a lot of those different in a lot of the communities, we find that they have different resources. What might make perfect sense in one area of the country might not in another, because they may have a very robust LPN program, for example.

Robyn Begley:
Or they might have a technical school or a college that is able to really attract and produce students, so that can do certain roles. But of course, nursing always comes top of mind. But I think it just when we look at what's required for healthcare, we just have much, complexity. And I think nurses need to, because what we do is direct care and we need to make sure we coordinate care. Maybe that's the best a better way of terming it, but other disciplines and other roles can really participate in the delivery of that care. But from my perspective, it's the nurse that makes sure that these pieces all connected. The extraordinary puzzle putter together and connector. So we really need to think about we're not going to have enough nurses to do nursing in the old primary nurse way that I learned 50, almost 50 years ago, which was a very innovative model at the time, replacing the team, the old team knock model of care. Now it's as we look to the team of the future. I think nursing obviously has a very important role, but it's not just about the nurse. So that ability to get all the disciplines that need to participate on that particular patient or patient population, I think is one of the things that we have to figure out. We bake similar language in healthcare, but not always identical.

Robyn Begley:
We have different ways of documentation. There's just so much variation. And I think those days have to be in the past, and we really have to think about what's best and what's most efficient for our patients. We know our population is aging. I recently, I think I read that 10,000 baby boomers are turning 65 every day, and by the end of the decade, everyone in the baby boomer generation will be 65 or older. When we think of the group that consumes most of our healthcare, the age group, it is certainly our seniors. And not only are our is our nursing workforce aging as our baby boomers nurses age out, but we also have then that additional bulk of population, if you will, to care for. So it's a double whammy. And before the pandemic, I think we saw challenges in the way we were delivering healthcare, and we knew we were facing an attrition of our senior nurses, but it only became accelerated. The National Council of State Boards report that they put out earlier this year, is a great example of actual data collected around the numbers, and we know we have to change. I think never waste a good crisis. We have to take what we see right now as a challenge and make healthcare better for the future for all.

Molly McCarthy:
Yeah. Think you made some very interesting points, especially inclusion of the patient. So important as we continue, I think as nurses to really be at the forefront of that bedside care, but also to your point around an inclusive model that includes multi-stakeholders within the team, whether that's the OT, PT, the physician, the radiologist, etcetera, because we know that patients are becoming more and more complex, especially within the acute care setting. So thank you for sharing that. I think one other piece that I wanted to pull out that you said was to slow down and take the time upfront to really think about what you're trying to achieve. And that's something I've heard really throughout this podcast. It's so important. It might feel slow and frustrating at first, but to really think about it and do the hard work will pay off in the end in terms of adoption, etcetera. All right, so speaking of adoption, my last question here, second to last. So I made the point in the opening piece really around technology can make caregivers lives sometimes harder, not easier. And obviously in today's world there's so much noise, especially this year around AI, generative AI, ChatGPT, you mentioned virtual nursing, and more specifically, let's hone in on virtual nursing. But based upon your conversations with your members and constituents around the transformational promise of virtual nursing, really, beyond just a camera in the room, what are your thoughts around nurses adoption of this new technology based upon what we've learned from the past? So, for example, with EMR adoptions, I would love for you to share what you're hearing and seeing in within your membership.

Robyn Begley:
Yeah, happy to do that, Molly. And right now, we've got a call out to our members at AONL to share with us where they are in the innovation space. And one of those categories is absolutely virtual nursing. So we are seeing, it's very interesting. We're seeing different applications, which we, that we hope to really learn more from. And I don't know if you want me to share particular names and systems, but there are, and so we'll stay away from that. But there's a large system, for example, that has done a lot of work, as we said, preparing the ground and piloting in one of the hospitals the virtual care model. At first there was not a lot of interest, but it was one unit. And they they put the time in to really identify the roles. What was the what were the expectations of the nurse that is in the room at the bedside versus the virtual nurse. And we're very deliberate about trying to identify upfront what would be how the day would go, what it would look like, the workflow, etcetera, doing reeducation. And it also involved not only in other. It was actually part of a care team, the virtual nurse, and defining the roles of the other members of the care team. Fast forward the outcome and also what how the patient is educated. What is the expectation? All of a sudden there is a screen and a face on the screen. How do we prepare the patient for this? The results have been remarkable for this particular organization. They have, almost a year later, 100% retention of the staff.

Robyn Begley:
They have excellent patient satisfaction numbers. They have calculated near-misses and things that have been averted because of the oversight of the virtual nurse. And even as importantly, is everyone is signing up and wants to be on one of the one of the virtual units. And the plan is to spread from what was initially one unit in one hospital to, I believe, 50-plus units by the end of the year, the calendar year. And have there been modifications? Absolutely, as they learn new things. Is this a role that you do or do you become a virtual nurse, or is it a role that you might do one day a week and do your other shifts in the hospital? So they're testing things like that. Another healthcare organization is also using the virtual nurse as the educator for the families, and it doesn't necessarily mean that discharge, education, and planning all happens in the hospital. But they're experimenting with the patient gets home, and then within two hours, the family is there at the request of the patient, of course, for hearing the plan, the reinforcement of the education and the virtual nurse is very effective in saying things like, okay, get your prescription. Can you show me exactly... And the patient then or the family can do the return demonstration in the home so that the nurse can be really reassured that the family and the patient get it. So I think there's some opportunities that probably, in the beginning were not identified that really are very helpful. And that might avert a home visit if it's something that the virtual nurse can check off.

Robyn Begley:
We haven't really talked about how they can enhance the new graduates, but that is a role that is pretty consistent across our that we've been hearing across our hospitals that are implementing and how it is received by the new nurse. And for the most part, it is very positive because they feel like they have a set of very knowledgeable eyes, not only just watching a particular task that a nurse is maybe doing for the first time, once since they've graduated, but also really just someone to say, I'm looking at the labs and, and a person who has a lot of experience that can either validate their concerns or say, in my experience, it's okay, let's continue to wait until the next lab value comes back or something like that. But so I think we're really just beginning to learn all of those facets of the virtual nurse. I would also just really quickly add here that usually there's a doorbell or something that announces the virtual nurse to the patient. But in other words, there's privacy for the patient. Because I know a big concern was, well, we just going to have someone observing in a room and nobody knows that they're there. And that might be intrusive, but that is not the case. They announced themselves, and many family members have expressed that they feel very comfortable that there's also that extra set of hands and eyes or eyes and virtual hands. I should say that also is part of the care team.

Molly McCarthy:
That's great. I love your anecdotes around the results and the 100% retention of staff. Kudos to that health system. I have obviously heard the increase in patient satisfaction and then the near misses, the patient safety, the quality all wrapped in also with the new grads and just even boosting their confidence, I think is such a huge component of the overall promise of virtual nursing. And then the thing that I loved, what you said is, and I'm just going to put it in my own words, is really it's the tip of the iceberg. As we continue along in this path, more applications are identified, even the education in the home. I actually hadn't heard that yet, but that's so key to prevent readmissions, etcetera as well as satisfaction. So those are all amazing examples, and I'm excited just to see it continue and to grow. As we wrap up today, our listeners are healthcare leaders, CNOs, CNIOs, and their respective teams. And obviously, you have a wealth of knowledge, a unique lens of having walked in the hospital for many years from bedside to boardroom and now with AONL and AHA. And if you could just give one nugget of important practical advice for our listeners today, what would that be in today's environment?

Robyn Begley:
Hard to say. Just one thing, Molly, but..

Molly McCarthy:
You can say, okay.

Robyn Begley:
First of all, I think timing is everything. And I think we are at a place in time where all of us intuitively know that the way we've done things in the past needs to change. So some of those ideas that maybe it wasn't their time ten years ago and they might not look exactly the same, but maybe the time is now to to reexamine them and see if there's a way to find a way to make things happen. And I guess I would just end by saying that as I we have many challenges and healthcare, we are from a workforce perspective, for sure, it's been crisis mode. But as I have been back traveling the country and talking to nurses at conferences and doing site visits, and just this morning, I actually was on, I participated in a class with nursing students, and I'm so energized because they're very optimistic. And I really think we have the brainpower and the will to continue to really transform the way we deliver care. So I'm excited about it and I hope everyone gets a chance to, and I'm not a Pollyanna. I try to be an optimist most of the time, but I know the real challenges that do exist. But I'm very optimistic about the future, and I believe we have the desire, the knowledge, and I think the innovation piece is what I'm so excited about seeing because we're appropriately questioning the way we've always done things. And I think I see that there's other ways for us to accomplish our goals, and I'm very confident that we're going to be able to make some significant changes.

Molly McCarthy:
Thank you. Robyn, as you mentioned, timing is everything. And it sounds like the time is now. I will let you get back to your members and your organization and really appreciate your time and insights today.

Robyn Begley:
Thank you Molly, it's been great to be with you.

Intro/Outro:
Thanks for listening to the Smart Care Team Spotlight for best practices in AI and Ambient Intelligence, and ways your organization can help lead the era of smart care teams. Visit us at virtualnursing.com and for information on the leading smart care facility platform, visit care.ai.

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