Episode 4 : The Nurse’s Seat at the Table:

SCT_Spotlight_Rebecca Love: Audio automatically transcribed by Sonix

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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 CMO 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 Molly McCarthy, and I want to welcome you to the Smart Care Team Spotlight. Today, we have a tireless advocate for nursing, Rebecca Love. Rebecca, welcome to the show today.

Rebecca Love:
Molly, thanks so much for having me.

Molly McCarthy:
We were just discussing before we started recording about when we first met. I think it was when you were the director of Nursing Innovation and Entrepreneurship up in Massachusetts at Northeastern.

Rebecca Love:
That was, I remember, back in 2016, Molly. I remember we did that first hackathon conference that nurses should talk about, Innovator. Nobody really thought that nurses should be innovators, and look at, I can't believe how far we've come. We were on that panel at South by Southwest, the first nurse panel to discuss this. A lot of the world has unfolded in the course of the last eight years as we've tried to pave a new path for nurses to have seats at the table.

Molly McCarthy:
So I'd love to really hear from you about what you're doing in your role right now, as well as just to mention SONSIEL.

Rebecca Love:
Yeah, so my current day job is I serve as the Chief Clinical Officer of an organization called IntelyCare. That is one of the largest workforce management, or lack of a better term, nurse staffing companies across the post-acute care space in the country. If you sort of have thought about the urbernization of nursing, allowing nurses to pick up shifts when and where they want, that is sort of the idea of the IntelyCare platform. I joined with the idea if we could basically create a platform that optimized the way that nurses could work, could we actually scale a workforce that you and I both know is significantly at risk? In my spare time, and I joke with my friends, Molly, I don't think I have a lot of hobbies. I feel like I eat, breathe, and drink, and sleep nursing all the time. I and you, along with a group of the rest of us, founded an organization called SONSIEL, the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders back in 2019, right before the pandemic. The idea was, could we create a place where nurses could have conversations to elevate our expertise to drive healthcare transformation? And thanks a lot to part of the work that we had done in your past role at Microsoft, we led those hackathons during the time of the pandemic. We wrote a book that went on to being one of the best sellers in the history of nursing, and that was an organization that we built. And just in December, I transitioned on from being the active president to president emeritus and turn that helm over to Hiyam Nadel, who, as we both know, was the first nurse appointed at Mass General Hospital to be the director for the Center of Innovations at that organization. It's been a remarkable experience to watch where we were years ago, who we all were years ago as nurses, and where we're sitting today on a global conversation. So that's where we spend our time.

Molly McCarthy:
Yeah, that's great. I was reading recently, and I actually just pulled it out, it's called "Reimagining the Nursing Workload: Finding Time to Close the Workforce Gap." And I want to read to you a statistic that is no surprise. I think I see this about once a day. It says, As of March 2023, 45% of inpatient nurses who make up about 2 million of the 4.2 million nurses in the United States reported that they are likely to leave their role in the next six months. Among those who reported an intent to leave, the top two reasons cited were, one, not feeling valued by their organization, and secondly, not having a manageable workload. It goes on to say that nurses have consistently reported increasing workload burden as a main factor behind their intent to leave. Kind of expanding upon that, as we continue to ask our nurses to really keep up with an overwhelming workload, maybe we could even say humanly impossible. How do you see technology? Perhaps we use it in other industries that can really bring together patient care as well as smart care teams. Because today I think we're still seeing an array of point solutions already further fragmenting the fragmented system. Just wanted to get your thoughts on how our current technology that we're utilizing in the hospital, for example, point care solutions or they have to sign in multiple times, EMRs. How does it exacerbate burnout in your mind, among nurses?

Rebecca Love:
Molly, I know you were just sorting or citing the McKinsey study, which was shocking about this study that you just cited was that there was actually a worsening in those statistics from a study that they took in 2021, which said 35% of bedside nurses were looking to leave due to burnout. It actually worsened in the course of the last two years, which I think people thought would have calmed down post-pandemic. I think it speaks exactly to the point that you're talking about. Let's be very honest. The last decade of healthcare became a point of rapid transformation as technology was adopted. I don't think we ever thought about the end user. Basically, we took a lot of paper processes, put them on technology, and actually overcomplicated the process by which paper was very effective in those settings, right? Now, we thought that this was going to be a good thing because that had happened almost every other industry banking. But the truth is, is those systems, when you took paper, and you put it on technology, were able to be operated by computer systems that didn't have a human element at the back end. That's where this, in my opinion, technology has broken down a lot in the space of what has led to the burnout of nurses. We were hoping that by providing technology, we would lessen the burnout or the workload of nurses, but we actually did was create infinitely more complicated systems for them to work. Now, think coming out the other side of this, we've started to recognize this in the course of the most recently, last couple of years, we've actually started to see some technologies that are actually kicking this trend, that are actually providing technology that provides value to the frontline workers. I think one of them, and let's be very honest, addressing this is the issue of virtual nursing in this space. Why that works is because it allows us to amplify the nursing workforce by allowing a critical element of needing to capture data by a registered nurse that does not need to be done face to face because there doesn't have to be a human-to-human interaction of actually delivering care, which frees up the bedside nurse to be able to deliver the care that's needed, hang the change the wound dressing, but not spend an hour behind a computer doing an intake or a discharge or patient education that can be done manually. I think that what the world is waking up to is that the nurses that have survived the last decade were really the guinea pigs of this transformational time that healthcare brought in a whole bunch of technology to rapidly adapt into the space with a primary focus on solving a specific need, but not necessarily workplace efficiency. And I think we're seeing some of this change as we started to recognize that the more technology we rolled out, we perhaps created more work for the nursing workforce than actually alleviate the pressures on them. I don't think that's separate from our physician colleagues, either.

Molly McCarthy:
I would agree. I think to your point around virtual nursing, I did a lot, I worked a lot on that actually throughout my time at Microsoft, and really before when I was with Philip, and thinking about, when I first was coming onto the scene with a tele ICU or what we called, we had a program through Microsoft in conjunction with the hospital, we called it a bunker nurse, actually Skyping in with nurses to double-check medications, etc. So the practice and the thought process, I think, has been around for some time in terms of having someone not in front of the patient, assist in caregiving through teaching, for example. And I know one of the areas I worked with a hospital earlier this year that was really excited to roll out a virtual nursing program, during their pilots they had two spots for nurses, and they had 100 and, almost 200 applicants for those two spots. Yeah, and that's one thing that surprised the staff, the managers, and also it allowed some of the more seasoned nurses to really look for a path to retirement without losing all the knowledge that they've gained and can and really pass on to the younger generation. And anecdotally, none of these findings are published yet, but it really improved just obviously the patient experience, the caregiver experience, but then the safety, because you had maybe perhaps a younger nurse with, paired with a more seasoned nurse. I'm just curious to see when you think about virtual nursing, what is that like? When I say that even, what does that mean to you? How do you define that?

Rebecca Love:
Let's, I think what could be helpful is regimenting why this is a solution, right? We know that the average length of experience on a 12-hour shift prior to the pandemic was around six years of experience. Since the pandemic, it's dropped to 2.8 years of experience, which speaks to your entire example of a knowledge drain that is significantly hit the nursing workforce. And actually, most recent study that just came out showed 200,000, this idea that 100,000 nurses actually left the workforce, that was ones who let their license go. We also just saw a recent study that showed that 200,000 nurses over the age of 65 have left practice in its entirety. That is a huge segment of brain drain. And why that's important to knowledge is that the average age of a nurse in this country who has been practicing up to date is 54. So 50% of our nursing workforce is over the age of 54. 70% is over the age of 40 in this country. The truth is, is these massive movements of those that are heading to a retirement or saying, you know what, I just can't keep up with the rapid change that is healthcare. I no longer can be a nurse in the capacity that I want to be because I have all of this technology I now need to know, and master, and manage, but it has taken me away from the bedside. I hear this sentiment from nurses over and over again. The reality is, is that virtual nursing allows us to recognize the accommodations that we could provide to this aging workforce in a meaningful way that actually could drive data that could be actionable for us. Just one of the segments that you just spoke to is, absolutely, could it help with training and precepting? 100%. Can it help manage admissions and discharges, which helps with bed throughput through hospitals? Another 100%. Can it mitigate the major errors and falls and medication errors that lead to the harm of the patients in huge numbers that we know exist in the hospital system today? We know that all the studies are coming out to show that it's having positive impact. Virtual nursing, for me, is not using an AI robotic managed nurse who's going to be there to text back and forth. What it is, is it's zooming an actual experienced nurse into the settings and providing that second set of hands and oversight that our workforce needs, right? And managing that patient education. I think one of the things that people keep calling me about, and I'm sure they call you all the time, right, this evolvement of AI in healthcare, there just seems to be so much chatter that, could it replace the nurse? You know this, working at Microsoft, you acquired Nuance, a good colleague of mine, and I'm sure a colleague of yours, Mary Presti, who is overseeing the Nuance Dragon Workforce. We had a meeting with her, and what she said to me is, Rebecca, we've been able to algorithm out, the physician workflow, right? If you do this, this comes up, you do this. What she said is we have not been successful at algorithmic out nursing workforce. What happens with nursing workflows is they monitor for a change of status that multiple systems start going wrong, that need an intermittent intervention to save that life. Because it's unpredictable, because acute events are often unpredictable still at scale, AI is not as successful at managing what a nurse should be doing at the bedside as those who are experienced and lived it. That, to me, is a dividing factor. That, to me, empowers why virtual nursing should be used to scale those who are leaving the bedside and create a safe workspace so that our nurses can take care of patients and drive the outcomes that, you know, in all honesty, we've all been fighting for decades and seem to keep going the wrong direction as opposed to the right direction.

Molly McCarthy:
I agree. I think also, aside from the blanket term artificial intelligence, I heard you a few minutes ago say actionable insights or intelligence, and that's really it. It's how can we, we don't want to just put another human into the room live or via camera. We need to ensure that the activity, or the event, or the questions are appropriate for that person who is a licensed or registered nurse or doctor, etc. Aside from just the smart, aggregating the information so that it's being presented, I always like to say a dashboard, so the nurse knows what's going on with the patient, has the data at their fingertips. And I don't think, the human touch is so important. I always say it's really about the people process is huge, and the technology, and I feel like the biggest impact right now for tech is looking at those processes and how can we weed out things that really don't make sense for a nurse to do. They need to be working to the top of their license and especially driving that joy back. Any thought to just, even thinking of a smart hospital and walking into a room and having ambient intelligence? You have sensors in the room that can really understand what's going on with the patient, maybe the family, etc. I know that within the physical therapy world, or even I forget what we called it, maybe a remote sitter for patients at high risk for falls, but having that camera in the room. But really beyond that, thinking about sensors in the room, etc. Have you encountered that? I'd love to get your thoughts on that beyond the virtual nursing and how that might help us as nurses work to the top of our license.

Rebecca Love:
It's a really great question. And let's actually, I think we've actually been here where there was only technology, and the human was missing. Let's look at what happened in COVID. We were absent of people in the room of the patients that we were treating, right? They were sitting with only technology around them with virtual screens zooming in on them. What we knew is that it broke the spirits and the hope of these patients. They largely had technology all around them, but they died alone. That caused incredible amount of PTSD, both within our healthcare workforce. The families that witnessed this, I just think that we have this idea that we can have this completely technologically enabled environment, that absence of human interaction, that we think that this is going to drive better outcomes for patients, but I actually think absolutely not. I actually think it could potentially worsen outcomes for patients because loneliness, depression, and isolation is actually being shown to be such a dramatic impact on one's health and mental wellness. I think we want to be very careful with the rooms that we're designing, and thinking that we can remove the human element, especially in healthcare. People are in hospitals and nursing homes today, not because they are well, they are. They're in their worst moments of life. I can't imagine sitting in a room and the worst and darkest moments of my life and only have technology around me monitoring my vital life signs, right? To me, that's where, I think that we, as much as smart homes and technology can enable us, if we're looking at something to empower this future generation, this next generation of smart homes and sensors, it has to be exactly what it does. It has to enhance the experience of the caregiver to be there in a meaningful way and deliver the meaningful impact of their skill sets that are going to drive the changes in behavior or outcomes that patient needs, just careful that it's not devoid of the human contact. So what that means to me is, can these technologies, to your point, have remote monitors? And Paul Coyne, he's the chief nurse executive for Hospital for Special Surgery; before he was in that role, he was the CEO and founder of a company called Inspiren, and Inspiren developed a whole bunch of sensors that were put in rooms to monitor patient movements to make sure that patients were getting moved and turned every two hours. If a patient was getting unstable, they would go and fall. They would be alarmed for these things. Those, to me, were beneficial kinds of interactions. It has allowed for this holistic view of a patient when they were perhaps at risk. I think those are the kind of technologies that if we're looking at, we should be looking to mitigate harm, extend the ability for the nurse to intervene at the right point, at the right time, but also allow the patient to interact with the human when they need to. I think COVID taught us that the isolation of patients did a lot more harm than it did good. I think that if we think that technology can replace the human and we're going to lead to better health outcomes, I actually think we may see the reverse. It's something a conversation that I think we need to have at a larger level.

Molly McCarthy:
I, personally, I think that there's room for the caregivers. There has to be There is nothing that can replace that. I'm just thinking about how we can really utilize information and data because there's so much today to elevate our practice. Kind of along those lines, one of the concepts I've been thinking about with all of this information coming in from the patient, from the room, from the family, etc., is really thinking about the team-based approach in nursing. You might have a primary nurse, you might have the ancillary staff could be, PT, OT, also perhaps a virtual nurse thinking about smart care teams. And one of the things that I'm very adamant about is my line of that nurses should really be involved in the design, development, and deployment of technology. With that in mind, thinking about the smart care team and really, how can we empower nurses to be at the table, be present in the selection, etc., and really leading the smart care teams. I'm just wondering, from your perspective, just thinking about where nursing will be in a year or two or even five years with regards to care teams. Just some thoughts about that and how tech could potentially enable that to happen and have nurses taking charge and leading those.

Rebecca Love:
It's a great question. I think, let's be very honest. Hospitals, nursing homes, they cannot operate without nurses, right? Everything else could be done. Outpatient, physical therapy, OT, surgery, all of those could be in outpatient settings, but also that the direction of care is moving away from the hospital, it's moving into the home. Those that are delivering the care in the home where I think technology makes sense is nurses are at the forefront of designing these hospital-in-the-home models where the additional technology that can monitor the vital signs and interactions and answer questions has been hugely helpful into designing these models. I think the experiences that we've learned as nurses is the, nursing, although siloed within their profession, they cut across all layers of a hospital in regards to the patient care coordination. The one thing where nurses have not been empowered enough to do is design the care coordination for these patients through the lens of a nurse. I think if we step back and said allow nurses to develop the entire care coordination plan and implementation of how that holistic view could come together from their hospital stay to their home state, let's be very honest. The middle step of nursing homes are rapidly disappearing. There are simply not enough nursing homes, they're closing, and 600 of them have gone out of existence, the pandemic. So we need to be getting patients out of hospitals to home faster and quicker for a significant number of reasons. And the only people who are going to understand that viewpoint, to understand that transition, and to understand how that home is going to be safe for that patient is going to be the nurse. I believe that if we're going to look at the future of nurses, having seats at the table in healthcare is going to continue to push patients back into their communities for managed care. The nurses have that expertise. The hospitals, I think, are going to become very acute environments, places where surgeries are going to have to happen, rapid imaging is going to have to happen. Physicians, nurse practitioners, PAs are going to be there to manage those acute episodes, but their length of stays are going to go to three days maximum, right, after that recovery, that recuperation, that healing period of time, to me, sits squarely with the nurse. The nurse has always been central to helping people regain their ability to enter life again after the darkest moments of their life. For us as a healthcare system, we've never valued that. We've valued the inter, we've valued that one moment of surgery as what was life-saving. But if you had that surgery and just sent a patient on their way, we know 90% of patients would go on to develop infection or die or have serious complications because they're to manage that transition. And we may say, that's great, we can do that with a lot of AI. We can have them ask those questions, which I think can enhance that experience of the nurse that they can help drive that. I believe that is the opportunity if we want to transform healthcare, bring back that element, and give that to the nurse. You're going to find that the entire delivery system and patient outcomes post these interactions are going to, in my mind, that is the golden age of nursing. It's what we've always known.

Molly McCarthy:
And that's really, to that point, I'm a firm believer in that technology should work in the background. It should be not seen or heard, so to speak, but accessible, so the primary relationship is between the caregiver and the patient, not a device-caregiver and patient. One last question, because I know we're wrapping up, and there are lots of other things that I could pivot on. I just want to ensure that our listeners who are, I would say, probably, chief nursing officers, CNIOs, as well as chief clinical officers, as you think about where we are in today's world, and I know you do a lot of speaking, but just maybe in a minute or less, what's your single most important practical piece of advice for them today, thinking about everything we just discussed?

Rebecca Love:
I think when you're thinking about the nursing workforce, you have to recognize the demographics are changing in ways that we thought weren't going to happen for another ten years, so everything is accelerated into a timeline. The older generation is retiring faster. The newer generation is turning over at rates much faster than we anticipated. We're not producing enough nurses in this country, but more importantly, we're not retaining the ones that we do have. I think that, for a very long time, we looked at nurses as a commodity in our healthcare systems. We know that they are a cost, and we always thought there was simply be more of them. If I can speak specifically to the nurses in the audience who are in positions of leadership, I would say, we have come to a moment in history where our profession is at the greatest risk that I believe we've ever seen it before, that nursing is at a moment in time where there might not be enough nurses to keep healthcare operating in the future if we don't start really redesigning our environments to place them at the forefront of what needs to happen. So what that means to you as an actionable direction is the best piece of advice that I can ever give is, spend more time with your frontline trying to remove the barriers that are burning them out at extreme levels. They may seem like small, insignificant issues to us in the grand scheme of things, but it is those insignificant things, to us, that I think are most commonly what is driving our frontline to feel that we do not hear them, or see them, or value them. That would be the advice that I would leave. If we can start coming together as a profession on these things and solving for that, I think there's a path forward to stabilizing the loss that we've been seeing in the last few years.

Molly McCarthy:
Thank you, Rebecca. It's been wonderful to have you today on the Smart Care Team Spotlight, and I look forward to seeing you in person very soon. Take care.

Rebecca Love:
Thank you so much for having me.

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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