Episode 27 : Virtual Transformation:

SCTS_Mary Morin: 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 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 to share a little bit more about our guests today, Mary Morin. Mary has been a registered nurse for almost 43 years. Currently, she is the Enterprise Chief Nursing Officer and Senior Vice President for Sentara Health in Virginia Beach, Virginia. She is accountable and responsible for nursing practice and care—employee health workers compensation with over 33,000 employees and other system clinical support services. Sentara Health, an $11 billion healthcare system, is composed of 12 acute care hospitals, a large integrated medical group, ambulatory services, large post-acute services, and four health plans. It's also the largest healthcare system and the second largest employer in Virginia. Upon graduation from George Mason University in Fairfax, Virginia, Mary was commissioned as a Navy Nurse Corps officer in the United States Navy, retiring after 25 years of active and reserve duty in June of 2006. During the past 43 years, Mary has been a staff nurse in medical, surgical, critical care, specialty critical care, and emergency room and trauma and has held nursing leadership positions in acute and ambulatory settings. Welcome, Mary. So wonderful to have you here and to get ourselves situated today.

Mary Morin:
Yes.

Molly McCarthy:
Thank you so much for your time.

Mary Morin:
Thank you, Molly.

Molly McCarthy:
I want to get started by talking a little bit about your career journey. It's obviously an inspiration to many and quite a unique path to your current role as CNO at Sentara. Can you tell us a little bit more about how serving in the United States Navy Nurse Corps for 25 years has prepared you for your current leadership role, and how you approach the challenges of today's healthcare systems?

Mary Morin:
Yes, and thank you, Molly. I want to start with that. It was such an incredible opportunity and honor to be able to serve in the United States Navy Nurse Corps. That 25-year history was both active duty as well as reserve time and how the Navy prepared me for my current role. The Navy makes you very flexible and very adaptable. It allows you to work with diverse groups of people across multiple settings. And you have to be flexible because you're expected to move and change your job essentially every, you know, sometimes 18 months to three years. The other thing about the military is that many times they're early adopters of technology. So as I moved more into the civilian healthcare world, that was important as well. As a young Navy nurse, you immediately move into a leadership role, leading teams of young corpsmen as you advance. You have younger nurses, but you're working with relatively in hospitals, relatively young people, physicians, and nurses. And so it does prepare you for that leadership role, not only at the bedside but in an organization leading larger initiatives. And so today, with technology, one of the things that we are moving very quickly on is the use of virtual nursing technology.

Mary Morin:
We've had that virtual care more in our ambulatory environment. One of the advantages of COVID-19 is that we learned to use and leverage technology differently. And so those virtual visits on the ambulatory side have continued. What we are currently doing is moving that virtual technology into the acute care hospital settings. So we are focused on medical-surgical units and intermediate care units and leveraging a virtual nurse to, first of all, take some of the burden off that bedside RN. Sentara is no different than other healthcare systems challenged with having those bedside nurses, particularly in the medical-surgical areas. And so, based on feedback from around 1000 direct care RNs in Sentara, we are moving forward with a virtual RN, bi-directional cameras, and bi-directional audio, as well as the use of ambient and artificial intelligence to start with admission discharges and patient education. And we've had the advantage of seeing on-site. I've had the advantage of interacting with other systems—CNOs who have already implemented components of virtual nursing and learning from them. First and foremost, patients love it. And the staff on the units love it. You know, you don't need a nurse at the bedside to do an admission or a discharge.

Mary Morin:
You need that nurse at the bedside to do those critical assessments that require hands-on care to administer those critical medications. And so that's the advantage of leveraging that technology and bringing in a registered nurse. Right into the room in real-time and do work that can be done virtually. And so we're learning from other organizations and getting ready with phase one. Our plan is, by October of 2025, to have all of our medical-surgical units in intermediate care units across Sentara live with virtual RNs. And again, starting with admission discharges and patient education. We then will expand because the opportunities are almost limitless as to what you can do using virtual technology. Then, you layer ambient intelligence and artificial intelligence onto it, and it becomes an incredible learning system. And, of course, there's a huge safety component to this as well, meaning it can improve safety. The ability for a virtual nurse to zoom in and read the fine print on an IV bag, for example, to perform a double check with another nurse when administering high-risk medications. I mean, that's just one example of many.

Molly McCarthy:
Yeah. No, I love that. You dug in there from the beginning. So, thank you for sharing all that. I love your stories about getting into leadership early on, obviously within the military, diving in, being flexible, and just going because you must. You have to. Obviously, you've accomplished so much during your time with the Navy, and then currently, you have, I think I read, over 9000 nurses who support the 12 hospitals and numerous medical groups, as I mentioned, and ambulatory sites. So, aside from thinking about some of today's challenges, how do you get feedback from your team, and how do you prioritize where to invest the systems, time, and resources to best serve your front-line caregivers? And obviously, it sounds like virtual nursing is at the top of your list today. I mean, wow, I'm impressed that you have that goal by October 2025. So just curious about some thoughts about feedback from the team and then how you move those forward.

Mary Morin:
So in terms of the TMLs, speak to the direct care nurses out there taking care of our patients 24/7. And that started with meetings with direct Cairns back in August and September, October of 2023. Most of them were not familiar with virtual nursing, and this was part of a larger strategy. We were in a transformation evolution, and this was one of the top transformation initiatives. That isn't just about the acute care setting. We're also looking at leveraging that technology across the post-acute environment, home health, for example, even more so in our medical groups, and potentially in our health plans, using that virtual technology to help manage inpatients, our post-acute patients, and then our consumers that we serve in our medical groups as well as our health plans. So, it's a system priority as well. This is something the virtual work you have to do. I mean, this is what I call the ATM machine of healthcare, that we will never deliver healthcare in the same way. Because as you start to think about all the things you can do, really, your mind explodes with ideas. But getting in front of frontline staff nurses, before we were looking at virtual care, we were conducting site visits.

Mary Morin:
And so with those meetings with frontline staff, they're the ones, as I talked about virtual nursing, they are the ones that said, hey, admission discharges and patient education for us, our major pain points. And that's where the decision came from. It wasn't a leadership decision. It was really what did our frontline staff say? So we've taken that and really focused on learning from other organizations that have implemented that component, specifically knowing that it will most likely quickly evolve. We have shown demos to our frontline staff, and they're no different than leaders like me who see it and start going, hey, can we do this? Can we do that? And we've heard from other organizations that it can quickly evolve. And you do have to have a well-constructed plan because it's very easy to get overwhelmed with all the things that you can do. But there is a system, a major system initiative that crosses all the venues of care. It is a top priority in Sentara. So those resources have been financial resources, in particular, have been allocated to make this a reality.

Molly McCarthy:
Yeah. I mean, I love your analogy of the ATM. Actually, a lot of times, I make an analogy around depositing a check where, in the olden days, you'd walk into a bank or even then evolve into a drive-up teller. I personally make my deposits on the phone, or it's automatic. So, I think that's a really good analogy. It's changing the workflow and making us more efficient. When you think about it, and it's you mentioned a few of the use cases. I know ADT admits discharge and transfer patient education and that you're conversing with your CNO colleagues. So important in terms of sharing what works, and what doesn't work. And we're not waiting around a year to figure it out. But we're collaborating with other orgs. And I think we're going to, you know, as many people have said, this is really just the tip of the iceberg. And it's really beyond nursing, too. It's looking at pharmacy and other specialties, and it's really just going to be part of care. And we won't necessarily in the future, call it virtual inpatient care, we'll call it inpatient care. And that will be a component kind of like what works today. We also work remotely. Yeah. So I think that's fantastic. I love that plan. And I love that you're getting feedback from the front line. Nurses are so critical in the adoption and really figuring out the best ways to utilize the technology. So we've talked a little bit about virtual nursing and ambient intelligence, I'm sorry, ambient monitoring and artificial intelligence. So, when you think about the future of nursing within the hospital, what is your vision for nursing? And also when you think about change management as care models are being reimagined, as we just discussed, and the role of technology will play to empower the bedside caregivers and patients in new ways. How do you see nurses, I guess, working and their role as that center of the wheel, so to speak, of care with that patient and advocating for them? And how will that change your ideas of nursing?

Mary Morin:
So will it. Absolutely. So in addition to the virtual transformation initiative we are under, or we are engaged in care delivery, redesign. And so the role of the registered nurse, and this is something that I learned in the Navy. You have to be a leader at the bedside. And that leader means leading others who can deliver care safely, effectively, and efficiently. But they don't require an R.N. license. So, by leveraging others to get the patient care work done, there will be fewer registered nurses at the bedside. We're we're already seeing it today. And so that RNs got to be comfortable leading a team and partnering with other caregivers and patient care technicians. Again, licensed practical nurses are very important and very valuable, particularly in a med surg area, because they can administer medications. Leveraging other team members to take care of patients, then moving into a role of still doing hands-on care, they move into a role of prioritizing what needs to be done for the patient, delegating the care, monitoring, and supervising that care. So, I do call it being a leader at the bedside. And I would say that that is top of licensure work for a registered nurse. We need them to do those thorough assessments on patients, make decisions about the status of the patient, connect those dots based on the findings and data that are collected from others, assistive staff, for example, to make decisions as to does something needs to be done differently for this patient and escalating.

Mary Morin:
But it is, again, coordinating a team. So we're moving back to what we're going to call zone nursing. But more of a team approach. You mentioned I've been a nurse for 43 years as of next month, and we moved from a team-based model in the 80s to primary nursing. And I would challenge that we never did primary nursing. What we did is we fragmented how we approached care on a unit. Molly, you had your six patients. I had my six patients. Wasn't that we weren't good team members, but we didn't approach the care that we delivered to our patients as a team like we did in the 80s. So there's relearning here for nurses—my contemporary and maybe about 5 to 10 years younger. But for most of the workforce, it's a model they've never practiced. So we have to invest in that training. So Sentara's partnering with our schools and universities to re-establish that type of training, training RNs to be leaders at the bedside, and learning how to delegate delegation takes practice. It's a skill. It requires that you understand what needs to be done. It requires prioritization. It also requires being comfortable setting expectations, following up, and asking questions as to whether or not somebody is competent to perform a task or a procedure that you will delegate. So, I see it as an exciting revitalization of the role of the registered nurse, from a taskmaster to a leader of the bedside.

Molly McCarthy:
Yeah, so many nuggets of wisdom in what you just said. And just I'm going to pull out a few for our audience today. Just the top of license is critical with, quite frankly, the shortage of nurses. And I think working as a team is critical in your point about being a leader at the bedside. I like to think of it as being able to hone our critical thinking skills as nurses. Yes, that we've learned, and putting those to work and not being so concerned with obviously checking off a list, so to speak, but looking at the big picture and orchestrating that care, whether it's with the family, the LPN or other licensed caregiver, the physicians, nurse practitioners, and whoever it might be dietary. Obviously, coordinating that care is critical. And your point about prioritizing, obviously, who's most at risk, etc. So many good points there. And the other piece I want to reiterate is the partnership you mentioned Sentara is having with schools and universities. We want to infuse into our schools and universities into our students what's going to help us the most when they come out. And it is that team-based approach, and it's for me. And I'm not going to get on my soapbox here. But it's not just within nursing but with the whole care team. That's important for them to have modeled, seen, and participated in during their education.

Mary Morin:
Absolutely. And I jokingly refer to it as back to the future.

Molly McCarthy:
Back to the future.

Mary Morin:
Yes.

Molly McCarthy:
So, the pendulum always swings. Yes. First of all, thank you for your time. I do have one final question. I would love for you to talk with our listeners, obviously some of our CNOs, some of our CNIOs, some are bedside patient caregivers, and some might not even be nurses. So, given each of your experiences in healthcare, could you just share 1 or 2 parting gifts of wisdom with our listeners? What is your single most important, practical piece of advice for them as it relates to their responsibility of being tireless advocates for their patients?

Mary Morin:
So, first and foremost, the patients aren't always right, but they're always our patients. And I think we sometimes forget that, and when patients and their family members come into our care, they relinquish control. And they also place their humanities into our hands. And I think it's both an honor and a privilege to be able to care for the people. And so that is something that I felt very strongly about my whole career, it is always about the patient. And I also just say to those out there, if you don't have the fire in the belly anymore. Then seriously think about how you can get that back, or where you can go where that is rekindled because that fire in the belly is so important. It matters. It matters to leaders like myself. And I think it really matters to those we work with as well as those we care for.

Molly McCarthy:
Yeah, Mary, I think it is a privilege and honor to care for the patients. And to your point, we're all human, and we need to continue to remember that when we care for them. I just want to say, first of all, thank you so much for your 25 years of service.

Mary Morin:
Oh, thank you.

Molly McCarthy:
And thank you so much. Yeah. Thank you so much for being a guest today. I appreciate your patience. I know we had some technical challenges, but really grateful for you to share your experience with our audience. So thank you.

Mary Morin:
Well, thank you for the opportunity.

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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