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SCTS-Katie Boston-Leary: Audio automatically transcribed by Sonix

SCTS-Katie Boston-Leary: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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 really excited to share a little bit more about our guests today, Dr. Katie Boston-Leary. Dr. Boston-Leary is the director of nursing programs at the American Nurses Association, overseeing the Nursing Practice and Work Environment division and Healthy Nurse Healthy Nation program. She was also the co-lead for Project Firstline, a multi-million dollar grant collaborative with the CDC for training on infection prevention and control. Dr. Boston-Leary is also co-chair for the Diversity, Equity, and Inclusion Committee for the Healthcare Leaders Network in Delaware Valley. Dr. Boston-Leary is an adjunct professor at the University of Maryland School of Nursing and the School of Nursing at Case Western Reserve University. She also serves as staff on the National Commission to Address Racism in Nursing, and is part of the National Academy of Science and Medicine's National Plan to address clinician well-being supported by the US Surgeon General, Dr. Vivek Murthy. Welcome, Dr. Boston-Leary. So great to have you.

Katie Boston-Leary:
Thank you for having me. Really, really a pleasure. And please feel free to call me Katie.

Molly McCarthy:
Thank you. Yeah. I was just going to ask if I can call you Katie. So obviously, thank you so much for taking time out of your day-to-day to speak with me and to share your story and insights with our listeners. You, obviously, have an amazing background and experience, from hospital to national policy organizations, academic institutions, really with an emphasis on operations, program development, and leadership. So my first question is, I really would love for you to share a little bit more with our listeners about your career journey from hospital to where you are today with the American Nurses Association, and what motivated you to move from the clinical setting to more of a policy organization.

Katie Boston-Leary:
Yeah, I thank you for that question, Molly. I guess I'd like to call myself in terms of my career, which is not right for anyone, and I don't recommend this, but I've been more of an accidental tourist with my career. I wasn't planning on going into nursing, but someone saw something in me and suggested that I pursue a career in allied health, and I ended up in a line that was a line for nursing, and that's how I became a nurse. I haven't regretted it. Best decision, non-decision I've ever made. And then after getting into finishing nursing school and getting into practice, of course, naturally, organically you end up for most people starting in hospitals. And I worked there for a while and then in that setting for a while, and then continued to progress up the ladder and went from a charge nurse to a supervisor to a nurse manager to a director, to a senior director, and then a chief nursing officer. After about maybe 15 to 20 years in leadership, I decided that, in the practice setting, I decided to pursue my doctorate degree. And as I was pursuing that degree, I figured that I have to start thinking about what I'm going to do with it. So a fire was being light inside of me about getting into some social change, broader change and impact on a profession. So I decided to pursue something along the lines of social change to impact the profession more broadly. And I started to look into a position that a friend had forwarded me from ANA, but I had held that to share with someone else. And around the time that I was questioning what I wanted to be when I grew up, I revisited that email and inquired. And we, ANA and myself, we realized that we needed each other. And that's how I ended up in ANA. And it was scary for me because I felt that I would be bored. I felt that I would be forgotten because I also started during the pandemic. So we were remote, and the rest is history. I started as a consultant and was brought on staff six months later, and we've been doing this now for four years, and it's been another great decision, accidental decision that I've made that I'm really happy about.

Molly McCarthy:
Well, thank you. I love your phrase, an accidental tourist, and the best non-decision that you've ever made. So we're obviously glad that you decided to become a nurse. And your focus within ANA, you know, I recently read that your work at ANA also included reinvention of the Healthy Nation program, supporting the physical, mental, and emotional health of nurses nationally through peer-to-peer education. And I would love for you to share with our listeners a little bit more about the program. And then I have a follow-up question to that too, is: It's really is why is this so critical in today's healthcare environment and ever-changing landscape?

Katie Boston-Leary:
Yeah. Well, I will start with the last part of your question and then work my way to the initial question. All roads in terms of care delivery leads to how nurses are in terms of their health and well-being. The nurses not optimally healthy and to a certain degree, at a certain point, have some level of wellness or on a continuum of well-being; that's in a positive sense. It will impact everything else. There's such a thing called presenteeism, where it's on the other side of absenteeism, where people don't show up. But with presenteeism, when people show up, how are they showing up? And I think we've, for a long time, too long ignored that piece. We have not done enough work to understand how nurses are, how they're feeling, how they're showing up, what's impacting them before they show up, what's impacting them while they're at work, how do we take the, put themselves back together after they're done. So that's why the Healthy Nurse Healthy Nation program is so important. And Healthy Nurse Healthy Nation is a free program that we provide to nurses and others, because it's not just for nurses, for them to focus more on their health and well-being, their overall health and well-being. We have six domains that we focus on that is beyond the physical and the emotional or psychological. We also talk about rest. We talk about sleep, we talk about nutrition and quality of life. And we really feel that that holistic view of how nurses are doing is important to understand for them to be able to deliver on the outcomes that we would like to see in terms of patient care. So the best part about Healthy Nurse Healthy Nation, and we have a number of things that we offer where you can do a heat map survey to understand how you are and compare it to other nurses that complete the survey. We also offer a community that's very lively, where the nurses talk to each other on what they need to do to be well. We do challenges every month, some sponsored by our funders, for people to take on a new activity for that month to be well. Some, we did one on allyship, drinking water, showing gratitude, all those different things. So after the challenge is over, we hope that it builds into your being where you keep it moving forward. So those are the different pieces about Healthy Nurse Healthy Nation. And we just revised the definition of what a healthy nurse is because we realize, especially with after the pandemic, and there are a number of things that we've revisited because we became more attuned to a number of things that we felt were done. We revisited our definition because we felt that our definition was inadequate, and it needed some rework based on what we now know about nurses. And we're excited about that too. And we really talk about how it's about nurses striving to get to a positive sense of well-being. It's not an end game or an end state. It's really about recognizing that we are humans, we're open systems. We're impacted by a number of things because we're humans. And we have holes. So it incorporates all that in the definition, which I really love. And thanks to our committee that helped with that redesign.

Molly McCarthy:
Yeah. That's fantastic. I love a couple of things that I just want to reiterate. Your first comment about all roads lead to nurses within health care; I think that's really important. And I know, I actually recently had Leah Binder from the Leapfrog Group, the CEO, and she, her parting message, really, to the listeners was that if your nurses aren't healthy and respected and taken care of, the patient safety will be impacted. And so that reminded me of what she had said and really resonated. I think also your comment about presenteeism, and that's a newer word to me, I mean, obviously absenteeism, but when we're here, are we actually here and how do we show up? How do our nurses show up? Obviously, it is critical. So appreciate that. I know when I was at Microsoft, we did a little bit of work with that program around a bot actually, and I believe it was before Covid. I'd have to go back and look, but it's been a while. My next question really is based on an article of yours that you recently co-authored. I saw it in nursing management. And really looking at accountabilities, responsibilities, and competencies for nurse leaders. And I wanted to share an excerpt with our listeners. Says: Advancing digital technology as a leader to align with workforce strategy is important to ensure that the workforce has efficient systems. Since the pandemic, the emphasis on emergency mitigation and recovery is expanded to be certain that leaders are prepared and connected internally and externally with the communities they serve to manage events. And it goes on to say it's also critical that leaders engage staff by co-creating a shared decision-making model to make changes in the workplace. That really stood out to me just as we think about the well-being of nurses, but then also the partnership between nurse leaders and bedside nurses. And so when I thought about that and really around the digital technology piece, but I would love for you to share how you envision digital technology aligning with workforce strategy in light of the challenges faced by nurses at the bedside and nurse managers, quite frankly, safely staffing the care units.

Katie Boston-Leary:
Yeah, I think that this is a key focus area. I, one of the things that is included, you mentioned in my introduction, the work that we're doing with the National Academy of Science, Engineering, and Medicine with the Clinician Well-being Action Plan. And one of the tenets that's included in terms of things that should be addressed is the technological burdens that falls on health care professionals overall, which includes nurses. And it's hard for you to meet a nurse that would say, that they're happy with their electronic health record systems. I've tested this in a number of rooms over the years when I do talks, and you're hard pressed to find anyone that says, I'm really happy with this. It's working to what I expected. And some people even call it healthcare's biggest letdown, because there were so many promises that were supposed to come with that digitalization of the electronic record or the patient record that never really materialized. And not only did some of those promises not come to fruition, but we also know that in a number of ways, it's added to the work burden for nurses cognitively and physically. It's also impacted that nurse and patient relationship and interaction, and it's really become this thing where you can say the tail is wagging the dog here now. It's setting up how nursing is delivered in almost every way. It's driving everything. Care is heavy protocolized. So we have to figure out how we address that. Even though we're all healthcare professionals, we're also consumers. So as consumers, we see it. We see that the typical hellos that we get and when people are doing our assessments or nurses are doing assessments, the eye contact isn't there. Most of the attention is on that computer. And that's also with physicians. So how do we look at these systems that we created, where to a certain degree, we've created systems that takes nurses away from patients versus bringing them closer to patients. And maybe this was some unintentional design, but we have to get to the fact that this is a human-created problem so humans can fix it. And we have to look at how we can look at technology differently as a tool to augment care, to improve that human connection versus the other way around. And that's part of what it is. It's not, as for nurse leaders, with that article, we want to emphasize that this is a priority for every leader. This is our charge. We have to own this and take it on because we've seen enough and it's not working the way it was intended to.

Molly McCarthy:
Yeah, I think that's really some fabulous points with regards to the EMR and just taking paper records and making them digital. It's very different than rethinking care model delivery. And so in your opinion, what role do some other technologies play? For example, I know we've done a lot around virtual inpatient care, virtual nursing, ambient monitoring, and artificial intelligence. And to your point, how can technologies like that augment nursing care?

Katie Boston-Leary:
Well, we published a couple of years ago with the National Nurse Staffing think tank that we put together, we published Under Care Delivery Model, because we're actually saying that this is a part of the care delivery model redesign. And we had in there a model that we encourage every institution to take on. And we called it a tribrid model, similar to, you know, you hear about hybrid meetings and hybrid cars. We're saying take a tribrid model to redesigning care. One, of course, you're going to have nurses on the ground, boots on the ground, providing care for sure. Two, look at technology to reduce nurses workload. And three, use technology as an additive to, similar to what you see in virtual nursing hospital at home, to make sure that you have that virtual nurse or support to improve care. You take that three-armed approach to redesign your care delivery model, you have a winner. And can't emphasize enough the technology to reduce nurses' workload piece. We know one of the biggest barriers for throughput in institutions is pulling patients out of the Ed and discharging patients. We also know that nurses, when they do their best job of having a great day, doing the care they should deliver, providing the care they should deliver, one of the things that they will tell you is that I do great care, but my reward is getting a new patient. And nurses usually fear getting a new patient because it means they have to do a full-on assessment that you barely have time to do. And right now, most assessments in most hospitals are done where nurses are writing on their pant legs or on paper towels and putting in the system later. Why haven't we automated that process and it's 2024? So that's an example of one of the things we can do to automate processes to reduce the work burden on nurses. We have voice-activated technology. We should not be here. And some of these things should be attacked with urgency. And I understand people say, Well, this is costly to and you have rural hospitals that probably can't afford it. Totally agree. But there are a number of things that we need to do to that we have the opportunity to do and had the funds to do to improve these work processes, to make them more efficient, and we never invested in them.

Molly McCarthy:
I want to call out the Tribrid model, I love that phrase as opposed to hybrid, but really making it a three-pronged approach, and with the ultimate goal when you're redesigning care is to reduce nurses, what I'm going to call that I've heard be called before, Non-value added tasks, and enabling them to be with the patient, to do that assessment hands-on and really focus on the patient in front of them rather than the technology. And just as a lifelong tech geek, I, you know, I definitely agree with all of those comments, especially around making the life of clinicians easier through technology, not the opposite way. And, you know, understanding what the problem is and how technology can really enhance either the process or workflow is critical. And actually a lot of the virtual nursing programs that you've probably seen, and I've seen, the discharge, the admissions, or some of the areas where I've seen virtual nurses make an impact for those nurses. And you're right. I mean, I remember you would be afraid to discharge your patient because you would get another one, and those patients would require a lot of time and assessment, right, when you're getting them, regardless of where they're coming from. E.R., O.R., ...

Katie Boston-Leary:
Yeah, absolutely.

Molly McCarthy:
Thank you for that. I wanted just to leave our listeners here today who typically are chief nursing officers, CNIOs, you know, their respective teams, and you have just a really neat variety of experiences within healthcare. And I would love for you to share just one parting gift of wisdom for our listeners. So what is your single most important, practical piece of advice for our listeners and nurses as it relates to the responsibility of being tireless advocates for their patients in thinking about today's challenges and environment?

Katie Boston-Leary:
Yeah, I think the one, I'll put a header on it, then I'll go into detail on how it applies to different groups. But the one takeaway that I'll give, and it's probably going to sound like a Captain Obvious type of statement, but I'm going to give it anyway. Collaboration is a no competitive edge. And there's deeper collaboration that needs to happen internally and not assume that just because there are relationships, that is collaboration. Collaboration is really about understanding what the vision is and what the outcome is and how you measure it based on that relationship. And when I say that, it's not to say that these are transactional relationships. It's really about making sure that we stay focused on the main thing, right? They say, Keep the main thing, the main thing. And keeping the main thing about collaboration being that internally, the cross-functional teams and the matrix teams that we have should be communicating to figure out ways to make things more efficient. When you look at good to great principles, it's really not necessarily about taking on something new; it's about what you can take away so you can be better at what you do and finding out what your niche is. And that niche can also be attained by establishing new relationships externally. A lot of companies or competitors that you never would talk to should be the ones that you should be engaging to help make you better. I remember one of the things that I struggle with as a chief nursing officer years ago. I was in an institution where we were in a rural part of the state of Maryland. And the only schools that I had nearby was community college that didn't graduate a lot of students. And before you knew it, because we were in such a place where it was a struggle to get nursing talent, they will all go to the larger hospital. I had a pediatric unit that was small, and I had this giant pediatric hospital that they will all go to. My daughter was admitted there and I walked into the emergency room. I knew almost every nurse. Because they all had worked for me at some point. So I was their training ground. And yes, that hospital had something to offer to them that I did not have, which was a larger portfolio of care because we were in a small community hospital. So one day, out of frustration, after I heard about more transitions and turnover, nurses leaving to go to that larger hospital, I decided to call the CNO at that hospital. That was a big no-no because they would consider it to be a competition. Cold-called her. She answered the phone. And I said, We need to collaborate. And she said, I'm intrigued. And I quickly thought on my feet and I said, I need you to employ my nurses while they work for me. And that started off a lot of conversations where ultimately we worked on a master services agreement, where we put their brand, because they had a strong brand, on our pediatric unit. They employed my nurses. We kept them whole, even made put them over what they were in terms of their salary and wages and their wages and benefits package, and then reopened the unit like under new management with their logo and branding and collaboratively did that. Community came with a celebration. And with that effort, we reduced transfers to their hospital because we didn't have the talent to care for patients to a level that we should, and then we built trust in the community that their patients can come here. So the point that I'm making is with that, that happened a few years ago, we need more of that. We need to look at the people that we've always considered to be our competitors, companies that we thought wouldn't care about what we do, and forge relationships to help make us stronger and better, particularly as we navigate this very, very challenging world as nurse leaders. And for nurses themselves, we need to look for collaborative opportunities within the places that we work as well, different floors, different departments, because we can't do this alone. And this is the attitude that we need to have for us to be better. So that's my one takeaway that I can give today.

Molly McCarthy:
I love that. And he mentioned it was Captain Obvious. But I think really it's not, when you think about what you did at your hospital and engaging the larger hospital, which people probably would have considered just a crazy idea. I love it because coming from, you know, I've worked in industry, I've worked for an association, I've worked across many different organizations within healthcare, and at the end of the day, we really need a variety of talent and skills on the care delivery side, on the tech side, and that collaboration to really start to make a transformation within healthcare as nurses. But at the end of the day, quite frankly, we're all consumers too, as you mentioned before. So Dr. Katie Boston-Leary, thank you so much for all of your insights today, and really appreciate your time here.

Katie Boston-Leary:
Thank you so much. Appreciate you, Molly.

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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SCTS_Mary Morin: Audio automatically transcribed by Sonix

SCTS_Mary Morin: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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.

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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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SCTS_Dr. Robyn Begley 2: Audio automatically transcribed by Sonix

SCTS_Dr. Robyn Begley 2: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Molly McCarthy:
Hi, it's Molly McCarthy, podcast host for the Smart Care Team Spotlight. I'm excited to reshare an episode I did with Robyn Begley, CEO of the American Organization for Nursing Leadership, AONL Foundation president, and AHA's Chief Nursing Officer. Robyn recently announced her plans to retire at the end of 2024. Thank you, Robyn, for your passion, leadership, and willingness to collaborate over the years and personally, thank you for being a mentor to me, always answering my calls and questions. And, of course, go Hoyas!

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. Robyn 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.

Dr. 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?

Dr. 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.

Dr. 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.

Dr. 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.

Dr. 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.

Dr. 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?

Dr. 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.

Dr. 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.

Dr. 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.

Dr. 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.

Dr. 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.

Dr. 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?

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

Molly McCarthy:
You can say, okay.

Dr. 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.

Dr. 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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