Knowing how to communicate with legislators and governing bodies is an essential part of nursing advocacy.
When it comes to participation in the legislative process, it's important to identify and build relationships with local, state, and federal policymakers.
CNOs should know who the decision-makers are and what committees they are on, and try to become their subject matter experts who they can call upon to discuss nursing-related issues.
Storytelling and data are the keys to successful advocacy efforts, say these nurse leaders.
Legislators play a key role in nursing practice, from scope of practice to workplace violence prevention to patient care delivery. But right now, most of the elected officials making decisions about nursing policy are not nurses.
According to a 2023 study, the number of nurses serving as legislators has declined from 2013. In 2023, there were only 72 nurse legislators in 36 states. According to the American Nurses Association, there are only three nurses currently serving in the United States Congress.
As this year progresses under a new administration with new ideas about legislation and policy, it’s more important than ever that CNOs and other nurse leaders get involved so that nurses can be the ones leading the way for legislative change.
The panel included three key points about nursing policy and legislation.
Key nursing policies
There are several critical areas of focus for nursing legislation, the first being workplace violence. Nurses experience some of the highest rates of workplace violence out of any profession. According to a National Nurses United report, eight in 10 nurses experienced at least one type of workplace violence between 2023 and 2024. The panelists emphasized that nurse leaders should be aware of the SAVE Act, which would make it a crime to knowingly assault or intimidate healthcare employees at work.
Additionally, the passage of the One Big Beautiful Bill Act (OBBBA) will mean dire things for rural hospitals and health systems, and many patients previously enrolled in Medicaid will lose access to coverage. The panelists emphasized that nurse leaders must speak up about the impact of this bill on the most vulnerable patients and communities, and the downstream effect that it will have on nursing practice and care delivery.
CNOs also need to pay attention to legislation regarding rules around telehealth, advanced practice nurses, and mandated staffing ratios. Additionally, leaders must keep tabs on legislation that might have a secondary effect on nursing, even if it seems like there won't be a direct impact. That includes any piece of legislation regarding childcare or other things that impact a nurse's ability to participate in the workforce.
Ways to get involved
When it comes to participation in the legislative process, the panelists recommended identifying and building relationships with local, state, and federal policymakers. CNOs should know who the decision-makers are and what committees they are on, and try to become their subject matter experts who they can call upon to discuss nursing-related issues.
The panelists also emphasized that CNOs should also get involved with hospital associations and explore what their mission and values are, and how they can work together to make progress. Many organizations also have government relations teams who can partner with CNOs on nursing issues and help navigate conversations with legislators.
CNOs should also build pipelines for newer generations of nurses who are inspired and want to get involved in advocacy. It's critical that nurse leaders foster a sense of confidence among nurses to stand up and have a voice.
Driving home the point
Lastly, there are two key strategies to use when speaking to legislators: data and storytelling. The panelists recommended presenting the data from a policymaker's constituency and the health system's community. Metrics to keep in mind include turnover rates, workplace violence numbers, patient outcomes and experience, nurse vacancies, and nurse sensitive indicators.
Storytelling is also a powerful tool, especially when combined with data, the panelists explained. Policymakers often don't understand the nuances and intricacies of being a nurse, and storytelling conveys the passion and the importance of why these issues matter. CNOs should also consider doing their advocacy work in person, when possible, to further communicate the subject's importance and to build better relationships with lawmakers.
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CNOs must learn the different ways to get involved in the legislative process to make the nursing industry better.
Now more than ever, it's time for the voice of nursing to enter the conversation.
Policymakers should have the input of nurse leaders when making decisions about whether to support legislation that will impact nursing. As lawmakers proceed with healthcare-related bills, it's critical that CNOs give their input and use their position to advocate for patients and the nursing workforce.
There are several pieces of federal legislation that healthcare executives should be paying attention to, including the PRECEPT Act and the I CAN Act. The PRECEPT Nurses Act aims to instate a tax credit for nurses who successfully serve as nurse preceptors for nursing students. The I CAN Act would remove federal barriers in Medicare and Medicaid programs that prevent APRNs from practicing to their fullest extent. CNOs should also keep tabs on the state and local legislative sessions and advocate for laws that will greatly impact their workforce and community.
According to the HealthLeaders CNO Exchange members, there are several ways that CNOs can get involved in political advocacy. First and foremost, CNOs should brush up on their knowledge of how laws are made and educate themselves on policy issues. The second step is for CNOs to ask for support from their peers and join policy circles. Lastly, CNOs should visit their legislators in their communities, attend town halls, and leverage their votes.
Getting more involved
CNOs should be able to collaborate with professional organizations, educate policymakers, and drive nursing-forward agendas that impact patient care, healthcare equity, and workforce development and sustainability.
But where do you start?
The next webinar in our Winning Edge series will explore the various issues and pieces of legislation that nurse leaders should be advocating for. Join us to learn about the different ways that CNOs can get involved in the legislative process to make the nursing industry better.
Nurses play a critical role in preventing sepsis, through early detection, infection control, and patient education, and CNOs must be prepared.
HealthLeaders spoke to Nicole Telhiard, chief nursing officer at Our Lady of the Lake Health, about the health system's new nurse-led sepsis protocol in the emergency department. Tune in to hear her insights.
The health system, taking part in HealthLeaders’ AI in Clinical Care Mastermind program, says AI has the potential to radically improve cancer diagnosis and treatment, but only with appropriate guardrails in place.
For cancer care specialists, one small needle of information in a haystack of data could mean the difference between effective treatment and a bad clinical outcome. And that’s where AI holds so much promise.
“AI can look at millions and billions of data points, at images, genomics raw data, at everything we know about the patients clinically, at social factors and other variables, and it can uncover patterns and answer questions,” says Nasim Eftekhari, chief AI and analytics officer at City of Hope.
Eftekhari, a participant in the HealthLeaders AI in Clinical Care Mastermind program, says the Los Angeles based health system, one of the largest and most advanced cancer research and treatment organizations in the country, is very deliberate in how it approaches AI, with a strategy that focuses on considered and steady development. She joined the organization in 2017 as one of its first data scientists, and says AI programs, from good old predictive modeling to generative AI should focus on data quality, good benchmarks, and proper validation.
“Good data beats more data every day,” she stresses.
Cancer care is a complex process, and one in which City of Hope has been fully immersed since its founding in 1913. Yet for all the advances made in diagnosis and treatment, there’s still a lot that healthcare providers don’t know about the disease.
“Cancer is probably the biggest, most difficult, still unanswered question,” Eftekhari says. “We don't even know exactly why it happens, and how to stop it from happening. That’s where the real potential of AI is, to help uncover that can explain some of those unanswered questions and help discover and design better [treatments,]” and better predict the onset of disease.
Eftekhari says generative AI “is a different paradigm” than traditional automation and predictive analytics programs, so City of Hope has had to adjust its guardrails accordingly. Small, incremental steps forward are preferred, as each change in the data can blossom into a much larger problem if unchecked.
Nasim Eftekhari, Chief Ai and Analytics Officer at City of Hope. Photo courtesy City of Hope.
She says healthcare organizations need to monitor their data, update their AI models often, watching for drift, making sure the information used in patient care is the latest available and the results from AI models are the best possible.
“We’re not doing this overnight,” she adds. “Because it’s always about the patient. Every decision that we make at every intersection is always centered around the patient.”
Eftekhari also believes that AI won’t advance in a vacuum, and that health systems and hospitals need to share their data and their methods to support progress. That may go against the idea that data has financial value and that organizations need to erect silos around that information.
To truly move the needle on cancer care, “the answer may lie in mountains and mountains of data that no single organization [may have] on their own.”
As with many other healthcare organizations, embracing AI in clinical care also means dealing with change management. Providers are generally hesitant to adopt new ideas, and need to be nudged forward, often with promises that their workflows will improve. Eftekhari says AI may have the potential to change healthcare, but it still has to prove its value and fight through the skepticism.
“How do you meaningfully deploy a machine learning or AI model in day-to-day workflows and how do you measure the impact?” she asks. “And how do you make sure that these models keep adding value?”
The answer to those questions, she says, may lie in focusing more on the people than the technology. AI will succeed if the providers using the technology are ready for it.
Organizations have strategies to invest in technology, “but what makes it really work is investing in people,” she says. “People who can actually make it work, who can bridge the gap between technology and healthcare. It’s a much smaller investment but it’s usually the hardest to get because it’s not the shiny new toy that everybody wants to have.”
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Idaho's St. Luke's Health is embracing ambient AI not for the clinical benefits (just yet), but because it helps them keep their doctors and nurses.
Small health systems like St. Luke’s in Idaho aren’t embracing AI for the clinical outcomes (though that is a big benefit). They want to help their doctors and nurses, because there aren’t a lot of them to go around.
Provider stress and burnout is a concerning issue for rural health systems, with much of the grief tied to documentation and administrative duties. That’s why healthcare leaders are embracing ambient AI in droves even before the technology has proven its ROI. They want relief now, and will map out the benefits later.
“Our CFO said, ‘Look, we want to make a positive impact on provider well-being,” says Reid Stephan, VP and chief information officer of the Boise-based, six-hospital, not-for-profit network. “If that's all we do with this pilot, I will consider it a success.”
By all accounts, that plan is working.
Working through their Epic EHR, St. Luke’s installed Ambience Healthcare’s AI scribing tool last April, and Stephan says they’re now seeing results. Over the past year, the health system has seen a 38.8% decrease in overall documentation time for clinicians, including a more than 40% drop in after-hours documentation. This translates to a 22% increase in face-to-face time between clinicians and their patients and a 25% reduction in clinician burnout.
Stephan says those numbers translate to happier providers, a key factor in a region where the doctor-patient relationship is as durable as the Rocky Mountains surrounding Boise, a city of some 235,000 people. The idea behind using AI isn’t necessary to increase access to care, but to enrich those care pathways.
“Our approach has been we're not going to pursue supply-side-driven AI opportunities because the amount of supply-side opportunities is enormous and we might get lucky, but more likely we're going to just waste resources and capacity hoping something's going to work,” Stephan pointes out. “So we really focused on the demand-side-driven need we have. And again, it was an obvious one: primary care, in particular. Can we use generative AI specifically to help then with that patient-provider encounter?”
Because of its size, Stephan says the health system isn’t looking to be a trailblazer with AI, but rather wants to use the technology to address its specific pain points.
“We aren’t pioneering this,” he says.
Reid Stephan, VP and Chief Information at at St. Luke's Health. Photo courtesy St. Luke's Health.
There are financial benefits as well. St Luke’s is using a “coding aware” platform, which not only captures the conversation but provides real-time coding of the encounter. The tool is reportedly generating more than $13,000 annually per clinician through more accurate coding and better communications, and Stephan says the deployment paid for itself within five months.
Whether those numbers play out over time remains to be seen. Critics say these AI tools are great at catching early benefits, but long-term results are hazy. Stephan, on the other hand, says as long as his clinicians are happier and engagement is better, the value is there for him.
He also says the results of the first year of implementation have given leadership the support to expand the platform. After starting with family medicine clinicians, the health system is now using the AI tool in some 28 specialties.
“This instilled in us a lot of confidence that we can do this again and again and not have to recreate … across each different specialty,” he says.
In fact, Stephan says he was surprised at how fast clinicians caught on to using AI, and would have considered expanding the pilot sooner had he known the results.
“The word spread across the community, and within a few days or a couple of weeks of the initial rollout of the pilot, we started to have a groundswell of hands being raised,” he says. “’When is my turn? Why wasn’t I part of the pilot? How can I get this sooner?’”
Stephan says it’s important to temper expectations with AI, not only to make sure the hype doesn’t overtake reality but to make sure clinicians know what they’re using. While he tells them AI will improve their workflows, that doesn’t mean management wants them to take on extra patients or patient visits or do more work.
True ROI, he says, comes in a more enriched doctor-patient encounter, where both doctor and patient are more engaged.
“Maybe then the provider is able to pick up on something or hear something that they might have otherwise missed when they’re trying to do the swivel chair game of typing and listening,” he says.
Nurse turnover can be extremely costly for health systems, and CNOs must do their best to combat it.
From an economic perspective, it's expensive for health systems to operate under workforce shortages.
Labor costs are higher across the country in every aspect of healthcare, and having to fill gaps in the nursing workforce with agency nurses and overtime pay is also costly.
A fleet of planes is just one way that Driscoll Children's Hospital makes sure its patients (and their families) get the care they need.
When your patients are sick children, you bring healthcare to them. And that's where true healthcare innovation happens.
Such is the case with Driscoll Children's Hospital. Based in the southern coastal city of Corpus Christi, Texas, the pediatric health system comprises two hospitals and a number of specialty clinics and care sites covering a 25,000-square mile swath of rural southern Texas roughly the size of South Carolina.
Driscoll was launched in 1953 by Clara Driscoll, an author, politician, activist and rancher who spoke five languages, was a confidant of FDR and was credited as the ‘Savior of the Alamo.' She had a soft spot for children, especially those on the opposite end of the economic spectrum, and upon her death in 1945 left her fortune to a fund that would create the hospital.
Mary Dale Peterson, Driscoll's Executive VP and COO, says it's that "Renaissance spirit" that propels the health system today. Among its accomplishments is a 98.5% survival rate across more than 600 pediatric cardiac surgery cases, one of the best in the country. And their length of stay is among the shortest in the country, with transition housing on the hospital campus to help patients and their families move more quickly from the hospital back home.
"You don't always have to be in the largest urban areas to create greatness," she says.
Mary Dale Peterson, Executive VP and COO of Driscoll Children's Hospital. Photo courtesy Driscoll Children's Hospital.
Healthcare innovation comes in many forms, and at Driscoll it begins with the idea that healthcare access is a priority. That's why Driscoll has a fleet of five planes that cover a 33,000-square mile area each day, ferrying specialists to clinics and transporting children to hospitals.
"We have a history of bringing care to the children where they are," Peterson points out.
She says the service dates back to Jim Simpson, a cardiologist who flew his own plane across the state some 50 years ago to screen remote children for congenital heart disease. The planes, purchased through philanthropic donations, help specialists like the only pediatric rheumatologist in all of south Texas meet with children and their parents, saving them hours-long car trips and days away from home.
And it saves money. Peterson – who was president and CEO of the Driscoll Health Plan from 2005-18 before joining the hospital – says the fleet saves Driscoll millions of dollars in Medicaid costs, while also improving time and access to treatment, which in turn improves clinical outcomes.
"We've saved the state a lot of money by flying our doctors to these communities," she says. "Maybe the new innovation is figuring out how we provide equivalent care to our rural communities that we have in our urban communities."
'What We Want to Do Is Really Look Upstream'
That's not the only instance of bringing care to the kids. Driscoll recently launched a pilot project to embed behavioral health specialists in primary care practices as well as local schools.
Peterson says the idea was borne out of a troubling statistic: A 60% increase in ER visits for children over three years, due only in part to the pandemic. In short, children were experiencing mental health crises, and they and their families weren't recognizing the warning signs or seeking help until the only option was emergency care.
With some grants and philanthropic money, health plan funding and an alternative payment program, Peterson sent specialists out into the communities, coordinating with pediatric primary care practices and five elementary schools and a high school.
"When I got to thinking about it, it's like, how do we prevent children from going into crisis?" she says. "We don't have inpatient mental health services in our hospitals, so they end up in overcrowded EDs. What we want to do is really look upstream."
Another example: In 2007, while head of the Driscoll Health Plan, Peterson studied the data on pre-term births and noticed that 20% of all births were ending up in the NICU, while 30% of all births were medically induced. In addition, there was only one maternal-fetal medicine specialist in south Texas. That led to a $10 million investment to establish clinics and build up the telemedicine program, moves that helped bring the pre-term birth rate down to 9% and save millions of dollars in healthcare costs.
"I've worked 30 years as a physician treating these babies with the ravages of prematurity," she says. "I know we can't prevent every preterm baby, but we can do better."
"There's a lot of, you know, sexy technology that's out there in the surgical realm that I love … but I think there's a whole lot of work that we still have to do in the non-sexy areas that have a huge impact on people's lives," she adds. "And that is in coordination of care and behavioral healthcare, and really helping families who are struggling with these issues."
Data and Dollars
As a former health plan president, Peterson says innovation is predicated on two ideals: New ideas are based on data proving their value and can be justified financially. With a patient population in which some 80% rely on Medicaid, that's a challenge.
"Having an integrated health system where we have a health plan, a physician practice group and the hospital all working together helps with that," she says. So the health plan manages the risk, and the health system turns that into opportunity.
That philosophy has helped her to understand when a new idea doesn't work as much as she might want. Peterson says Driscoll embraced telehealth enthusiastically during the pandemic, which was pretty much the only way to access most care. But after the crisis, she crunched the numbers and found that care management had suffered, and well-child visits and immunizations had dropped.
"We'll offer it to everyone," she says of the virtual care platform, "but patients actually do prefer face-to-face visits."
So Driscoll mixes its platforms, offering virtual care alongside in-person care to meet the needs of its patients and their families. Peterson says she's eager to blend the two with new ideas, like remote patient monitoring and AI. And she's excited about research in genetics and precision medicine that is creating new treatments for children.
"In the past you would just have to tell these families their baby's going to die, but now we have something to offer," she says.
Happy nurse, happy patient - that's why wellbeing is important, says this CNO.
On this episode of HL Shorts, we hear from Dr. Brad Goettl, chief nursing officer at the American Nurses Enterprise, about how nurse wellbeing contributes to the growth and sustainability of healthcare organizations. Tune in to hear his insights.
This new sepsis protocol is saving time and saving lives, according to this CNO.
CNOs everywhere need to be concerned about sepsis.
According to the CDC, 1.7 million American adults develop sepsis annually and at least 350,000 adults with sepsis die during hospitalization or are discharged to hospice. Nurses play a critical role in preventing sepsis, through early detection, infection control, and patient education.
It's the CNO's responsibility to ensure that nurses are fully equipped to deal with sepsis. Nicole Telhiard, chief nursing officer at Our Lady of the Lake Health, implemented a new, nurse-led sepsis advisory in the emergency department (ED), alongside physician leaders, to help with tedious sepsis BPA alerts in the health system’s EPIC platform. Through a collaborative effort, the team came up with two key questions in the EHR, which serve as an alternative to the BPA alerts in clinical documentation.
"These two key questions allow the nurse to use their expertise and their input," Telhiard said.
The first question is: Is the patient presenting with an altered mental status? The second question is: Do you and all of your expertise feel like the patient is presenting with suspected infection?
"After answering those questions, it then goes through some of those other cycles of clinical data that we were using to really formulate and help us initiate our sepsis protocol," Telhiard said.
Addressing pain points
According to Telhiard, the biggest pain point that this new protocol aims to address is unnecessary testing. In the past, nurses would have to draw blood cultures when patients arrived in the ED with sepsis. The wait times for physician orders plus the time it took for the actual blood draw and then the waiting times for the results proved to be unnecessary.
"It took a lot of time on the nurses' part to draw a sterile blood culture and do it well, and these are quality processes that we were measuring, is the cleanliness and sterility of our blood culture collection process by nurses," Telhiard said.
Once the nurses began taking a more active, engaged role in sepsis detection and prevention as part of the protocol, Telhiard explained that it saves the nurses time by reducing the number of cultures drawn and helps them refocus on other patients in the ED, and the ones who definitely have sepsis and need treatment. The protocol has also made data collection quicker and more efficient, due to the implementation of the IntelliSep rapid sepsis diagnostic test that can deliver test results in approximately eight minutes.
"We now have [better and quicker] data at our fingertips to know these patients are septic, these may have other infections but not sepsis, or have other things that we then need to work through with our physician colleagues in the emergency room," Telhiard said.
The protocol has been extremely beneficial for the nurses as well, according to Telhiard.
"Not waiting and delaying for other comprehensive panels and cultures that take time has really been a tremendous help for the nurses," Telhiard said. "Having them be a key part of the interprofessional team has really helped improve the morale in the department and improve the time that they have to spend on other patient care duties and work more collaboratively with our team."
Looking at outcomes
According to Telhiard, there have been several positive outcomes following the implementation of the sepsis protocol and the IntelliSep tool. Length of stay has decreased, along with revisits, and the health system has seen a 39% rate reduction in sepsis mortality.
"We're accurately testing and screening people appropriately, so we've seen great success with patients not having to revisit the emergency department," Telhiard said. "We have a much more accurate perspective of what's going on with them on that first ED visit versus repeating multiple visits within a seven- or 10-day period."
Additionally, the health system is working on an early mobility protocol for when patients are admitted to the med surg or critical care units. Learning how the nurses use the sepsis protocols and some best practices learned from the early mobility protocol helps ensure that patients on the units move around earlier and get out of their beds and sit in their chairs to eat, Telhiard explained.
"It's helped the full perspective of nursing care and interprofessional care at Our Lady of the Lake by transitioning the clinical protocols from just an emergency room focus to a process used across the full spectrum of healthcare," Telhiard said.
For other CNOs who want to implement a similar strategy, Telhiard emphasized the importance of including frontline staff and working with multidisciplinary teams.
"I mentioned some of our key leaders that were part of this process, but I can quickly visualize the charge nurses and nurse supervisors in the ED that wanted to have an input into this work," Telhiard said. "Including frontline staff, shared governance, which many CNOs value, that work is very important to this process."
Telhiard also recommended following up by spending time with frontline leaders and charge nurses, listening to their voices, and letting them be part of the decision-making process. Lastly, CNOs should focus on removing barriers.
"Our medical executive committee has been very supportive of collaborating with the nursing team, having those protocols reviewed, and oversight of those protocols on an annual basis so that we are all working from the same page," Telhiard said.
