Nursing education is evolving to accommodate new generations of nurses, says this nurse educator.
Amidst one of the largest workforce shortages in healthcare history, CNOs are looking for ways to recruit new graduate nurses now more than ever.
Many health systems are partnering with nursing schools and other academic institutions to help raise the next generation of nurses and create pipelines into the industry. CNOs need to stay up to date on the current state of nursing education to maximize the potential of incoming new graduate nurses.
There are several reasons for the nursing shortage, and according to Dr. Jason Dunne, chief academic officer at the Arizona College of Nursing (AZCN), the American Association of Colleges of Nursing (AACN) anticipates that 1,000,000 nurses will retire by 2030.
“At the same time, I think our population is aging and living longer, creating higher demands for nurses,” Dunne said, “and in recent years, the pandemic only exacerbated the situation, and many nurses opted to leave the profession early, unfortunately.”
Additionally, the Bureau of Labor Statistics (BLS) expects the nursing workforce to expand by 6% over the next 10 years, Dunne explained. Nurses are also experiencing high levels of burnout, which is also causing them to leave the profession.
“The other piece that’s near and dear to my heart is nursing school enrollment is not keeping pace with the demand for new nurses,” Dunne said. “So even with the high interest in the profession, many qualified applicants across the country are just not being admitted because there’s not enough spots for nursing program applicants.”
Several factors are blocking students from enrolling in nursing programs, according to Dunne, including funding from the federal and state governments, and clinical availability. Nursing schools also struggle with recruiting faculty, specifically those who have at minimum a master’s degree.
“As students progress to the nursing program, they actually need clinical experiences and health systems to hone skills and be competent, so those are not as readily available as we’ve been moving forward,” Dunne said. “It sounds like a perfect storm as you think about the future of nursing.”
Preparing career-ready nurses
Nursing schools must provide the proper curriculum for new graduate nurses so that they can enter the clinical environment equipped with the necessary skills for modern nursing.
To Dunne, there are a number of qualities that nurses must learn to ensure career longevity.
“One of the things that’s top of mind for me is critical thinking skills, which really forms the basis of how we approach situations in terms of analysis, integration, [and] prioritization,” Dunne said, “and that forms the foundation of this term called clinical judgment, which is an essential component of safe clinical practice.”
Nurses also need to understand the burnout risks associated with the position. According to Dunne, 52% of nurses are considering leaving their current position due to insufficient staffing. To combat burnout, it is essential that nurses learn self-care.
“[Nursing educators must help] new nurses understand what [self-care] means and really intentionally build it into a nursing curriculum,” Dunne said, “so folks out of the gate are understanding how to take care of themselves, [and] how to fill their cup.”
New graduate nurses must have an awareness and appreciation for patient diversity as well, said Dunne, since the world is diverse and culturally rich.
“That creates a level of complexity for nursing that nurses need to possess cultural competency,” Dunne said, “meaning having the skills and abilities and skillset to really take care of patients and their families from a variety of cultural backgrounds and settings.”
Communication and multitasking are other key components for new nurses as the industry continues to evolve.
“You don’t have to change careers to change your job,” Dunne said. “There’s so many diverse opportunities for nurses, you may get tired of one spot, [but] there’s so many opportunities for nurses to pursue other experiences.”
Evolving with new generations
CNOs also must be aware of how nursing education is changing to accommodate the viewpoints and expectations of new generations. The integration of technology has shifted nursing education just as much as it has revolutionized the rest of the healthcare industry.
Dunne explained how the use of high-fidelity simulation and new mannequins alone has shifted nursing education tremendously by mimicking human situations and experiences. Online learning, virtual reality, AI, and virtual science labs are also on the rise, which warrants an increase in data literacy education.
“Having these experiences for our students allows them to engage in patient care scenarios in a safe environment,” Dunne said, “really helping them to build the necessary clinical judgment skills that are essential for safe practice.”
Competency-based education is a concept that has gained momentum, according to Dunne.
“Now it’s [about] the demonstration of specific competencies, [and if] students are gaining the learning they need as they move forward,” Dunne said, “and many programs actually tailor education experiences to the individual student needs where they are.”
Interprofessional education has become front and center as well. Working with other members of the healthcare team has proved to be extremely beneficial, Dunne explained.
“Learning alongside each other, understanding roles [and] responsibilities as you get out into the healthcare world really helps to create great patient outcomes,” Dunne said.
Mental health and a focus on holistic patient care are also priorities in current nursing practice, along with the idea of lifelong learning. Generational differences also need to be addressed in nursing education, since new nurses prefer more collaborative and technological approaches to learning, Dunne explained. There is also a much stronger focus on ethics and social justice, in both nursing education and patient care.
“Healthcare continues to evolve and become more complex,” said Dunne, “so we’ve got to keep pace in order to provide safe, effective care to our patients.”
Bridging the gaps
To fill spots in nursing programs, nursing schools need to tailor the academic experience to better suit the students as they move through the curriculum, Dunne said. Academic institutions must provide resources and remove obstacles, and remember that being a student is not as traditional as it used to be.
“The folks that we serve, they have families, jobs, children, other priorities, and it’s really important for nursing schools to help students navigate life so they can be successful academically,” Dunne said. “If we don’t help them build those life skills, academics is not even on the priority list.”
Nurse educators need to see the whole student, Dunne explained, and align their program’s mission values with the social justice values that nursing students care about.
“We at Arizona College sponsor students to be part of the National Black Nurses Association, the National Association of Hispanic Nurses,” Dunne said, “and we just want to create a culture where students are engaged and active members of the learning process.”
For CNOs, partnering with nurse educators and academic institutions to create pipelines into the industry is an essential component of sustaining the nursing workforce, Dunne stated.
“I believe schools need to work closely with clinical partners to ensure that curriculum and training aligns closely with the needs of the workforce,” Dunne said. “Nursing education, programs, [and] schools need to keep pace, so our students are workforce relevant.”
AZCN offers a BSN program at 20 campuses across 13 states, and is designed to prepare students for their careers as registered nurses. At each of these campuses across the country, they have community advisory boards that include the healthcare partners in each campus’ local community.
“These advisory boards are essential to creating those synergies between academic teams and the practice teams,” Dunne said, “to ensure lines of communication are open and also that we’re able to be responsive to the needs of our practice partners [with] how quickly health and health information [are] changing.”
Nurse residency programs, joint faculty appointments, mentorship between academia and practice, scholarships and grants, and tuition reimbursement programs are all ways that academic institutions and health systems can partner to recruit and retain more nurses.
Lastly, Dunne recommended that nurse educators and nurse leaders come together to be the unified voice and advocate for the nursing profession.
“As we know, nursing is a trusted profession,” Dunne said, “and we really need to continue to advocate for the needs of our nurses, short term as well as long term.”
Federal officials have decided not to appeal a court order that shut down the rule, saying it exceeded HHS authority under HIPAA.
Federal officials have withdrawn a plan to restrict hospitals from using tracking technology to collect data from consumers visiting their web portals.
The Health and Human Services Department (HHS) has withdrawn its appeal of a district court vacating the federal rule, which was outlined in a December 2022 bulletin from the HHS Office for Civil Rights. The rule stated that entities covered by the Health Insurance Portability and Accountability Act (HIPAA) “are not permitted to use tracking technologies in a manner that would result in impermissible disclosures of PHI to tracking technology vendors or any other violations of HIPAA Rules.”
The American Hospital Association and several other groups filed suit against HHS in late 2023, charging that the federal agency exceeded its statutory authority in preventing healthcare providers from collecting the IP addresses of people visiting public-facing websites. On June 20 of this year, a federal district court in the Northern District of Texas ruled that the federal order “was promulgated in clear excess of HHS’s authority under HIPAA.”
The AHA and others had argued that the rule could have been interpreted to prevent hospitals from using common technologies, such as analytics software, video, translation and accessibility services and digital maps to access IP addresses, assess the usability of their portals and communicate with patients.
HHS’ decision to drop its appeal was hailed by the AHA.
“The American Hospital Association is pleased that the Office for Civil Rights has decided not to appeal the district court’s decision vacating the new rule adopted in its Online Tracking Technologies Bulletin,” AHA General Counsel Chad Golden said in a statement. “As the AHA repeatedly explained to OCR—both before and after OCR forced the AHA to file its lawsuit—this rule was a gross overreach by the federal government, imposed without any input from healthcare providers or the general public. Now that the Bulletin’s illegal rule has been vacated once and for all, hospitals can safely share reliable, accurate health care information with the communities they serve without the fear of federal civil and criminal penalties.”
CFOs have their priorities in certain areas of their organization.
The 2024 HealthLeaders CFO Exchange brought about several insightful discussions for CFOs from across the nation and showed where their main focuses lie.
From virtual care to physician collaboration, see where the event attendees are prioritizing their time (and money).
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Nurses need to be involved in decision-making surrounding AI, says this CNIO.
HealthLeaders spoke to Robbie Freeman, vice president of digital experience and the chief nursing informatics officer at Mount Sinai Health System, about five questions nurse leaders should be asking while implementing AI. Tune in to hear his insights.
Faced with pharmacy closures and struggling to make ends meet, health system executives are innovating pharmacy operations to cut costs, reduce waste and give the pharmacist a bigger role in care management.
For an increasing number of hospitals, the path to healthcare innovation leads through the pharmacy.
Whether it’s to keep the doors open in a rural region or address care gaps brought on by retail pharmacy closures and disruptor drawbacks, healthcare leaders are taking a closer look at hospital pharmacy operations. Some are eyeing a hub-and-spoke drug distribution model to cut costs and waste, while others are making the pharmacist a more active member of the care team.
“We’re definitely more involved in patient care,” says Jason Tipton, inpatient operations supervisor at Carle Foundation Hospital, part of the Illinois-based, eight-hospital Carle Health system. “Basically, what it boils down to is safety.”
Carle Health turned to digital health company DrFirst to improve medication management through the pharmacy. The AI-enhanced tech platform helped health system executives boost efficiency by at least 16%, cutting down on long hours spent in front of a computer or on a phone talking to doctors and retail pharmacies, searching through patient histories and matching the right prescriptions and drugs to the right patient.
Tipton says the health system has not only reduced medication errors, but identified the barriers that keep patients from filling out their prescriptions or following doctor’s orders. By integrating that platform into the EHR, pharmacists were able to work with the care team to identify the right medications, including doses and frequency, check for side effects and potential interactions, even make sure the patient fills out the prescription.
According to the health system, the technology has helped Carel Health improve medication management and reduce stress on its pharmacy staff, to the tune of roughly 1,209 acute care hours saved annually.
While the issue of pharmacy closures and deserts has hit the front pages recently, Tipton notes the problem began during the pandemic, when pharmacies were struggling to keep up with the surge and patients were looking to their providers for help. Health systems like Carle Health saw the opportunity not only to improve patient engagement then, but to plot a long-term strategy to boost that business line.
Hospital pharmacists and pharmacy technicians “have always been involved in that process,” he says, “but this was a chance to be more of a part of the care team. And physicians liked that as well. After all, if [patients] aren’t getting their medications [or they’re not following doctor’s orders], they’re going to show up in the hospital.”
Taking on Pharmacy Innovation in a Rural Hospital
In Virginia, a reimagined pharmacy was the key to the July 2021 reopening of Lee County Community Hospital, which had closed its doors in 2013.
Executives say the hospital in Pennington Gap, which is part of the Ballad Health system, reopened due to public pressure: There just weren’t that many healthcare options in the rural region dividing southeast Kentucky and southwest Virginia. But with that opening, which cost the health system roughly $15 million, came pressure to cut expenses, reduce waste and improve care delivery.
And that meant an automated virtual pharmacy.
“In pharmacy, we've really learned [that] everything that we do is expensive,” says Trish Tanner, vice president and chief pharmacy officer for the 20-hospital health system. “My people are expensive. My drugs are expensive. My equipment is expensive, [and] it's really hard to recruit here, so [we are] trying to find ways to be innovative and bring that same level of care to patients regardless of where they're located.”
Instead of having a pharmacist on site, Lee County Community Hospital has an automated drug dispensing system and a remote order entry platform, as well as a telehealth platform that includes medication management. The hospital partnered with Omnicell to automate their pharmacy management operations.
Eighteen of Ballad Health’s hospitals are now on this platform, with the last two expected to go live by January of 2025. From a central pharmacy, drivers visit each hospital to refill drug cabinets, check expiration dates, and do any other tasks needed.
“We can’t put a pharmacist in there,” Tanner says of Lee County, though she could be talking about any of the small hospitals in the health system. “We're able to redeploy the pharmacist who would be there to other tasks that aren't currently being met, our greatest one being medication reconciliation.”
Through a telehealth platform and a focus on community engagement for the providers who do work at each hospital, Ballad Health officials say they’re able to improve quality of care and keep each hospital’s doors open.
“What is [important] is that we really know our patient population and the drugs that they're typically on,” Tanner says. “And while I don't have a pharmacist physically at bedside at Lee County, we do have them virtually.”
The telehealth platform gives providers an opportunity to dig into the data on a patient’s care management needs and find ways to close care gaps, whether it’s finding a more affordable prescription or developing a routine to ensure that a patient takes their medications when expected.
“50% of the country is not following doctor’s orders right now,” Tanner points out. “That’s a huge outlier for any hospital, especially a rural hospital that is trying to watch its costs. So we've worked really hard to make pharmacy services [as] seamless as possible for our patients on their journey [and] for our physicians across the organization.”
Marvin Eichorn, Ballad Health’s vice president and chief administrative officer, says the pharmacy is the ideal use case for today’s digital health innovations.
“In today's world it's very difficult to recruit almost any position,” he says. “So if we can maybe do it [with] robots or other technology or maybe off-site somewhere, that can provide [a benefit] to the hospital. And then we can use [the money saved] to focus on other areas of care, to make care better.”
Exploring Payer Collaboration
At Baptist Health in Kentucky, officials recently cut the ribbon on a new, 102,000-square-foot central pharmacy aimed at reducing costs and clutter in the nine-hospital network and improving the supply chain. The health system took a good look at how UPS handles things to develop its central pharmacy strategy.
Baptist Health also launched a partnership with Clearway Health, a company that focuses on improving specialty pharmacy operations.
With independent and chain pharmacies struggling and patients wondering where they’ll get their next prescription, Nilesh Desai, Baptist Health’s chief pharmacy officer, says it was imperative to look at each patient’s entire pharmacy journey, not just the part that intersects with the hospital.
“It's better for them because they're coming to see our physicians, our providers, and they're like, ‘Hey, you know what? I'd rather see my own pharmacist,’” he says. “So then maybe we can answer their questions or make a phone call. It really makes it easier on all fronts.”
Key to the Clearway Health partnership is access to the payer market, which is also keeping a wary eye on the pharmacy turmoil. Desai notes that health plans are affected just as much when a member can’t or chooses not to fill a prescription.
He says it’s important for health systems and hospitals to work with payers to make sure patients/members have access to pharmacists. That includes understanding payer networks and adjusting to give hospital pharmacists and pharmacy technicians more opportunities to impact care management.
“There is a provider shortage, there is nursing shortage, [and] medication management in general has become very, very complex,” he says. “You need someone who's an expert, who understands medication all the way through. Who better than the pharmacist?”
Desai says the workforce shortage will only get worse over the next three to four years – there’s a 65% shortage in pharmacy school applications now. It’s up to the healthcare industry to address that, not only by working with medical schools to boost the pharmacy tech pipeline but to take on more pharmacy services.
“Sometimes we do the reverse,” he says. “We've called the patients at home to say, ‘Hey, how's the medication working on you? Are you having any issues?’ So, having that continuous dialogue is going to be very, very important.”
There are seven tips for CMOs to help clinicians communicate well during telehealth visits, according to the CMO of RWJBarnabas Health.
Telehealth visits increased exponentially during the coronavirus pandemic and remain well above pre-pandemic levels.
According to a study, the rate of telehealth visits among commercially insured U.S. adults increased from 0.3% of all healthcare encounters in March 2019 to 23.6% of encounters in June 2020.
A recent journal article, which was published by the Journal of the American Medical Association, gives four tips to help clinicians communicate well during telehealth visits, and Andy Anderson, MD, MBA, executive vice president and chief medical and quality officer at RWJBarnabas Health, provides three more.
1. Wait a second or two
According to the journal article, an experiment found that the time between one person speaking and another person speaking in a conversation increased from 135 milliseconds during in-person conversations to 487 milliseconds during video-based conversations.
"These findings suggest that during video telehealth encounters, clinicians should allow patients a second or two longer to respond to their questions than may feel natural," the journal article says.
It is often a good practice to give patients more time to respond to questions during telehealth visits, according to Anderson.
"If a patient seems hesitant or seems to need more time, that time should be given to the patient," Anderson says. "The clinician should go at a pace that the patient is comfortable with and give them time to respond to questions."
2. Start a telehealth visit with small talk
A clinician should ease into a telehealth visit with small talk, according to the journal article.
One study found that "friendly conversation" including small talk established a positive connection between pediatric cancer patients and oncologists.
"This argues for the utility of beginning a telehealth session with a small talk prompt, such as, 'How has your day been so far?'" the journal article says.
Starting a telehealth visit with small talk is helpful, just as it is in an in-person encounter, according to Anderson.
"Having a personal connection and having the patient start with talking about something that is easy to talk about warms them up," Anderson says. "It makes the telehealth visit feel more like a normal, in-person conversation."
3. Project a professional image
Selecting an appropriate virtual background such as an image of a doctor's office can help build credibility for a clinician during a telehealth visit, according to the journal article.
One online education study evaluated how students reacted to the virtual backgrounds of their instructors. The study found that personal virtual backgrounds were linked to a perception among male students that the instructor was less caring and trustworthy.
"Institutional or professional virtual backgrounds may help establish credibility," the journal article says.
Whether a clinician's background is virtual or real during a telehealth visit, it should be professional, according to Anderson.
"It can be an office or an examination room," Anderson says. "For example, the clinician should not be sitting in their living room with a television. As long as the background is professional, whether it is a real background or a virtual background with the name of the health system, either is OK."
4. Try to establish eye contact
Particularly for first-time telehealth patients, clinicians should look directly into the camera, and explain why they may have to divert their gaze for taking notes or completing other necessary tasks, according to the journal article.
Anderson also emphasized the importance of looking into the camera for clinicians who conduct telehealth visits.
"Ideally, you want to have good eye contact," Anderson says. "If you have to look away, you can tell the patient that you are going to write something down or look at the computer."
Other best practices
There are three other best practices for clinicians to optimize communication during telehealth visits, according to Anderson.
The telehealth visit should be treated just as an in-person visit would be treated in terms of some of the basics such as allowing the patient to talk and tell their story. Other basics include listening intently to the patient and giving the patient time to ask questions.
In terms of appearance and dress code, the clinician should dress professionally. Professional attire can boost the clinician's credibility.
Lastly, a clinician should ensure the patient is comfortable with the virtual visit technology in terms of how to use the camera, how to speak, and hearing the clinician. Cross-checking the technology is an important part of the visit to make sure it is working well for the patient.
Cedars-Sinai researchers are analyzing biomarkers in the retina that identify Alzheimer’s and cognitive decline, studies which could lead to the development of new tools to diagnose the disease through a non-invasive eye test.
Could healthcare providers soon be able to diagnose Alzheimer’s disease through an eye test?
Researchers at Cedars-Sinai Medical Center are touting the results of three recent studies that indicate an eye test could be used to assess the eye-brain connection, which would allow clinicians to diagnose Alzheimer’s earlier and begin treatment.
“The retina, a layer of tissue at the back of the eye, is part of the central nervous system and is directly connected with the brain,” Maya Koronyo-Hamaoui, PhD, a professor of neurosurgery, neurology and biomedical sciences at Cedars-Sinai and senior author of all three studies, said in a press release. “It has similar cell types and vascular structures to the brain, but is not shielded by bone, so it is more accessible to noninvasive imaging. Our latest research unearths new details about the eye-brain connection.”
Healthcare leaders are looking for innovative and less-invasive strategies to diagnose Alzheimer’s disease, which affects some 5.8 million Americans; that number is expected to jump by 14 million by 2060. Alzheimer’s accounts for some 60% to 80% of dementia diagnoses, and leads to roughly $413,000 in lifetime healthcare costs per patient. Nationally, the price tag for Alzheimer’s care was estimated in 2020 to be $385 billion.
Earlier detection and treatment could reduce those costs and improve clinical outcomes.
At Cedars-Sinai, researchers launched a study to analyze tau, a protein that helps stabilize the structure of nerve cells in the brain and retina and a critical marker for Alzheimer’s. They found that higher levels of abnormal tau in the retina corresponded to brain changes related to Alzheimer’s, as well as cognitive decline.
A second study, focusing on clumps of protein called amyloid plaques, found two to three times as many plaques clustered near blood vessels in the retinas of patients diagnosed with Alzheimer’s or mild cognitive impairment. A third study focused on other Alzheimer’s biomarkers in the retina, including reduced blood flow, inflammation, nerve cell damage, damage to the barrier that prevents harmful substances from entering retinal tissue, and deposits of amyloid-beta proteins inside blood vessel walls.
“Imaging technology now being developed will allow us to see these changes in patients in clinical settings,” Keith L. Black, MD, chair of the Department of Neurosurgery and the Ruth and Lawrence Harvey Chair in Neuroscience at Cedars-Sinai and co-author of the studies, said in the press release. “This technology, which is noninvasive and affordable, allows us to see changes in the cells and blood vessels in tremendous detail.”
In this episode of the HealthLeaders podcast, CEO editor Jay Asser is joined by Crouse Health CEO and HealthLeaders Exchange member Seth Kronenberg to tackle the biggest questions surrounding the workforce. Kronenberg and other leaders will share their insight on the topic at the Workforce Decision Makers Exchange in Washington, D.C. from November 7-8.
