CNOs need to keep tabs on the current state of nursing education so they can adjust accordingly.
In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.
As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.
Nursing education is just as important for CNOs to keep an eye on, and according to the World Health Organization’s (WHO) State of the world’s nursing 2025 report, the education situation is a mixed bag.
There are several positive and not-so-positive trends that CNOs should pay attention to in the workforce, says this CEO.
On this episode of HL Shorts, we hear from Phil Dickison, CEO of The National Council of State Boards of Nursing (NCSBN), about what the 2024 National Nursing Workforce study reveals about the current state of the nursing workforce. Tune in to hear his insights.
HealthLeaders editor Jay Asser chats with Venanzio Arquilla, managing director for Kaufman Hall's revenue and operations improvement (ROI) practice, on the valuable resources created through the dynamic partnership between Vizient and Kaufman Hall.
A new survey finds that home health agencies are abandoning virtual care due to complexity and a lack of reimbursement. This could hinder efforts by healthcare leaders to extend more hospital services into the home.
Home health agencies embraced telehealth during the COVID pandemic to support patient care, but a growing number are giving up on virtual care, saying it’s too complicated for their patients and unsustainable.
That’s the key takeaway from a study commissioned by the National Institute on Aging and conducted by the University of California, Irvine, and several other universities. Conducted between 2023 and 2024 of roughly 260 home health agencies, it places blame for the drop-off on a lack of Medicare reimbursement, and raises questions about whether home-based care programs can support telehealth at a time when health systems and hospitals are moving more services to the home.
“Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets,” Dana Mukamel, a UC Irvine Distinguished Professor of Medicine and corresponding author for the study, said in a press release.
According to the study, published online in Health Services Research, telehealth adoption among home health agencies stood at roughly 23% in 2019, then surged to 65% in 2021, during the height of the pandemic. By 2024, however, 19% of those organizations had opted to discontinue virtual care, due to a lack of Medicare reimbursement and concerns about sustainability.
On a side note, one-third of all the home health agencies responding to the survey haven’t embraced telehealth at all, saying it’s inappropriate for their hands-on model of care. The study was tilted toward organizations that focus on elderly patients, especially those dealing with dementia-related health concerns.
“These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic,” the press release points out. “The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.”
The study raises two important points.
First, many surveys have shown a decline in telehealth adoption after the pandemic, the inevitable result of patients wanting to get back in front of their doctors after relying almost exclusively on video visits. Telehealth advocates say this pendulum effect should wear off as both providers and patients understand the value of virtual visits and work toward a hybrid strategy that mixes in-person care and telehealth.
The monkey wrench in the works here is reimbursement. Federal and state lawmakers enacted a number of waivers during the pandemic to ease restrictions on telehealth use and boost coverage. While some states have moved to make pandemic-era conditions permanent, the federal waivers are set to end this fall. Many advocates fear that without those waivers, particularly those having to do with Medicare reimbursement, healthcare organizations will scale back their telehealth programs.
Second, there’s the pesky little fact that America’s population is aging, with a large chunk set to hit retirement age soon, and they’re healthier than their predecessors and looking to stay at home and out of the nursing home or assisted living center. The healthcare industry isn’t ready to handle that extra workload – it’s already struggling with workforce shortages and questionable costs. Telehealth offers a channel for providing care to this population while reducing the stress on providers.
While aligning federal policy to improve telehealth reimbursement is a critical piece to telehealth strategy moving forward, the home healthcare industry also needs to rally around virtual care tools and platforms that are effective and intuitive. With health systems and hospitals looking to extend their services into the home, through remote patient monitoring, Hospital at Home and other strategies, they’ll need support from the home health industry to make those services effective and sustainable.
Now that immigration enforcement can happen in hospitals, CNOs must prepare their nurses.
Many things in healthcare have changed since the beginning of the year from a policy perspective.
On Jan. 20, the Trump Administration revoked a policy that protected sensitive locations, including hospitals, from Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CBP) enforcement actions.
In the wake of these removed protections, preparedness is key. CNOs need to take a look at their health system's policies and provide guidance to nurses who might have future interactions with ICE or CBP agents.
Guidance for organizations
According to the ACLU, there are two laws that health systems should remember when considering immigration enforcement policy: the Fourth Amendment and HIPAA. The Fourth Amendment prohibits illegal searches or seizures, and depends on the reasonable expectation of privacy. Patients can expect privacy in a hospital room.
Currently, health systems are required to allow ICE agents into general areas that are open to the public, such as lobbies, waiting areas, and other public areas. ICE agents can be barred from entering clearly distinguished and enforced private areas, such as treatment rooms, inpatient units, offices, and any space closed to the public.
The ACLU recommends that health systems work with their legal departments to identify and distinguish private spaces from public areas, and leverage signs and security guards to clarify private areas. ICE agents cannot access private spaces without a valid judicial warrant that is signed by a judge and identifies the name of the patient and specific location. Organizations should have their legal counsel review warrants before deciding to grant access. Additionally, a deportation or arrest order does not permit agents to enter private spaces.
CNOs should take a look at their policies and make sure to include a list of designated private areas, and procedures for how to interact with ICE and CBP agents and handle law enforcement requests, according to the ACLU. Health systems should appoint a trained individual or legal advocate who can interact with ICE agents when they arrive.
In states where it is not required for patients to disclose their immigration status, the ACLU recommends instructing healthcare staff not to ask questions regarding that status, and to inform the patient that they may decline to answer such questions. Currently, there is no legal obligation for health systems to record a patient's immigration status unless required by state laws.
Guidance for Nurses
CNOs must prepare nurses for what to do when ICE agents arrive at the hospital. According to the Ohio Nurses Association (ONA), the nurse's first priority should be advocating and caring for patients while protecting their rights and privacy. ONA emphasized that nurses should only engage with ICE agents to direct them to the correct authority figure or department. These include legal services, security, and/or a compliance officer.
ONA recommends nurses state politely, "I'm not authorized to provide information. Let me notify the appropriate person to assist you," while not revealing the patient's location, status, or care without explicit authorization from the legal team. The nurse's supervisor or security team should check the ICE agent's identification and verify any judicial warrants that are presented, and notify the legal team if that is the case.
Patient safety is also critical. CNOs should instruct nurses not to discuss a patient's health, immigration status, or any identifying details in the presence of ICE agents or any other unauthorized individuals. Patient care must not be delayed or interrupted by ICE agents, the ONA states. If a patient expresses fear or a safety concern, the nurse should immediately contact their supervisor, social worker, or hospital security.
ONA recommends that nurses document any incidents they witness regarding immigration enforcement. The date, time, location, agents and individuals involved, and actions taken should be recorded and forwarded to the nurse's supervisor and to the health system's legal office. CNOs must make sure nurses are familiar with all policies regarding immigration enforcement, and disseminate those policies throughout the workforce.
The New Jersey health system is rolling out two new vehicles this summer as part of its Eat Well program, which connects patients to nutritious food and other resources.
The Food is Medicine movement suggests that people who eat nutritious meals will see better health outcomes, and that proper nutrition should be a part of the care plan. The challenge for healthcare innovators lies in connecting patients to the foods they should be buying and preparing.
Virtua Health has been addressing that issue since 2017 with its Eat Well program, which began with a mobile farmer's market and two brick-and-mortar 'Food Farmacies,' where patients could get food 'prescribed' by their primary care providers and access resources on nutrition.
More recently, the New Jersey-based health system has gone mobile, bringing food to those who can't easily get to the market or grocery store.
This past April, Virtua Health unveiled a new Eat Well Mobile Grocery Store, a 40-foot vehicle that visits neighborhoods where food insecurity is an issue. And the health system will soon be adding the Eat Well Mobile Food Farmacy, a mobile version of its brick-and-mortar program that will be dispatched to primary care locations where doctors are prescribing nutritious meals for selected patients.
Identifying the Barriers to Care
Stephanie Fendrick, Virtua's EVP and chief strategy officer, says non-profits traditionally use health needs assessments to gain a better understanding of the barriers to care faced by their patients.
"This assessment has consistently shown us that food insecurity is a top concern in our local community," she said. "So that really put it on our radar."
Stephanie Fendrick, EVP and Chief Strategy Officer for Virtua Health. Photo courtesy Virtua Health.
Fendrick says Eat Well was launched with the idea of giving primary care physicians a tool to address nutrition in care management, particularly for patients who are living with chronic issues. She says those doctors "are some of our biggest champions."
"Our physicians are acutely aware of the fact that it's hard to be healthy if you don't have access to healthy foods," she says. "They know that [with] many of the chronic diseases that they're facing every day, it's important that their patients have access to fresh fruits and vegetables and understand how to make a healthy meal, how to combine different ingredients to create those healthy meals."
The mobile program, Fendrick says, came from an understanding that food insecurity often goes hand-in-hand with transportation barriers. So instead of asking their patients to go to the market, Virtua Health is bringing the market to the patient.
"You can recommend all of that, but if you don't have access to the food, then how is someone going to change their lifestyle and incorporate [healthy eating] into their lifestyle?" she asks. "We felt that the mobile piece of it was important, to take food where people needed it,"
Virtua Health launched its first mobile grocery store in 2020, and April's rollout of a refurbished bus given to the health system by the New Jersey Transit Authority replaces the original bus, which was also a NJ Transit vehicle. A $1.5 million donation this year from the state of New Jersey paid for two vehicles (at $500,000 each), as well as renovations to the health system's distribution center, food and staff.
Fendrick says the mobile food program targets neighborhoods where food insecurity is high. The buses are parked at public locations like health centers, churches and senior housing complexes. Anyone in the neighborhood is welcome to shop at the bus, which offers nutritious foods at prices 40% to 50% lower than retail sites.
in some cases, Fendrick says, the food choices are tailored to the neighborhood's cultural identity. In Camden, for instance, roughly half of the population is Hispanic, so resources are offered in Spanish as well as English and certain foods are added to the bus.
"We're establishing trust with our community," she says.
Virtua Health has a fleet of six vehicles altogether, with three devoted to mobile programs such as pediatrics and cancer screenings. In some instances the health system will pair a food truck with another vehicle to offer multiple services in one location.
"We're really trying to wrap services around our patients to keep them healthy in their communities," Fendrick says.
Prescribing Food as a Part of the Care Plan
The Food Farmacy, meanwhile, is more focused. The program – which now consists of brick-and-mortar Food Farmacies in Camden and Mount Holly – enables primary care providers to prescribe certain food to patients who have food insecurity as well as a chronic condition like diabetes, high blood pressure or heart disease. The program gives patients free groceries that are "medically tailored" to their care plan, as well as access to nutrition counseling and other resources, for up to six months.
"Having access to certain healthy foods is great, but having the knowledge of what to do with them and how to use them to make healthy meals is also a very important part of the program," Fendrick points out.
The new mobile Food Farmacy will offer the same services, and will visit primary care offices (initially in Hammonton and Washington Township) where doctors are giving their patients prescriptions for the program.
According to Virtua executives, the outreach is showing positive results. The mobile grocery store program saw more than 7,500 transactions in 2024 and has grown year over year, while all of the Eat Well programs saw more than 47,000 transactions in 2024, an 8.6% increase over the previous year.
In addition, according to a survey of participants, 94% of customers to the mobile grocery store reported consuming more fruit and vegetables, and 88% say they've prepared more nutritious meals as a result.
Fendrick says this data is important, but the real test of the program's value will come over time, as the health system looks at clinical outcomes. For patients with chronic conditions, short-term details like weight loss, A1c levels and blood pressure will be charted. Over the long run, they'll be keeping track of health and wellness metrics and quality of life.
"That's taking us a little more time to get our arms around," she says. "Are we truly making an impact on their health outcomes?
The long run also means developing connections with the retail community and others to ensure a steady supply of food. Since the program's launch in 2017, more than $10 million in philanthropic donations have been invested in the program.
"We're looking for different types of partnerships and relationships to help keep this sustainable," Fendrick adds.
As for where the program goes from here, Fendrick says she wants to see steady growth for now, along with more education for both providers and patients about the value of good nutrition. She notes that Virtua Health sent one of its buses down to Atlantic City for a while at the request of the governor, and the program was such a success that a local provider is now running its own program there.
And of course, now that Virtua Health has a mobile farmer's market and grocery stores, could a food truck or two not be far behind?
The next goal of this health system's virtual nursing program is to see how virtual care can impact other areas, says this nurse leader.
Health systems everywhere are experimenting with virtual nursing, and there are many key strategies that they can learn from each other.
Maria Brown, nursing excellence manager at ChristianaCare, outlined what ChristianaCare wants to accomplish with their virtual nursing model.
Brown is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.
Goals for the program
ChristianaCare launched a pilot of their virtual care program in 2022 with the primary goal of reducing burden at the bedside and giving time back to nurses to care for patients. The program then expanded to 500 beds in 2023, starting on med surg units and growing to include a postpartum unit and other specialty units, such as elderly, stroke, and cardiac step-down units.
According to Brown, the virtual acute care nurse program has had a significant impact on patient experience and on new nurses.
"Our experienced nurses function as clinical coaches," Brown said. "For those new nurses or novice nurses that are at the bedside providing hands-on patient care, if they have questions on clinical situations or need an experienced perspective, they're able to call the virtual nurse."
Brown says there is the possibility of using the virtual care program to keep tenured nurses in the workforce. ChristianaCare specifically uses experienced nurses in the program so they can provide the best care and guidance to other nurses.
"We definitely want to be able to keep our nurses practicing as nurses as long as they can, even if their bodies may not be able to physically do it, but they really want to continue as a nurse," Brown said.
Logistics
According to Brown, the nurses taking part in the program are pulled from practice areas to function as a virtual nurse—they are not being hired externally.
"We do have a few full-time nurses that have transitioned from those areas to a full-time virtual nurse role," Brown said.
The virtual nurses are housed in a remote location together and they are not allowed to work from home.
As for technology, ChristianaCare is leveraging a homegrown app paired with iPads at the bedside, which were initially used during the COVID-19 pandemic.
"They are in each patient's room purposely placed at each bedside—they don't come out," Brown said. "The only thing that comes out is the patients from admissions and discharges."
The health system created a dashboard to keep track of metrics such as length of stay, 30-day readmissions, and some harm metrics. Brown noted the significant impact on patient experience.
"We definitely think that's attributed to that nurse one-on-one time with the individual patient, and [the nurse] not being called [away] for a phone call or to help the patient in the next room, and those kinds of things," Brown said.
From present to future
According to Brown, both the nurses and the patients are positively reacting to the program. The nurses see the program as an opportunity to take a physical break from the bedside and connect with patients in a more focused manner.
"Culture change is hard, especially when you've been doing this for many, many years, and then we throw technology into the mix and then a different care delivery model into practice," Brown said. “Sometimes it takes a little bit of getting used to, but I think overall, nurses also support this new model."
Going forward, Brown believes that the health system's current staffing model may change from pulling nurses off of units to having a fully staffed virtual nursing model. The next goal is to expand further and see how virtual nursing can impact other areas.
"We hope to evolve to all other kinds of settings, meaning potential ICU type areas and EDs," Brown said. "We are doing some pilots in different types of areas, like an ambulatory space to kind of see how nurses could function that was as well."
As for technology, Brown expressed that the model is evolving, and due to the significant cost of switching technologies, some patience is necessary.
"I don't know if we've found that perfect technology that does everything, and so we wanted to wait and see what we can do with what we have," Brown said. "By the time we are able to decide on a technology, I think we would include things that have AI technology, maybe some ambient listening, [and] maybe some ways to use predictive analytics."
Advice for CNOs
For those CNOs and other nurse leaders who are attempting virtual nursing for the first time, Brown had several pearls of wisdom.
"I would say first and foremost, don't wait for the perfect scenario, because there never is a perfect scenario," Brown said. "If you're waiting for perfection in technology [or] staffing, you're going to be waiting a long time."
Brown also recommended getting stakeholders involved in the project as early on as possible, and ensuring that buy-in and support are present from all participating departments.
"You want to make sure that they're involved and have a stake in the process," Brown said, "and that everything is bought in, so that your program is successful."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights intoexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
A new tool assesses coronary inflammation, which is often overlooked in measuring the risk of a heart attack. One doctor says this test could detect problems years in advance and save lives.
An AI tool that can detect inflammation in the coronary artery could help clinicians diagnose heart disease much earlier, even decades before the patient shows any outward signs of distress.
CaRi-Heart Technology, developed by Connecticut-based Caristo Diagnostics, was recently given its own Category III CPT code by the American Medical Association’s CPT Editorial Panel, an important step in the path to adoption after FDA approval and, just as important, payer reimbursement. The technology has also shown promising results in trials conducted in 2024 at five National Health Service hospitals in the UK, where reports indicate more than half of patients analyzed by the AI tool had their treatments changed.
To clinicians, the tool could be a critical step forward in the diagnosis and treatment of heart disease, the leading cause of death in the country.
“Cardiology disease is very different than other diseases in terms of how we treat it,” says Stephen Bloom, MD, MSCCT, FASNC, FAHA, FACP, FACC, a cardiologist with Midwest Heart and Vascular Specialists in Overland Park, Kansas, part of the HCA Midwest Health System. “We do mammograms before people have breast cancer. We do colonoscopies before people have colon cancer. And then in cardiology, we wait until they have symptoms, and then we do our best to treat our patient, now with established disease. It doesn't even make sense.”
AI has the potential to analyze data from tests, such as a CT scan, more quickly and with more detail than the human eye. While traditional imaging can identify visible plaques that cause narrowing and blockages, the CaRi-Heart tool zeroes in on perivascular fat, or coronary inflammation, which is overlooked in assessing someone’s heart health.
And since acute MIs occur when non-calcified plaque ruptures, any method for detecting non-calcified plaque better and earlier would save lives.
“[AI] could actually look at each coronary [artery], each segment, if you break it down to three, and [it] can actually summarize not only how much calcified plaque you have, but also non-calcified vulnerable plaque, which has more of a tendency to rupture and cause a heart attack,” Bloom says.
Bloom notes that inflammation can be present in many diseases and measured by a blood test (c-reactive protein (CRP)). However, this blood test is not specific for the heart and less sensitive.
But with coronary CT with AI, clinicians can drill down further than they’ve been able to in the past. Bloom says doctors often use stress testing, but these tests only become positive for heart disease when the patient has a coronary blockage greater than 70%. This can create a false sense of security. Analyzing inflammation with plaque analysis from a CT could create a much better definition of a patient’s cardiac risks.
And it could be done long before any signs of heart disease are evident.
“We can take patients even before they have symptoms and diagnose whether or not they have early coronary disease and treat them with appropriate medication as well as a change in their diet [and] exercise,” Bloom says.
The challenge, as always with new technologies, is reimbursement. Most payers currently don’t cover tests like nuclear cardiac stress testing, MRI stress scans or even coronary CTs unless there are symptoms. Bloom is hoping that the results of the UK tests and the newly approved CPT code will prod payers to cover the CaRi-Heart test.
“The good thing is it’s simple [and] it’s painless and less expensive than nuclear and other tests like MRI, and so it could be the gatekeeper to reducing heart disease by finding it early and treating the patient in the early stages,” he says.
“The next five years will probably dramatically change the way we treat our patients with coronary disease,” Bloom adds, adding that plaque analysis from a CT has only been approved for reimbursement this past year. As more clinicians use these new tools with coronary CT and gather data on its effectiveness, they’ll build a better argument for coverage.
“We will be able to diagnose and treat coronary disease well before symptoms occur and finally reduce heart disease as the number one cause of death today ”.
MedStar Health SVP and Chief Innovation Officer Bill Sheahan says AI will meet its potential to transform healthcare when it improves clinical outcomes. And that will take some time.
As AI programs reach maturity, so, too, will their value. Early-stage tools that are under the spotlight now for cost will succeed in the long run if they also improve clinical outcomes.
That, says Bill Sheahan, senior vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation, is where AI will be truly transformative. And that's how healthcare executives have to think about the future.
"We believe that the real transformative potential of AI will come from integrated, systemwide adoption," Sheahan, a participant in the HealthLeaders Mastermind program for AI in clinical care, said in a recent e-mail Q&A. "Much like the building of a new hospital within a health system, the long-term impact of AI across our health system will be measured in patient outcomes and margins, not millions."
In a HealthLeaders story last December, Sheahan described how the Maryland-based health system was taking a slow and steady approach to AI, with a particular focus on change management. That process has continued with governance.
"Over the past year, MedStar Health's AI governance has matured from a more exploratory, ad-hoc process into a structured and proactive system," he said. "We launched an AI review process involving experts across the enterprise in innovation, legal, compliance, equity, quality and safety, information security, operations, and beyond. Leaders at MedStar Health are empowered to explore and propose AI tools to address their needs and bring them forward for evaluation."
"The overall volume of new AI products and features being added across all areas of the organization, along with a better understanding of the complexity of integrating AI into clinical care, necessitated different approaches to governance and strategy," he added. "AI that is impacting clinical decision-making or that is patient-facing is typically higher-risk and more complex, requiring more internal expertise from our AI COE (Center of Excellence) than what are typically lower-risk clinical administrative or broader business applications (e.g., coding and billing)."
With that process in place, Sheahan says they're now looking ahead.
Bill Sheahan, senior vice president and chief innovation officer at MedStar Health. Photo courtesy MedStar Health.
"As we further establish our governance processes and opportunities, we increase our focus on strategic imperatives in areas with significant transformational potential that are not yet fully addressed within our current vendor ecosystem, either due to product fit or pricing constraints," he says. "Within these areas, we often buy a solution if offerings in the market are more robust and well-defined, while prioritizing an internal build/partnership model in more nascent areas."
Sheahan and others in the Mastermind program have said it's important to point out that AI isn't exactly new. Traditional machine-learning and predictive modeling have been around for quite some time. The addition of large language models, however, has given a boost to generative AI capabilities.
"In the generative AI space, we are integrating various tools throughout our software stack to support a wide range of application areas, ranging from our safety event tracking system to human resources and informatics," Sheahan says. "Exploration of EHR data is under way, utilizing internal tools to extract and code notes and radiology reports to drive workflows for incidental findings and quality."
"We will also soon roll out an internally-built ‘chat' program in phases across our system," Sheahan adds. "This internal alternative to widely-available tools aims to protect data, improve understanding of usage patterns, and support administrative and clinical staff in searching for system-specific information (e.g., human resources policies). More complex future iterations are expected to integrate patient-level clinical information to allow reasoning over both internal and national clinical guidelines."
Sheahan says the large-scale data warehouses that power large language models are also enhancing the value of traditional predictive modeling.
"Currently, we are implementing a next-generation sepsis algorithm and workflow, with plans to expand to pressure ulcers, fall prediction, and other critical events," he says. "We anticipate that older clinical ‘scores,' such as risk prediction calculators involving only a few simplified variables (e.g., falls, readmission, sepsis, etc.) to inform diagnoses and decision-making, will gradually be replaced with more accurate and fully-automated algorithms. We are also expanding our radiology portfolio to increase the number of findings that tools can detect and use for triaging radiologist review."
At this point in the AI curve, however, ROI is still elusive. There have been some great stories about AI tools that have reduced administrative burdens and workflows and helped both doctors and nurses spend less time on the computer and more time in front of their patients. Sheahan says it will take time for the long-term benefits to show.
"Many of these applications still have limited validation, whether for clinical outcomes or ROI," he says. "As an example, ambient dictation offers the advantage of personal scribes at a fraction of the cost, and providers and patients find it improves the quality of their interactions; however, many health systems are still working to fully quantify and capture the impact needed to secure long-term investment in these products."
"Many of the most promising products are enormously challenging to validate for clinical accuracy or safety as well given current tools, such as large language model products that summarize charts or aid clinicians in reaching diagnoses," Sheahan concludes. "These products otherwise have substantial potential to transform clinical care. Improved frameworks and accepted validation models will be necessary to address safety and outcome questions, leading to greater refinement and broader deployment."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The global state of nursing is complex and CNOs must understand it to make the most informed decisions.
In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.
As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.
The World Health Organization’s (WHO) State of the world’s nursing 2025 report states that progress in closing workforce gaps has slowed, despite the number of healthcare workers increasing steadily over the last 10 years.
Here are some key findings that CNOs should be aware of.
Nurse employment
According to the report, there are 29.8 million nurses globally, but the distribution and density of those nurses around the world is extremely unequitable and hides a shortage of 5.8 million nurses. Additionally, 78% of nurses are found in countries representing only 49% of the world population, and high-income countries, which are about 17% of the population, contain 46% of nurses globally.
The density of nurses across countries is largely based on income, with high-income countries having 10 times the density of nurses than low-income countries. African and Eastern Mediterranean regions have significantly less nurses than European regions, as defined by WHO.
These facts show a troubling trend throughout the world and indicate a lack of access to healthcare services provided by nurses for large populations. However, the report also showed that the nursing industry has become more professional, with 80% identifying as "professional nurses," and around 70% of them work in public sector facilities.
WHO emphasizes that differentiated roles, scopes of practice, and corresponding compensation are necessary to prevent nurse migration to only countries with better professional opportunities. The report also predicts that the number of nurses will increase to 36 million by 2030, and while the overall shortage will lessen, there will still be inequity in the global density of nurses.
In terms of leadership, the report provides a mixed outlook. According to WHO, 82% of the participating countries reported having a government CNO (GCNO) or a similar position, but their roles in workforce, policy, and planning are undefined.
WHO emphasizes in the report that the gap in governance impacts education, working conditions, patient care quality, and more. GCNOs must have clarified authority and the proper resources so that they can have a hand in important healthcare decisions for each country.
Additionally, 92% of responding countries reported having a regulatory body for nursing, along with competencies (72%), continued professional development (72%), and advanced practice nurse (APN) positions (62%). However, many of the competency standards and APN regulations are different per country, which can complicate nurse qualifications and potentially impact patient safety, according to WHO.
Lastly, most countries reported having laws surrounding minimum wage (94%), social protection measures (92%), and health worker safety (78%), but only 55% reported regulations for working hours and conditions, and 42% reported provisions for mental health and wellbeing. More mental health support and emphasis on healthy work environments are needed for nurses globally if the industry wants to remain sustainable.
