Professional practice models enable health systems to elevate nursing education, practice, and outcomes, says this CNE.
Organizations often have to endure cultural shifts as well as workforce changes, so it's critical that CNOs are able to guide nurses and provide resources to help them adjust accordingly.
Stefanie Beavers, DNP, RN, NEA-BC, chief nurse executive at OU Health, and HealthLeaders Exchange member, recognized the need for resources during OU Health's cultural transformation, which occurred as the organization leaned into its identity as an academic health system.
"I learned very quickly as we walked through, what are the resources for our teams?" Beavers said. "How do we organize within the nursing workforce from the lens of nursing excellence, and what's the definition of nursing excellence?"
The solution, for Beavers, was a professional practice model.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
The 'future' of virtual nursing is here, and nurse leaders must prepare for the next evolution.
Healthcare is constantly changing as new waves of innovation become harder and harder to keep up with. While many health systems are already far along on their virtual nursing journeys, many are still just testing the waters.
Virtual nursing enables health systems to uplift the nursing practice in ways that, until now, were not possible. The invention and integration of virtual care technology gives time back to bedside nurses by removing administrative burdens and streamlining admissions and discharges.
Virtual nurses can take on documentation and spend uninterrupted time with patients, while bedside nurses spend more hands-on time caring for them. Virtual nursing also gives nurses flexible scheduling options, which can be especially beneficial to nurses who have physical limitations or who are burnt out and need a break.
Progress so far
Virtual nursing has come a long way since its inception, and its takeoff in popularity during the COVID-19 pandemic. Many health systems started with the "quick and dirty" approach, with just a few iPads and carts, or whatever they had available at the time. Nowadays, many systems are fully outfitted with complete audio and video setups, with integrated built-in cameras and permanent TV monitors.
Steve Klahn, system clinical director for virtual medicine at Houston Methodist, previously told HealthLeaders that within the next five to 10 years, 60% to 70% of nursing positions across the industry will likely become virtual or have a virtual component.
"I'd say well over half," Klahn said, "just with [the] massive growth and expansion over the last two years."
Klahn explained that this is largely due to the response to virtual nursing programs.
"This is going to stick with us for a while," Klahn said, "understandably so, because there's such positive response to programs that are engaging a virtual component or fully virtual."
However, not all health systems have the same bandwidth for investment in virtual nursing. Smaller hospitals and rural health systems often have budget limitations that can make implementing new technologies more difficult.
CNOs and other nurse leaders have an important opportunity to brainstorm ways for health systems with those limitations to implement virtual nursing so that their patients and staff can see the same benefits.
What comes next?
As the nursing workforce continues to evolve, health systems must try and keep up with the latest technological trends to keep patient care innovative and efficient. Virtual nursing offers health systems a way to bridge staffing gaps and bring care workflows to the next level.
The next webinar in our Winning Edge series will explore what additional technologies can be integrated into your virtual nursing program, and how to optimize it to best support the bedside nurse and be cost effective.
AI allows health systems to coordinate technology and improve care delivery, says this CNE.
On this episode of HL Shorts, we hear from Betty Jo Rocchio, chief nurse executive at Advocate Health, about how AI will continue to impact the nursing industry. Tune in to hear her insights.
This model enables OU Health to elevate nursing education, practice, and outcomes, says this CNE.
Foolproof change management processes are essential for CNOs who want to streamline their workforce during times of transition.
Organizations often have to endure cultural shifts as well as workforce changes, so it's critical that CNOs are able to guide nurses and provide resources to help them adjust accordingly.
Stefanie Beavers, DNP, RN, NEA-BC, chief nurse executive at OU Health, and HealthLeaders Exchange member, recognized the need for resources during OU Health's cultural transformation, which occurred as the organization leaned into its identity as an academic health system.
"I learned very quickly as we walked through, what are the resources for our teams?" Beavers said. "How do we organize within the nursing workforce from the lens of nursing excellence, and what's the definition of nursing excellence?"
The solution, for Beavers, was a professional practice model.
The concept
A professional practice model, according to Beavers, is an evidence-based practice that aligns organizational values with a framework driven by research and outcomes. The goal is to elevate nursing excellence and patient outcomes, but also to solidify the identity of the organization's teams.
The OU Health Nursing Professional Practice Model was developed based on the Joanne Duffy Quality Caring Model, so that the organization could take caring behaviors and integrate them into OU Health’s values.
"As we led this initiative, I wanted to make sure that we did not confuse the workforce," Beavers said, "[and that] we didn't confuse our nursing teams and create this whole different grouping or parallel model that was outside of our organizational values."
According to Beavers, this strategy followed the streamlining and establishment of OU Health's mission, vision, and core values.
"It was important to me that our nurses could find their identity," Beavers said, "and we took those caring behaviors from the Dr. Duffy model, and we wove them in."
Defining values
Beavers explained that, first and foremost, patients come first at OU Health.
"They're at the core and center of everything that we do," Beavers said.
The dedication to relentless excellence, integrity, practicing in a space of inclusion, teamwork, and learning are also critical core values, according to Beavers.
"We took the professional practice model as our guiding light and really [asked,] what is our identity as [the nursing workforce] within the organization?" Beavers said. "What is the brand of OU Health nursing, and how do we show up, and then how does that translate to our care delivery?"
The next step was to spread the word about the professional practice model to the nurses.
"How do they know the expectations?" Beavers said. "How do they know this is the professional identity that we live in the organization?"
According to Beavers, they incorporated the model into all clinical orientations and did a huge roll out with emphasis on elevating the professional practice of nursing.
"A lot of questions always come up around Magnet designation, and what I tend to tell people is the Magnet designation is one aspect," Beavers said. "Nursing excellence is a continual journey."
OU Health has also worked to line up the layers of nursing leadership and intertwined the professional practice model with the AONL core competencies of leaders.
"We take it and translate for the bedside nurse with our values and those caring behaviors," Beavers said, "but then we actually elevate it even more for our leaders, and say, 'okay, what are the core competencies of leaders in the organization? What are our standards through AONL? And then how does that actually look in practice?'"
Outcomes
Beavers said there have been several positive outcomes from implementing the professional practice model. With the organization in a continual state of evolution, OU Health has been able to more accurately define standards and processes in nursing.
The next step is determining how to improve processes and define what high reliability looks like in the organization, according to Beavers. It's about having all the tools come together to define the culture, which should be one of engagement.
"I always say, if your nurses are not engaged, it's really hard to propel a healthcare organization forward," Beavers said. "They become the backbone because they are that constant at the bedside, right? Every discipline has to wrap around them."
OU Health has seen massive improvements in quality performance, fall reduction, and stabilization of quality outcomes and data-driven metrics. The organization has also seen huge workforce initiatives, including a partnership with the University of Oklahoma College of Nursing.
"This professional practice model has been an opportunity to really dive in and help as students come in, even to identify [transition to practice processes]," Beavers said. "What does it look like to be successful as a nurse, and what does it look like to be a professional nurse?"
OU Health has employed a student model in the organization as well. When students come in, they can work as employed students, and they can participate in jobs like a nurse tech role. This way, OU Health is setting the stage for professional practice, while also helping students identify where they want to work as a nurse.
"We're matching them to those spaces so that they can actually transition to practice through their clinical expertise, their nurse tech roles, focusing those shifts in the area that they think they want to work in as a nurse," Beavers said.
The students can acclimate to professional practice in real time, and are gaining experience in the environment they want to spend their careers in.
"We set the stage with our professional practice model. Now, here we paint, 'what does your career journey look like?'" Beavers said. "It allows us to elevate the core of the organization through academic practice, but also helps people to see, as we've been through all of these changes in the past, we are a stable organization."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Leaders need to develop a sound business case for virtual care. How can health systems make these platforms both scalable and sustainable?
During these uncertain times, health systems won’t embrace new technology unless there’s a firm understanding of ROI attached. Healthcare leaders need a good, sound business plan to move forward.
This is especially true with virtual care, which was the sweetheart of the rodeo during the pandemic, when providers needed to reduce pressure on hospitals and patients wanted to access care from home. Federal and state regulators even reduced telehealth restrictions to allow more access, and payers like CMS relaxed their rules to reimburse for more virtual care services.
But now that the pandemic has passed, the pendulum has swung back. Many COVID-era waivers have expired, patients are expressing a desire to see their doctors in person, and healthcare executives are tasked with revising or even redefining how virtual care services can be sustained and scaled.
So how do health systems and hospitals define the ROI of a telehealth platform or digital health tool in this day and age? Clinical outcomes, provider workflows and workforce shortages are all part of the recipe, but there also has to be a financial benefit. Can all of these interests co-exist in a business plan?
A recent study of 6 FQHCs in New York found that state Medicaid reimbursement policies are exacerbating workforce shortages and creating a divide between them and hospitals. And that’s doing real harm to their patients.
Federally qualified health centers (FQHCs) are often the only access point for underserved populations needing healthcare services, and telehealth can be a critical tool for improving that access.
But a new study out of Columbia University finds that several FQHCs in New York City are struggling due to inadequate Medicaid reimbursements for telehealth, which exacerbate workforce shortages and create disparities between those safety net clinics and nearby health systems and hospitals.
“Telehealth has many advantages for patients and providers, but only if it’s supported by equitable and sustainable funding policies,” Thalia Porteny, PhD, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health and first author of the study, said in a press release. “Our findings underscore the urgent need for Medicaid reimbursement reforms to address workforce shortages and ensure vulnerable populations can access the care they need.”
Telehealth is often viewed as a crucial element in helping people access care, and was a resounding success during the pandemic in helping hospitals connect with patients, but providers often won’t embrace the technology unless they’re reimbursed for switching away from billable in-person care. That’s especially true of FQHCs and other clinics, who need that support to buy the technology and train staff.
In the study, Porteny and her colleagues interviewed executives and staff from six FQHCs across New York City, and found that inadequate state Medicaid subsidies had caused them to lose about 40% of their mental health staff. Alongside the inadequate payments, restrictive policies around working at home, which were eased during the pandemic, are prompting many mental health workers to leave.
“One participant explained how making mental health practitioners come to the FQHC not only hindered workforce flexibility but did not add clinical value: ‘Every therapist…and psychiatrist [is] making financial sacrifices to work for folks like us, [and now] they have to come to the health center to get on the phone basically, and talk to their patients. And there is zero clinical value to that,’” the study noted.
This, in turn, is contributing to disparities in accessing care.
“One FQHC informed us that they had 700 patients on a waiting list for behavioral health services, because their health center lost half its behavioral health practitioners when they began to require that their practitioners work in the office, rather than remotely,” the study reported.
The study also noted that Medicaid reimbursement policies are designed to support larger health systems and hospitals while hindering small, resource-thin clinics like FQHCs.
“As one noted, ‘When a lot of the rules are made, or when a lot of the emergency fundings for [telehealth] programs come out, they’re all geared through the hospital, and then they expect the hospitals to work with everybody else, where we all know nine times out of 10, that doesn’t happen.... The decision makers at the top who pull the purse strings…are leaning towards hospitals.’” Porteny and her colleagues reported.
The upshot of the study is that FQHCs and other small providers are struggling to embrace telehealth at a time when they should be using the technology to improve access to care. The concern is heightened that those reimbursements may be even further reduced by potential Medicare and Medicaid cuts.
“In the face of potential Medicaid cuts and broader austerity measures, our study’s findings suggest that it would be detrimental to implement cost-cutting measures in telehealth reimbursements in community health centers in New York and more broadly,” Sorcha A. Brophy, PhD, an assistant professor of health policy and management at Columbia’s Mailman School and co-author of the study, said in the press release. “Such budget cuts could exacerbate provider shortages, increase barriers to care for vulnerable populations, and ultimately lead to worse health outcomes. Consequently, this could further destabilize community health centers—a healthcare program that has long enjoyed bipartisan support.”
The study supports improving Medicaid policies toward telehealth, through both better reimbursement and support for work at home plans, digital literacy and training, and other services.
“Participants held a common belief that if telehealth reimbursement policies were well aligned with practitioners’ compensation expectations, as was the case during the COVID-19 PHE response, access and compliance issues would greatly improve in FQHCs because there would be more opportunities and flexibility to see practitioners,” the study concluded.
“As one participant described, ‘Behavioral health compliance went up dramatically [during COVID-19]. Behavioral health was always an area where patients used to cancel or no show. Well, once you had a telemedicine platform for behavioral health, suddenly we had 100% compliance rate.’ Another explained, ‘We used to have a 30% no show, but because of [telehealth during COVID-19] our no-show rates were reduced to like 16%, you know, so it got cut in half.’
CNOs should frame questions correctly and bring in a variety of resources to solve problems, says this CNE.
Betty Jo Rocchio has more than 30 years of experience in nursing. She has a passion and drive for leveraging technology and data analytics to support nursing and clinical teams to enhance patient care outcomes.
Rocchio holds a bachelor’s degree in nursing and an associate in business administration from the Franciscan University of Steubenville, Steubenville, Ohio. She started her career in direct patient care as a registered nurse (RN) in the intensive care unit; returned to school to become a certified registered nurse anesthetist (CRNA) and at the same time earned her master’s degree in health sciences at LaRoche College in Pittsburgh, Pennsylvania. Most recently, she obtained a doctor in nursing practice (DNP) in the nurse executive track at The Ohio State University, Columbus, Ohio.
Her previous experience includes nursing leadership roles at Mercy, a well-known nonprofit Catholic health care organization headquartered in St. Louis, Missouri, and in the Mount Carmel Health System in Columbus, Ohio. Now, Rocchio serves as the chief nurse executive at Advocate Health, where she leaders 43,000 nurses.
On our latest installment of The Exec, HealthLeaders sat down with Rocchio to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
Social media is here to stay, and CNOs must adapt.
In an era where nurses and healthcare workers are not just caregivers but content creators, social media has become a double-edged sword—an unfiltered window into the world of healthcare, wielded with equal parts power and peril.
With nursing’s reputation as the gold standard of ethics slipping, CNOs must step into a new role: social media strategist. The same platforms that spark division can also inspire collaboration if approached with transparency and purpose.
Here are three ways CNOs can utilize social media.
AI is everywhere (that’s nothing new) at this year’s event, while RPM is getting some good attention. But what about the weather?
As ViVE 2025 races toward its snowy conclusion and attendees figure out whether they have to revise their travel plans, here are a few observations from the first two days of this very entertaining conference.
AI is Everywhere. That’s no surprise, really. During a CHIME panel on Monday, Aaron Miri, Baptist Health Jacksonville’s EVP and Chief Digital & Information Officer, said technology is a differentiator in attracting new clinical talent, a key pain point at a time when nearly all health systems are struggling with workforce shortages. Dangling an ambient AI tool in front of a potential hire seems to be doing the trick.
During a separate panel, Michael Pfeffer, Chief Information and Digital Officer at Stanford Health Care, noted that ambient AI is more popular than any other technology they’re used. If management introduces a new tool and then discontinues it, no one will complain, he said. But if they shut down the AI tool, he’ll be flooded with angry e-mails.
“That doesn’t happen with technology,” he said.
And it’s not just doctors and nurses that are affected by AI. Theresa Meadows, SVP and CIO of the Cook Children’s Health Care System, said during the CHIME panel that they’re investing in new community-based training programs to address the workforce shortage throughout the system. With new AI programs comes a need for IT and Rev Cycle staff that know how to use the technology.
And at a time when budgets are tight, Andy Crowder, CHCIO, CDH-E, Advocate Health’s Enterprise Chief Digital Officer and SVP and CIO for the health system’s southeast region, said they’re spend as much on technology this year as they’ve spent over the past five years.
The message is clear. AI is affecting the industry at all levels, and health systems and hospitals need to have an enterprise-wide strategy in place to make sure they’re doing all they can to make that transition easier. That doesn’t necessarily mean setting up a specific AI governance committee or policy, but understanding that tech now has a set at the strategy table.
AI is helping to redefine the CIO’s role as well. Crowder said he’s both an advisor and an educator, while Miri said CIOs are now called upon to be CFOs and CMOs to facilitate AI adoption.
Medicare may need a reboot. That’s the opinion of Sachin Jain, MD, MBA, President & CEO of the SCAN Group and Health Plan. Jain said he’s cautiously optimistic that the Trump administration—in particular, potential CMS chief Mehmet Oz—will take a good look at Medicare and lean toward Medicare Advantage.
Traditional Medicare “has gotten a free ride,” he said, but hasn’t evolved with the rest of the country. It “doesn’t provide the benefits that people really need,” and that MA plans are embracing, like dental and vision coverage, and services like virtual care that address social drivers of health.
It’s safe to say Medicare and Medicaid are on everyone’s minds, because many health systems and hospitals rely on CMS to support coverage for those populations. Several executives attending ViVE said they were hopeful that CMS waivers for telehealth and Hospital at Home would be renewed before they expire at the end of this month, but resigned to the fact that those waivers might soon end. The pressure is on the industry to prove the value of virtual care.
During the CHIME panel, Meadows pointed out that pediatric hospitals like Cook Children’s are especially sensitive to the Medicare/Medicaid discussion because so many of their patients are on those programs. Any changes to those programs will seriously affect a hospital’s bottom line.
RPM is gaining steam. Remote patient monitoring, long the potential game-changer for home-based care, is building a nice following. During a panel on the future of wearables, Sarah Pletcher, MD, MHCDS, Chief Digital Health Officer and SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, said continuous patient monitoring programs using wearables in the ICU and in-patient units have done so well that they’re looking at using the technology to support patients outside the hospital.
“The sky’s the limit on what we can do with that,” she said.
At the same time, she and Esther Kim, ScD, RD, LDN, Head of Emerging Technologies and Solutions at Mass General Brigham, said there are still gaps between the consumer-facing wearables that the public traditionally uses, like smartwatches and activity trackers, and the clinical grade technology favored by doctors and nurses. Clinicians don’t want to see a patient’s daily step counts or event their heart rate.
“It is important to consider how you’re going to curate all that data,” Pletcher said.
Both noted that clinicians want to see data from wearables that’s meaningful to them, and that can be used to identify and act on health concerns. Two months of heart rate or blood sugar data will be overwhelming, but a program that can sift through the data and give clinicians insight into deviations, irregularities or trends will be valuable. And that’s where AI will likely come into play.
RPM programs will also require some commitment on the part of the patient.
“It’s not just about the vitals,” Kim said. These types of programs need to be developed to address a patient’s lifestyle, and to effect changes that improve health and wellness.
“It isn’t the tech or the regulatory [concerns],” added Pletcher. “It’s getting people to change their behaviors.”
The evolution of pharmacy services. Another area of innovation is medication monitoring. Health systems and hospitals are investing in their pharmacy services to improve the nation’s dismal medication adherence rate and, in doing so, boost clinical outcomes.
There are several reasons for this. As evidenced by the plight of Walgreens, CVS and Rite-Aid, community pharmacies are struggling, and many are closing. Disruptors, meanwhile, are leaning heavily into online and mail-order services. Health systems and hospitals are countering this by beefing up their own pharmacies and co-locating pharmacy services with primary care clinics.
In addition, with the advent of RPM and virtual care, hospital leaders are rethinking the role of the pharmacist. They’re including the pharmacist or pharmacy tech in care teams, and giving them the opportunity to collaborate with patients on medication management and adherence. This also takes the pressure of doctors and nurses.
And finally, will the healthcare industry start recognizing the folly of scheduling major events during the winter? So many conversations this week have started with, ‘How was your trip?’ The wintry weather disrupted many travel plans, with attendees and even some speakers delayed or even forced to cancel their plans. And with a few inches of snow expected in Nashville tonight and tomorrow morning, more than a few people are more concerned now with how they’ll get home than what they’ll see here today.
Still, this is ViVE, and the vibe has been good. Healthcare executives do relish the opportunity to get out of the office and meet in person to talk about innovation and transformation.
Clear and frequent communication is key to change management, says this CNE.
On this episode of HL Shorts, we hear from Stefanie Beavers, DNP, RN, NEA-BC, chief nurse executive at OU Health, and HealthLeaders Exchange member, about how CNOs can streamline their change management processes. Tune in to hear her insights.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
