One nurse leader talks about how the nursing profession is set to evolve in the face of healthcare transformation.
Change can be daunting, but it can also lead to unexpected opportunities.
Robyn Begley, DNP, RN, chief executive officer of the American Organization for Nursing Leadership and senior vice president and chief nursing officer of the American Hospital Association is one who has experienced how change can lead to opportunities in nursing.
Begley, an experienced nurse leader, had spent 35 years of her career at AtlantiCare in Atlantic City, New Jersey, before taking on her role at AONL in 2018.
"I had always planned on retiring from AtlantiCare, but this was an opportunity that came out of the blue that I just couldn't pass up," she says.
She encourages other nurses to be open to and embrace change in their careers as well.
"In my career, I've had opportunities that I've taken advantage of, and I wasn't afraid to make changes. I was glad [when] an opportunity arose, and it was something that I went for. So, my life wasn't a planned progression of a career trajectory," she says.
With new payment models, changing workforce demographics, and evolving technology, openness to change seems to be a much-needed characteristic in nurse leaders today.
During a recent interview with HealthLeaders, Begley shared her perspective on the nursing profession including what's changed, what still needs to evolve, and the challenges and opportunities facing nurse leaders.
Following is a lightly edited transcript of that conversation.
HealthLeaders: How did you get started in nurse leadership?
Begley:I was the oldest of six daughters and I always just took charge. In college, a few of my professors said I just automatically started organizing things and getting people to do what needed to be done. It was just something that I think I was suited to.
My first management job was after I was only a nurse for a very short time. [I don't think it was] even a year. We had a management training program for nurses, but I really learned management and leadership from the people I worked with. They may not have [had the manager title] but they had the skills. There were a few staff nurses who were from the UK, who worked with me and they were so instrumental in my learning. They really took an interest in helping me develop and they were wonderful.
I also looked to other nursing leaders in the organization who I admired and who had management and leadership traits I wanted to emulate. So, that was sort of my immersion into nursing leadership.
HL: Did that experience shape your leadership values?
Begley: [Those staff nurses], who were probably in their 50s, really helped me on my journey despite the fact that I was a young, 22-year-old newbie. They were just wonderful. I remember doing my first set of evaluations for staff and being a nervous wreck about it, but they helped me and made it easy. People were very kind to me, and I try to pay it forward. Mentorship and helping the next generation of leaders is a core value of mine.
HL: How has the nursing profession changed over the course of your career?
Begley: The perception of the profession and the role of the nurse has changed. I think the biggest positive change is that nursing is now seen as a distinct profession. Nurses were previously seen as individuals who carried out physicians' order, and who were hospital-based. Now we are recognized as a distinct profession that not only cares for the sick and injured, but we also protect, promote, and optimize health and wellness. We advocate for the care of patients, not just individually, but also in communities and populations. I think we're at a time in our history, as it intersects with the transformation of healthcare, to fully define the role of the nurse.
HL: What do you think still needs to change for nursing to be ready for the future of healthcare?
Begley: Different technologies are crucial for us to be able to provide care across the continuum. We're just beginning to understand how those technologies can assist us, our patients, and populations. There's going to be an explosion of technology and nurses must figure out how to optimize it, use it appropriately, and embrace it. I think that's been a challenge for us. I think these new technologies are going to help us to reduce errors and to do those task-oriented things that don't necessarily use our higher skills. [Technology will] allow nurses to help improve the health status of our communities. For example, things like artificial intelligence, we're just beginning to learn how that is helpful in targeting care.
HL: What are some of the challenges nurse leaders face today?
Begley: This has been a challenge for the bulk of my career in nursing leadership—recruiting and retaining nurses. Not only are we losing numbers of nurses, but we're also losing the intuition, the expertise, and the collective wisdom of the nurses who are retiring.
There are places that are not experiencing shortages. The cities that have many academic centers and schools of nursing perhaps are not experiencing a shortage, but the rural hospitals and underserved communities, they are really having a difficult time. Recruiting is variable depending on where [a healthcare facility is]. And of course, specialty recruitment is still a challenge.
We also have the movement of the younger nurses. Younger nurses do not stay in one place for a long period time. Even if it's in the same organization, they want some flexibility and fluidity and change across settings. At my former organization, we had nurses in our urgent care centers who wanted to go work in care management or in medical home roles. That's not necessarily a bad thing, it's just a challenge.
Another challenge is around violence. Whether it's mitigating violence against nurses in the workplace, caring for victims of violence, or addressing community violence, violence is a major issue affecting healthcare.
Additionally, there are financial pressures for nursing leaders. We know that the world of healthcare is changing to value. The old way that we were reimbursed is changing and we need to look at models that will provide high-quality care and give the patient the best experience.
Finally, we need to keep an eye on our workforce to make sure they are feeling productive, that they're feeling valued, and they feel that they're able to actualize their goals.
HL: What are some of the opportunities and drivers of change in healthcare?
Begley: Technology, whether it's portable monitors, wearable devices, or telehealth, is an opportunity for us to serve more, not just from a volume perspective, but to also serve the needs of patients at a higher level because some of those things that were more task-oriented can be taken care of by machines.
The economics of healthcare is changing as we change to a value-based system. The emphasis really moves from treating illness to promoting health and wellness. We need to have a systematic approach to the core challenges facing our patient populations.
Diversity and inclusion are critical to achieving health equity and reducing disparities in healthcare. A critical part of this is recruiting and retaining a diverse and inclusive nursing workforce. That's important in order to achieve our goal of health equity.
Nurses in many health systems are in creative and innovative roles where they're screening patients for socioeconomic risk factors and needs. Everyone's talking about the social determinants of health, but this is key work as we move forward. It's important that nurses are aware of the cultural sensitivities and social inequalities that people experience within their community. So, we really need to work on diversity and inclusivity.
Another driver of change is the rise of consumerism in healthcare. In the past, patients relied on referrals and insurance coverage for their care. Now, the patient is much more involved in decision-making. They readily access healthcare information in many ways. They want care to be convenient. We always think about the nurse-patient or the physician-patient relationship as critical, and I think it still is, but I think it's [becoming] more episodic because people are very self-directed when it comes to healthcare.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.
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