'AI needs to be a partner with us,' says NCSBN CEO David Benton.
The AI wave comes at a crucial time in nursing because it can effectively train nursing students, improve patient care management, and adjust nurse workloads, which ultimately helps to reduce stress and burnout.
And that’s just the tip of the iceberg for the emerging technology.
This transcript has been lightly edited for clarity and brevity.
HealthLeaders: What are the most useful AI innovations for nurses that you’re aware of?
David Benton: You've got to think about this in terms of different sectors. Artificial intelligence has been used within the education sector, in the clinical sector, and in the managerial space, as well, and the level of sophistication of those systems varies by sector.
Within education, what we're starting to see is artificial intelligence being used to help craft communication support and simulation systems that enable individual students to have a common experience, but it's tailored to their response. For example, patients with "various conditions" are developed that then interact with the students. The students are given a prompt and the AI is then scoring their responses, so it tailors their learning experience to their specific needs.
First of all, it's a safe space, so they can develop their skills in an environment where they're not going to do any harm, but they're going to get targeted feedback on their performance. Second, at a time when there are faculty shortages, this gives them a unique experience to their learning needs, rather than learning within a group experience on a particular topic.
In the management space, artificial intelligence can be used for scheduling, in a way to manipulate large amounts of data in very short periods of time.
We’re also starting to see it in the clinical arena as well, such as in Illinois, where it’s available to schedule cancer services as part of a clinical program. Asia is probably further down the track in developing these systems. In China, they have systems that are being used for venipuncture, so if you need to have an IV inserted, there is a system now that scans the person's arm, identifies the veins, and gets it right 90+% of the time.
David Benton, CEO, National Council of State Board of Nursing / Photo courtesy of NCSBN
HL: What are nursing pain points that AI eventually will be able to resolve?
Benton: Every two years, we do a survey of the workforce, and one of the areas that we've identified here is an increase in burnout. One of the things we need to think about is if nurses are asked to do things that technology could do more efficiently or more effectively. There's no need for nurses to be doing that kind of work when a machine can do it much more quickly, more efficiently, and in a less-stressful manner.
Taking some of that stress for these routine tasks and focusing on the things that only the nurse can do—that's what people came into nursing to do. They came into it to work with patients and to keep them safe.
HL: The technology is still new, of course, but how prevalent is AI in nursing?
Benton: It depends on the institution that you're working in, and where you are working, as well. Some countries are far more advanced, and some health systems are far more advanced than others in AI usage. Sometimes, people don't even know that they're using some of these systems because they're now embedded into the technology.
For example, some of the cardiac dysrhythmia monitoring systems that are prevalent within intensive care units, cardiac care units, emergency departments, and even in ambulances have built-in technology to support the clinician in their determination of what's going on with that individual. Some of these systems are almost under the radar in terms of the support that they're now offering.
HL: How receptive are nurse leaders to AI?
Benton: In the discussions that I'm having with nurse leaders, there's everything from enthusiasts to laggards. It depends on their own personal experience with these systems and their levels of comfort.
If they understand the technology, then they're often more receptive. There are concerns, obviously, about artificial intelligence. Artificial intelligence learns from data sets and if there are errors in those data sets, then they learn those errors or biases. That's why nursing needs to be very prominent in helping to develop these systems and to implement these systems and to detect where there are errors in the system.
In the early work on ChatGPT, when you would ask questions, it would confabulate with made-up answers and give the wrong response, and unless you knew the topic extremely well, you could be quite convinced by the response because it was very strongly asserted. The latest generation, ChatGPT-4, has started to address some of those issues and ChatGPT-5 will be getting even better still.
This is an extremely rapidly evolving space, and one of the challenges that nurse leaders have, in particular, is keeping pace with all of these developments and taking the time to familiarize themselves with what some of these technologies can do, and indeed what they can’t do, as well.
HL: Some in healthcare approach AI as "augmented intelligence," rather than "artificial intelligence," to advocate the idea of the technology assisting, rather than replacing, nurses and other healthcare staff. How important is that distinction?
Benton: At this stage, it is an important distinction because "augmented" enables the individual to retain accountability for their actions, because the ultimate decision sits with that clinician, whether they be a nurse or a doctor. Artificial intelligence infers that it’s doing it all on its own, and therefore as a device for discussing AI with the public, with politicians, etc., it’s a useful distinction at this point.
But when the machine can outperform the human consistently, then the question is, "As a human, would you overrule the machine when you know it's going to get it right 99.99% of the time, and a human gets it right only 90% of the time?" I know that I, as a patient, would want to deal with something that's going to get it right 99.99% of the time.
These are real dilemmas that society needs to be familiarized with, and not just clinicians, because that’s giving people the information they need to decide. And I have a duty as a practitioner to make sure that you are making an informed decision.
HL: What would you like to see AI do for nursing?
Benton: In the clinical space, where artificial intelligence can do as good a job or better job than a nurse, then we need to be partners with our technology, just like any other tool. If you think about years gone by when we were using mercury thermometers to take people's temperature, we didn't think anything about it; it enabled us to get an accurate value in terms of whether someone might have an infection.
Nowadays, we've got different technology that does that in real time, and we think nothing about it. AI needs to be a partner with us in terms of delivering safe, effective, and efficient healthcare into the future.
The investment is intended to 'double down' on increasing demand for RNs, NPs, nurse midwives, and nurse faculty.
Most of the $100 million committed by the Health Resources and Services Administration (HRSA) to grow the nation’s nursing workforce will go toward building advanced practice nurses (APRNs).
HRSA, an agency of the U.S. Department of Health and Human Services (HHS), announced Thursday the investment to “double down” on the increasing demand for RNs, nurse practitioners (NPs), certified nurse midwives, and nurse faculty, said Xavier Becerra, HHS secretary.
Nearly $65 million of the investment will fund training for APRNs who will deliver primary care, mental health care, and maternal healthcare, according to HHS:
The Advanced Nursing Education Workforce Program will receive $34.8 million to increase the number of primary care NPs, clinical nurse specialists, and certified nurse midwives trained and prepared to provide primary care services, mental health and substance use disorder care, and/or maternal healthcare.
The grants also will address bottlenecks in nurse training through the Nurse Faculty Loan Program, which will receive $26.5 million for award recipient schools to provide low-interest loans and loan cancellation to incentivize careers as nursing school faculty.
HRSA’s investment targets some of healthcare’s most difficult challenges:
The need for primary care APRNs is considerable, particularly in rural areas as hospitals close and the number of physicians declines. Nearly 80% of U.S. rural counties are medical deserts, with no access to healthcare services, according to the National Rural Health Association.
Rural residents with mental healthcare needs are also struggling with the lack of providers. Nationwide, some 158 million people live in Mental Healthcare Health Professional Shortage Areas, according to AANP.
Areas with low or no access to maternal care affects nearly 7 million women across the United States, according to the March of Dimes’ 2022 report on U.S. maternity care deserts. This unavailability is growing, with a 2% increase in counties that are maternity care deserts since the organization’s 2020 report.
"Nurses are the frontline in delivering life-saving care and in keeping all of us healthy and well," said Carole Johnson, HRSA administrator. "[These] investments from the Health Resources and Services Administration demonstrate our ongoing commitment to supporting the nursing workforce, training and growing the next generation of nurses, creating career ladders for nurses, and recognizing the critical role nurses play in primary care, mental healthcare, and maternal healthcare."
Grand Valley U. will recruit and educate NPs interested in rural or underserved areas, primary care, or mental health.
The Kirkhof College of Nursing (KCON) is using a four-year, $2.6 million federal grant to recruit and educate 37 nurse practitioners (NPs) from the very areas that need them most.
The need for primary care advanced practice nurses (APRNs) in rural areas is tremendous, as hospitals close and the number of physicians declines. Nearly 80% of U.S. rural counties are medical deserts, with no access to healthcare services, according to the National Rural Health Association.
KCON, part of Grand Valley State University in Allendale, Michigan, is using the grant to continue collaborating with two health systems—McLaren Health Care and Trinity Health Muskegon—to prepare more nurse practitioners interested in working in rural or underserved areas, primary care, or mental health.
Rural residents with mental healthcare needs are also struggling with the lack of providers. Nationwide, about 158 million people live in Mental Healthcare Health Professional Shortage Areas, according to the American Association of Nurse Practitioners.
The program will recruit and educate 37 nurses from disadvantaged or underrepresented backgrounds in the college's Doctor of Nursing Practice (DNP) program.
"It's really hard to relocate a provider who has never experienced rural living or who doesn’t have a sense of community in a rural entity," she says. "Rather than spending those additional funds outside and trying to recruit it, if you can recruit within and then bring them back, retention is much greater, at least in my experience."
Collaboration is key
The $2.6 million grant from the Health Resources and Services Administration (HRSA) continues an initial grant from 2019 that supported 20 DNP students in collaboration with the same to health systems, says Katherine Moran, DNP, RN, CDE, FAADE, associate dean for KCON graduate programs and research. She also is the principal investigator and project director for the grant.
One key to the grant's success has been the partnership among the health systems and KCON, Moran says.
"Both McLaren and Trinity Health Muskegon are recruiting from the communities these nurses will serve," Moran said. "These are working nurses who have expressed a desire to enhance their education in primary care, mental health, or substance use disorder care."
'Quality education is the best way to address social inequality and promote economic mobility.'
A $12 million gift to the Cleveland Clinic will double and diversify nurse scholars to help reduce healthcare disparities.
The Howley Foundation’s gift funds the ASPIRE initiative for local high school and college students, which aims to expand diversity in healthcare and address opportunity gaps, both of which will help reduce a community’s health disparities.
"It’s essential that we diversify the pipeline of our future healthcare workforce, including nurses, to better represent our patients and the communities we serve," said Tom Mihaljevic, MD, CEO and president of Cleveland Clinic.
"We are grateful for the Howleys’ continued support and passion for increasing diversity and equity in our next generation of caregivers," Mihaljevic said.
The gift will enable the nurse scholars program to double enrollment to about 50 students from Cleveland-area high schools each year.
Students enter the ASPIRE program as high school juniors, where the curriculum introduces and explores the nursing profession and healthcare.
Once they’ve graduated high school, program participants have the opportunity to earn a scholarship to pursue a Bachelor of Science degree in nursing from the Breen School of Nursing and Health Professions at Ursuline College.
The students work as patient care nursing assistants at Cleveland Clinic during the summer after high school graduation and throughout their college career. Upon college graduation and licensure, they may join a Cleveland Clinic facility as an RN.
The nurse scholars program celebrated its first five graduates in December 2022. They are now employed as full-time RNs at Cleveland Clinic.
More than 15 students are expected to graduate from Ursuline College with nursing degrees by 2024.
"We feel strongly that a quality education is the best way to address social inequality and promote economic mobility," said Nick Howley, chair of The Howley Foundation. "We want students to be able to complete their nursing degrees poised for success."
Because of the gift, along with the Howley Foundation’s cumulative support, all programs within the Cleveland Clinic’s ASPIRE initiative will be renamed to bear the Howley name, including the Howley ASPIRE Nurse Scholars Program, according to the health system.
'Inclusivity is about making people feel comfortable to say who they are, being who they are.'
When students of Brenda Cassidy, DNP, RN, CPNP-PC, at the University of Pittsburgh School of Nursing expressed uncertainty about how to respectfully ask patients about sexual orientation and gender identity, a consult with her colleagues found their students felt the same hesitancy.
Cassidy and those colleagues—Betty Braxter and Andrea Fischl—set about to develop a unique interactive learning module and resource toolbox to provide best practices in LGBTQIA+ healthcare to those students—and all healthcare providers.
The unprecedented resources are available to any healthcare provider who wants to approach patients in a welcoming and inclusive manner, Cassidy says. The module is available with and without CE credit.
The module is not medical training, she notes.
"It’s about having a welcoming environment and having the right terms to be gender neutral," she says. "That’s really what’s missing and causes health disparities and discrimination in this population."
Cassidy referenced the American Association of Colleges of Nursing’s initiative to improve academic nursing programs’ ability to prepare working nurses for a diverse patient population, including LGBTQIA+ individuals (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex and asexual and/or aromantic).
Fewer than 20% of nursing students get such preparation, and one-third are ill-at-ease when attempting to provide care for LGBTQIA+ patients, according to the association.
LGBTQIA+ individuals are often hesitant to discuss their sexual identity with their clinicians. One study shows that "the disclosure of sexual orientation and provider’s attitude were important influencing factors that negatively affected their experiences about healthcare delivery" and that "lack of training can strain the therapeutic relationship between the providers and patients."
Negative experiences include having their concerns dismissed or being blamed for health problems and the strained relationship can affect quality and appropriate delivery of healthcare, the study notes.
Most providers aren’t deliberately prejudiced, but instead harbor unconscious bias, says Cassidy, a pediatric nurse practitioner whose specialty is adolescent healthcare, particularly sexual reproductive health.
Unconscious biases—also termed implicit biases—"surreptitiously influence judgment and can, without intent, contribute to discriminatory behavior," according to the New England Journal of Medicine.
"Pennsylvania conducts a health needs survey of LGBTQIA+ residents every two years, and they've consistently received responses from residents about having had negative reactions from their healthcare providers when they revealed their status," Cassidy says.
"In 2022, that assessment said that 26% of the respondents—which is one in four of the LGBTQIA+ residents who responded—said that they'd had a negative reaction from their healthcare provider with their disclosure of sexual orientation or gender identity," she says. "So, we have to know our biases, and approach patients from the get-go in an inclusive manner."
Consequences of unconscious bias can be devastating for LGBTQIA+ patients, Cassidy says.
"Unfortunately, it results in discrimination and stigma toward this population who's already vulnerable," Cassidy says. "Negative experiences that they have had creates hesitancy on their part to delay seeking care, which then delays diagnosis and treatment, and that results in negative consequences."
Delaying care results in this population’s higher rates of physical and mental health problems, such as cervical cancer, lung cancer, obesity, smoking, addiction, suicide, and homelessness, she says.
"That is a direct result," Cassidy says, "of not feeling comfortable in the healthcare arena."
Finding a solution
When Cassidy and her colleagues began to research ways to address this issue, there wasn’t a lot to find.
"The first thing we did was go to the literature and say, ‘What are we supposed to teach about?’ What we found in the literature was very little information as far as recommended content on LGBTQIA+ health for nursing," she says.
National curriculum guidelines for such modules in nursing education don’t exist, and it generally is not taught in nursing programs.
So, they used focus group methodology to include the voice of faculty, students, LGBTQIA+ individuals, and healthcare providers who care for this population.
"We used the voices of stakeholders to develop the content," she says. "We didn't decide what they needed to know."
"What we found from our focus group was that the most important thing was to be able to communicate that this is a safe space and a welcoming environment to tell us about you so that we can take care of you," Cassidy says.
The learning module covers LGBTQIA+ terminology, statistics on health disparities, and respectful communication so learners can practice using gender-inclusive language in different scenarios.
The toolbox also covers LGBTQIA+ terminology, along with content about trauma-informed care, youth, older adults, disability status, minority care, homelessness, socioeconomic factors, substance use, healthcare specific to non-binary and transgender care, reproductive care, and care of LGBTQIA+ veterans, alongside local resources.
The first step is for a clinician to be aware of their own biases.
"We all have implicit unconscious biases, and anybody who thinks they don't is kidding themselves," she says. "We have them. It's important to be aware of them. Being aware of them doesn't necessarily make them go away, but it helps us to be aware that we have those biases so that those biases don't impact how we care for our patients and the decisions we make about care."
Providers must be open to learning and using gender-neutral terms, Cassidy says.
Some focus group members said they don’t know what to say, but they don’t want to offend the patient, so they don’t say anything. So, Cassidy demonstrated how she starts each conversation: "Hello, my name is Brenda Cassidy. I use pronouns she, her, hers. You can call me Brenda. What would you like me to call you?"
"We heard loud and clear from both the LGBTQIA+ focus group participants as well as the healthcare providers who work with them that welcoming starts when they walk into the area, whether it's an exam room, a waiting room, or a patient room," she says.
It hasn’t been that long since providers were required to be rigid with LGBTQIA+ patients, Cassidy says.
"I remember when you had to say to someone, ‘I know you want me to call you Chloe, but your legal name is Sam,’ and being told we had to put the legal name in the chart or else the insurance company wouldn't cover the visit," she says.
Now, her students who accompany her to see patients at Children’s Hospital’s Center for Adolescent and Young Adult Medicine are more prepared and much less hesitant to talk openly and honestly with patients, she says.
"In this clinic we see LGBTQIA+ youth," she says, "and my students who have completed this module are so much more comfortable approaching these youth in a more inclusive manner and asking them about sexuality now that they have taken this module."
The learning module and toolbox are now part of a four-year research study between Pitt and the Louisiana State University Health New Orleans School of Nursing, looking at an advocacy program and simulations for undergraduate nursing students. Baylor University also is using the module, and Pitt Nursing is promoting it for more schools to adopt. The National Association of Pediatric Nurse Practitioners has made it available to pediatric nurse practitioners, as well.
"Inclusivity is about making people feel comfortable to say who they are, being who they are," Cassidy says, "and we really have made wonderful, great strides, but our work is not done."
Nurses' list of complaints includes lack of sanitized OR equipment; hospital counters that new state-of-the-art sterilizers have reduced safety events by 51%.
Operating room (OR) and post-anesthesia care (PACU) nurses at Brigham and Women's Hospital in Boston are overwhelmingly demanding the removal of Samantha Rowley, the hospital’s vice president of Perioperative Services.
Nearly 100% of the OR and PACU nurses signed a petition of no confidence in Rowley, who joined BWH in 2021, because of "a series of decisions that have undermined the safety and quality of care provided to surgical and post-surgical patients and caused high turnover because of a culture of management bullying and retaliation," according to the Massachusetts Nurses Association (MNA).
The petition, delivered to senior leadership, was signed by 131 of 132 regularly scheduled OR nurses of nurses and 120 out of 124 PACU and perioperative float pool nurses, MNA said.
"We, the registered nurses of Brigham and Women's Hospital, declare no confidence in Vice President of Perioperative Services Samantha Rowley for a series of damaging decisions that have jeopardized patient safety, degraded our work environment, and made it even harder to retain staff," the petition reads. "A change in senior management is necessary to stop the ongoing harm to patients and caregivers."
The petition outlined several specific issues:
Poorly planned changes to sterilization procedures have created a lack of sanitized OR equipment, putting patients at risk and causing unnecessary stress among staff.
A culture of management bullying and retaliation leaves staff fearful of raising important patient safety concerns.
The hospital's new post-surgery boarding ward is “deplorable,” and puts patients in an unsafe and uncomfortable environment.
A unilateral change in OR staff schedules has created serious morale issues and pushed experienced nurses away at a time when they’re needed most.
BWH continues to schedule procedures without sufficient staff to perform them all safely.
BWH addressed the accusations in a lengthy statement released to HealthLeaders:
"We have made considerable changes to the Central Processing Department (CPD) by significantly investing in additional staff as well as equipment and working on a much-needed overhaul of the CPD workspace. This included installing state-of-the-art sterilizers and enhancing on-site instrument repair. Through this work, we’ve reduced safety events by 51%."
"We’ve also added 16 new full-time CPD positions and increased the certification rate among employees from 25% to 95%. While certification is not required by Massachusetts, we are working to align ourselves with national standards which leads to higher levels of accuracy when cleaning our instruments. Over the last two years, we have seen bioburden decrease by 76%, immediate use steam sterilization decrease by 98%, and CPD safety events decrease by over half."
"We support every member of our peri-operative team—including the local leadership team, our physicians, our nurses, our technical staff, and our support staff. They collectively exhibit great expertise, compassion, and skill each and every day."
New post-surgery boarding ward:
"The Department of Public Health has evaluated and approved these beds as safe, appropriate beds for use by patients recovering from surgery staying in the hospital 48 hours or less and who do not require an inpatient bed," according to BWH.
"The space provides privacy curtains, call bells, and all appropriate equipment to care for patients safely and effectively while recovering from certain surgeries. We are confident that this space meets the needs of both patients and our staff well while also addressing the capacity issues that hospitals across the nation are facing."
"While we would like for all staff to be able to work their preferred schedules, this may not always be possible, and our priority in creating staffing schedules must be patient care. We are continuing to work to balance the needs of our patients and our staff," according to the statement.
"Our OR nursing vacancy rates have decreased from 12.3% last December to 10.84%, and we remain focused on recruitment strategies to further reduce vacancies. To that end, we have hired more per diem staff to help create increased flexibility in scheduling and allow nurses to decrease hours as needed. Additionally, we have increased our training offerings to allow additional nurses to be onboarded."
"Our priority is the patient. We create staffing schedules centered on the right provider, caring for the right patient, at the right time."
"While hospitals and healthcare organizations nationwide are facing unprecedented staffing challenges and pandemic-related back logs, we’ve implemented a multi-faceted response to these challenges related to patient volume, acuity, and staffing to best support our staff while providing comprehensive care to patients."
When Rowley joined BWH, she brought with her more than 20 years of professional experience and academic training, according to BWH’s website.
She previously was senior vice president for Surgical and Critical Care Services at Parkland Hospital in Dallas; executive director of Perioperative Services at Mission Hospital in Asheville, North Carolina; and director of Perioperative and CRNA Services at University of Miami Hospital.
Researchers examine whether advancements in robotics and AI can replicate nurses' human qualities.
The concept of AI-powered robots in nursing isn’t far-fetched anymore—Baptist Health in Jacksonville, Florida, is using Moxi, a robot, to help with tasks that might otherwise take up time away from patients—but issues remain whether they are capable of providing quality nursing care, a new study says.
Researchers from three Japanese universities examined whether AI and robots have the ability to perform nursing tasks as well as humans.
"This study in applied ethics examines whether robotics, human engineering, and human intelligence technologies can and should replace humans in nursing tasks," says Tomohide Ibuki, an associate professor at Tokyo University of Science.
Ibuki and his associates examined whether the current advancements in robotics and AI can implement these human qualities by replicating the ethical concepts attributed to human nurses, including advocacy, accountability, cooperation, and caring.
Advocacy in nursing involves speaking on behalf of patients to ensure that they receive the best possible medical care and are safeguarded from medical errors, providing treatment information, acknowledging the preferences of a patient, and acting as mediators between the hospital and the patient.
While AI can inform patients about medical errors and present treatment options, "the researchers questioned its ability to truly understand and empathize with patients’ values and to effectively navigate human relationships as mediators," according to Tokyo University of Science.
The researchers also questioned holding robots accountable for their actions, though they suggested development of explainable AI, which would provide insights into the decision-making process of AI systems, might improve accountability.
Teamwork is key in modern patient care, and nurses are required to collaborate effectively with their colleagues and other clinicians to ensure the best possible care for patients.
"As humans rely on visual cues to build trust and establish relationships, unfamiliarity with robots might lead to suboptimal interactions," the researchers noted and emphasized the importance of conducting further investigations to determine the appropriate appearance of robots for effective cooperation with human medical staff.
The success of AI-powered nurse robots also relies on patients, who must be willing to accept robots as care providers, the researchers say.
Robots may not fully replace human nurses anytime soon, but it is a possibility, the researchers note. If that time comes, "their deployment requires careful weighing of the ethical implications and impact on nursing practice," the university notes in a press release.
"While the present analysis does not preclude the possibility of implementing the ethical concepts of nursing in robots and AI in the future, it points out that there are several ethical questions," Ibuki says. "Further research could not only help solve them but also lead to new discoveries in ethics."
Few U.S. baccalaureate nursing programs prepare graduates for perioperative nursing.
A new University of Tennessee (UT) program to educate nursing students as perioperative nurses makes it one of the few such programs dedicated to that particular specialty, which is experiencing a deep shortage.
The Operating Room Scholars program, developed by the UT Health Science Center’s (UTHSC) College of Nursing, will educate nursing students as perioperative nurses through the college’s Bachelor of Science in Nursing (BSN) program. Baptist Memorial Health Care is working with the College of Nursing to develop the curriculum and pilot the program.
Undergraduate nursing students’ limited exposure to perioperative content, combined with insufficient interest in the specialty, a growing demand for perioperative nurses, and nurse retirements, have all contributed to the shortage of perioperative nurses, according to the Journal.
Open perioperative nursing positions have increased from 3% in 2012 to 11% in 2021, according to the industry publication OR Today. The OR Scholars program is launching this summer with two students in the inaugural cohort.
UT’s program is designed to help offset the shortage.
"This is an innovative pilot program designed to better prepare new graduates to work in the perioperative areas," said Wendy Likes, PhD, DNSc, APRN-BC, FAANP, dean of the UTHSC College of Nursing. "The program will fill a critical need and has the potential to create a new way of preparing nurses for areas with the most critical shortages."
The program’s developers also expect it to decrease the time new nursing graduates must spend in orientation or residency at hospitals, as well as help increase retention rates of perioperative nurses, according to Likes.
That would be a welcome outcome to Mary Ellen Sumrall, MSN, RN, chief nurse executive of Baptist Memorial Health Care and chief nursing officer for Baptist Memorial Hospital-Memphis.
"Nursing has evolved into many specialties that require more specific training and focus," Sumrall said. "This pilot program in perioperative nursing could transform how we prepare undergraduate nurses for specialty areas."
The OR Scholars program is open to students in the college’s traditional, four-semester BSN program. Students entering their third semester who meet academic requirements including a minimum 3.0 GPA can be considered for the program. They receive some tuition support from Baptist and agree to work for Baptist as a perioperative nurse for two years after graduation.
'Mandated ratios don't address systemic problems or the changes in the healthcare delivery system,' she says.
As a handful of state legislatures have enacted or are considering mandating nurse-to-patient staffing ratios, the American Organization of Nursing Leadership (AONL) recently released a strongly worded statement contending that government mandates are not the answer to nurse staffing.
"Staffing is a complex decision based on the experience and clinical expertise of the nurse, care team, resources, and patient needs," AONL said in a prepared statement. "Organizational leaders, nurse managers, and direct care nurses, not policymakers, should collaboratively align staffing with patient needs."
This transcript has been lightly edited for brevity and clarity.
Robyn Begley, CEO of AONL, and CNO, SVP of workforce of AHA / Photo courtesy of AONL / AHA
HealthLeaders: Why are state governments getting involved in staffing legislation?
Robyn Begley: It’s hard for me to speculate on the motive at the state level. AONL and AHA focus on federal legislation; we don't engage in any state level advocacy work, but I can say that there's growing evidence to support that federal policymakers as well as state lawmakers do appreciate that we have a healthcare workforce crisis in this country, and everyone is looking at ways to address this because healthcare is critical to our nation.
It is part of our infrastructure and our lawmakers are understanding how important this is to our country. AHA and AONL are working with the policymakers at the federal level, for sure.
HL: Why should policymakers not have a hand in nurse staffing levels?
Begley: Staffing ratios and that model of care delivery really is becoming antiquated. The process of a nurse-patient ratio is informed by an older care model and does not align with healthcare delivery today. In particular, it does not consider advanced capabilities in supportive technology, or what we're seeing across the country right now, which are interprofessional team-based care models.
The way of determining the staffing ratio is a very static method. It's a tool that is at a single point in time. At the beginning of a 12-hour shift, for example, the activity, the patients, their conditions, and the staffing of a floor can look very different than what's required throughout that 12-hour period. That nurse-patient ratio fails to acknowledge that care needs can change on a dime in a hospital. Although staffing is critically important—and I want to emphasize that we need enough staff—more licensed nurses does not necessarily translate into quality care outcomes.
One of those unintended consequences may be that you're creating less access to care for patients. For example, if a hospital or health system has to close several units because they don't have the prescribed number of nurses to care for patients who would have been in those beds, patients are unable to make it past the emergency department, or they may be transferred to other facilities that that are not close to their home. So, those are serious concerns that need to be evaluated before something as dramatic as a mandatory nurse-patient ratio is implemented.
HL:Why is it crucial to keep staffing in the hands of nurses?
Begley: I’ve been a nurse for a long time—46 years. At the beginning when I became a nurse in the 1970s, nursing was establishing itself as an independent profession, so I believe that as a professional, nurses have the responsibility to determine adequate staffing to take care of their patients and their community.
It may seem expedient right now to impose a mandated staffing ratio law, but it's short-sighted because it takes accountability and professional judgment out of the equation. It belongs in the hands of nurses.
HL: In January 2004, California became the first and only state to establish minimum RN-to-patient ratios in every hospital unit. Why do you think no other states have gone the same direction as California?
Begley: It’s hard to speculate but despite the pros and cons, people will get on both sides of offering evidence that it's been successful versus not successful. I don't know that there's been any clear-cut studies or outcomes that have shown that, "Oh, yes, this is absolutely the way to go and what we need to do," and it’s been almost 20 years.
HL: Nurses in health systems and hospitals across the country, where nurse leaders handle staffing, are striking for safer staffing. Can you address that?
Begley: My comments are based on the whole, and not specifically to any particular hospital. As we mentioned earlier, healthcare is facing dramatic challenges, especially nursing. These challenges existed prior to the pandemic. We knew the vast number of baby boomer nurses would begin to retire and we were concerned and working toward pipeline issues and also working on burnout issues, which existed prior to the pandemic. But when the pandemic hit, it just ignited the fire and exposed things that had been underlying issues for a number of years.
Our caregivers are exhausted. We minimize the effects of the longitudinal nature of the effects of the pandemic. The American Nurses Foundation has done studies and AONL has done longitudinal studies and, well, nurse leaders and nurses are tired. They’ve had demands placed on them for the past several years, in addition to their family responsibilities, whether it's their children at home from school or their elders that need care. Although we are working on diversifying the nursing workforce, approximately 90% of our workforce is women, so that provides another challenge because we know that women have more responsibilities that are outside of the workplace.
Another thing is when we anticipate a temporary event such as gearing up for a snowstorm or a surge in census, we rise to the challenge, and we have lots of short-term actions to deal with increases in patients or lack of staffing. That is something we're very accustomed to dealing with. What we have not been as well-versed at, perhaps, was the longitudinal nature of the pandemic, and the fact that it was lasting for years. This has really taxed our entire system, so it's a long-term effort to be able to address these workforce challenges.
However, especially the last six months, hospitals, health systems, and nursing leaders that I interact with every day, are working on solutions for the now, near, and far. What I mean is, “now” are actions and activities that are going to have impact right away. With the “near” and “far,” the actions will start right now but might not have impact for a longer time.
For example, to recruit a diverse nursing workforce—in gender, in ethnicity, in race, and for nurses drawn to different specialty areas—it means having exposure to seventh- and eighth-graders and having them experience what healthcare is like. That’s why we’re partnering with schools as well as looking at a pipeline where people may come in as food service or environmental service workers, but if they have the ability and drive, we want to see them as future nurses. Our health systems are working on actively supporting those folks.
So, mandated ratios don't address systemic problems or the changes in the healthcare delivery system, and if there was regulation around it, it really stifles creativity and innovation for the future.
The University of Montana (UM) in Missoula will create an online, accelerated model to upskill licensed practical nurses (LPNs) to become RNs with the aid of a $3.6 million federal grant from theHealth Resource and Service Administration.
Collaborating with rural communities, which particularly struggle with staffing issues, is a major focus of the grant.
"Rural Montana is particularly feeling the effects of this [nursing] shortage," said Lily Apedaile, director of the Office of Health Research & Partnership, one of three UM organizations that will implement the new training program. "This new nurse training program developed at Missoula College will create a pathway for licensed practical nurses in Montana to quickly upskill to become registered nurses."
"We see this program as a key part of addressing the nursing shortage by developing a needed step in the nursing career pathway," she said.
The two other UM organizations implementing the new program are the Missoula College Nursing Program and the Center for Children, Families, and Workforce Development.
The new LPN-to-RN Bridge Program will develop assessments to grant credit for experience LPNs have gained in their current role, which will allow them to bypass certain courses, Apedaile said.
It also will focus on public health nursing and health equity in Montana, both of which are emerging areas of need in the largely rural state. A key component of the program will be allowing LPNs to do their classroom instruction through an online platform while continuing to complete clinical training in their own community.
"The Missoula College Nursing Program is excited to be able to offer a pathway for rural LPNs to achieve RN status in a short period of time while working in their communities," said Linda Barnes, Missoula College Nursing Program director. "This grant will help to change the lives of many working nurses who are unable to travel long distances for continued education."
The funding also will support RNs at partner facilities to serve as clinical instructors for LPN students. These RN preceptors will receive specialized training to strengthen the nursing education workforce.
The LPN-to-RN Bridge Program will partner with rural Montana healthcare facilities to aid their efforts in designing career pathways for employees.
"This program will be an important part of recruitment and retention of nurses in rural communities by allowing existing LPNs to stay and train in their hometowns while also increasing the number of nurse educators in rural Montana," Apedaile said.
The application process for the new program is expected to open in spring 2024, with the first cohort of nursing students starting in summer 2024.