Virtual nursing must be additive, not a replacement, according to this nurse leader.
HealthLeaders spoke to Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Association (ANA), about several pressing concerns for CNOs, as well as nursing trends, like virtual nursing, that will continue into the new year. Tune in to hear her insights.
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Here's what CNOs were reading in 2024 on HealthLeaders.
2024 was quite the year for healthcare.
This year, CNOs and other nurse leaders faced a wide array of challenges, from expanding the nursing workforce through recruitment and retention, to tackling new technologies like AI and virtual nursing, and to addressing nurse burnout and wellbeing. Many of these issues are expected to continue, while more will appear on the horizon in the new year.
Here are the top five nursing stories from HealthLeaders in 2024.
Will There Be a Surplus of Nurses by 2028? It Depends - Read here
Top 3 Trends in Nursing in 2024, So Far - Read here
Here's How the Chevron Decision Will Impact Healthcare - Read here
Nursing Needs a Reality Check: Changing Expectations - Read here
You Won't Need As Many Nurses. Sooner Than You Think. - Read here
Virtual nursing is so transformative that we are near the first generation of nurses who may never touch the patient.
Editor's Note: This is an excerpt from a larger cover story, which can be found here.
2024 was a year for great innovation.
Health systems made great strides toward implementing new technologies into workflows, including AI, robotics, and wearables. Perhaps the biggest leap forward was made in the realm of virtual care, especially in nursing.
Back in August, HealthLeaders spoke with nurse leaders who are turning to virtual nursing to address staffing and wellbeing, and to learn how they will adapt and advance to this new technology.
The future is now
The use of telemedicine following the COVID-19 pandemic kick started the virtual nursing movement. And while some systems are just getting started, many have been utilizing virtual nursing for years and continue to expand.
In fact, according to Steve Klahn, system clinical director for virtual medicine at Houston Methodist, virtual nursing roles are about to expand exponentially. Klahn predicted that within the next five to 10 years, 60% to 70% of nursing positions across the industry will 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."
Dr. Shakira Henderson, dean and chief administrative officer and associate vice president for nursing education, practice, and research at the University of Florida College of Nursing, and the system CNE of UF Health, said this strategy will transform the landscape of nursing by enhancing care and improving efficiency.
"One of the facts that struck me was that we are going to produce now the first generation of nurses who could potentially never touch a patient," Henderson said.
Get ready for the new care model
Leaders must keep in mind that with every new wave of technology, there will be an adjustment period as the technology is integrated with workflows. That won’t be any different with virtual nursing.
Klahn said the standard care model for nursing will be highly comprehensive, due to the integration of virtual nursing. It will include both task-driven support from remote nurses and a new way of collecting biometric data.
Nurses will soon be able to monitor a wide variety of healthcare data including blood pressure, heart rate, and respiratory rates through remote patient monitoring, according to Klahn. The collected data can be automated and synthesized through a software system and delivered to the experienced clinical personnel that are remotely supporting bedside teams.
This new model also enables non-traditional nursing ratios in the form of paired nursing teams, where the bedside nurse can take on more patients while moving a portion of their workload to the virtual nurse.
"Now you can actually have one or two nurses supporting a much larger group of patient populations," Klahn said, "and truly load balancing and taking those calls as they come in and reducing the wait times for that process."
Workplace violence prevention requires a proactive approach that disrupts the pathway to violence, according to this CNO.
HealthLeaders spoke to Michele Szkolnicki, senior vice president and chief nursing officer at the Penn State Health Milton S. Hershey Medical Center, about staffing challenges and workplace violence, and what health systems can do to address those issues. Tune in to hear her insights.
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Some of the obvious solutions for health systems are not even options for rural hospitals, says this CNO.
On this episode of HL Shorts, we hear from Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about how the healthcare needs of rural communities differ from those in urban areas.
At Phelps Health, the goal is to create support systems for nurses and to embrace technology, says this CNO.
HealthLeaders spoke to Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about rural healthcare challenges and how Phelps Health is tackling recruitment, retention, and new innovation. Tune in to hear her insights.
CNOs should gear up for the next wave of nursing challenges in 2025.
2024 was filled with many challenges for CNOs and other nursing leaders, and while many of the same ones will continue, there will be new trends and obstacles that leaders will face.
Students know they want to be in service of people, but they don't necessarily know they want to be doctors, says this CMO.
On this episode of HL Shorts, we hear from Dr. Lindsay Mazotti, chief medical officer of medical education and science at Sutter Health, about how CMOs can build pipelines for residents into the healthcare industry to attract new physicians. Tune in to hear her insights.
While many challenges are the same in rural healthcare, the available solutions can be vastly different, according to this CNO.
Health systems of all shapes and sizes are dealing with significant challenges, from staffing shortages to workplace violence, to implementing new technologies.
However, not all hospitals are starting on equal footing.
In rural communities, the challenges go deeper. According to a 2024 report from Chartis, 50% of rural hospitals in the United States are operating in the red, and since 2010, 167 rural hospitals have either closed or moved away from inpatient care.
Rural hospital closures have large impacts on their communities, and CNOs must work to prevent that and maintain patient access to care.
Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, has first-hand experience with the issues facing rural healthcare settings. Phelps Health is located in Rolla, Missouri, which is about two hours from all the major urban areas in Missouri, including St. Louis, Springfield, and Columbia. The health system serves six counties and about 250,000 patients.
Rural vs. urban: What’s the difference?
According to Brookshire-Heavin, the care needs of the rural community are very similar, and include chronic disease, heart disease, obesity, and lack of education and primary care prioritization.
The real difference lies in accessibility and the lack of resources to address those concerns.
"A lot of our residents…have no transportation to get to healthcare," Brookshire-Heavin said. "We don't have public transportation, we don't have a bus, we don't have the subway, we don't have things like that, so that's a challenge."
Even accessibility solutions that more urban health systems use, such as telemedicine, are not options for more rural areas, Brookshire-Heaven explained.
"Maybe if you were going to use telemedicine to serve some remote population, some of our community members don't have reliable Internet access," Brookshire-Heavin said, "so things like that are not even an option."
When it comes to nursing in the rural environment, the philosophy has had to change over the years. According to Brookshire-Heavin, the idea of hiring experienced or specialized nurses is no longer feasible. Phelps Health is focused on partnerships with local colleges, nursing schools, and nursing programs to find ways to get students to join the team.
"What we have found is our workforce is primarily unexperienced new graduate nurses that we have to provide experience to," Brookshire-Heavin said. "We changed our mindset from 'we're going to hire and look for all these experienced individuals,' because they're not there for us, to 'let's grow programs to grow experience and make new nurses.'"
At Phelps Health, the goal is to create support systems, new training programs, and extended training to start new graduates in specialty areas, along with programs that get students involved before they become nurses. Brookshire-Heavin detailed the internship program that pays students to come do their internships at the health system, which has been increasing the number of new graduate nurses entering the workforce.
"We're also seeing those nursing students [do] better on state boards," Brookshire-Heavin said. "They are more successful at one year for retention, [and] when we look at retention, we're seeing that rate increase as well."
Talking costs
Finances in general are a challenge in rural health systems and hospitals, and in the case of technology, Brookshire-Heavin explained that it boils down to a lack of resources to invest.
"You don't have extra to invest in those types of programs," Brookshire-Heavin said. "You are truly trying to keep up with operations and equipment purchases for capital budget, and things just to keep operations going and up to date."
Even for larger health systems, it’s difficult to find the funding for new cutting-edge technologies, and CFOs take convincing. In the rural setting, Brookshire-Heavin says the challenge depends on the financial status of the organization.
"We're very fortunate and we do have resources that we can dedicate to that," Brookshire-Heavin said. "Our organization has really embraced technology, and we do try to look at using technology to do things better."
Brookshire-Heavin recommends partnering with other members of the C-Suite to advocate for innovation.
"As a CNO, I think a big part of that is my relationship and partnership with our CFO to really be able to communicate the needs and the vision," Brookshire-Heavin said, "and the financial case for why this may have cost up front, but what value does it bring in the long run."
Advocating for the community
In terms of community needs, many patients in rural areas lack the resources and ability to invest in their health and wellness, such as public transportation to the hospital. According to Brookshire-Heavin, this issue requires CNOs to have an awareness of legislation and relationships with policy makers and lawmakers.
"We have a government affairs department," Brookshire-Heavin said, "and so I do talk with them and stay in the loop of legislation that's coming, discussions that are happening with legislators, [and I] answer questions and get involved."
Brookshire-Heavin emphasized staying up to date with local organizations and opportunities that can provide more funding.
"I try to stay active with MHA information about legislation, legislative issues," Brookshire-Heavin said, "but also [I look] at grant opportunities and ways to fund programs that we may otherwise not be able to do."
CNOs in rural areas should stick together as well, according to Brookshire-Heavin, and discuss the issues that are confronting their communities. Connections and relationships with other leaders in other organizations are just as important as connections within the CNO's own organization. Brookshire-Heavin also recommends staying current and challenging rigid ways of thinking.
"I think there's a uniqueness about rural healthcare, I find it very rewarding," Brookshire-Heavin said, "but I also think it's important to think outside the box, and try not to be limited by the ruralness of the area you're in."
