This virtual care model gives nurses time back at the bedside, according to this CNE.
On this episode of HL Shorts, we hear from Cynthia Latney, senior vice president and CNE at OhioHealth, and HealthLeaders Exchange member, about what the nurses' role is in the virtual care model at OhioHealth's new Pickerington Methodist Hospital. 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.
CNOs should be ready to adapt to the evolving nature of healthcare while advancing nursing practice, according to this nurse leader.
Nurse leaders always have a lot on their plates, so since we are halfway through 2024, it's time for a mid-year check-in.
So far this year, the nursing shortage has remained top of mind for many CNOs, followed by the rise of new technologies such as virtual nursing and AI. Leaders have also been working to address nurse wellbeing and burnout, workplace violence, and innovative recruitment and retention strategies.
Here are three current top trends in nursing, according to Vicky Tilton, vice president, patient care services and chief nursing officer at Valley Children's Healthcare. Tilton said that these trends reflect ongoing efforts to advance nursing practice, improve patient outcomes, and adapt to the ever-changing needs and challenges in healthcare.
"It is essential to note that the nursing profession is diverse and dynamic," Tilton said, "and trends may vary based on factors such as specialty area, practice setting, and geographic location."
Technological integration
According to Tilton, advanced technologies such as AI, machine learning, robotics, and virtual care platforms are being increasingly incorporated into workflows. Tilton explained that nurse leaders should get ready to upskill nurses in digital literacy and specialized training programs to effectively implement these new tools.
"In 2024, nurses may see expanded roles in utilizing and managing these technologies to improve patient care, streamline workflows, and enhance clinical decision-making," Tilton said.
These new technologies have and will continue to impact nurse workflows and care delivery, and according to Tilton, they will have a significant impact on telehealth, remote patient monitoring, precision medicine, and genomics.
"As technology continues to evolve, healthcare organizations must adapt to harness its full potential and address associated challenges," Tilton said, "including data privacy concerns, interoperability issues, and disparities in access to digital health tools."
Mental health and wellbeing
The second trend that CNOs and other nurse leaders should focus on is the mental health and wellbeing of their staff.
The COVID-19 pandemic shined a light on the importance of having mental health resources and support systems, Tilton said, along with the need for building resilience among staff. CNOs should expand mental health training and resources for nurses as well as foster a culture of empathy and self-care.
"In 2024, nurses may play an increasingly vital role in promoting mental health awareness," Tilton said, "[by] providing psychosocial support, and integrating mental health screenings and interventions into routine care practices."
One way that CNOs can address mental health and wellness is through innovative staffing models. There are four new staffing models that Tilton said will revolutionize nursing: team-based care, flexible staffing, care continuity models, and telehealth nursing.
"Staffing models are expanding by incorporating specialized roles and leveraging advanced practice nurses to optimize care delivery and address workforce needs," Tilton said. "Contingency labor and role specialization to ensure operational efficiency and adaptability in meeting patient care demands are being leveraged as well."
Holistic patient-centered care
The last growing trend in the nursing industry is the focus on holistic and patient-centered care. Tilton explained that this might lead to the implementation of interdisciplinary collaboration models, such as nurse-led care teams, that provide comprehensive and personalized care. The goal is to address the specific needs of each patient.
"Nurses may prioritize care approaches that consider not only patients' physical health but also their emotional, social, and spiritual well-being," Tilton said.
The shift toward patient-centered care and consumerism is causing leaders to reshape healthcare delivery models, Tilton continued, and patients are more empowered to take an active role in their healthcare decisions by demanding transparency, convenience, personalized care, and access to care through technology.
"CNOs need to prioritize patient engagement, satisfaction, and safety by redesigning care processes, enhancing communication and education strategies, and incorporating patient feedback into quality improvement efforts," Tilton said.
Tilton also emphasized that CNOs are instrumental in fostering a patient-centered culture and in making sure that nurses are responsive to the diverse needs of patients and their families.
"By staying informed about these trends and proactively addressing the opportunities and challenges they present," Tilton said, "CNOs can effectively lead nursing departments, drive organizational success, and promote excellence in patient care."
As many health systems employ AI technology and virtual nursing, the idea of a "smart room" has come to the forefront.
HealthLeaders spoke to Cynthia Latney, senior vice president and CNE at OhioHealth, and HealthLeaders Exchange member, about the recently launchedPickerington Methodist Hospital, which is equipped with smart room technology that will create a different experience for patients and their families. Tune in to learn more.
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The Chevron decision has the potential to impact public health and access to public healthcare, according to these organizations.
The United States Supreme Court recently overturned the long-standing Chevron deference doctrine, which held that courts should defer to agency interpretations of statutes that fall under the particular agency's purview, when the interpretation is reasonable, and the meaning of a statute is not made explicitly clear by Congress.
Hospitals and health systems will now potentially have to wait through legal challenges to regulations that were previously determined by the many federal agencies that influence healthcare.
An amicus brief, published in September 2023, warned that "overruling Chevron would have enormous impact on the administration of federal programs, including Medicare, Medicaid, and CHIP, that are critical to public health."
The brief was signed by the American Academy of Pediatrics, American Cancer Society, American Cancer Society Cancer Action Network, ALS Association, American Heart Association, American Lung Association, American Public Health Association, American Thoracic Society, Bazelon Center for Mental Health Law, Campaign for Tobacco-Free Kids, Child Neurology Foundation, Epilepsy Foundation, Muscular Dystrophy Association, National Health Law Program, Physicians for Social Responsibility, The Leukemia & Lymphoma Society, and Truth Initiative.
Here's what you need to know about how the Chevron decision will impact healthcare.
While prevention isn't always possible, there's still much to be done about workplace violence.
On this episode of HL Shorts, we hear from Mary Beth Kingston, executive vice president and CNO at Advocate Health, about how CNOs can help prevent workplace violence. Tune in to hear her insights.
The health system aims to bring patients, families, and the care team together through smart room technology, says this CNE.
As many health systems employ AI technology and virtual nursing, the idea of a "smart room" has come to the forefront.
Smart rooms have stationary, built-in technology that can help improve nurse workflows and keep the patients safe and comfortable. Some of the technologies include ambient listening, virtual nursing setups, and smart beds and wearables that can help measure a patient's vital signs.
OhioHealth launched the new Pickerington Methodist Hospital in December 2023, which according to Cynthia Latney, senior vice president and CNE at OhioHealth, and HealthLeaders Exchange member, is an 86-bed hospital that will create a different experience for patients and their families.
According to Latney, the patients at OhioHealth are looking for value, safety, and connection with their caregivers, which are all aspects that can be addressed with technology.
"Coming out of the pandemic, we saw the benefits of using technology to help support our caregivers," Latney said, "and we saw the benefits of keeping our patients safe."
Technology
Latney was excited to bring the new technology, which is called the virtual care model, to OhioHealth, with the aim of bringing patients and families together.
The virtual care model, according to Latney, includes a large screen at the front of the patient's room and a camera. The patient can interact with the TV and use a tablet to find out who is on their care team, ask for the pharmacist or the meal trays, or to make general requests from the care team. Virtual nurses are also able to use the technology as part of their workflows.
The room technology also enables families to enter the hospital room without having to physically come to the hospital.
"If you're talking about somebody who's had a new baby and you have a large family, [and] you want to give the mom and dad some privacy, but they want to see the new baby," Latney said. "We're using the technology so the whole family can come meet the baby virtually and give the privacy to the mom and dad."
Integration with nurse workflows
The virtual care model has three aspects. The first is a primary nurse that sees the patient in person and is responsible for care. Then there is a patient care aid and the provider, and a virtual nurse who bridges any gaps.
"[The virtual nurse] sits in between the technology and looking at the medical record, and the care team that is seeing the patient directly," Latney said.
Many of the tasks that the virtual nurse does are what the primary care nurse can give to them, including shift reports, admissions and discharges, care coordination, and reviewing the record to make sure there is no missing documentation.
The virtual nurse also helps develop patient care plans and support new nurses.
"When you have a new nurse that comes into the room and they need support, then you have the [virtual nurse] that pops in that can be there in the background to help support them," Latney said, "or they can be the second eyes for a nurse who needs a double check."
A virtual nurse remains in place 24/7 to help no matter what, Latney said.
"Today when our nurses are thinking about leaving, it is about their environment and all the things they have to do," Latney said.
The virtual nurse helps reduce the bedside nurse's anxiety and their workload so that they can spend more time with the patient.
"As nurses, we want to be there for our patients and our families, and not spending a lot of time on the phone or in the medical record," Latney said, "but really be able to function and practice at the top of [our] license."
Outcomes
The nurse and patient reaction to the new hospital has been positive, according to Latney. The nurses value the technology and are happy to have someone there to help with documentation and pulling information, which is a burden that would typically fall on them.
The patients also appreciate having somebody there that they can call at any point for questions or other information without worry, Latney said.
"They understand the importance of having a primary nurse with them," Latney said, "but when they need to reinforce information or they have a question, they really think about their nurses and who they're pulling away from."
The care model has also benefited nursing students, according to Latney. New graduate nurses now have the support they need from a more experienced nurse at the push of a button.
"Our nursing students come into Pickerington Methodist Hospital, and they [say], 'I just feel so good that I have somebody that's with me,' and they can't wait to graduate and come join the team," Latney said.
In terms of ROI, Latney said service and quality scores have increased or remained positive, and staff satisfaction has been positive. Leadership asked the front lines to design the model collaboratively, so the staff felt valued throughout the process.
"We knew that they needed support," Latney said, "but we wanted to make sure that we designed it based on their feedback and what they valued."
Latney pointed out that the program is still new, and that it will take time to measure all of the possible outcomes of the new hospital.
"It's a new hospital, so we're going to need time to really evaluate the impact of this new model," Latney said. "At the same time, we understand this is a model for the future."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Workplace violence prevention takes efforts from the health system and the community, according to this nurse leader.
HealthLeaders spoke to Mary Beth Kingston, executive vice president and chief nursing officer at Advocate Health, about how to CNOs can prevent workplace violence. Tune in to hear her insights.
The Supreme Court's decision will impact patients receiving care through Medicare, Medicaid, and CHIP.
The United States Supreme Court recently overturned the long-standing Chevron deference doctrine, which held that courts should defer to agency interpretations of statutes that fall under the particular agency's purview, when the interpretation is reasonable, and the meaning of a statute is not made explicitly clear by Congress.
Hospitals and health systems will now potentially have to wait through legal challenges to regulations that were previously determined by the many federal agencies that influence healthcare.
The 6-3 decision was made on June 28 to reverse the original ruling made in the landmark case Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., in 1984. It is now up to the courts to determine their own interpretations of ambiguous regulatory standards.
There are many unknowns about how this decision will ultimately play out, but the impact on federal agencies such as the EPA, FDA, and OSHA and their ability to regulate environmental, health, and safety matters is undeniable.
This decision will also potentially impact the healthcare industry in two key ways.
Access to public healthcare
An amicus brief, published in September 2023, warned that "overruling Chevron would have enormous impact on the administration of federal programs, including Medicare, Medicaid, and CHIP, that are critical to public health."
According to the brief, approximately 65 million Americans receive healthcare coverage through Medicare, while Medicaid and CHIP cover 90 million low-income children and adults and seniors with disabilities.
The brief was signed by the American Academy of Pediatrics, American Cancer Society, American Cancer Society Cancer Action Network, ALS Association, American Heart Association, American Lung Association, American Public Health Association, American Thoracic Society, Bazelon Center for Mental Health Law, Campaign for Tobacco-Free Kids, Child Neurology Foundation, Epilepsy Foundation, Muscular Dystrophy Association, National Health Law Program, Physicians for Social Responsibility, The Leukemia & Lymphoma Society, and Truth Initiative.
When Chevron was still in effect, the brief stated, courts deferred to the Centers for Medicare & Medicaid Services (CMS) to make policies that the agency needed to make while "plugging the interstitial gaps that inevitable arise as it administers the health insurance statues in a myriad of every-changing real-world settings."
In a press release published the day of the ruling, the organizations said they were disappointed in the Supreme Court's decision, saying Chevron has helped those organizations ensure that healthcare laws are "interpreted and implemented appropriately."
"We anticipate that today's ruling will cause significant disruption to publicly funded health insurance programs," the contributors said, "to the stability of this country's healthcare and food and drug review systems, and to the health and well-being of the patients and consumers we serve."
The brief’s signees argued in favor of the importance of having experts interpret standards that will have that impact.
"As our amicus brief noted, large health programs such as Medicaid and Medicare, as well as issues related to the Food, Drug and Cosmetic Act, are extremely complex," they said in the press release. "So it is key that decisions about how to interpret and implement relevant laws are made by experts at government agencies."
Healthcare leaders and workers will likely feel the effects of this decision through the impact it will have on public health.
"As leading organizations that work on behalf of people across the country who face serious, acute and chronic illnesses, as well as many people who lack access to quality and affordable healthcare," the signees said, "we will continue to work to ensure that healthcare laws are implemented in ways that benefit the public health."
Virtual nursing ROI can be measured in a variety of ways, including sick time, says this nurse leader.
On this episode of HL Shorts, we hear from Clair Lunt, senior director of nursing informatics at Mount Sinai Health System, about using sick time as an ROI metric for virtual nursing. Tune in to hear her insights.
CNOs must protect and support nurses from workplace violence using methods that are tried and true, say these nurse leaders.
Nurses everywhere continue to experience high levels of violence and abuse at work on a regular basis.
In 2023, eight in 10 nurses experienced at least one type of workplace violence, according to a National Nurses United report. While prevention isn't always possible, CNOs need to make sure that nurses are getting support and assistance after workplace violence incidents occur.
Nurse leaders must advocate for using evidence-based approaches to find out what really works and what doesn't.
Prevention
According to Mary Beth Kingston, executive vice president and CNO at Advocate Health, there need to be more studies done to see what prevention methods are actually effective. For example, weapons detection systems might prevent people from bringing weapons in, but they will not mitigate the typical violence that nurses face in the workplace, Kingston explained.
"Look to see what makes sense within your organization," Kingston said, "but also go back and look for the evidence about what does work, and what truly does help keep people safe."
"Make sure staff know about all of the different things that we have to offer for them to support them," Schuetz said, "then make sure that we're assessing the environments [and] making sure we have environmental controls in place that make sense for the location."
To Kingston, prevention involves three key factors:
"I'll focus on the training and practice and preparation, partnering with safety and security, and really assessing the physical environment as well as all aspects of the environment," Kingston said.
Leaders can control environmental factors by making sure that nurses have exits that they can get to at all times, and assessing items in the room that could potentially become weapons in the midst of an incident.
Kingston emphasized that partnerships with safety and security teams, other departments in the health system, and organizations within the community are also critical. Behavioral health response teams can be particularly beneficial.
"When you feel as though a situation is beginning to escalate, you can call for support and have that show of support, as opposed to a show of strength," Kingston said, "a show of support for both the patient and for the nurse at the bedside."
CNOs can also leverage technology for workplace violence prevention.
"With some of the technology that's out there now, you can have a button or some type of alert on your badge, or on some other type of device," Kingston said, "and you can alert folks when you need help, [and] that can prevent an incident from going to injury."
Schuetz added that a zero-tolerance policy for patients behaving aggressively is essential, as well as proper procedures for removing patients when necessary.
"Our facility developed a pretty rigorous process around patient dismissal when they cannot really participate with the team in a way that's conducive for them to get better and it's abusive to our team," Schuetz said.
If patients come through the emergency department, they will still be treated as required, but patients will be discharged and dismissed from the health system if they cannot comply with the patient code of conduct, Schuetz explained.
"A number of these patients will stop coming back to the facility once they have been dismissed because they don't want the hassle," Schuetz said. "It's our hope that they find a facility where they can have a relationship with the team where they can get the care that they need."
Support after incidents
When incidents inevitably do occur, the next steps that CNOs and other nurse leaders take can make a huge difference for the nurse.
Schuetz explained the peer-to-peer support program at her health system, and their new program that involves a team of people that can provide resources to everyone involved in an incident.
"Oftentimes there's collateral damage, people that witness an event are equally as traumatized as the person," Schuetz said.
The program brings leadership, counseling, and chaplain support to the person or people involved to help them recover. Survivors of workplace violence incidents can suffer from PTSD, which can severely impact their careers if they do not receive the proper support and resources.
"We're trying to wrap our arms around those people," Schuetz said, "[by] making sure that they get some time off work if they need it, making sure they know about pressing charges and the support they can have for pressing charges."
Kingston noted that CNOs need to understand that the impact of workplace violence often lasts beyond the incident.
"I think in healthcare we've done a reasonable job of initial follow-up," Kingston said, "but we have to recognize that this can have an impact days after and weeks after."
CNOs should implement a series of responses, according to Kingston, starting with a strong employee assistance program. Organizations should have a formal support process that is not dependent on the individual manager or leader.
It's also important that other types of violence don't go unnoticed.
"If someone's being called a horrific name all day long while they're working, they may not have a strained shoulder or a bruise, but they are also experiencing workplace violence," Kingston said, "and I think we have to recognize the cumulative impact of some of the behaviors we see."
Lateral violence, such as bullying or incivility at work, are also issues that need to be addressed.
"We have to support our frontline leaders to be able to address those types of behaviors," Kingston said. "They're not something that's reported because people don't even recognize that always as another form of workplace violence."
Part one of this piece was published on Monday, June 24, 2024.
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