Behind the Screen But Not Behind the Scenes: Virtual Nurses Provide Clinical Support, Additional Expertise

Behind the Screen But Not Behind the Scenes: Virtual Nurses Provide Clinical Support, Additional Expertise

Virtual nurses may work from behind computer screens, but their impact is felt throughout healthcare as their expertise is increasingly integrated into patient care and nursing workflows.virtual-nurses-provide-clinical-support-additional-expertise

Since the invention of the telephone in the modern digital age, healthcare providers have used telecommunication tools to bring clinical expertise and care to wherever patients need them. Regardless of the technology, nurses play essential roles throughout telemedicine, usually conveying or using insights or information.

Simply put, virtual nursing is the practice of nursing using telecommunication and telehealth tools and technologies.

Initially focused on increasing access to care in rural and remote areas and responding to the aftermath of natural disasters, telehealth, and virtual nurses have become part of the care provided to thousands of patients across the globe every day. They now support clinical teams throughout the patient care continuum to help ease the overwhelming demands and address serious healthcare issues.

During the COVID-19 pandemic, many care providers considered how telehealth tools could be used in innovative ways in the care of patients. The United States Government Accountability Office reported a 15-fold increase over the prepandemic level in telehealth use among Medicaid beneficiaries. Numbers skyrocketed from 2.1 million in the year before the pandemic to 32.5 million from March 2020 to February 2021.

Teresa Rincon, PhD, RN, FCCM, is a pioneer in virtual nursing. In 2003, she was one of the first nurses to practice from behind a camera as part of a teleICU. Today, she is an assistant professor at UMass Chan Medical School and its Tan Chingfen Graduate School of Nursing in Worcester, Massachusetts, and a senior telehealth consultant with Blue Cirrus Consulting, Greenville, South Carolina. She recently served as editor for a symposium of articles on virtual nursing for AACN Advanced Critical Care, a journal published by the American Association of Critical-Care Nurses (AACN). 

When Rincon became a virtual nurse, there were fewer than 1,000 teleICU beds in the United States. Over 20 years, that number has grown 20x, with an estimated one in eight ICU patients now monitored remotely.

The level of technology acceptance has created opportunities to apply the virtual nursing model to virtuallyanywhere,” she said. The ability to leverage clinical expertise across and despite geographical boundaries is an efficient and cost-effective way to ensure safe, timely, and effective care in critical situations and routine care delivery.”

Immediate Access to Clinical Support

Virtual nurses regularly assist with tasks that do not require physical proximity to the patient, such as patient-family education, completing admission and discharge tasks, and participating in two-person verification processes.

During a patient assessment, a remote nurse and an on-site nurse can efficiently work in tandem, with one managing tasks that require physical proximity to the patient and the other completing tasks such as clinical documentation, patient-family education, and expert nurse surveillance.

Virtual nurses provide an additional layer of clinical support to nurses at the bedside. At the push of a button, bedside clinicians have immediate access to additional nursing support.

This ease of access gives bedside nurses peace of mind, knowing that an experienced fellow nurse is not only assisting in monitoring for changes in a patient’s status but is available to collaborate and assist with care at a moment’s notice.

Virtual nurses serve as valuable mentors to novice nurses as they develop into competent and confident clinicians. They also may support travel or agency nurses to help bridge knowledge gaps caused by a lack of familiarity with specific facilities and policies. In addition, peer-to-peer collaboration can help on-site colleagues feel more supported.

Lisa-Mae Williams, PhD, RN, CCRN, is the chief nursing officer at Intercept Telehealth, Weston, Florida.

In addition to caring for patients, virtual nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams said. Knowledge and expertise are precious commodities, especially when caring for critically ill patients.”

Beyond the ICU

Virtual nurses and tele-critical care (TCC) programs have become more pervasive, thanks to technological advances, modalities expansions, and the number of patients served.

Weve seen significant growth in the number of tele-critical care services, as they expand beyond traditional critical care areas, including to emergency departments, medical-surgical units, and even home-care settings,” said Fiona Winterbottom, DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN, clinical nurse specialist, at Ochsner Health in New Orleans.

Advances in technology have led to increased use of mobile carts, which bring the expertise of intensivists and TCC nurses wherever they may be needed. In the emergency department, they can proactively manage patients waiting for hospital admission, providing earlier access to interventions and improving outcomes.

Remote clinicians can also support rapid response teams to help stabilize a patient with a deteriorating condition. The patient can often remain in their current unit and avoid transfer to an ICU. An added benefit is that the mobile cart can stay in the patients room, allowing the virtual nurse to continue monitoring them for a defined period.

There are also opportunities to create an observation space in the emergency department where patients who need short-term care for diabetic ketoacidosis, drug/alcohol overdose, allergic reactions, and other issues can get the expert care they need without being admitted to another unit.

Beyond the hospital, wearable devices and monitoring kits that link to an on-call automated system and a mobile app can help patients self-manage at home with a medical support system.

Unlimited Options

Ryan Morcrette, BSN, RN, CEN, is the director of virtual care and clinical communications at St. Lukes University Health Network in Pennsylvania and New Jersey.
 
The concept of virtual nursing will continue to mature along with the technology to support it, and were going to look back and wonder how we ever provided healthcare without this asset,” Morcrette said. It will become second nature for patients, bedside nurses, and other clinicians.”

“As we look to the future, we have to think about how to harness the knowledge and skills we need to improve the care we provide to patients. We need innovative solutions to manage the impacts of the global nurse staffing shortages successfully,” Rincon said. Thanks to telehealth technologies, an expert can be located anywhere in the world and connect with someone who needs their assistance.”

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Nursing Certification: Achieving Excellence and Professionalism

Nursing Certification: Achieving Excellence and Professionalism

In the world of nursing, certifications and their corresponding designations carry with them the concepts of excellence, professionalism, and focused dedication to career growth. Not all nurses pursue certification during their years of service in healthcare, but many hear the call and take inspired action to achieve such a goal.nursing-certification-achieving-excellence-and-professionalism

Making an effort to become certified in your nursing specialty is like doubling down on your skills and knowledge. Doing this takes discipline and forward-thinking, demonstrating that you care enough to show the world that nursing excellence and professional mastery matter.

Every year on March 19th, we celebrate National Certified Nurses Day to honor the nurses who take their careers to the next level by becoming certified. This celebration encourages us to take a moment to acknowledge the role that certification plays in strengthening the nursing profession while improving care and patient outcomes. Being certified is meaningful, and we make meaning by pausing for the cause of reflection and recognition of the nurses who choose this path.

Nursing Certification 101

According to the American Association of Critical Care Nurses (AACN), the first nursing certification was issued in 1945 to recognize nurse anesthetists. Certification boards began to be created in the 1960s, and the number of available nursing certifications continues to grow to this day.

Many nurses choose to pursue certification of their own volition, while some employers may encourage or even require nurses in specific specialty areas to become certified. Having your employer pay for and support your certification goals can be a desirable benefit, especially if your certification process has a financial cost you’d rather not bear yourself.

The American Nurse Credentialing Center (ANCC) offers various certification pathways, as do the American Holistic Nurses Credentialing Corporation (AHNCC), the American Academy of Nurse Practitioners Certification Board (AANPCB), and numerous other nursing organizations and associations.

A 2021 Journal of Nursing Administration study states, “Nurse specialty certification is ’a mechanism for validation or formal recognition by documenting individual nurses’ knowledge, skills, and abilities specific to their specialty’. It is a form of individual credentialing above and beyond entry-level education and licensing. By pursuing specialty certification, nurses exhibit a commitment to professional growth and lifelong learning while establishing competency in a specialized area of care such as oncology or medical-surgical nursing. The intended outcome of certification in nursing is to improve safety, quality of care, and health outcomes for those using healthcare services.”

Popular certifications include:

No matter what certification you choose to pursue, rest assured that being certified is something to be proud of and to clearly and proudly document on your resume as a mark of nursing distinction and professional mastery.

Why Should You Consider Becoming a Certified Nurse

As mentioned above, certification is a demonstration of dedication to your area of specialty nursing practice. Being certified can serve many purposes and brings with it a variety of benefits, including:

  • Marketability: Being certified can make you a stronger candidate in the job market, especially if it sets you apart from non-certified applicants for the same positions.
  • Career mobility: Some employers may value nursing certifications very highly, with certified nurses more likely to advance on the organization’s clinical ladder or into positions of greater responsibility, including nursing leadership.
  • Respect and recognition: Certification can elicit in others a sense of respect for and recognition of your professionalism, expert knowledge, and skill.
  • Personal/professional pride: Certification may elicit pride in your expertise, mastery, and accomplishments as a dedicated nurse.

Certification is a feather in your nurse’s cap. It marks you as a nurse focused on career growth and expert skill and knowledge. By being certified, you benefit not only your career but also inspire others to follow in your footsteps and contribute to the improved quality of patient care, not to mention strengthen your employer’s organizational profile.

Certification Speaks Volumes

Having one or more nursing certifications speaks volumes about your professionalism and desire to develop yourself as a nurse of integrity and mastery. Being certified says a great deal about you, and your certifications can enhance your ability to advance your career in any direction you’d like to go.

Some nurses may sit on their laurels and do the bare minimum, while others may seize the day and take every opportunity to develop themselves professionally. Only you can decide if the path to certification is right for you based on your perception of the benefits of certification and the value of that process to your career.

In recognition of Certified Nurses Day, let’s acknowledge those nurses who’ve stepped up to the plate and taken on certification as a prospect worthy of their attention and hard work. And if you’re already certified, give yourself a pat on the back for going the extra mile and showing the world that you’re a nurse who wants to be the best you can be.

Happy Certified Nurses Day

Happy Certified Nurses Day

Nurses go through years of hands-on training and academic courses to become a nurse and then excel at their profession. And when nurses find a nursing specialty that is especially rewarding to them, becoming certified is the next step for highly motivated nurses.green "Exam" button for certification

On today’s Certified Nurses Day, nurses who take on additional work to become certified in their specialty are honored for their pursuit of excellence.

As a nurse, certification is a signal to your professional community and to your community of patients that you have done all you can to achieve the latest knowledge. That means a nurse’s training and understanding of the most recent evidence-based practices is current.

Making the decision to become certified and then taking the actual steps to make that happen requires both dedication and focus. Nurses generally must complete a certain amount of hours within a specialty before sitting for the certification exam. That process helps give them a solid foundation of the skills and processes needed to specialize in their chosen area. But the time spent working in one area also helps nurses decide if that is the path that is right for their career goals and professional aspirations.

The American Nurses Credentialing Center offers a wealth of resources and various certification exams for nurses. A nurse certified in a particular specialty is one who wants to have all the tools possible to provide the highest standard of patient care. And certification isn’t limited to one area. For instance, specialty certified emergency, trauma, transport, and burn nurses often take the Board of Certification for Emergency Nursing’s  Certified Emergency Nurse (CEN) exam, and they might also want to consider the Certified Burn Registered Nurse (CBRN) or the Certified Pediatric Emergency Nurse (CPEN) as well. No matter what area a nurse works in, taking the time and effort to earn a certification is noticed, and even sometimes celebrated, within the organization where they work. Certified nurses often are seen as experts in their areas and so are excellent resources for their teams and also mentors to other nurses.

Some nurses say the fear of failure keeps them from taking a certification exam. But from the perspective of many certified nurses, the information on the exam is information that is part of their daily work responsibilities already. That doesn’t mean exam preparation and studying isn’t necessary, but it does mean that many nurses find they are familiar with the information that they will be tested on.

Combined with preparing for the exam, that existing professional knowledge boosts their chances of success. And if fear of failure is a real roadblock, nurses don’t have to tell anyone that they are taking the exam. Their organization won’t know they are taking it, so if they don’t pass on the first try, it won’t be noticed at work. And if the first try doesn’t go as planned, taking the exam again is worthwhile. Having that additional understanding and the certification to show your dedication to nursing knowledge and process is a significant professional achievement.

Today’s Certified Nurses Day honors all the hard work nurses do to provide top-notch care and also to signal their commitment to the nursing profession as a whole.

How Data Leads to Better Nursing: Improving Workflows and Patient Care

How Data Leads to Better Nursing: Improving Workflows and Patient Care

Whether nurses think their job includes data informatics or not, it does in one way or another. For almost any nurse, data is a touch point in their day, whether they work at the bedside, in an independent office, or a boardroom.ow-data-leads-to-better-nursing-improving-workflows-and-patient-care

“Data is critical,” says Andrew Awoniyi, ND, RN, NI-BC, education director and board member of the American Nursing Informatics Association (ANIA). “It underlies everything we do.” When a fellowship experience revealed the way technology could have a positive and significant impact on healthcare, Awoniyi says he developed a new understanding of how nurses can use it. “It opened my eyes to how you deliver the best healthcare,” he says. 

Many nurses hear informatics and think it does not apply to their jobs, but the opposite is true, says Awoniyi. “There’s a school of thought that all nurses are nurse informaticists,” he says. “Everyone is using data whether they fully understand it or not.”

Often, a nurse’s day includes responsibilities unrelated to numbers or patterns in data. Still, those responsibilities and the equipment or directions they rely on are a direct result of information that has been collected and analyzed. 

It’s All About Data

“When a new initiative comes out, or there is a new process or new product, that is all because of data,” says Kathleen Ulanday, MBA, MHA, BSN, RN, NI-BC, CPHIMS, and a senior clinical informatics specialist at Texas Children’s Hospital. For example, a new process that aims to solve an identified workflow issue is often found because measurements indicate needed improvement. Once implemented, the new process will be measured as well. All the data produced during those assessments reveals patterns or other information that can influence everything from how nurses dispense medication to shift adjustments.

The most basic nursing process of identifying a problem, assessing what is being done, intervening, and evaluating all relies on some collection of information, Awoniyi says. Assessing a patient uses the data produced through vitals, lab results, and tests, so everyone from a bedside nurse to a chief nursing officer knows how to check those results to help direct patient needs. “Nursing is holistic, and everything we do around that involves data,” he says. “It is not foreign to us.”

Ideally, nurses work more efficiently when any change is implemented to improve an outcome because they gain fact-based information that can be applied broadly, says Ulanday. If a new process has a more significant positive impact on a cardiovascular patient population than a gastro one, there’s an opportunity to learn why. “Nurses might notice those patients go home quicker and ask why is that,” she says. That discrepancy can trigger a deeper investigation into new areas needing attention. 

Informatics Isn’t Just Computers

Nurses who are especially drawn to the idea of working as a nurse informaticist might be happy to know that gathering data doesn’t mean sitting in front of a computer all day. Data, Awoniyi says, has a way of helping nurses when the results are interpreted and applied. And with artificial intelligence leading to advances in medical robotics and more targeted applications, nursing informatics is advancing rapidly. It can be a significant factor in closing gaps in healthcare access. The recent expansion of telehealth shows how technology expands potential. As the population shifts and more people are living longer and with more complex conditions, data, says Awoniyi, can help close the gap in healthcare because it can offer healthcare in settings that are located far from high-tech hospitals.

While data is something that nurses can point to as proof of something working (or not), there’s another unexpected benefit to using data to help guide how nurses perform their jobs and care for patients in any setting. Compliance with a new process can improve a workflow, says Ulanday. When nurses see that improvement, their motivation and morale increase.

An In-demand Career Path

As data output grows, the industry needs nurses who use data efficiently and know how to interpret and apply the data to different nursing scenarios. “There’s a lot of data that is generated,” Awoniyi says, “and we must understand that.”

Whether they want to switch careers or not, Awoniyi recommends that nurses understand how and why technology is incorporated into healthcare processes and settings. “Be willing to contribute,” he says. Partner with other nurses, look at how new systems impact nursing workflows and offer feedback on what might improve the process or quality.

Informatics opens up nursing jobs for everything from a nursing informatics specialist or clinical informatics specialist to that of a professor or educator. According to the Healthcare Information and Management Systems Society (HIMSS) 2022 Nursing Informatics Workforce Survey, 60 percent of the 1,118 respondents reported annual salaries of at least $100,000. The survey also showed how nursing informatics roles are positioned in organizations, with 34% of respondents reporting to information systems/technology, 33% to informatics, and 30% to nursing. Reflecting on this kind of role’s medical and technical aspects, most respondents said they report to two departments more often than just one.

How Data and Healthcare Work Together

Even as informatics helps nurses and patients, it does require time and investment, so backing from leadership is critical, say Awoniyi and Ulanday. At Texas Children’s Hospital, Ulanday says the Magnet® status of the hospital requires that the perspective and experiences of bedside nurses, who give hands-on patient care and know how a workflow is helping or not, are included in leadership’s decision-making.

Nurses who are interested in learning more can start by reaching out to their organization’s technical team to ask questions and gain insight into how technology impacts healthcare, says Ulanday. She says to join a professional organization like ANIA to hear about the latest developments and bring those back to leadership.

Ulanday says nurses know it takes time to learn and adapt to new technology, but they also find it will save them time in the long run. It also has a significant safety impact, as data can improve how something is done. Implementing a new workflow based on those findings can eliminate outdated processes and improve patient safety and outcomes.

“As we look to the future, data needs to be a critical part of that,” says Awoniyi. “Understand how data is collected, analyzed, and interpreted. It’s then about how to leverage that data to bring about change.”

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How Can Your HR Department Help You?

How Can Your HR Department Help You?

Nurses help people all day long. Whether it’s a colleague who needs a hand or a patient who needs support, a nurse will evaluate what’s needed and find a way to make that happen.

But when nurses need something, they are frequently reluctant to ask for help. But a nurse’s human resources (HR) department can help with professional help and often has extensive assistance available. One of the most important tasks a nurse can complete professionally is to have a thorough awareness and understanding of what an HR department offers. a stethoscope over a face mask and with a graphic heartbeat image for HR week

Here are a few things to consider when you need help from HR:

Know Your Benefits
Benefits are much more than health insurance and vacation time. Benefits encompass everything from short- and long-term disability to wellness reimbursements to parental leave policies. The HR benefits manual or explanations your organization has on file are worth reading and understanding. There could be hidden discounts that you aren’t aware of or nuances to emergency time off that you should familiarize yourself with. Your benefits can help you pay for additional education and might have excellent professional development resources you weren’t aware of.

Understand What Happens in an Emergency
Nurses know that life can change in a second. So if something happens in your own life that can impact your job attendance or performance, you shouldn’t have to scramble to find out what you need to do. Does your company have a waiting policy before you take any kind of disability? What happens if you need time to recover from a health emergency? If a family member needs your care, does your organization have any time available for you to take off to help? You’ll want to know about bereavement time as well.

Determine the Complaint Process
No one likes to have problems at work, and it’s a frequent reason that employees leave companies. Whether it’s a problem with a colleague, a supervisor, an annual review process, salary questions, or a scheduling issue, resolving it to your satisfaction is important. It might not always be possible, but understanding how your HR department deals with complaints is good information to have.  Is there an ombudsperson or a neutral mediator in your organization who can help?

Figure Out Retirement Options
Good retirement options are a key part of any benefits package, but it’s up to you to know what it includes and how it can best apply to your own situation. No matter how close to or far away from retirement you are, having a good understanding of what is offered will pay off in the long term. Does your company offer a retirement plan? Is there a retirement match and is there a minimum employee contribution required? What happens if you need help with making decisions? All of these are questions you can pose to HR to find out how any of the offered benefits can increase your own retirement savings. And if you are close to retirement age, it helps to understand the process for when you want to retire. If there are timelines involved or steps you will need to take as you ready for retirement, you will need to work with HR for a smooth transition.

HR departments offer so much information that employees might not be aware of. Take the time to find out what might be available for you.

Meet a Champion of Nursing Diversity: Barbara Bosah

Meet a Champion of Nursing Diversity: Barbara Bosah

Barbara Bosah, MS, RN, PCCN, is a highly skilled nurse manager in the thoracic and surgical intermediate care unit and vascular progressive care unit at the University of Maryland Medical Center (UMMC), downtown campus in Baltimore, MD. meet-a-champion-of-nursing-diversity-barbara-bosah

With over 14 years of experience leading care teams for patients with complex medical conditions, she is passionate nursing leader who fosters dynamic and supportive work environments that encourage continuous learning and professional growth.

Bosah has been recognized for leading several important nursing initiatives at UMMC that have positively impacted quality and patient experience. 

She is particularly proud of her role as a founding leader for the Academy of Clinical Essentials initiative. This revolutionary academic-practice partnership model has been implemented at the University of Maryland Medical System (UMMS) and has resulted in intentional support for new graduate nurses as they prepare for and transition into clinical practice.

Bosah’s contributions to the nursing field have earned her a spot in the Champions of Nursing Diversity Series 2024. This series highlights healthcare leaders who are making significant changes in the nursing field and are prominent figures in their organizations

Meet Barbara Bosah, MS, RN, PCCN, nurse manager in the thoracic and surgical intermediate care unit and vascular progressive care unit at the University of Maryland Medical Center. 

Talk about your role in nursing.

I am the Nurse Manager for the Surgical and Thoracic Intermediate Care & Vascular Surgery Progressive Care units. Our unit specializes in providing care for some of the sickest patients within the Maryland region. These patients are admitted to our unit after undergoing surgery. As a Nurse Manager, I lead our team of dedicated nurses. Our primary focus is to provide high-quality and patient-centric care. This involves ensuring that all staff members are well-trained and equipped to handle the complex needs of our patients.

Additionally, I oversee the allocation of staff and financial resources to ensure the effective operations of our unit. By carefully managing these resources, we can maintain a safe environment for our patients while delivering exceptional care. Our team is committed to staying up-to-date with the latest surgical and thoracic care advancements. We regularly participate in professional development activities and collaborate with other healthcare professionals to provide the best possible outcomes for our patients. My role as the Nurse Manager involves overseeing our unit’s day-to-day operations and creating an environment that promotes collaboration, excellence, and compassionate care. 

How long have you worked in the nursing field?

Nursing is my second career. Before pursuing nursing, I obtained my Bachelor of Science in Business Administration with a focus in Marketing and a minor in International Business from the University of Louisville in Louisville, KY. Following my passion for healthcare, I furthered my education and earned a Bachelor of Science in Nursing from Bellarmine University in Louisville, KY.

In 2005, I began my nursing career at UMMC as a new graduate nurse in the Surgical Intermediate Care Unit. Over the past 19 years, I have dedicated my professional life to serving patients at UMMC, gaining valuable experience, and honing my nursing skills. I take great pride in my journey from business administration to nursing and the diverse skillset it has provided me. Through my years of experience at UMMC, I have developed a deep understanding of the healthcare industry and a genuine passion for delivering high-quality care to those in need.

Why did you become a nurse?

I choose to pursue a career in nursing because I find fulfillment in assisting patients and their families during difficult times. I thrive in situations where the outcomes are unpredictable, and I can provide the necessary support and guidance. It is gratifying to ensure that their journey through the hospital is as seamless as possible, and I strive to treat each patient and their family with utmost respect and care. 

My approach involves delivering high-quality, empathetic, and compassionate services. Moreover, I believe in establishing a personal connection with them and valuing them as individuals rather than just patients. They become part of my extended family in my care, and I am committed to meeting their needs and advocating for their well-being.

What are the most important attributes of today’s nursing leaders?

I firmly believe that nursing leaders are crucial in addressing staffing challenges. They need key attributes to be effective. First, they must be transformational leaders who inspire and empower their staff. A clear vision is essential for navigating complex situations and guiding teams towards success. Accessibility promotes open communication and collaboration. Empathy fosters a supportive work environment. 

Lastly, a passion for mentoring and developing nurses is essential for continuous growth. By embodying these attributes, nursing leaders can lead their teams, inspire excellence, and drive growth.

What does being a nursing leader mean to you, and what are you most proud of?

I am honored to serve as a nurse leader, particularly as a minority nurse leader, at UMMC. I have the privilege of contributing to the future growth and development of new nurses entering the profession and mentoring experienced nurses to strive for advancement in their careers, whether as a clinical nurse, an Advanced Practice Provider, or a nurse leader. 

While I thoroughly enjoy working with patients and their families, I am incredibly proud of the exceptional team I work with on the Surgical & Thoracic IMC and Vascular Surgery PCU. Our team demonstrates remarkable resilience and delivers outstanding patient care while supporting one another. The collaboration and teamwork within our team are truly impressive, as we care for some of the most critically ill patients in the Maryland Region. I am inspired to come to work each day because of the unwavering dedication of this remarkable team, as each staff member contributes to the mission and vision of UMMC. I am incredibly proud and humbled to be their leader.

Tell us about your career path and how you ascended to that role.

I started my career as a new graduate nurse in the Surgical Intermediate Care Unit. Initially, I was still determining what my career path would be. However, I approached each day with dedication and focused on providing the best possible care to my patients. Although I was unsure if there was room for growth as a nurse then, I was determined to make the most of my past experiences and leverage my background in business and marketing. I set goals and developed a vision for my career to ensure that I had a clear direction. One area that I had always been passionate about was quality and performance improvement. 

Fortunately, my nurse leader, Cindy Dove, MSN, RN, Director at UMMC, recognized my passion and took me under her wing. She became my mentor and played a crucial role in my leadership development. Thanks to her guidance and support, I was able to advance through the Professional Advancement Model (PAM) from Clinical Nurse I to Senior Clinical Nurse II, and I currently hold the position of Nurse Manager. 

This journey has spanned 19 years, during which I have continuously grown professionally and personally. Looking back, I am grateful for the opportunities to expand my horizons and make a difference in nursing. I am excited to see what the future holds and how I can continue contributing to nursing.

What is the most significant challenge facing nursing today?

One of the most critical issues currently confronting the nursing profession is the persistent problem of staffing constraints and burnout. This challenge has been further exacerbated after the COVID-19 pandemic, which has left nurses exhausted and overwhelmed. The shortage of qualified nursing staff has put immense pressure on healthcare systems, leading to increased workloads and reduced quality of patient care. The demanding nature of nursing work, coupled with the long hours and high stress levels, has dramatically increased burnout rates among nurses. This not only affects the well-being and job satisfaction of nurses but also directly impacts patient outcomes and overall healthcare system effectiveness.

Therefore, addressing staffing constraints and burnout is of utmost importance to ensure the sustainability and effectiveness of nursing care in the present and future. Efforts should be made to implement strategies such as increasing the recruitment and retention of nurses, improving working conditions, and providing adequate support and resources to prevent burnout and promote the well-being of nurses. By addressing these challenges, we can create a more resilient and robust nursing workforce that can deliver high-quality care to patients and contribute to the overall improvement of healthcare systems.

As a nursing leader, how are you working to overcome this challenge?

As a nurse leader, overcoming the challenges in nursing has been quite difficult. It requires a lot of patience, as sometimes it may seem like no end in sight. However, it is important to remain hopeful and continuously review the current best practices to combat these constraints effectively.

One way to address these challenges is by actively listening to the concerns and needs of the bedside staff. We can create a more supportive and empowering work environment by advocating for their needs and ensuring that their voices are heard. Additionally, reviewing and implementing wellness programs specifically designed to support the staff is crucial. Encouraging participation from the entire team by forming task forces can help us successfully enact these changes.

Furthermore, it is essential to focus on the recruitment and retention of nurses. By actively promoting the profession and fostering a healthy work environment, we can attract and retain talented individuals passionate about providing high-quality care. This can ultimately contribute to our nursing practice’s overall success and improvement.

What nursing leader inspires you the most and why?

The saying “It takes a village to raise a child” resonates with me as I reflect on my journey from being a new graduate nurse 19 years ago at UMMC. Throughout my career, I have been fortunate to have the support and guidance of numerous UMMC leaders who have inspired me. Being a nurse goes beyond the technical aspects of the job; it involves working with phenomenal stakeholders and partners across various departments such as Rehab (Physical Therapy & Respiratory), Case Management, Hospital Operations, and Pastoral Care. However, I must highlight the significant impact that the Surgery and Neuroscience division’s nurse managers, Cindy Dove and Ruth Lee (VP of Patient Care Services), have had on me. Their leadership and dedication have been a constant source of inspiration, and I consider them part of my extended family within the hospital.

What inspirational message would you like to share with the next generation of nurses?

As a proud member of Delta Sigma Theta, Inc., the quote by our dynamic Soror Nikki Giovanni resonates with me, and I hope it will inspire you!

“A lot of people resist transition and therefore never allow themselves to enjoy who they are. Embrace the change, no matter what it is; once you do, you can learn about the new world you’re in and take advantage of it.” – Nikki Giovanni

Is there anything else you’d like to share with our readers?

I am incredibly grateful and deeply honored to have this fantastic opportunity to share my journey with you. It fills my heart with immense joy to connect with you and inspire you. I want to emphasize the importance of staying true to yourself and embracing self-love. Remember, you can shape your destiny and create the life you desire. Cherish every moment of your journey, and let your inner light guide you towards greatness.

Patient Safety Is a Nurse’s Top Priority

Patient Safety Is a Nurse’s Top Priority

Nurses put a priority on keeping their patients safe and Patient Safety Awareness Week, which takes place March 10-16 this year, helps focus attention on this important part of any healthcare provider’s job. No matter how much attention nurses give to patient safety, there is always room to make improvements. swirl logo for the Center for Patient Safety

But there’s more to patient safety than knowing and following procedures and protocols, says Kathy Wire, JD, MBA, CPPS, CPHRM, FASHRM, executive director of the Center for Patient Safety. The complexities of patient safety and how it is incorporated, monitored, and managed in any healthcare organization are real. Patient safety isn’t just limited to healthcare providers–it also involves the patient and the patient’s loved ones, too.

The overall organizational culture often sets the tone around patient safety. “A culture develops as a result of attitudes and related behaviors,” says Wire. “The underlying components of safety culture are well known. Some require action from senior leadership; others fit nicely in unit-based efforts. For example, supervisors can encourage non-punitive responses to errors, focusing on addressing underlying system issues and acknowledging human fallibility.”

Nurses often look to leadership to implement processes in which questioning a decision or a process is supported. If nurses push back on something that appears unsafe, they need to know they will have a manager’s support, she says. And this kind of transparency is in the best interests of any organization as patient safety is often tied to nurse safety. “A lack of patient safety can lead to errors and near misses that any conscientious nurse will find disturbing,” says Wire. “Even minor events can trigger this ‘second victim’ phenomenon. Many provider organizations have developed programs to address this trauma in their staff, but isn’t it better to prevent the issue in the first place?” And in the high-stress situations when loved ones are concerned about the care being given, anger and fear can spark threats to nurses, so open communication is essential, she says.

A patient’s family and loved ones contribute immensely to patient safety, says Wire. As nurses need to feel comfortable about being vocal about safety, loved ones also need to be heard and feel they can raise questions safely. Nurses also can trust that those closest to the patient can be advocates and have information the nurse might not. “Helping them understand planned nursing interventions and treatments while encouraging them to ask questions will establish that relationship,” says Wire. “We must let them know that an additional, dedicated set of eyes and ears can help busy nurses provide the best care. For example, family members can often recognize subtle changes in the patient’s condition that may be more difficult for a nurse to see.”

Even the best environment can’t prevent all errors. “Good safety culture tells us that people make mistakes and can drift from the ‘standard,'” says Wire. “Reporting mistakes and errors helps the organization learn about gaps in policy and how well it is supporting its nurses, and it also helps all nurses benefit from the learning that a reported event can generate.”

The highly tuned ability that nurses have in assessing a situation and evaluating the needs in the current moment can also help reveal problems, even problems that were never there before. “It can also bring mistakes and near misses to light, avoiding unnecessary injury to patients,” says Wire. “They must know that safety is not a condition or a statistic. Patient safety is an ongoing set of activities, and a state of mind focused on recognizing risk and generating improvement. It doesn’t care what you did last week.”

Tune Into New Podcast Series: Conversations About Health Care Delivery in the United States

Tune Into New Podcast Series: Conversations About Health Care Delivery in the United States

Springer Publishing launched a new monthly health care podcast series, Conversations About Health Care Delivery in the United States, featuring discussions with prominent experts, innovators, and leaders in the health sector available on Spotify, Apple Podcasts, and Amazon Music starting on March 7.
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The podcast series is hosted by Jim Knickman, the former Robert Derzon Chair at the NYU Wagner Graduate School of Public Service, and Brian Elbel, MPH, Professor of Population Health and Health Policy at NYU Wagner and the NYU Grossman School of Medicine. The series dives into complex and challenging issues affecting the U.S. health care system, its workforce, and the populations interacting with it, covering topics like health management, public health, health behavior, population health, healthcare quality, and health economics.


Knickman and Elbel engage with guests who are leaders in the health sector, from aging services to health policy, to learn more about the key drivers shaping the health care system, challenges and complexities related to health inequities, and the exciting career opportunities available to future health care professionals and leaders.

The podcast series is a companion to the 13th edition of Jonas and Kovner’s Health Care Delivery in the United States, as each episode has ties to essential concepts, challenges, complexities, and themes in the textbook.

Podcast Episode

How the U.S. Health Care Systems is Preparing for the Demographic Cliff features Ramsey Alwin, President and CEO of the National Council on Aging, and Kathleen Cameron, Senior Director of the National Council on Aging’s Center for Healthy Aging.

The episode offers an in-depth discussion about the demographic shift, how the roles of families and social systems have evolved, federal and state-level programs for seniors, social isolation and inequities in the aging population, healthy aging, and exciting career opportunities in aging services.

The podcast series also features a supplemental instructor guide for anyone using the textbook that provides learning activities, discussion questions, and other guidance to engage with each episode, delivering practical and engaging content to learners and professionals in the health care space.

Meet a Champion of Nursing Diversity: Kimberly Williams

Meet a Champion of Nursing Diversity: Kimberly Williams

Kimberly M. Williams, DNP, MSN, RN, NE-BC, has dedicated her career to serving patients at every level. She started in health care as a front desk clerk and worked up to her current position as the Director of Nursing Operations at the Bass Center for Childhood Cancer and Blood Diseases at Stanford Medicine Children’s Health.meet-a-champion-of-nursing-diversity-kimberly-williams

Williams is an important nursing leader, and we are honored to feature her in the Champions of Nursing Diversity Series 2024. This series highlights healthcare leaders who are prominent figures in their organizations and are making significant changes in the nursing field.

Meet Kimberly Williams, DNP, MSN, RN, NE-BC, Director of Nursing Operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health.

Talk about your role in nursing.

I am the director of nursing operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health. As the director of nursing operations at a world-class pediatric hospital, I hold a multifaceted role encompassing numerous responsibilities. My role extends beyond the provision of patient care and involves strategic decision-making and ensuring the overall efficiency and effectiveness of the Center’s nursing operations. To do so effectively, I partner with over 180 nurses throughout the Bass Childhood Cancer Center’s various departments, including hematology, oncology, stem cell transplant, and the Center for Definitive and Curative Medicine. We deliver compassionate, high-quality care to our young patients and their families.

As the chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council, I actively address health disparities, advocate for culturally sensitive care, and promote diversity, equity, and inclusivity within the healthcare system. I also mentor aspiring nurses, guiding and empowering them to pursue their dreams and overcome obstacles.

Tell us about your career path and how you ascended to this role.

My path progressed with a series of fits and starts. As a parent, I had to juggle motherhood, a full-time job, and my academics, so it took me roughly six years to obtain my BSN. Upon graduating from Texas Christian University in 2001, I settled into my first nursing role at Cook Children’s Healthcare System on the medical/surgical floor. Still, I always had my eyes on becoming a PICU nurse. After a year there, I transferred to the PACU to get some experience in intubation and sedation. I then transferred to the PICU, where I worked as a nurse and a charge nurse. There, I got the desire to return to school and obtain my master’s. I completed my MSN in 2010 from the University of Phoenix. Afterward, I accepted a job as a nurse manager, where I spent eight years before taking a leap of faith and accepting a position at Stanford Medicine Children’s Health as a patient care manager for The Bass Center for Childhood Cancer and Diseases. I worked in that role for about two years before taking the interim role of director of nursing operations. I have now been in that role for a little over three years.

It’s been a long journey, beginning as a Black, economically disadvantaged girl from a small town outside Pittsburgh, Pennsylvania. Growing up, I faced numerous challenges that could have hindered my progress. However, I was fueled by a burning desire to make a difference, overcome limitations, and pursue my dream of becoming a nurse. I rose above my circumstances to succeed in nursing, and my experience culminated in a leadership position at Stanford Medicine Children’s Health, serving as a testament to determination, resilience, and the power of education.

How long have you worked in the nursing field? Why did you become a nurse?

Sometimes, others can see something within us that we may not recognize.

I have been in nursing for almost 25 years and came into this field by happenstance. I was a single mother of three rambunctious boys at the time, working as a clerk in a children’s hospital. One of the physicians I worked with recognized that I had the qualities and potential to excel as a nurse. She would often tell me I should consider going to nursing school. For over a year, she kept encouraging me and was determined to get me to take one class. I finally agreed. I will never forget the first class I took, Psychology 101. I received an ‘A’ in that course. All I needed to confirm that I could do anything I put my mind to. I owe a lot of gratitude to that doctor. Her encouragement motivated me to pursue a new path and passion, creating a better future for myself and my family. Looking back, I feel that my journey is a true testament to the transformative power of mentorship.

What are the most important attributes of today’s nursing leaders?

I want to be intentional in answering this question from the lens of a Black nurse and DE&I advocate. I feel the most essential attributes of today’s nursing leaders include cultural competency, advocacy, mentorship, and community engagement.

To truly provide equitable, compassionate care, we must recognize and respect the unique cultural dynamics and challenges faced by the diverse communities we serve. As leaders, we must be attuned to these nuances through cultural learning, which equips us to deliver holistic care, meeting each patient’s and their family’s psychological, emotional, spiritual, cultural, and individual needs.

Advocacy is a crucial attribute for leaders in the nursing profession today. We can promote patient rights, ensure patient safety, empower patients with the needed information to make informed decisions, and more through advocacy.

As I mentioned before, mentorship has the power to change lives. When I came into the field, few Black nurses were in any leadership roles. I was often the only Black leader in more rooms than I’d like to remember. And this was the catalyst for my commitment to promoting and supporting up-and-coming nurses and diversity within the profession.

The last attribute I’d like to touch on is the importance of community engagement. People don’t know what they don’t know. As the eyes and ears of some of our most vulnerable populations, we must embed ourselves within our communities to promote community health initiatives, provide educational resources, and collaborate with community leaders to address health disparities and promote health equity.

What is the most significant challenge facing nursing today?

One of the most significant challenges facing nurses today is the persistent disparities and inequities in healthcare access and outcomes among marginalized populations. One key challenge is the need for more diversity within the nursing profession. While progress has been made, nursing continues to struggle with achieving a workforce that reflects the racial, ethnic, and cultural diversity of our communities. A homogenous nursing workforce can limit patients’ ability to connect with and receive culturally sensitive care from healthcare providers who understand their unique needs and backgrounds.

Additionally, biases and discrimination persist within the healthcare system, impeding equitable care delivery. Implicit biases can influence decision-making, communication, and patient interaction, leading to disparities in treatment and outcomes. Moreover, the challenge of healthcare access persists for marginalized populations, including racial and ethnic minority groups, low-income individuals, LGBTQ+ communities, and those with limited English proficiency. These populations face significant barriers, including lack of health insurance, geographic disparities, and social determinants of health, contributing to healthcare inequity.

As a nurse leader, how are you working to overcome this challenge?

As a Black nurse leader, I strive to create inclusive and welcoming healthcare environments.

While often difficult to navigate, we can overcome many challenges by advocating for policies and practices that address these systematic barriers.

Nurses can foster culturally sensitive, competent care by actively listening to patients’ concerns, promoting patient autonomy, and respecting patients’ values and beliefs. As mentioned earlier, I am chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council at Stanford Medicine Children’s Health. In this role, I advocate for inclusive policies and practices that value and support diversity, prevent discrimination, and cultivate an inclusive workplace that celebrates different perspectives and ensures equitable opportunities for professional growth. Through organizational partnerships, Stanford Children’s is addressing some of these challenges by developing nursing-focused education programs that emphasize DE&I as fundamental components of the curriculum. This ensures that our workforce, especially nurses, are clinically skilled and culturally educated. Ongoing diversity training, mentorships, and continued education opportunities can promote nurses’ understanding of diverse patient populations and foster inclusive practices.

Despite the numerous obstacles within our profession, I am confident that with continued education and systemic support, nurses can play a vital role in advancing health equity and reducing disparities in healthcare.

What nursing leader inspires you the most and why?

There are so many who inspire me. When I look at the history of Black nurse leaders, the first person that comes to mind is the remarkable contributions of Mary Eliza Mahoney. Mary Eliza Mahoney (1845-1926) was the first African American registered nurse in the United States. Mahoney’s resilience and dedication to overcoming significant adversity in pursuit of her nursing career during a time of racial discrimination and inequality had a lasting impact on nursing and continue to inspire nurses of all backgrounds to this day.

However, the nurse leader who inspires me the most is my sister-in-law, Dr. Shakyryn Napier, DHS, RN, CPN, NEA-BC, LSSYB, and the Director of the Heart Center at Cook Children’s Healthcare System. Dr. Napier is one of the few Black nurse leaders I’ve enjoyed working alongside for most of my career. She possesses exceptional humility, demonstrating intense sincerity in her interactions with others. What sets her apart is her unwavering commitment to professional and personal mentorship. She invested her time and energy into me and was one of a few Black nurse leaders who recognized my potential, even when I doubted it myself. She believed in me and played an integral role in my leadership development.

Is there anything else you would like to share with our readers?

I want to share a personal experience reaffirming that I am truly walking in my purpose.

Four months ago, my father was diagnosed with stage IV lung cancer that metastasized to his bones and spine. About a month after his diagnosis, my 35-year-old son underwent an above-the-knee leg amputation. The experience of sitting on the other side of healthcare as a daughter and a mother has profoundly touched me and deepened my understanding of humility, compassion, mercy, and grace. As I provide support to my father and son during these difficult times, I am witnessing firsthand the physical, emotional, and psychological toll that illness and disability can have on families. This experience has enabled me to approach my role as a nurse leader with an even greater depth of compassion and understanding. Humility is a crucial quality in healthcare, as it allows us to recognize our limitations and biases while respecting the diverse perspectives and needs of those we care for. My experience has humbled me, reminding me of life’s vulnerability and fragility. Through my experience, I hope to provide a comforting presence, lend support, and cultivate stronger connections with patients and families navigating their difficult journeys.

Lastly, I’d like to emphasize the importance of self-care. Please seek support when needed, as our careers and personal lives can also affect our well-being. When prioritizing well-being, we can provide better compassionate care and leadership to those who need it.

Navigating the World of Long-Term Care: A Guide for Nurses

Navigating the World of Long-Term Care: A Guide for Nurses

In the vast and varied landscape of healthcare careers, long-term care is sometimes overlooked. However, this sector, which provides sustained assistance to individuals with chronic illnesses or disabilities, offers a unique and rewarding path for nurses.Navigating the World of Long-Term Care: A Guide for Nurses

The field challenges nurses’ medical expertise and calls on their deepest reserves of empathy and understanding. Clinicians who choose this path will find it as rewarding as it is demanding.

What is Long-term Care?

Long-term care (LTC) refers to a range of services to meet a person’s health or personal care needs for an extended period. These services help people live as independently and safely as possible when they can’t perform everyday activities on their own.

This care can be delivered through:

  • Home-based care: Having nurses or therapists visit patients in their homes is suitable for patients who prefer to receive care in a familiar environment or for those who find it challenging to travel to healthcare facilities. Home care is different from home health.
  • Community services (adult day care centers): Community-based facilities that provide care and activities for older adults, typically during daytime hours. They are for older adults requiring supervision and social interaction but not round-the-clock care.
  • Assisted living: Residential communities that offer a balance of independence and support. Residents are usually seniors who require assistance with activities of daily living but not intensive medical care.
  • Memory care: Specialized residential communities for those with memory problems who require intensive, specialized care.
  • Skilled nursing communities: Also known as skilled nursing facilities, these provide comprehensive, 24/7 medical care for individuals with complex healthcare needs. Residents often have chronic conditions, disabilities, or advanced age or diverse demographics, requiring nursing care and medical supervision.

What it takes to work in LTC

Clinical skills for long-term care nurses encompass a broad range of abilities and competencies tailored to the unique needs of elderly and chronically ill patients in long-term care facilities. These skills are essential for providing comprehensive care, promoting residents’ quality of life, and ensuring their safety and well-being.

LTC nurses must possess specific skills to care for residents with complex, long-term health needs. Here’s what’s typically required:

Clinical Skills

  • Patient assessment and monitoring
  • Medication Management
  • Chronic condition management
  • Disease-specific knowledge
  • Fall prevention and mobility assistance
  • Infection control
  • Dementia care
  • End-of-life care

Communication and interpersonal skills

  • Effective communication
  • Active listening
  • Cultural sensitivity
  • Conflict resolution
  • Empathy and compassion
  • Team collaboration
  • Respect for privacy and dignity

Organizational Skills

  • Time management
  • Record keeping
  • Multitasking
  • EHR knowledge and competency

Rewards and Challenges

LTC jobs can be gratifying, offering the chance to forge meaningful relationships and make a tangible difference in patients’ lives. However, they also present unique emotional and physical challenges that require resilience, empathy, and a strong commitment to patient care. Understanding this is crucial for anyone considering this field.

Rewards

  1. Meaningful relationships: One of the most rewarding aspects is the opportunity to develop deep, meaningful relationships with patients over time.
  2. Making a difference: Significantly improving patients’ quality of life is deeply satisfying.
  3. Professional growth: LTC offers diverse learning opportunities and the opportunity to broaden clinical knowledge and skills.
  4. Team collaboration: LTC often involves being part of a multidisciplinary team, offering collaboration and learning opportunities from peers in various specialties.
  5. Job stability: The demand for LTC care is steadily increasing, providing job security. According to the U.S. Bureau of Labor Statistics, the employment of home health aides is projected to grow more than 20% year over year. Similar projections are seen for other LTC professions like nurse aides and licensed practical nurses.

Challenges

  1. Emotional demands: Dealing with patients who have chronic illnesses or who are in the last stages of their lives can be emotionally challenging. It requires managing personal emotions while providing compassionate care.
  2. Physical strain: The job can be physically demanding, involving long hours assisting with patient mobility and other tasks.
  3. Complex care needs: LTC patients often have complex medical and personal care needs, requiring meticulous attention and patience.
  4. Dealing with loss: Handling patient loss can be emotionally taxing for caregivers.
  5. Burnout risk: Due to the high demands of the job, there’s a risk of clinician burnout, making self-care and stress management important.
  6. Navigating family dynamics: Working closely with patients’ families can be challenging, especially when navigating complex emotional situations or communicating about sensitive health issues.

How much do LTC jobs pay?

The average annual salaries for LTC clinicians range from $32,110 for personal care aides to $92,080 for occupational therapists, as shown in the table below. Demand is projected to grow rapidly, driven by the aging population and increasing need for LTC services.

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Long-term Nurse Salary Range

*Source: U.S. Bureau of Labor Statistics. These approximate figures vary based on location, experience, and long-term care facility.

The strong demand for LTC jobs and the diverse range of career paths available make it a promising field for those seeking a stable and rewarding career.

Daily Life of LTC Nurses

The daily life of nurses in long-term care is varied and centered around providing comprehensive care to their patients. Their day typically involves a mix of medical and personal care tasks. This includes administering medications, monitoring vital signs, and responding to patient health changes. They also document patient care, update records, and plan care with other team members.

Beyond these clinical responsibilities, nurses engage in meaningful interactions with patients, offering emotional support and ensuring their comfort. They also communicate regularly with families, providing updates about their loved one’s care.

LTC jobs offer diverse work-hour options, catering to various lifestyles and preferences.

LTC nursing offers job security in various settings and the opportunity to develop meaningful relationships with patients and their families while delivering care.

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