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Culture Breaks First, with Julie Tuel · The Clinical Realist

0:00
SPEAKER_01: Virtual nursing gets sold to hospital boards as a staffing patch.
0:04
SPEAKER_01: And you're short nurses, and the market's expensive.
0:07
SPEAKER_01: So you put a camera in the room, you put an experienced nurse behind it, and the math on the slide looks like it works.
0:12
SPEAKER_01: But almost nobody in that boardroom asks the question that decides whether it works on the actual unit.
0:18
SPEAKER_01: What does this do to a shift in week three?
0:20
SPEAKER_01: So my guest today has the answer at a scale almost nobody else has.
0:24
SPEAKER_01: Julie Toole is System Vice President of Nursing Care, Transformation, and Clinical Digital Care at Common Spirit Health.
0:30
SPEAKER_01: She's a critical care and stroke nurse by training.
0:32
SPEAKER_01: She spent the last stretch of her career doing the unglamorous part of this work, which is taking virtual integrated care from a concept that presents well to a care model that has survived contact with a real men's search floor in a real market with real nurses who did not necessarily ask for it.
0:48
SPEAKER_01: So that's the conversation I want.
0:49
SPEAKER_01: Not the strategic vision, the first 90 days, the month the workload got heavier before it got lighter, and the line item that CNO did not budget for.
0:57
SPEAKER_01: And the part almost no one will say into a microphone what this technology structurally can't see.
1:02
SPEAKER_01: So, Julie, welcome to the Clinical Realist.
1:04
SPEAKER_00: Good morning.
1:05
SPEAKER_00: Thank you for having me.
1:06
SPEAKER_01: Of course.
1:07
SPEAKER_01: So I want to start where the slide deck ends.
1:10
SPEAKER_01: So walk me through what virtually integrated care actually looks like in the first 90 days at a place like Common Spirit and not just the strategic vision, the daily reality for nurses on the floor.
1:20
SPEAKER_00: Yeah, what's important to know how we do things at Common Spirit Health is we can talk about the first 90 days at Common Spirit Health, but what I'd rather talk about is how we implement it each individual hospital.
1:30
SPEAKER_00: Love it.
1:31
SPEAKER_00: And that is what's led to our success is that we look at each individual hospital, each individual unit as their own unique project, understanding the culture, understanding the needs of the staff, and making sure that they're engaged.
1:45
SPEAKER_00: So the first 90 days, Sarah, as you hinted at in the intro, is really about understanding the culture, making sure that we engage with the staff, engage with the leaders.
1:56
SPEAKER_00: And that's from informal all the way to the formal leaders on the unit level, uh, hospital level, so house supervisors all the way up to the ELT team as well.
2:07
SPEAKER_00: And then also rapid cycle change improvement throughout the project and hearing the challenges that they're experiencing once we implement and rapidly changing those to make sure we meet the need for success.
2:19
SPEAKER_01: I love that.
2:19
SPEAKER_01: So when we think about the change management muscles that are necessary for a hospital system, I mean, this is a huge deal.
2:25
SPEAKER_01: Nursing staff is the majority of staffing essentially in a hospital system.
2:30
SPEAKER_01: How do you really approach it when you have nurse managers, nurse leaders at these various hospitals that maybe didn't want this change, but now they're there.
2:39
SPEAKER_01: How do you take on those conversations?
2:41
SPEAKER_01: Any suggestions for people who are going through it themselves?
2:44
SPEAKER_00: Well, I think what's important to understand is that not everybody accepts change at the same level.
2:49
SPEAKER_00: And as anybody coming in and implementing that change, it's important to understand that you're gonna have your early adopters, you're gonna have your mids, and you're gonna have your lates.
2:57
SPEAKER_00: And it's important that you don't just focus on those early adopters, that you make sure you bring those late adopters along with you along the project because they will get on board.
3:07
SPEAKER_00: Change is scary, it's fearful.
3:10
SPEAKER_00: There are lots of things that have to be worked through and understanding what is driving that fear, what's driving that concern for change is really important too.
3:19
SPEAKER_00: Um, so that's what's really made success for us is making sure that we engage those individuals, like I said, at the bedside all the way up to that ELT level as well.
3:28
SPEAKER_01: So tell me a little bit about virtual nursing.
3:30
SPEAKER_01: I think there's a lot of misconception about what that is.
3:33
SPEAKER_01: You know, there's everything from outpatient, urgent care-esque to virtual discharge.
3:38
SPEAKER_01: Where are you seeing the biggest kind of bang for the common spirit buck when it comes to virtual nursing?
3:43
SPEAKER_00: Yeah, what's set our program apart?
3:45
SPEAKER_00: And um, I do want to give a huge kudos to our chief nursing executive, Kathy's Dr.
3:50
SPEAKER_00: Kathy Sanford.
3:51
SPEAKER_00: She came up with the vision of virtually integrated care back in 2012.
3:57
SPEAKER_00: So I've I've been a nurse at law much longer than that.
4:00
SPEAKER_00: You think about where we were in 2012, that wasn't even in the vision of bringing that to the bedside.
4:07
SPEAKER_00: And that title that she used, virtually integrated care, is so important because that model is what we truly become.
4:15
SPEAKER_00: We become integrated into the care team.
4:18
SPEAKER_00: So we don't just focus on admissions, discharges, and transfers.
4:22
SPEAKER_00: We focus on being part of that care team.
4:24
SPEAKER_00: So, how do we mentor and support at the bedside?
4:27
SPEAKER_00: How do we relieve tasks from the bedside to unburden them?
4:33
SPEAKER_00: There are lots of tasks that we can all relate to that don't require a nurse to be touching a patient, that we can task to that virtual nurse that frees up that bedside nurse to be present with the bet with the patient at the bedside.
4:46
SPEAKER_00: And that's really where we've seen success with our program compared to an ADT model.
4:52
SPEAKER_00: I like that.
4:53
SPEAKER_01: So when we think about the number one complaint from nursing when a new implementation like this happens, if you could choose one thing, what is the thing that they are most frustrated or concerned about?
5:05
SPEAKER_00: Change.
5:06
SPEAKER_00: I think, you know, when we look at nursing in today's world, we are taught to be primary nursing, which means we as nurses, we do everything.
5:16
SPEAKER_00: And for this model to be successful, we have to learn to delegate and delegate those tasks.
5:22
SPEAKER_00: And as a nurse, I can say that's not something, and a critical care nurse especially, that's not something that we're good at doing.
5:27
SPEAKER_00: We want to have that control and have that, have that vision of our patients of what's going on for them.
5:32
SPEAKER_00: And that's not something that we're taught to do.
5:34
SPEAKER_00: And that's something that's taking some work to get through for this model to be successful.
5:39
SPEAKER_01: Now, every implementation I've watched has a valley.
5:42
SPEAKER_01: Now, nobody puts a valley on the slide, but there's a period where the tech kind of makes it shift heavier before it makes it lighter.
5:48
SPEAKER_01: Where do you see that happening?
5:50
SPEAKER_01: And when does the curve tend to change and go back upward?
5:54
SPEAKER_00: Well, what I would say with ours is a little bit different is that we Common Spirit Health has proprietary-owned software, which means we receive feedback from our patients, we receive feedback from our bedside staff members, we receive bed feedback from our virtual care nurses that something is or isn't working with the technology, and we and we can rapid cycle make a change.
6:21
SPEAKER_00: So we're not seeing that peak and valley occurring as much with the technology or letting it's not getting ahead of us, and that adoption is not as much of a challenge because of that proprietary nature of the software.
6:32
SPEAKER_01: That's great.
6:33
SPEAKER_01: You know, when I think about kind of CNO sign off on a VIC rollout, we can budget for the software, we can budget for resources, we can budget for time.
6:42
SPEAKER_01: What's the number that we're not budgeting for that we should be?
6:46
SPEAKER_00: I I think the change management, like we've hit on, the continuous education that is needed for this to be successful.
6:54
SPEAKER_00: And it's and again, it's not just at the bedside, it's how do we elevate everyone to the top of their scope to be successful in this model?
7:01
SPEAKER_00: That's really the piece that is not always budgeted for as we move forward.
7:07
SPEAKER_01: And now you you mentioned before, you know, bedside nursing is a humongous job.
7:13
SPEAKER_01: The idea that bedside nurses should be fully trained and the ability to handle change management is a ridiculous ask.
7:19
SPEAKER_01: Agreed.
7:20
SPEAKER_01: When you think about your nurse managers, your nurse leaders as they move through ranks, how do you think it's best for us to start helping nurses in leadership learn more and have the expertise in change management to make these things successful?
7:33
SPEAKER_00: We really have to focus on their development as well.
7:37
SPEAKER_00: As a healthcare, and this is not just Common Spirit Health, across the board.
7:42
SPEAKER_00: We elevate good clinicians to being leaders without support.
7:49
SPEAKER_00: And then we struggle to under struggle to understand why they can't succeed.
7:53
SPEAKER_00: And it's we've not given them the skills to do so.
7:56
SPEAKER_00: So we really need to hone in on what development, leadership development do they need to succeed?
8:04
SPEAKER_00: They are pivotal at outcomes occurring at the unit level, at the hospital level.
8:10
SPEAKER_00: That nurse manager role is so important to success that we really have to focus on them moving forward.
8:17
SPEAKER_01: I can say this because I am a physician, but doctors are just about the smartest, dumb people you'll ever meet.
8:22
SPEAKER_01: And they're great at providing care, but they're not great at so many other things.
8:28
SPEAKER_01: And I think that probably the same thing's true with nurse.
8:30
SPEAKER_01: You know, you're trained in certain ways.
8:32
SPEAKER_01: And so these are kind of outside of our traditional scope of practice, if you will, in what we're taught in nursing school or medical school.
8:40
SPEAKER_01: There's no curriculum for change management in an ever-changing world like AI is today.
8:46
SPEAKER_01: As a nurse leader yourself at the executive level, how have you found these last two years, as we move into the speed and agility of AI software and things of that sort, that you've had to change in your own kind of change management practice within yourself?
9:02
SPEAKER_00: I'll be honest, I've always been about change.
9:03
SPEAKER_00: So that hasn't been a challenge, but it's been validating the change and understanding the value.
9:12
SPEAKER_00: There's a lot of information coming at, I can say for my especially, a lot of information coming at me of we should try this, we should try this, what about this new technology or this technology?
9:23
SPEAKER_00: But it's really important to get to the real value and the real facts of the uh resources and the validity of what's being presented.
9:33
SPEAKER_00: So is it, is there good ROI?
9:36
SPEAKER_00: I don't know.
9:37
SPEAKER_00: Takes research.
9:39
SPEAKER_00: Exactly.
9:39
SPEAKER_00: Is there, uh is it going to be a value or is it gonna be a more burden to the to the clinicians?
9:43
SPEAKER_00: I don't know.
9:44
SPEAKER_00: It takes the research.
9:45
SPEAKER_00: So for me personally, it's been a lot of research and a lot of spending a lot of time navigating those changes.
9:52
SPEAKER_01: That's a great point because I think a lot of folks have a problem and they automagically think, oh, well, technology is a solution.
9:59
SPEAKER_01: But you know, when we think about what the technology sees and what it misses, you know, virtually integrated nursing creates invisibility that a nurse just walking down the corridor might not have.
10:09
SPEAKER_01: So what is it servicing in practice?
10:12
SPEAKER_01: And what do you think is actually structurally missing?
10:15
SPEAKER_00: So servicing, like you touched about, we have the ability to, and we've seen, we have the ability to take a lot of very seasoned nurses who are ready to leave the career.
10:26
SPEAKER_00: And we don't want to lose them.
10:28
SPEAKER_00: We don't want to lose their knowledge, we don't lose their skill set.
10:30
SPEAKER_00: And a lot of them have transitioned to being virtual nurses so they stay at the bedside and are more of a mentor and support, which in turn provides that support to the novice nurses at the bedside or those that need more support.
10:43
SPEAKER_00: Additionally, that additional knowledge allows us to really see from a quality perspective, from an outcome perspective, see that more global picture and help drive up more outcomes from that perspective.
10:55
SPEAKER_00: What are we missing?
10:57
SPEAKER_00: You know, when you're a virtual nurse, it takes a lot of communication from the bedside.
11:01
SPEAKER_00: And that is the huge piece of that.
11:03
SPEAKER_00: I wouldn't say we're missing anything.
11:04
SPEAKER_00: That is just a pivotal point for success moving forward in a program like this.
11:09
SPEAKER_01: Of course.
11:10
SPEAKER_01: So when you think about scaling a care model across a footprint of that size, what do you find kind of breaks first in standardization?
11:16
SPEAKER_01: Is it the tech, the workflow, the culture, the people?
11:19
SPEAKER_01: What do you find is kind of that breaking point that will pop up first?
11:24
SPEAKER_00: The culture.
11:26
SPEAKER_00: Um, and again, it's really that's why we have changed the approach of we really have to be very focused and understand what is going on at that unit level, what's going on at that hospital level to support that in a very unique way.
11:39
SPEAKER_00: I think sometimes as leaders, what we want to do is we want to create a standard and just spread that out across.
11:44
SPEAKER_00: And that doesn't, it doesn't sustain.
11:47
SPEAKER_00: It may work in a short period of time, but it will not sustain because you've you've missed the mark as a leader in understanding what are those gaps that are occurring at those individual levels.
11:56
SPEAKER_01: Well, let's talk about that localization.
11:58
SPEAKER_01: You know, we think about economies of scale, especially from a standard standardization perspective.
12:02
SPEAKER_01: The more we have standard, the easier it is for reporting or data, et cetera.
12:06
SPEAKER_01: But where are you seeing this localization really important?
12:09
SPEAKER_01: Is there a market that does it differently?
12:11
SPEAKER_01: And where have you said yes, please do that differently?
12:14
SPEAKER_01: And where have you said actually no, stick to the standard?
12:18
SPEAKER_00: So I would say we have virtual nursing standards.
12:21
SPEAKER_00: I want to clarify that.
12:22
SPEAKER_00: We have virtual nursing standards that we follow across the program.
12:25
SPEAKER_00: Where we really want to understand is what are they quality-wise, certain quality metrics, certain outcome metrics that they may be struggling with, or turnover metrics, uh, recruiting metrics are they struggling with?
12:38
SPEAKER_00: That's really what we want to understand from a cultural perspective to help them build into.
12:42
SPEAKER_00: So, for example, is there a certain region who is struggling with recruiting CNAs?
12:49
SPEAKER_00: Yes.
12:50
SPEAKER_00: So helping them focus on how we can understand that gap and build into that recruiting technique.
12:57
SPEAKER_00: Where another one may be more struggling with recruiting LVNs into the model.
13:02
SPEAKER_00: Well, then how do we help with that piece?
13:05
SPEAKER_00: Makes sense.
13:06
SPEAKER_01: I think it's interesting, you know, when we think about the outcomes, you know, we have this thought process.
13:12
SPEAKER_01: Okay, there's a category of harm that VIC is designed to prevent our outcomes data, our kind of dashboards, everything.
13:20
SPEAKER_01: What's your read on the real outcomes data?
13:23
SPEAKER_01: Not the conference version or the marking version, but how are you really seeing it these days?
13:28
SPEAKER_01: Are you seeing the impact that you're hoping for?
13:31
SPEAKER_00: We are.
13:32
SPEAKER_00: And what I will say is that we have an amazing team on our virtually integrated care team of performance excellence managers and system leaders that we align with our national leaders with Common Spirit Health, our regional leaders, our market and local leaders to make sure that our outcomes match what they are working on.
13:51
SPEAKER_00: So we do pre-implementation data before we even enter a site.
13:56
SPEAKER_00: So we know what outcomes have they seen.
13:58
SPEAKER_00: So we have baseline.
13:59
SPEAKER_00: And then we measure those outcome data points every single month.
14:03
SPEAKER_00: And then we adjust based upon those outcomes.
14:07
SPEAKER_00: So yes, we are seeing what we are expecting to see.
14:10
SPEAKER_00: But again, it's understanding that culture for each site of what are they struggling with, those outcomes, and making pivotal changes every month to help them meet their goals.
14:20
SPEAKER_01: So when you think about falls or pressure injury, failure to rescue, what do you think's moved first for common spirit?
14:26
SPEAKER_00: Um, our biggest decrease that I do you want to talk about quality or you want to talk about operations?
14:32
SPEAKER_00: I mean, we've had a lot.
14:33
SPEAKER_01: Either way, because I think that there's a lot of positive outcomes and ops and a lot of positive quality operate like outcomes as well.
14:40
SPEAKER_01: And so people measure those differently, but what have you found has been the biggest impact as this?
14:46
SPEAKER_00: Yeah.
14:46
SPEAKER_00: So for us, our we've seen a 43% reduction in first year RN turnover.
14:52
SPEAKER_00: Now, what I want to say is that is not all related to us.
14:58
SPEAKER_00: It takes a team here at Common Spirit Health to do that.
15:00
SPEAKER_00: So it takes a residency program, it takes the local leaders, it takes a national leader, it's not just all virtually integrated care.
15:06
SPEAKER_00: What we have measured is that.
15:08
SPEAKER_00: So that's huge.
15:09
SPEAKER_00: If you think about that, if we're able to retain those nurses, hopefully that means that trajectory can spread.
15:15
SPEAKER_00: We retain that knowledge, which then in turn should mean we have better outcomes for our patients because that knowledge has maintained at Common Spirit Health.
15:25
SPEAKER_00: Amazing.
15:26
SPEAKER_00: So addiction, sorry, go ahead.
15:28
SPEAKER_00: Oh no, go ahead.
15:29
SPEAKER_00: Additionally, if we want to look at our quality outcomes, we've seen a 37% reduction in CADES and Clapsis across our uh program as well.
15:38
SPEAKER_00: And then as far as patient experience, we've also seen a 20% increase in nursing communication in uh HCAPs.
15:47
SPEAKER_00: Those are some great outcomes.
15:48
SPEAKER_00: Yeah.
15:49
SPEAKER_01: When we think about kind of measuring these things, you know, it's hard to manage what you don't measure.
15:55
SPEAKER_01: And one of the things I see hospital systems do consistently poorly is measuring the wrong things.
16:02
SPEAKER_01: So when you considered the metrics that you're actually measuring and how you're going to manage those, let's talk about the industry at large, not just common spirit, but where do you think the industry is measuring really well?
16:15
SPEAKER_01: And where do you think they're just they're measuring the wrong things they're measuring poorly?
16:19
SPEAKER_00: Hmm.
16:20
SPEAKER_01: So as an example, like HCAP scores, some of the quality measures they're required from a regulatory perspective, there's very specific equations we have to use to measure those.
16:29
SPEAKER_01: So it's really hard to argue with it.
16:31
SPEAKER_01: But there's other pieces like nurse satisfaction or patient satisfaction, things like that that are a little squishier.
16:38
SPEAKER_01: And we use them as part of our outcomes.
16:40
SPEAKER_01: But at the same time, sometimes the way we measure them isn't actually a very good way to do it.
16:46
SPEAKER_01: Are you fine that there's things that are just hard to measure?
16:49
SPEAKER_00: I don't know that I would say they're hard to measure.
16:52
SPEAKER_00: I think it's just understanding how they're measured.
16:56
SPEAKER_00: My approach always has been if I can't change it, how it's measured, it's okay.
17:02
SPEAKER_00: Let's just understand the out of how it's measured and then let's work around it.
17:06
SPEAKER_00: Right or wrong.
17:08
SPEAKER_00: So, for example, we're getting ready to roll out critical care, Vic critical care in the next week.
17:16
SPEAKER_00: Those outcomes are gonna be very different than what we measure in acute care, obviously.
17:21
SPEAKER_00: Do we want to look at patient satisfaction?
17:23
SPEAKER_00: Yes.
17:24
SPEAKER_00: But would that be appropriate in this model?
17:27
SPEAKER_00: Not likely.
17:28
SPEAKER_00: Because what do we know about age caps?
17:30
SPEAKER_00: Those are measured on patient discharge.
17:33
SPEAKER_00: Most patients are not discharged from the ICU.
17:36
SPEAKER_00: Length of stay is another one.
17:37
SPEAKER_00: Would we like to measure length total length of stay?
17:40
SPEAKER_00: Yes.
17:40
SPEAKER_00: We do for our VIC programs, don't be wrong.
17:43
SPEAKER_00: But for critical care, yes, we would like to measure that.
17:45
SPEAKER_00: But we're gonna have to look at that a little bit differently because again, length of stay doesn't stop when the patient leaves the ICU.
17:53
SPEAKER_00: So it's understanding my approach has always been let's understand the definition and if that works for us, let's make it work.
18:00
SPEAKER_00: If not, let's find a different way to measure it.
18:02
SPEAKER_00: Or let's not use it.
18:03
SPEAKER_00: Perfect.
18:04
SPEAKER_01: That's a great way to do it.
18:05
SPEAKER_01: So the last section, and this is part of the interesting things that I'm thinking about these days, is you know, if a health system layer calls you and says, you know, should we do VIC?
18:16
SPEAKER_01: What would you tell them?
18:17
SPEAKER_01: And what would you say to them that is maybe the pros or the cons?
18:22
SPEAKER_00: I would say absolutely do it.
18:23
SPEAKER_00: Unfortunately, the nursing shortage is projected to continue to worsen.
18:30
SPEAKER_00: And that really is just so sad.
18:31
SPEAKER_00: And we know as the population ages, we're gonna need more healthcare and we're gonna need more healthcare workers.
18:38
SPEAKER_00: So we need more nurses.
18:40
SPEAKER_00: I mean, there's lots of things we can do without, but we need more nurses no matter what.
18:43
SPEAKER_00: We do.
18:43
SPEAKER_00: And as a leader, we need to look at alternative ways to take care of patients.
18:48
SPEAKER_00: And this is a amazing way to do so by not only mentoring nurses by having an expert behind the camera, but unburdening them.
18:58
SPEAKER_00: So hopefully they will maintain in the career field and we will not continue to see an evolution of people leaving the field, which is what we're seeing right now.
19:07
SPEAKER_00: Absolutely.
19:08
SPEAKER_00: So I would say yes from that perspective.
19:09
SPEAKER_00: Oh, go ahead.
19:10
SPEAKER_01: I apologize for stepping in there.
19:13
SPEAKER_01: So when we think about VIC, where do you think the industry is kind of blowing out of proportion in a positive way?
19:21
SPEAKER_01: And where do you think it's being undersold?
19:23
SPEAKER_01: Because I think there's a lot of hype, but also a lot of fear when we think about these things.
19:28
SPEAKER_01: Do you think that any of those pieces are maybe kind of ridiculous when it hits a headline and you're like, no, no, no, that's not how this really is.
19:38
SPEAKER_00: You know, when I read some of the headlines, I think again, I'm gonna come back to this.
19:42
SPEAKER_00: It's important to understand where is the data coming from and is it valid?
19:47
SPEAKER_01: I mean, drop the mic.
19:48
SPEAKER_01: I think we're good there, right?
19:49
SPEAKER_01: So if we're thinking about five years out, I mean, it's 2026.
19:54
SPEAKER_01: Thinking five years ahead sounds crazy right now.
19:56
SPEAKER_01: I can barely think six months in advance at this point.
19:59
SPEAKER_01: Yeah.
19:59
SPEAKER_01: But what do you think nursing is gonna look like inside a system that got the IC right versus one that treated it as kind of a cosplay?
20:07
SPEAKER_01: Six months, 12 months, a couple years out.
20:10
SPEAKER_00: Yeah, for those that get it right, we see retained nurses who are experienced, who are happy.
20:17
SPEAKER_00: That is the ultimate goal.
20:18
SPEAKER_00: They're happy, they are content, they are not feeling burnout, and they're not feeling burdened.
20:23
SPEAKER_00: The patients are receiving excellent nursing care.
20:26
SPEAKER_00: And common spirit health is the place people want to work as nurses, and patients want to come for nursing care, those units.
20:36
SPEAKER_01: And as we think about a couple years out, the systems that got VIC right, like Common Spirit, like you mentioned, better retention, happier nurses, people staying in the field.
20:46
SPEAKER_01: What about the folks that are only treating it as a cosplay?
20:49
SPEAKER_00: Yeah, cosplay.
20:51
SPEAKER_00: I I can't stress enough, it is essential that we have to unburden the bedside.
20:57
SPEAKER_00: Workflows have to be built around what is working for them and what isn't working for them and understanding their needs.
21:03
SPEAKER_00: If it's just another layer on top of what they're doing or requires more work for what they need to do, it's not been successful in my eyes.
21:13
SPEAKER_00: And it's not probably going to be successful in their eyes because it's an extra set of burden for them.
21:17
SPEAKER_01: When we think about keeping folks in the profession, I see all those senior nurses staying in the field for a lot longer.
21:25
SPEAKER_01: Um, and I think that's wonderful to keep all that knowledge there.
21:28
SPEAKER_01: When we think about recruiting people into nursing in the first place, into, you know, nursing programs, et cetera, the idea of virtual integrated care, how do you think that impacts new nurse students in how they might get into the field or not?
21:43
SPEAKER_01: Is this something that's attractive or is it something that seems, you know, something they can do when they're farther along in their career?
21:51
SPEAKER_00: As working on that unit as a bedside nurse or as a virtual nurse?
21:55
SPEAKER_00: Just both.
21:56
SPEAKER_01: I mean, it's something they can, it's part of nursing now.
21:59
SPEAKER_01: And so It can be part of their profession.
22:01
SPEAKER_01: How do you think new grads are thinking about it?
22:04
SPEAKER_00: Yeah.
22:04
SPEAKER_00: So in collaboration with the national uh nursing education team at Common Spirit Health, one of my um program managers for professional practice has put together a beautiful program to provide an out rotation for nursing students across the country.
22:24
SPEAKER_00: And really the goal of that, um, and they actually had an opportunity to present this at a conference and they're working on a manuscript right now to share our results out, um, hopefully in a research platform.
22:37
SPEAKER_00: The goal of that, and continues to be, it's continuous, is that they can view those nursing students can view what does this new model look like and how can this benefit them.
22:47
SPEAKER_00: Secondly, then they can see I want to come work at this organization because this will be a place that can help me succeed as a nurse and not feel like I have to carry all of this, what I'm gonna call burden as a new nurse.
23:00
SPEAKER_00: So I think it's huge from that perspective.
23:03
SPEAKER_01: Yeah.
23:03
SPEAKER_00: As a new nurse, you leave nursing school and it's it's a lot.
23:08
SPEAKER_00: You're and it's just like med school, you're only taught so much.
23:10
SPEAKER_00: Most of your learning occurs the first couple of years out of nursing school and continues to occur occur.
23:16
SPEAKER_00: We need to be able to provide a platform for that to occur because as you have more novice nurses in the field, you have novice teaching novice teaching novice.
23:26
SPEAKER_00: That's another factor of why this unfortunate churn of nursing is occurring.
23:31
SPEAKER_00: So, another reason why virtually integrated care can be successful with this as well.
23:36
SPEAKER_00: As far as people working as virtual nurses, we our requirement is they have to have five years of nursing experience.
23:44
SPEAKER_00: Again, we want to make sure that they are experts behind that camera.
23:47
SPEAKER_00: So it is something they can absolutely work towards as they project through their nursing career.
23:53
SPEAKER_01: Well, wonderful.
23:54
SPEAKER_01: So the last thing I want to ask you, Julie, is really about what is the one thing you would suggest to nurse leaders going through such change management?
24:04
SPEAKER_01: I think that what I heard from our discussion today, you mentioned we need to decrease the burn at the bedside.
24:10
SPEAKER_01: No matter what.
24:12
SPEAKER_01: What else would you suggest is really important for nurse leaders like yourself all around the country to think about as they're making these changes?
24:19
SPEAKER_00: Yeah, I unburden the bedside.
24:21
SPEAKER_00: But what I cannot stress enough is shared governance and staff involvement and engagement from the beginning all the way through sustainment is essential to success to the project, to success as a leader, to success of buy-in and engagement of those staff.
24:42
SPEAKER_00: So that would be my guidance and wisdom.
24:46
SPEAKER_00: Please make sure you bring those individuals along.
24:48
SPEAKER_00: And again, like I said earlier in the podcast, don't bring just your early adopters.
24:53
SPEAKER_00: Make sure those late adopters are brought in as well.
24:56
SPEAKER_01: Thank you, Julie.
24:58
SPEAKER_01: This is exactly the conversation I was hoping for.
25:00
SPEAKER_01: Again, not the version that fits on a really nice conference live, the version up here system could actually repeat.
25:05
SPEAKER_01: So thank you for your time and for being really specific in a category where most people stay very general.
25:09
SPEAKER_01: So before we go, tell the people where to find you and where to follow Common Spirits work on this.
25:14
SPEAKER_00: Yeah, so I am available on LinkedIn under my name, Julie Tool.
25:20
SPEAKER_00: Also, we uh virtually integrated care is available on uh commonspirithealth.org as well for further information.
25:29
SPEAKER_01: Thank you.
25:29
SPEAKER_01: So for everyone listening, if you're evaluating virtually integrated care right now, go back, listen to the answer on what a CNO does not budget for, put that in there.
25:37
SPEAKER_01: Remember to unburden the nurse at the bedside.
25:39
SPEAKER_01: And this whole episode, go back and listen to it.
25:42
SPEAKER_01: If you enjoyed it, subscribe to the clinical realist wherever you get your podcasts.
25:45
SPEAKER_01: I'm Dr.
25:46
SPEAKER_01: Sarah Matt, and this is a clinical realist.
25:47
SPEAKER_01: See you next time.