Latest / Becker’s Healthcare Podcast / Building a Stronger Nursing Workforce and Advancing Equity with Dr. Katie Boston-Leary

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Building a Stronger Nursing Workforce and Advancing Equity with Dr. Katie Boston-Leary · Becker’s Healthcare Podcast

0:00
This is Scott Becker
0:02
with the Beckers HealthCare podcast.
0:05
I'm thrilled today to be joined by a
0:07
brilliant nurse leader.
0:09
We're joined today by doctor Katie Boston Larry.
0:12
And doctor Boston Larry is the senior vice
0:15
president of equity and engagement at the American
0:17
Nurses Association.
0:19
Doctor Boston Leary, could you take a moment
0:22
and introduce yourself and and tell us a
0:24
little bit about your career in the American
0:26
Nurses Association?
0:28
Sure. Thank you, mister Becker, for having me.
0:31
I'm excited to be with you.
0:33
I'm, I'll start with the fact that I'm
0:35
a nurse. I've been a nurse for about
0:37
thirty three years. I
0:39
have had a pretty lengthy career in leadership,
0:42
but most of my career has been in
0:44
practice. And then I started working with the
0:46
American Nurse Association six years ago where I
0:49
crossed over into the policy side.
0:52
So,
0:53
my role is focused on
0:56
efforts to make, the profession more diverse,
1:00
inclusive, and equitable,
1:02
not only for us as nurses, but also
1:05
for
1:06
us to take those considerations
1:08
in how we practice
1:09
in every aspect
1:11
and regardless of what setting you're in as
1:13
a nurse and also in how we carry
1:15
ourselves in society,
1:18
for us to understand the power of nurses
1:20
and how we can reshape,
1:22
the world if we, put our minds to
1:25
it and our our muscle into it. And
1:28
the other part of my work is to
1:29
build a sustainable workforce because,
1:32
nursing has been a pretty unstable
1:35
workforce for years. There's always been this worry
1:38
and cloud over this profession in terms of,
1:41
you know, who will care? How many do
1:43
we have in the arena that will care
1:45
for a growing,
1:47
population that has, clinical and medical needs?
1:51
And,
1:52
my role is to,
1:54
connect the two, but most importantly, to build
1:57
a a viable and strengthened
2:00
workforce that could be sustained over time so
2:02
we could remove this cloud that's been hanging
2:04
over the profession all these decades.
2:08
Thank you. And how do nurse shortages look
2:10
today? Are they getting a little bit better?
2:12
It seems like the nation
2:14
and and the nursing population
2:16
is growing again. Thank goodness. We're graduating more
2:19
nurses. It's like nurse education has improved dramatically
2:22
the last several years, where physician education still
2:25
remains really slow and stuck pre Internet.
2:28
Any thoughts on trends and improvements in nursing
2:32
and the movement of expert
2:34
expertting a little bit nursing education?
2:36
Sure.
2:37
Well, it it's the data shows that, this
2:41
is a great question. The data indicates that,
2:44
we graduate more nurses here in The US
2:46
in almost any country.
2:49
However,
2:50
we have a maldistribution
2:51
issue, which is mostly what we're dealing with.
2:55
We know that, because of the trends that
2:57
we're seeing,
2:58
some nurses and in the past, maybe the
3:01
acute care setting will be the first stop
3:03
for nurses before they branch out. And we're
3:05
finding that nurses are graduating and going into,
3:10
other areas and not going into acute care
3:12
setting spaces, which is where the needs are
3:14
the greatest
3:15
and most dire because that's where the patients
3:18
are the sickest.
3:19
And,
3:20
we also know that from,
3:22
urban to non urban areas,
3:26
from rural to large cities,
3:28
there we have maldistribution.
3:30
And I think what's contributing to it also
3:32
is the fact that,
3:35
we know that,
3:36
a lot of a lot of professions and
3:39
industries see nurses as a
3:41
sure bet type of profession that they would
3:44
like to have even outside of health care.
3:46
So,
3:48
the spaces that nurses can go is widening,
3:50
which we're excited about,
3:52
but it adds to our maldistribution
3:54
issue with,
3:56
nurses not being able to,
3:59
nursing workforce not being as stable as we'd
4:01
like to see it in areas where patients
4:03
are the sickest
4:05
and also with areas that don't have the
4:07
resources that large cities do.
4:10
So that's why a lot of the things
4:11
that are coming out in policymaking,
4:14
with rural focus on rural health, grants that
4:16
are available now, and a number of things
4:19
that are being done,
4:21
in a lot of states and communities to,
4:25
grow nurses,
4:27
and to have more people,
4:30
be interested in the profession is exciting to
4:32
see, and we hope that that would fill
4:34
the void. But, given how long it takes
4:37
to become a nurse in the process,
4:40
it's not a quick fix, unfortunately.
4:42
So we are concerned
4:44
about how, this is impacting care,
4:47
within in terms of delays and also,
4:51
people just deciding to self medicate because,
4:54
that emergency
4:55
room, is too overcrowded, and I don't wanna
4:58
have to wait and things like that. So,
5:01
and that's why we we're continuing to enforce
5:04
at ANA that the nursing shortage issue is
5:06
a public health crisis.
5:08
The public should be interested in in helping
5:11
address this issue as well.
5:12
Could not agree with you more. And your
5:14
point in this is so well taken. We're
5:16
not producing that. The latest numbers I saw
5:18
were 180,000,
5:19
200,000 nurses a year, but the mail distribution
5:22
is is right on. So you you hear
5:25
more and more from nurse leaders or nurses
5:27
saying
5:28
or new nurses saying, I'll work any place,
5:30
but I don't wanna work in the acute
5:31
care setting. And that leads a huge vacuum
5:33
in that area.
5:35
You mentioned rural health care crises,
5:37
and it's very hard to solve because it's
5:39
hard to get people to move to places
5:41
they don't wanna move to if we're oversupplied
5:44
with nurses in the top 50 metro area.
5:45
We're not oversupplied,
5:47
But if we're closer to to the number
5:49
we need in the 50 top metro areas,
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it it
5:52
it it's the same thing with physicians. Getting
5:54
physicians and nurses
5:56
to
5:57
want to live this generation in the rural
5:59
areas is less and less easy to do.
6:02
So it's a really challenging issue, isn't it?
6:04
It is. And,
6:06
we haven't even touched on the specialty gaps
6:08
that we see. Right? There's certain specialties where,
6:11
we have,
6:13
a critical need for nurses,
6:16
with,
6:17
forensic nurses, nurses that do sexual assault,
6:22
SANE nurses that we call them,
6:24
that would do those assessments with patients that
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have been victimized.
6:28
We're seeing a major issue there, and
6:31
thankfully, there are a number of states that
6:33
are doing a number of things to encourage
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and entice,
6:36
nurses to, become certified in that area.
6:41
But until then, which is one of the
6:43
saddest things I heard,
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we have some patients that are, because they
6:48
don't have that specialty ready and available
6:50
in emergency departments. There are some patients that
6:53
after they've gone through
6:55
a traumatic event, they they decide to walk
6:58
away and they don't come back to get
7:00
the proper testing and counseling that they need
7:02
after suffering,
7:04
such
7:05
a, a,
7:06
just an unfathomable
7:08
attack on on on their person.
7:11
Right? And and how that impacts what happens
7:13
down the line with prosecutions and everything else,
7:16
make people feel somewhat whole after an experience
7:19
like that. So,
7:20
we have to look at the specialty gaps
7:22
that we have as well.
7:24
Thank you. And you wrote a brilliant piece
7:27
a couple years ago
7:29
in in
7:30
in on sort of how a chief nurse
7:34
can feel like a an a black NFL
7:36
coach.
7:37
Can you talk about that a little bit?
7:39
I had a chance to read it. Brilliantly
7:41
thought out.
7:42
To take a moment on some of your
7:43
thoughts there on the shortage of sort
7:46
of black nurses in leadership positions still, although
7:49
moving in the right direction.
7:50
But but talk about that and and how
7:52
you did this brilliant analogy to NFL coaches,
7:56
the few black NFL coaches, though I think
7:58
moving in the right direction again there too.
8:01
But but talk a little bit about that,
8:02
if you don't mind. And and I'm a
8:04
fan of, the game, and, we are seeing
8:06
those numbers even worse. And I wrote that
8:08
piece, what, maybe four or five years ago.
8:11
So, so, I was writing from personal experience
8:15
because
8:16
I had a situation where,
8:18
I felt as if I was held to
8:21
a different standard compared to my other c
8:23
suite colleagues,
8:25
as it related to managing my labor pool
8:27
and my resources where I had to go
8:29
through a committee to approve,
8:33
my,
8:34
vacancies,
8:36
which presented a problem because,
8:39
that resulted
8:40
in, delays with,
8:42
filling positions and everything. And you know what
8:45
happens with that? You get a resignation. Your
8:47
nurse can give you two weeks to notice
8:49
to resign,
8:50
And then, by the time this committee meets,
8:53
it's three weeks in, and that nurse is
8:55
gone, and I have a gap. So I
8:57
raised to my colleagues the inequities that I
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felt was was occurring,
9:01
within,
9:03
our group, and and that was what was
9:05
also challenging
9:06
was that a lot of my colleagues were
9:09
members of this committee that was formed. And
9:11
it had me think of that. Okay. Well,
9:13
if we have you all,
9:15
reviewing my review my request to fill positions
9:19
that I'm already budgeted for, who's who's where
9:21
is the committee that's reviewing yours,
9:24
when you have gaps and when you have
9:26
vacancies? So I saw the inequity there, and
9:28
I raised it with one of my colleagues
9:31
that, I feel like I've been treating like
9:33
a treated like a black NFL coach because
9:36
the expectations were so high for me compared
9:39
to some of my colleagues in terms
9:42
of meeting my budget and
9:44
and some of the challenges that I was
9:46
having with personnel and what have you. And
9:48
I just quipped,
9:50
to them after I shared my concern about
9:52
this process and how inequitable it was,
9:56
about how I feel like a a a
9:58
black NFL coach.
10:00
And
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one of my colleagues then raised a concern
10:03
to to HR and said that they felt
10:05
uncomfortable by my statement.
10:08
So that's what caused that stayed with me,
10:10
because
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I said, well, you felt uncomfortable.
10:13
And HR had you know, instead of having
10:17
that discussion with them about the concerns of
10:19
inequity, they came to me and said that
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I'm making my colleagues feel uncomfortable by my
10:24
statement.
10:25
And and that's what just stayed with me
10:27
over the years. It it it just,
10:30
created this sternal rub that I could not
10:31
get rid of that that, again, this is
10:34
another level of inequity because
10:37
you have to question the fact that you
10:38
have a different process for me. And I
10:40
do believe when you are a person of
10:42
color, a nurse,
10:45
female, what have you, and a lot of
10:46
these suites, these C suites in health care
10:48
that are not diverse,
10:50
you don't sometimes you're the only nurse, sometimes
10:53
you're the only female, sometimes you're the only
10:55
person of color,
10:57
it's hard to get your message through. It's
10:59
hard to get,
11:01
things approved. As a matter of fact, I
11:03
remember this. Whenever my budget was askew, which
11:07
it almost always was because of the nature
11:09
of the way things are with nursing,
11:12
with relying on premium labor and everything else.
11:14
It seemed like my voice was dulled.
11:18
I I felt at times
11:20
I was the last person that people wanted
11:22
to hear from, and, of course, I was
11:24
given less opportunities to,
11:27
be involved in other projects outside of nursing
11:30
that I felt that I can contribute to
11:32
from a strategic planning perspective or
11:35
even from a, work from, how we can
11:37
engage a community. Anything outside of nurses, they
11:40
felt that I could not get involved with
11:41
because you need to fix your budget first
11:44
before we get you involved in these other
11:45
things.
11:46
So that's what I was referencing in that
11:48
article, and thank you for reading it.
11:51
No. Thank you. Fantastic. And and you're actually
11:53
right on on your stats. What I saw
11:55
recently or just looked up, three of the
11:57
32 NFL head coaches currently are black.
12:01
That number had got as high as seven
12:03
a couple years ago out of 32. And
12:05
and when you wrote the article, it was
12:07
down to, I think, one. So there was
12:09
some movement in the right direction, now in
12:10
the wrong direction.
12:12
And and so no. Fascinating. And then in
12:14
she in terms of chief nursing officers,
12:17
I think the stat that you had put
12:19
forth at the time was about 10% of
12:21
chief nursing officers were were were black at
12:24
that point. I don't know what the number
12:25
is currently,
12:27
but but fascinating.
12:29
Thank you.
12:30
Take a moment on, you know, who do
12:33
you cheer for in the NFL? No. I
12:34
know doctor Boston. You you could answer your
12:37
who is your favorite team? Do you have
12:38
a favorite team? I do. It's the Commanders.
12:41
I I became a Commanders fan,
12:44
during the Joe Gibbs era before it was
12:45
called the Commanders. And,
12:47
you know, I'll tell you something interesting,
12:50
mister Becker. I
12:52
started watching the NFL,
12:54
games because I felt that I was being
12:56
excluded from conversations.
12:58
The the the small talk that happens before
13:01
meetings on on a Monday morning, I was
13:03
a perioperative leader at the time, and I
13:05
walk into, 06:30 meetings. And,
13:09
the surgeons,
13:10
will all talk about the game from on
13:13
Sunday.
13:14
And they would just continue to talk, and
13:16
I would not be able to engage in
13:17
these conversations, which is a warm up for
13:20
some hard conversations we had to have on
13:22
the back end of that small talk.
13:25
And I felt that I was missing
13:27
I you know, whenever then we'll get into
13:30
the agenda,
13:31
I didn't have the collegiality
13:33
and connection with the people in the room.
13:36
So I I started parking myself at bars
13:38
on Sundays. I was single at the time,
13:41
and that's how I got involved with learning
13:43
about football. And, I became and I watched,
13:46
games that because I was in the DC
13:48
area, and I'm a Commanders fan true and
13:50
true, and I still am.
13:52
Oh, well well, fantastic.
13:53
And and and take a moment on as
13:55
you look at the rest of 2026,
13:58
what are you most focused on and excited
14:00
about?
14:01
Well, for '2 for 2026,
14:03
I'm excited about
14:05
technology and the impact that it can have
14:07
on, nursing. Did a study with McKinsey
14:11
on what nurses feel could be more tech
14:13
enabled to help them
14:15
with their workload so they can spend more
14:18
time with patients, and we heard from them
14:20
about how they'll like to see improvements with
14:22
tech and documentation,
14:24
how tech could also help with,
14:27
hunting and gathering,
14:29
which is searching for people, products, and and
14:33
and,
14:34
person other personnel.
14:36
You know, what about, how technology can also
14:38
help with, the positioning,
14:40
of patients and things like that with the
14:42
beds that we have available?
14:44
So I am excited about,
14:47
technology and the impact that it could have.
14:49
I know that there are a number of
14:51
nurses that are resisting
14:53
AI a little bit, and it's a trust
14:54
issue.
14:55
But I'm seeing some improvements with what AI
14:58
is doing and how it's impacting staffing. And
15:01
I'm working with a couple of folks from
15:02
California that I've just ran into at a
15:05
conference where,
15:07
they're seeing some inroads that AI is having
15:09
in with scheduling and things like that. So
15:12
I'm excited about that because I do think
15:14
that there are a lot more stories yet
15:16
to be told about how nurses are open
15:19
to how,
15:20
AI can impact
15:22
a lot of the administrative workload that they
15:24
carry, which,
15:26
impacts the,
15:27
ability to care,
15:29
the way they would like to and that
15:31
moral
15:33
fatigue that they feel,
15:35
where,
15:36
they just feel that they have not done
15:38
their best because they have not been able
15:40
to care for their patients the way they
15:42
should. So I'm excited about that. I'm excited
15:45
about,
15:47
how nurses are innovating,
15:49
how nurses are entering entering into entrepreneurship
15:52
and and,
15:54
creating their own,
15:55
startups
15:56
as well. That's really exciting because we believe
15:59
that
16:00
when nurses are at the table with creating
16:02
solutions for a lot of things that they
16:03
struggle with,
16:05
that's going to help with addressing a lot
16:08
of the concerns that nurses have had.
16:10
So, those are the queue the the two
16:13
things, and I'll give you a nontechnology
16:15
response. I I'm excited about how there are
16:18
a number of nurses that are continuing to
16:21
focus on diversity, equity, inclusion in spite of
16:25
the
16:26
pushback and the blowback,
16:28
that's occurring,
16:30
from high levels of leadership in this country.
16:32
And there are a number of nurses that
16:34
still feel that this is near and dear
16:36
to a nurse's heart.
16:38
This is who we are. This is part
16:40
of our DNA. This is part of our
16:42
code of ethics. And there are a number
16:44
of nurses that are staying standing planted firm
16:47
in this space because we do believe
16:50
that addressing the inequities that exist in health
16:53
care,
16:54
the way to do that is to address
16:56
the inequities that exist in the profession.
16:59
Thank you very, very much. And and and,
17:01
doctor Bussella, you've had this great career
17:03
great leadership career. Any advice that you would
17:06
give to emerging leaders?
17:08
Yes. The advice that I'll give to emerging
17:10
leaders is that we have to lead differently.
17:13
We're seeing a lot of information now about
17:15
how
17:16
we have moved from the era of,
17:19
the great resignation
17:21
to the era of,
17:23
the great
17:24
detachment, and this is from Gallup.
17:27
And we're seeing,
17:29
how
17:30
between nurses
17:32
and nurse leaders, there's this growing divide. Right?
17:35
We're seeing a lot of,
17:38
collective bargaining activity,
17:40
around the country,
17:42
that is,
17:44
showing and indicating that there is this divide.
17:48
And and how we can bridge that is
17:50
to understand that we have to lead differently
17:52
where
17:53
in the past, when nurses,
17:55
when there was a focus on the paycheck,
17:57
nurses really more care about their purpose. They
17:59
care
18:00
less about employee satisfaction. Help me see how
18:03
you can develop me. They don't want bosses.
18:06
They want coaches.
18:07
It's less about the annual review. Performance review
18:10
is more about the ongoing conversations throughout the
18:13
year. It's less about focusing on their weaknesses.
18:16
This is more about focusing on their strengths
18:18
and building on that. And it's less about
18:20
seeing me as a for all that I
18:22
can contribute to the job, and they want
18:25
people to understand the whole
18:27
the whole,
18:28
aspect of who they are and, you know,
18:30
their entire lives, that holistic approach.
18:33
And I think if we
18:36
understood and I did a TED talk about
18:38
this because it's been it's something that's been
18:40
sitting with me for a while.
18:42
We have to really see how we
18:44
express how we love the people that we
18:47
lead
18:48
in a number of different ways and show
18:50
them that we don't just want them and
18:52
care for them because of what they can
18:54
contribute,
18:55
but we want their whole selves to be
18:57
well, to be fully functioned, to thrive for
18:59
them to be excellent in the roles that
19:01
they carry
19:02
in the places that they work.
19:05
Thank you very, very much.
19:07
Doctor Bustin, Larry, what a remarkable
19:09
leadership career.
19:11
I I wanna thank you for joining us
19:12
today on the Becker's HealthCare podcast.
19:15
You're you're doing the Lord's mission. Thank you
19:17
so much for joining us. Thank you. I
19:19
appreciate it.