10 healthcare execs share predictions for nursing in the next 5 years

https://www.beckershospitalreview.com/nursing/10-healthcare-execs-share-predictions-for-nursing-in-the-next-5-years.html?utm_medium=email

The future of nursing infographic | Cipherhealth

The pandemic put nurses on the front lines of the battle against COVID-19 and caused shifts in the way they provide care.

During this year, nurses have adapted to increased adoption of telehealth and virtual patient monitoring, as well as constantly evolving staffing needs. 

These factors — and others, such as the physical and emotional conditions nurses have faced due to the public health crisis — are sure to affect nursing in the years to come. Here, 10 healthcare executives and leaders share their predictions for nursing in the next five years.

Editor’s note: Responses were edited lightly for length and clarity.

Beverly Bokovitz, DNP, RN. Vice President and Chief Nurse Executive of UC Health (Cincinnati): In the next five years, as we continue to encounter a national nursing shortage, I expect to see additional innovative strategies to complement the care provided at the bedside. 

One of these strategies will be some type of robot-assisted care. From delivery of medications to answering call lights — and completing simple tasks like needing a blanket or requesting that the heat be adjusted — we will see more electronic solutions. These solutions will allow for a better patient experience and help to exceed the expectations of our patients as customers.

Of course, nothing can take the place of skilled and compassionate bedside care, but many tasks could be automated — and will be — to supplement the professional nursing shortage.

Natalia Cineas, DNP, RN. Senior Vice President and Chief Nurse Executive of NYC Health + Hospitals (New York City): Nurses will continue to play a vital role in addressing the health inequities and social determinants of health among vulnerable populations as the nursing workforce itself becomes more diverse and inclusive. As the largest segment of the healthcare workforce — with some 4 million nurses active in the U.S. — nurses represent the faces of the communities in which they serve. As America becomes a more diverse and inclusive society, so too will the nursing profession become more diverse and inclusive. Currently, industry estimates indicate that between one quarter to one-third of all U.S. nurses identify as a member of a minority group, with between 19 percent and 24 percent of U.S. nurses identifying themselves as Black/African-American; 5 percent to 9 percent identifying themselves as Hispanic; and about 3 percent identifying themselves as Asian. The percentage of minority nurses has been rising steadily for the past two decades and is expected to continue to climb in the coming years.

Blacks and underserved minority populations face numerous genetic, environmental, cultural and socioeconomic factors that account for health disparities, and the impact is particularly visible in the areas of cardiovascular disease, diabetes, pregnancy and childbirth mortality, and cancer outcomes, as well as the enormous toll of the current novel coronavirus global pandemic, where communities of color have been among the hardest hit populations. 

In New York City alone, statistics compiled by the city’s health department show Blacks and Hispanics together account for 65 percent of all COVID-19 cases; represented 70 percent of all hospitalizations due to COVID-19; and, sadly, 68 percent of all deaths caused by COVID-19. As demonstrated during this pandemic, in the future, technology such as telehealth and virtual patient monitoring will play a major role in the care of patients. There will be a vast need to address social determinants of health by educating and providing resources to allow utilization of this technology such as using “wearable tech” to monitor ongoing health issues, such as high blood pressure, diabetes, heart conditions and other chronic illnesses.

Ryannon Frederick, MSN, RN. Chief Nursing Officer of Mayo Clinic (Rochester, Minn.): Nursing research will experience extraordinary demand and growth driven by a realization that both complex and unmet patient needs can often be best served by the role of a professional registered nurse. Nurses are uniquely positioned to implement symptom and self-management interventions for patients and their caregivers. Significant disruption in healthcare, including increasing use of technology, will lead to a dramatic shift to understand the role of the RN in improving patient outcomes and implementing interventions using novel approaches. Nursing researchers will provide a scientific body of evidence proving equivalent, if not better, patient care outcomes that can be obtained at a lower cost than traditional models, leading to an even greater demand for the role of the professional nurse in patient care. 

Karen Higdon, DNP, RN, Vice President and Chief Nursing Officer of Baptist Health Louisville (Ky.): The value of nursing has never been more apparent. Nurses have led the front line during this pandemic. In the next five years, we must be flexible and creative in establishing new models of care, specifically around roles that support nursing, such as assistant and tech roles. Creating roles with clear role definition, that are attractive and meaningful for nursing support will help build consistent, high-quality models for nursing to lead. This consistency, along with IT capabilities that enhance workflow, will better allow nurses to work at the top of their scope.

Karen Hill, DNP, RN. COO and Chief Nursing Officer of Baptist Health Lexington (Ky.): 2020 was declared the “Year of the Nurse” and this reality has never been more true than realizing the personal and professional sacrifices of nurses in dealing with issues surrounding the pandemic. The next five years will require nursing professionals to be flexible to address new, unknown emerging issues in all settings, to be open to new opportunities for leadership in hospitals, schools and communities and to use technology and telehealth to provide safer care to patients. Nurses need to evaluate our practices and traditions that are value-added and leave behind the task orientation of the past. We need to honor our legacy and create our path.

Therese Hudson-Jinks, MSN, RN. Chief Nursing Officer and Chief Patient Experience Officer at Tufts Medical Center and Tufts Children’s Hospital (Boston): Over the next five years, I expect that the support and retention of clinical nurses will become the top priority of every CNO and executive team, given nurses’ direct impact on supporting the business of healthcare. This will be particularly critical because there will be a concerning shortage of experienced clinical nurses as a result of advancing technologies increasing complexity in care, additional nurse roles created outside traditional areas, fierce competition for talent between large healthcare systems, aging baby boom workforce retiring at higher rates year over year, and a lack of sufficient numbers of PhD-prepared nurses working in academia and supporting higher enrollments.

I also believe that CNOs will be laser-focused on creating the practice environment that enhances retention of top, talented clinical nurses, and we will put a greater emphasis on the influence of effective nursing leadership in reaching that goal. In addition, I fully expect that nurses will be seen more as individuals with talents and experience than ever before — not just a number on a team, but rather a professional with specific, unique, talents that are highly sought after in competitive markets.

Finally, I anticipate that nursing innovation will blossom, given the exposure of the “innovation/solutionist superpower” within nurses during the pandemic. Philanthropy will grow exponentially in support of nursing innovation as a result.

Carol Koeppel-Olsen, MSN, RN. Vice President of Patient Care Services at Abbott Northwestern Hospital (Minneapolis): During the COVID-19 pandemic nurses have been working in difficult physical and emotional conditions, which may lead to significant turnover after the pandemic resolves. Nurses have a commitment to serving others and will persevere until the crisis is past; however, when conditions improve, many nurses may decide to pursue careers outside acute care settings. A possible turnover, coupled with a service economy that has been devastated, may result in large numbers of former service workers seeking stable jobs in nursing. Hospitals will have to be nimble and creative to onboard an influx of new nurses that are not only new to the profession but new to healthcare. Tactics to onboard these new nurses may include the use of retired RNs as mentors, instructor-model clinical groups in the work setting, job shadowing and aptitude testing to determine the best clinical fit.

Jacalyn Liebowitz, DNP, RN. Senior Vice President and System Chief Nurse Officer of Adventist Health (Roseville, Calif.): Over the next five years, I see nurses providing more hospital-based care in the home using remote technology. Based on that shift, we will see lower-acuity patients move into home-based care, and higher-acuity care in hospitals will increase. With that, hospital beds will be used at a different level. My bold prediction is that we will not need as many beds, but we will need higher acute care in the hospitals.

Nurses will learn differently. As we are seeing now, nurses have not been able to train in the traditional way. They are already using more remote technology to educate, onboard and orient to their roles. It looks and feels vastly different, and nurses need to be comfortable with that.

As for patient care, I think data that can be gleaned from wearable biometrics, and the use of artificial intelligence will help predict patient care on a patient-by-patient basis. Nurses will work with AI as part of their thought process, instead of completely focusing on their own judgment and assessment. 

I also believe we are going to face a nursing shortage post-COVID for a few reasons. Due to the emotional and physical toll of responding to a pandemic, some nurses will decide to retire, and another group will leave based on the risks that go hand-in-hand with the profession. 

As for patient care, we are going to collaborate differently. There will be more video conferencing regarding collaboration around the patient. And I think in the future we will see that the full continuum of care will include a wellness plan.

Debi Pasley, MSN, RN. Senior Vice President Chief Nursing Officer of Christus Health (Irving, Texas): I believe the demand for nurses will become increasingly visible and newsworthy throughout the pandemic. This could drive increases in salaries and numbers of qualified candidates seeking nursing as a profession in the medium and long term. The shortage will, however, continue to be a factor, leading to more remote work options to both supplement nursing at the bedside and substitute for in-person care.

Denise Ray, RN. Chief Nursing Executive of Piedmont Healthcare (Atlanta): Nursing schools will need to focus on emergency management and critical care training utilizing a team nursing model. While nursing has become very specialty-driven, the pandemic has demonstrated gaps in our ability to adapt as quickly utilizing a team model where nurses lead and direct care teams. By implementing a team model and enhancing education in the areas of emergency management and critical care, nursing can adapt quickly to the ever-changing environment.

Also, communication with patients and families will take on different dimensions with wider use of tele-therapeutic communication. Nurses will be leaders and liaisons in the process, connecting physicians, patients and patient families virtually. Nurses will play a key role in integrating patient family members as true patient care partners — making sure they have the information they need to serve an active caregiving role for their family members during and after hospitalization. We’ll also see more nurses becoming advanced nurse practitioners, playing an expanded role in all healthcare settings.

Fauci: The US is still in the first wave of COVID-19

https://finance.yahoo.com/news/fauci-the-us-is-still-in-the-first-wave-160137351.html

The U.S. is well into its third peak of the coronavirus, marking a new record for daily cases at more than 83,000 over the weekend.

The total case count has surpassed 8.6 million and the death toll rose above 225,000. Globally, more than 43 million have been affected with more than 1.1 million dead.

In recent days, some experts and reports have referred to this as a third wave, while others refer to it as either an elongated first wave or a second wave.

Dr. Anthony Fauci, the nation’s top infectious disease expert, settled the debate with Yahoo Finance this Monday at its annual All Markets Summit.

“I look at it more as an elongated — and an exacerbation of — the original first wave,” Fauci said.

He explained that while the Northeast has been able to reduce its outbreak, the national baseline never fell to a more manageable number like 10,000 cases per day. Instead it’s stayed high at about 20,000 cases per day.

In addition, for areas which chose to open up after the initial brief national lockdown, some states did not follow strict guidelines.

“We started to see a peak that brought us up to around 70,000 per day,” Fauci said, adding that, “Now as we’re getting into the cold weather, we came back up again to the worst that we’ve ever had, which was over 80,000 per day.”

We’ve never really had waves in the sense of up and then down to a good baseline. It’s been wavering up and down. So now, we’re at the highest baseline. … [It’s] kind of semantics. You want to call it the third wave or extended first wave. No matter how you look at it, it’s not good news,” he added.

A similar debate ensued in the summer, with many pointing to the surge hitting parts of the country that had yet been unaffected, thereby making it the first wave. Some experts say they are used interchangeably, and others say the differentiation is actually only between the local and national levels.

Dr. Shira Doron, an infectious disease physician at Tufts Medical Center echoed Fauci’s declaration of an elongated first wave.

“Only when looking back at the shape of a curve can you truly call something a peak or wave. It’s also important to mention that the overall U.S. graph looks very different than individual state graphs,” Doron said.

“The U.S. as a whole, however, never declined to low levels after its first peak, which is why some people say we are still in the ‘first wave,’” she said.

“Overall, I think it’s more a matter of semantics than something scientific.”

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Granlund cartoon: Face coverings - Opinion - Daily Review Atlas - Monmouth,  IL

What can Whole Foods tell us about integrating telemedicine?

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

How Whole Foods' Suppliers Are Shifting From Shelves to Screens to Better  Sell on Amazon | Inc.com

A quick stop at the local Whole Foods Market recently yielded surprising insights into the dilemma faced by physician practices in the COVID-era telemedicine boom.

The store location opened just last year, part of a brand-new residential and shopping complex designed for busy professionals. It’s larger than the old-style, pre-Amazon era stores, and was designed to integrate Amazon’s online grocery operations into the bricks-and-mortar retail setting. There’s a portion of the store set aside for Amazon “shoppers” to receive and pack online orders for pickup and delivery, along with an expanded array of convenience-food offerings for the app-powered consumer to scan and purchase.

But when COVID hit, the volume of online orders went through the roof, and the store hired a small army of Amazon shoppers (including one of our own adult children who’s on a “gap year”) to keep up with demand. The result has been barely controlled chaos—easily 70 percent of the shoppers in the aisles last weekend were young Amazon employees “shopping” on behalf of online customers. They’re all held to an Amazon-level productivity standard, which makes the pace of their cart-pushing somewhat frantic and erratic. And the discreet area at the front of the store for managing the Amazon orders has become a noisy hub, making entering and exiting the store problematic. Even the “regular” store employees at Whole Foods have begun to complain about the disruption caused by the Amazon fulfillment operation.
 
It’s a cautionary tale for traditional physician practices and other care delivery organizations looking to “integrate” telemedicine into normal operations. Integration sounds great in theory, but in practice raises important questions:

1) What physical space should be set aside for delivering virtual care?

2) Should telemedicine work be done in a separate, centralized location, or in existing clinic space?

3) How does the staffing of clinics need to change to meet the demand for virtual care?

4) How can we flex staffing up and down based on demand for telemedicine?

5) If new staff are required, how will they be incorporated into the existing team—or should they be managed separately?

6) What operational metrics will they be held accountable for, and what impact will those metrics have on other operational goals? 

If Amazon, a worldwide leader online, renowned for running tight, precision, productivity-driven operations, is having trouble figuring out physical-virtual integration at the front end of their business, imagine how difficult these challenges will be for healthcare providers. The sooner we start to dig into these issues and find sustainable solutions, the better.

An early pardon for overweight turkeys?

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

Thanksgiving's new leftovers: Turkeys too big for farmers to sell - The  Washington Post

Overweight patients infected with COVID-19 have a higher risk of severe disease—but it turns out the pandemic may have brought a reprieve for overweight turkeys. According to a recent Washington Post piece, turkey farmers are facing a glut of, ahem, larger birds, as social distancing and reduced travel are expected to result in fewer people around the Thanksgiving dinner table, and fewer families springing for a 20-pound bird.

Farmers commit to their chicks as early as January, making a bet on the ratio of larger (male) toms versus smaller (female) hens to meet holiday demand, so many were locked into their plans before the pandemic hit. Demand for larger birds has also been hit by fewer orders for piece parts: with fall Renaissance festivals canceled, demand for turkey legs cratered. (Spare a thought for mead brewers as well.) Sadly, these soon-to-be-spared holiday heavyweights are unlikely to spend the winter roaming free—look for a rise in ground turkey supply a few months down the road. 

How to safely celebrate Thanksgiving during the pandemic

Smaller birds for smaller gatherings: just another way our “Pandemic Thanksgiving” will look like none we’ve experienced before.