By Rose Hoban
We’re in the middle of National Nurses Week (May 6-12), which this year has the theme of The Power of Nurses.
The American Nurses Association says that it’s an occasion to focus on the contributions of nurses, but in North Carolina, those contributions could soon be harder to come by. Research shows that the state could face a shortage of as many as 21,000 nurses by 2033.
NC Health News Editor Rose Hoban, a registered nurse since 1992, spoke to Duke Health Chief Nurse Executive Terry McDonnell several weeks ago, just after the system’s third Nursing Innovation Summit. McDonnell leads the 12,000 nursing and patient care services staffers at Duke, and she talked about how it’s important to empower them to bring all of their creativity to the table.
This Q&A has been edited for length and clarity.
Hoban: What do you do for the Innovation Summit?
Terry McDonnell: We put out a call for volunteers, for people to come forward with innovations, things that they want to brainstorm about. We do a half day hackathon. We have them do three-minute pitches, and our judges judge based on the pitches. And then we decide what projects we’re going to move forward with.
Things that have come out of the two previous Innovation Summits are projects like one group that pitched virtual reality training for de-escalating workplace violence situations. You know, when a new nurse goes into a situation where a patient, because of medication or because of their underlying physical condition, becomes combative. Maybe there’s a bad outcome, or maybe a family member is upset. We don’t train people on how to deal with those situations.
This group of nurses pitched it, it was funded, and we created a virtual reality training system so nurses could be trained on how to de-escalate those situations before they ever hit a real-life situation. It’s really cool, because we have a partnership with the School of Engineering.
This year, we had 50 participants, and we picked the top three projects. But at the end of the day, all the projects were deemed worthy to move forward.
For Nurses Week, we’re going to launch an “empowerment through innovations” campaign where we’re going to do a call to action. A nurse on a floor decides that moving the linen cart 50 feet is going to make an impact, decrease the time to changing the room over and decrease the steps. That’s lowering the burden, the physical burden on the nursing staff. Well, okay, let’s do it. That’s a “no regrets.” We don’t have to go through committees.
It’s empowering.
Hoban: What was one of those top three?
McDonnell: We talk about blood infections from central lines a lot. This particular Innovation Summit, we wanted people to come together with ideas around reducing harms, because we want to get to zero harms in our health system.
For bloodstream infections, this team of nurses came up with a concept of blue light (Ultraviolet C) technology in a clave connector that connects to the central line. So with that blue light technology, it would kill viruses or bacteria that could potentially be traveling up into that central line. Again, we had the school of engineering, we had our chief nurse innovation officer, and we’re going to move forward with the concept.
Hoban: This is not our mother’s nursing, right? I went to nursing school in 1991, and it was six months before they let us put our hands on an IV bag! Now it’s so high-tech. Does the public’s view of nurses reflect the changes that have happened in nursing?
McDonnell: Not yet. And my hope, my wish, my dream, is that the nurse of 2025, and 2030, and 2035 and beyond is no longer seen as that image of Florence Nightingale. That the nurse today, and in the future, is seen as somebody who provides exemplary, safe care; meets the patient and family where they are, where they need to be; is using all of their skills and all of the technology and the innovations that are available to us — to improve outcomes, to improve care, to improve the patient experience, to reduce burden of the collective team.
In 2025 we’re all members of an integrative team that’s delivering care. It’s the physician, it’s the advanced practice clinician, it’s the nurse, it’s the nursing assistant, it’s the pharmacist — all coming around the patient. Now the nurse tends to be that thread of continuity, because we spend the most time at the bedside, but we should also be the ones that are able to pull it all together and lead the way.
Hoban: What policy changes are necessary to make that dream come about?
McDonnell: I don’t see in the current state that there’s any policy that needs to be changed. I think it’s a mindset, and it’s about how we really unlock the mindset and the thinking that people can make improvements in real time, within the scope of practice.
As long as there’s been nurses, nurses have always been the great work-around artists. They figure things out.
Hoban: Nurses as the great MacGyvers…
McDonnell: Ha! Yes. We don’t need to change policy for that.
Hoban: There are estimates from the Sheps Center for Health Policy Research at UNC that we might end up with a shortage of something like as many as 21,000 nurses — just in North Carolina — by 2030. How do we address this?
McDonnell: One is with pipeline. We’re extraordinarily fortunate here at Duke. We’ve got the School of Nursing, but we also have the Watts College of Nursing that is part of Duke Health. And this summer, we’re bringing Watts to be co-located here on the campus with the Graduate School of Nursing and our own health system educators. So we’ll be able to do some really creative things around transition to practice and making sure that, you know, our nurses who are entering the workforce as new graduates are competent and confident.
We’ve been seeing over the past five [years], we’ve been losing a lot of nurses in that first three-year time frame because we’ve been pumping out so many new graduates, and I’m not sure that we’ve necessarily been giving them all the tools they need to feel competent and confident when they hit the floor. One way to reduce turnover is by making sure that they’re really well trained by the time they’re coming off orientation.
Another way is by decreasing the burden, by integrating technology and other members into that care team.
Hoban: What’s incumbent on the state’s schools of nursing to drive this turnaround, to get more nurses out to the bedside and to keep them there?
McDonnell: We actually need more faculty. There’s … there’s a lot of demand, and we’re actually turning a lot of potential nurses away. And part of that is with funding for people to become nurse educators. We’ve got a lot of faculty who are on that cusp of retirement.
Hoban: These are things that just keep recurring, like faculty shortages. I’ve also heard for years that nurses don’t support the new grads. That’s going to require culture change. How do you drive that culture change and empower nurses?
McDonnell: It’s by making sure that people feel like they have a voice. We take away that stigma of questioning. We want to encourage people to question things and question convention: “Can we do it differently?” And that is what then turns the culture.
There are other narratives out there in the ether where there’s the nurse bot who’s going to take all of our jobs. Well, that’s not going to happen. We need to own technology and embrace technology and figure out how we’re going to integrate it to create those new models of care.
Hoban: Can you be a little more specific?
McDonnell: To be in that space where we’re boldly innovating, and we’re embracing the change and embracing the technology and leading and creating those models of care. How are we going to integrate virtual care?
When we started to implement the early models of virtual nursing, there was pushback, you know: “I’m busy… I’m going to have somebody on an iPad, or on the video screen, helping me with my admission?” And over time, we found the value in that.
[There’s] a segment of the workforce who physically have not really been wanting to continue with the physical load of bedside care. And phenomenally talented nurses who don’t necessarily want to leave the workforce … can go to virtual care. Or people who need to be on limited duty. They can use those talents in the virtual setting as coaches, guides, support for our floor nurses, but they also get to spend extra time with the patient, do a little bit of extra education.
They’re giving focused time to the patient, creating better education, better discharges, reduced ED visits after discharge. It’s a cycle that feeds improvement, but we needed to open ourselves up to the possibility of, “Okay, maybe it’s all right to have this other member of the care team now that’s not in the room with me.”
Hoban: Are you deploying something like that now?
McDonnell: It is now across the Duke system.
Hoban: Nursing can be exceedingly physical. This could be a way for older nurses to participate, right?
McDonnell: It’s all how we integrate it, and what it looks like on one unit may not look the same as another unit.
Hoban: We’re five years past the start of the pandemic. What effect did the pandemic have on nursing?
McDonnell: The impacts were profound. You know, at the beginning of the pandemic, we were all mobilizing to fight, and it was that hero narrative. And then the realities of COVID and the duration and the impact to us as humans — it all set in.
It was hard work. It took an emotional toll. It took a physical toll on a lot of people.
Then we had the Great Resignation, and there was a time point in there where nursing actually slipped out of that number one spot (of most trusted professions), because there was all of this disruption. Now I think we’re coming out of that, and there’s tremendous opportunity, and we can’t let all of the potential in front of us go without really embracing it and leading forward.
Ambient technology, you know, taking the burden out of documentation, it’s still in its early phases. We’re piloting, still trying to figure all of that out.
That technology — used right — can actually put that nurse in a position where they’re not writing all of the data down and then feeding it to the computer, they’re actually having a real-time conversation with a patient: “I see your pain today after your oxycodone is a two out of 10. Last night it was a seven out of 10. Let’s talk about how you’re feeling now.”
That technology is picking all of that up and then putting it to the flowsheet. We’re using technology to actually remove that computer screen between us and the patient.
Hoban: Do you have microphones on people? How is that working?
McDonnell: Right now, it’s iPhone technology, but what we’re looking at is creating innovation units that will have video, audio capability built into the hospital room of the future.
Hoban: What do you think frontline nurses would like to see from their leaders?
McDonnell: What our nurses expect from their operational leaders here is to have a voice, is for us to understand the issues that they’re experiencing, and for us to be engaged in and working with them on improvement.
I think what staff nurses expect at the legislative level is to make sure that they have a safe workplace, that their organizations have the tools that they need to make sure that they can be successful in delivering safe patient care.
Hoban: What can we do to allow nurses to feel more empowered to represent themselves in the media and in popular culture? For example, I’ve watched a couple episodes of The Pitt. And my critique of The Pitt is similar to my critique of the old show ER — namely, that the doctors are too interesting and the nurses are bit players.
McDonnell: Yep!
Hoban: Why does that image persist?
McDonnell: I don’t know. It’s funny. My husband actually is in nursing school. He’s decided to make a career change. He’s had a full career in technology, and now he’s changing. We watched the first episode and walked away. Yet my daughter, the pediatric resident, is all in and loves it.
Why don’t we see more nurses having conversations in the media that aren’t necessarily centered around the controversy of the day or the emergency of the day, but about how do we lead? How do we innovate? How do we create? We need to really start to fill that space, and then I think we’ll see the paradigm change. We need to be more interesting in all the good ways.
Hoban: How is it that nurses are always pigeonholed into being these background characters?
McDonnell: We need to change that narrative. Let’s look forward. Let’s look to the future. Let’s not repeat that cycle we saw in the pandemic. There’s always going to be change, there’s always going to be challenges. We can lead. We can be creative. We can figure a way forward, and we have to, right? And that’s why we’re doing this empowerment through innovations campaign.
The post ‘We can lead.’ Duke Health’s Nursing head emphasizes innovation appeared first on North Carolina Health News.
