All About Nursing (35)

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Welcome to All About Nursing with your host, Dr. Joyce Bachelor. Executive nurse advisor, Dr. Bachelor, will present a significant role in nurses play in providing health care in a multitude of health care settings.

Listen to some of today's key nurses who work in practice in academia settings and talk about the challenges they face in today's modern medical world. Welcome to the host of All About Nursing, Dr. Joyce Bachelor. Good evening.

I'm your host, Dr. Joyce Bachelor on All About Nursing and rely on the BBM Global Network and tuning radio. And this evening, I'm going to be the host on the show and giving you some updates about some of the changes and challenges that are happening in health care. As you may know, if you've listened to prior shows, I started their radio show in an attempt to really educate the public as a whole about what nurses do, the various places nurses work, the kind of specialization we're involved with, as well as the kind of work that they're leading as a way to really help improve the health care for all.

So I would really encourage, because I've had some really amazing experts on prior shows that I'm going to talk about some of them today as I go through some of this content. And you may want to go back and listen to them to hear more in-depth information on some of these topics. Just as a bit of an introduction, in case you don't know my background, I served as a CNO for a multi-hospital system at the system level in central Texas for about 19 and a half years. Most of my background clinically, as well as administrative, has been more on the critical care, cardiac, acute care side, emergency departments, I've managed transplant programs and a variety of different kinds of settings.

I currently serve as an executive nurse advisor. I do a lot of executive coaching. I also created a Chief Nursing Officer Academy that's been very valuable and very rewarding to really have. It's to really help both new and aspiring to be Chief Nursing Officers, learn how to be effective in such a key nursing executive role.

I also teach in the Doctor of Nursing Practice program at Texas Tech University Health Sciences Center in Lubbock. And I serve on a variety of different committees at the local state and national, and I'll tell you a little bit more about that as I talk with you this evening. So I kind of termed this on the horizon, just to kind of let everybody know some of the changes that are happening currently, and then what else is being looked at now to really help prepare for the changes and the kind of things that we need to make a difference on as we go forward into 2020 and beyond. So I think most of you all would agree that healthcare is certainly on the radar is because of the unprecedented focus, the having to take out costs of organizations and healthcare just being so expensive, major employers are really concerned about this.

And I think consumers are as co-pays and deductibles are increasing and being shifted to all of us because organizations can't really take on all that added expense. So organizations are very much focused on how to decrease costs while making sure that we maintain quality. And I think the another area that organizations are focused on, and I think you heard this when I had Dr. Aaron Perez on one of my shows discussing advanced care planning, 50% of healthcare spending is on 5% of the population, and a lot of that ends up in that last year of life.

And many times it's because families have not had the kinds of conversations they need to do around advanced care planning and what their loved one would or would not want done if they ended up in a less than functional state. And so I think that there's also a lot of focus on the chronic diseases that we're trying to manage. It used to be people came into the hospital with one chronic problem like diabetes. And now I mean today people come in and they have multiple comorbidities.

They have high blood pressure and they have renal disease and they're coming in because they started having headaches. And so they're now being worked up for something in their neurological system. So it really has made care a lot more complex. The other thing that's happening a lot in healthcare that I'm sure you're seeing in the news is just all the mergers and acquisitions.

And sometimes big systems are deciding to sell off or close hospitals in some areas. There are a lot of rural facilities that I think are at risk. And people are very concerned about what will happen to the care if in fact some of these rural hospitals continue to close because it's already difficult to be able to make sure that people have access to care. And that's just going to complicate things a little bit more.

And I think the other thing that I know I watch a lot is the number of chief executive officers in hospitals that are either retiring or losing their jobs as a result of some of the merging acquisition or boards are deciding that they need to have an executive leader. And one of the reasons that I watch that so closely is that when that happens many times chief nursing officers are impacted as well as other senior execs. When a new person comes in it's not uncommon that they want to bring in their own team. And it causes a lot of stirs you might imagine with the staff that work in the organization wondering what's going to happen now as the leadership at the top changes.

And sometimes organizations will experience more turnover and or go backwards a little bit on some of the work that they've been doing because of that change at the senior executive level. The other thing that I think you all are seeing too is that there's a lot more focus on the kind of quality that hospitals provide. And there's a lot more information now available on the internet. It's very easy to go out on the internet and start to look at the hospitals to see the kind of ratings that they have when it comes to how satisfied people are with the care that they're receiving.

There's also more information now about physicians practices. And I think that's just going to continue as I'll help here is being pushed to become much more transparent. I think recently you're all hearing that another area right now that is being really pushed on is having hospitals become more transparent about what things cost. And I know as I had colleagues that had higher deductibles and co-pays, they've gone in many times to ask ahead of time what will it cost if I have this procedure.

And they've done all their diligence, they save their money and then they get a lot of surprise bills that come in afterwards and people are very concerned about that. So I think that's a challenge that hospitals are working on and trying to make sure that we can do a better job of educating people about what different things cost. The other piece that I think is really important is that we're really also trying to figure out how to have our patients and our families become more engaged in their care. I think that I've always worked on the adult side of the world.

And I learned a lot though by my colleagues who worked in, you know, Nagelice Hughes and Pecus. It just seems like we do a better job with children and babies in terms of appearing loved ones to secure their family members when they go home. And I think this is a challenge because we want to be sure that care continues as it should when people are being discharged and a lot of that needs to be managed ahead of time. And one of the concerns that a lot of organizations have in general is the impact that that has on attendance and productivity and focus because so many people that are working today also have elder parents that they're caring for, that they're having responsibilities.

And sometimes loved ones come and live with them and other times it's out of town and that distance makes it much more challenging if you have your loved ones in a different part of the country. And I know that I've worked with some chief nursing officers who really look at the amount of time that there's like intermittent family leave that staff will take. They're finding that it's not just when our staff are having babies, but it's when people need to now be off because they're caring for their elder parents. And I think that's just going to continue to be a challenge as more and more people become baby farmers.

And I think that I will kind of stop there as we get ready to go to a commercial break because the next part that I want to talk to you about is really around the workforce in general. And so we'll come back and do that in just a little bit. So right now, this is all about nursing and I'm Dr. Joyce Vacherley, the host.

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Welcome back everyone. You're listening to All About Nursing live from the PVM Global Network and Tune & Radio. I'm Dr. Joyce Bachelor, the host of the show.

And prior to the break, I had started to just share some of the trends and challenges and things that are happening in healthcare today with a lot more emphasis being placed on organizations to take expenses out while maintaining quality and safety and making sure that we're preparing to be more transparent on our pricing that occurs in hospitals and other outcomes. And so one of the things that really plays into all of that is the workforce. And this is definitely an area of concern for a variety of reasons. One of the trends that we know is happening is just the baby boomers and the up and coming retirements that organizations are starting to really try to figure out how to manage.

And this is from the Census Bureau that the number of people that are over 65 will grow from 43 million in 2012 to 84 million by 2050, which is just a pretty incredible number of people that will be over 65. And one of the concerns is that usually people over 65 use about three times more of the healthcare services in general than the general public. And that kind of expense is definitely up concern to many because I don't think that we necessarily are set up for that kind of amount of money to be spent. So it's definitely an area that we're trying to figure out how to do a better job with.

And I think again, as I was sharing earlier, people also have a lot more chronic diseases and many times it's not just one chronic disease, but they have several different systems involved, which makes it more complicated to manage and make sure that people are doing what they need to do to take care of themselves. And as far as the impact that we look at in the nursing world is that we're concerned about the nursing shortage. And many nurses we're going to need to be able to replace those that plan to retire. I know organizations are looking at are there different creative roles that some of these nurses can be in so that we don't lose them out of the profession, because what's really up concern is the wisdom and the intuitiveness that is cultivated with nothing but experience.

And you can walk in a room and you just look at somebody and you know intuitively there's something wrong. And it's hard to explain that, but if we've had research that shows that something in fact that nurses can do very well as a result of their experience. And so you'll hear people sometimes talk about the experience gap, meaning that we've got a lot of nurses that are really wonderful and dynamic. But they're only like out of school for a year or two and like how you balance that as you are doing your staffing and you're scheduling and trying to make sure that you have people that have experience working alongside of them to assure that they continue to grow and we don't have mistakes being made.

So the staffing impact is definitely challenging. And I know along with that we are definitely concerned about making sure that we don't overwork our staff. I can be honest and tell you that I used to be really all over this when I was a chief nursing officer trying to look at not having a lot of nurses fatigued and how many hours that were working and how to have them take care of themselves and putting things in place for that. And at the same time when you have call in you turn to them and say can you work extra tonight even though you know that they've been here 12 hours you're asking them to extend to like 16 or 20 hours or something as you're piecing or staffing together.

And the reason that we're concerned about that is you might suspect is that when people are fatigued they're much more likely to make a mistake or not be quite as pleasant and cheerful to be working with. And so we're continuing to work on that because staff already worked 12 hours shifts which is a really long shift to really be sharp and on your toes. And it's one of the areas that we really focus on. The other thing along with that is that a lot of staff are now sharing that they're experiencing a lot more bullying and violence in the workplace.

And it's disturbing when we hear the stories and it's nurses bullying other nurses but it's not just that which again is something that we own and need to really fix in our own profession. But it's also bullying that goes on between other caregivers but more importantly the one that we're seeing an increase in that's fear disturbing is bullying and threats and violence from our patients and their families and organizations are doing a lot to really look at how to make the environment safe because the people that are working in healthcare really are doing this because they want to help other people and they don't want to go to work fearful that they're going to be hurt. But in fact I'll share with you a little bit later that there are in fact reports that the number of people that have experienced some sort of violence and been hurt on the job are increasing in its major area of concern. The thing that I think is also kind of impacting our workforce and I know that some people are early doctors and others are not but there's a lot of changes as a result of technology bringing in the electronic healthcare record has certainly been something that's caused a lot of anxiety and changes.

And I think our younger generation get it a lot easier and faster than some of our more tenured staff but along with that we've got changes going on that are happening outside healthcare like the Apple Watch so that you can be monitoring somebody's heart rate continuously rather than just a check in when they come to an office visit or visit an ED and a complaining about something. And so I think as we have more wearables that are able to really transcend that data and track it over time I think that's going to change the way we can treat people because we'll have more continuous data telling us like what's really going on. I know that there's a group here in Austin with the diligent robots they actually have been working with some of the chief nursing officers that I've helped to introduce them to but there's a robot that it's actually kind of a cute thing and it looks like kind of like a nurse but it goes up and down the halls in the hospital and it will restock the rooms. And I think that we know that there's a lot of hunting and gathering and time wasted by our staff trying to find things or room hasn't been restocked and so the robot definitely is helping that arena.

And now we're really trying to look at what else can robots do to really assist in the clinical areas. And so some places have robots where the base is really a screen and it is their position who's able to use telehealth and be able to come to take care of someone in a remote area and still have that kind of expertise. And I think we're going to continue to see more and more of that kind of technology as we go forward. The other thing that's been happening that I think is kind of exciting truthfully is there's what they call EICU which is an electronic that's basically oversight of all patients in the intensive care unit.

Now this has been around for a while. Not everybody has this. Those that have had this kind of environment really have a lot of experts all in a hub that are able to like see the patients and the technology really allows them to do this very, very easily. And it's very, very exciting.

I think that kind of focus is going to continue to work. So right now we're coming to you live in the Global Network in Tune in Radio for all about nursing and Dr. Joyce Bachelorette. It's time to take a break and we'll continue this conversation when we come back.

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Joyce Bachelor on All About Nursing and we're on the VBN Global Network and Tune in Radio. Prior to the break I was sharing a little bit more about some of the challenges that we're facing related to our workforce, talking about the impending upcoming retirements and nursing shortages that we know we're going to be experiencing, how to really assure that we still have enough experience nurses overseeing our younger nurses so that they gain the experience and expertise that they need. That leads me to talking about one of the things that has been developed. I was sharing that we have this concept of an electronic ICU where there's a hub of expertise in a room, basically where there's monitors and they can see all the patients in the intensive care units and they can intervene right then and there if there's issues and questions and they can see the patients really easily and hear them and the technology actually is pretty amazing.

We're using that same sort of concept. There's a couple of companies that are starting to look at how to have a hub where experience nurses are located so that they are available to then be contacted by less experience nurses to assist them as they're doing their care as a way to have better infrastructure support in place. I kind of call it like that's still the instructor model. We have confidence that somebody there is going to be around that you can ask questions to and continue to help teach, but they're available.

They're not quoting the numbers, they're not here. Patients, they're really there to be a resource to the nurses that are working on the different units. And so that's something I think that we're going to continue to see more advancement in as people are looking at the fact that we're not going to have enough people. So how do we perhaps do things differently and come up with how technology in fact can make things better and save a lot of time?

So along with that, one of the other things that I had shared with you a little bit is that we know that if we don't do some of these things right now the staff, let's say staff in general, it's not just nurses, physicians, respiratory therapists, lab technicians, social workers are really importing, are reporting more and more dissatisfaction with their work and burnout. And this is a major concern as you might suspect because when people are feeling dissatisfied and burnout, we know that there's a likelihood that they're going to make more errors. There's less empathy that they're going to be showing in the work setting and decision satisfaction will definitely be impacted by this. Because you can't be really giving to others when you're feeling pretty cranky and tired and they just want to tell you what their days like instead of listening to what the patients and families have to say.

And the other big factor that is being addressed now too is that we're seeing higher levels of depression and suicide. And this is major concern because again, people that go into these into nursing particularly that can speak to are doing it because they want to make a difference and care for others. And so we've got to figure out how to make things better so that when people do come to work, they're able to do the kind of care that they really want to do. And they can find to join meaning in that care because that's what it's all about.

So the other factor that goes with that of course is people are not going to be as productive when they're tired and feeling like they're just been drained and there's not much more energy for them to be exerting. And so it's actually gotten a lot of attention because we've had more and more data coming out and that shows that this is definitely a need that we need to be working on. One of the prior shows, Pam Sipniano, who's the former chief of the former president of the American Nursing Association. When she was on the show, she talked a little bit about the Healthy Nurse Healthy Nation initiative that the American Nursing Association has led, where they wanted to do a risk assessment of nurses to see what the health is like of our nurses in general.

And so there's some interesting facts that I thought would be helpful to just share with all of you. As you might expect, one of the first things that they reported is that workforce stress is a top concern and they're worried about safety, their own safety, the safety of patients and others. And along with that, to half of the staff that were in this study said that they had been bullied in the workforce. And again, that's something that we need to fix.

And one quarter of them had actually been physically assaulted at work. And I'm hearing this more and more from some of the chief nursing officers that I work with on a routine basis that this is something that is just becoming way too common. And there's changes that organizations are making. I know one place that I was working with and doing some consultative work, they actually had German shepherds were being part of their plan with their policemen that were there for security purposes.

And they said when the dogs show up, people just seem to like really settle down. So I think there's a lot more work that places are going to be doing because this is again an area of concern. And then 60% of the people that were in this study reported that they work through their breaks. They come in early, they stay late.

And that's a major concern because we know that in order to really have, again, good quality care, safe environment, people feeling supported, they've got to be able to take their breaks. They have to be able to get lunch. And so it really depends on your workforce numbers and on the staffing and being able to make sure you have a good place at step. And so it's one of those things that I would say is just never ending.

I think leaders are focused on that because we know it's important to get away and take a break so that you can refresh yourself. If you don't do that, again, people are much more likely to make mistakes or forget things and we know we need to be working on that. As I shared with you, nurses are not alone in terms of the kind of imbalance between work and work-life balance. And a study that was done over 50% of the positions that were in that study reported that they're also feeling a lot of burnout in their jobs.

There's a greater and greater discussion around poor work-life balance. And there was a report that over 400 positions commit suicide on an annual basis. And I think that number may be starting to come down, but this has really triggered a lot of work being done by major different organizations at the national level, really trying to look at getting a better understanding into what's going on and what needs to change. And this is also on residents and interns and people in medical school because it needs to be the whole continuum of looking at what's happening there.

So I know that on one of the prior shows also we had talked about what's called the quadru-blame. And the reason that we've always had this triple aim that's been around for a long time, that the Institute of Health Care Improvement has deemed as an area of focus, which is really around decreasing costs and improving the experience of patients and looking at patient population management. But this fourth aim has really been you've got to look at the work environment people are in and how to put joy back into the workplace because if you don't have that, it's going to be hard to have motivated team to really look at doing the triple aim. And I thought what a great way to summarize, but I think nurses have known for a long time with the research that's been done is that the workplace environment is really key in terms of your ability to attract and retain nurses.

And as I shared with you, my former role as a chief nursing officer, I had four hospitals that achieved magnetic designation. And again, I'm so pre-annal discusses on when she was on the radio show for because the American Association oversees that with the American Nursing Credentialing Center. But magnet designation is really the highest designation you can get that demonstrates that the nursing care is really top notch. It has to meet a lot of different outcomes.

And it can be very challenging. But it's one that I would tell you is very much with it. And I train new chief nurses all the time to use the magnet standards as a guideline, even if they don't get the designation, you can't go wrong because the research is so sound. So we'll talk a little bit more about that.

But right now we're coming to you live in the VPN Global Network and Tune in Radio. It's all about nursing show. I'm Dr. Joyce Batch the host and we'll be right back.

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And prior to the break, I was sharing with you some of the things that we're working on in the workforce environments to try to take a look at putting Joy back into the workplace. There's been an increased number of staff, and I say that, generically, it's nurses, physicians, respiratory therapists, and other healthcare workers in general, experiencing greater sources of stress and burnout. And really, we're having concerns about that because obviously we need people in a really good place to take care of patients and families when they're most vulnerable. So one of the initiatives that's been worked on nationally is what we call really trying to focus on the quadruple lane, where we're looking to put Joy back into the workplace.

And sharing a little bit before the break that I think nurses have known about this for a long time. We've studied the work environment for years. A lot of the research and standards that are what you need to be able to achieve for a magnet designation, which is a really high standard of care that really requires the whole organization to work well, but it's focused very much on nursing and outcomes that, again, nurses don't do it alone, but it's where nurses really do a lead a lot of this. And I had four hospitals that had designated as magnet.

And the first time before actually received that designation, we were number 61, 2, 3, and 4 in the country. So it was less than 1% of the hospitals had been able to do that work. So I've always been very proud of that. And it's not only difficult to achieve, I would say that it's also just challenging to be able to redesignate because the standards continue to change.

And they increase the requirements as we begin to learn even more about what's needed in order to really achieve that same level of excellence as time goes by. So the quadruple lane has been near and dear to my heart because I think it's very, very important where you're looking at how you have an environment that allows people to feel some joy and by needing their work. And when I work with others, I teach them that there's like basically there's three simple questions that they say that you should ask your team, which are very simple. So the first question is, am I treated with dignity and respect by everyone?

And the second is, do I have what I need when so I can make a contribution that gives me meaning in my life? And then third is, am I recognized and thankful when I do? Now, those are three simple questions to ask, but you can tell by the questions that there's a lot that you're probably going to hear from your team and you ask those questions. A lot of times when I do this with groups, I'll ask them to tell me what they think their staff would say.

And as you can expect, they don't all raise their hand saying that everybody would say that this is something that they're doing well. And so I'll talk about like, kinds of things that they can do to improve it. But it's really everybody needing to work on this. It's not just the leader, but the leader certainly has a huge role in this because they need to set that vision and direction and help to keep making sure things are accountable.

I used to always believe that I took care of my staff the rest of it was easy because when staff are happy and they feel supported and they feel like they have a voice and they can bring issues forward and be heard. It's magical in terms of what can happen because the pride and ownership they will take around the care that they're delivering is just what I call priceless. So, you know, when you look at Jo-Wae, I think that there's people that may be skeptical about that sounds like a squishy thing because people like really hard metrics, but it's really, you know, having people feel pleasure and happiness when they go to work and feeling connected and that they made a difference. And, you know, I think that in nursing, I've always said it's extraordinary what you do.

It's not ordinary. Not everybody can do these kind of jobs. And I think that what we have to do is make sure that we're setting people up so that they can feel good about what they've done and not drive home, think about everything that they didn't get done and being themselves up. So, one of the questions that we encourage people to ask and I think this which fit any business that you're working in is what matters most to you because if you can figure out what matters most to people and start matching them to have work that they really have a passion about, it's just, again, you get a hundred fifty percent out of them.

And I used to have team members that would meet with me and tell me I was overloading them with too much work and we'd go through and talk about what they should prioritize. And the next thing I know they signed up for something that was announced at the organizational level that they wanted to be involved in and I'd circle back and say, okay, so didn't we just spend like your last meeting with me talking about why you needed things taking off your plate and I see your hand up and they're like, oh, but I have a lot of passion for that. And I thought, okay, this really does matter. And so I started using getting better at that because it was not only good for them, but it sort of made my job easier once I knew who really had what kind of passion so that I could match that and got a whole lot more work done through people that I had on my team that were wonderful.

So there's actually a lot of really great toolkits that have been created to help people know the kinds of things that they can do to make the work environments better. And again, don't think any of this is rocket science in terms of what needs to be done, but I think it really does require discipline and focus and having leadership really like be committed to this. And again, I do a lot of coaching and we teach a lot of this in our Chief Nursing Officer Academy that we do so that it starts at the top because that top leadership does in fact really send the message to all in terms of what's important to focus on and what the vision is all about. And so I think that's just been something that's really, really important.

I think it's also an opportunity to have a lot more interprofessional teamwork and collaboration. And so that's been exciting to me to see is that it's a way for the nurses and the physicians and respiratory therapists, all short because again, really working more collaboratively so that everybody can do their part really well. And then having that be really well coordinated really then also most importantly ends up making the patient care much better. And that we used to always say we should give it a tell the patient story and on a daily basis know what's the plan for the day plan for the day when they go home.

Are they tracking and are they getting where they need to be or their changes we need to make. And I think you'll see many hospitals have adopted interprofessional rounds that include being in the room with the patients and families so that it's very clear to everybody about what's going on and it allows the patient and the family to also be engaged in asking questions so that if there's issues or concerns that can be addressed, especially if there's chronic issues that families are going to be needing to assist their loved when they go home. It's important to have that kind of education starting a lot earlier than sometimes we do. So that they end up going home.

It's not a surprise and then it's a lot more stress on the families when they are worried about whether or not they're doing things right. So I think that's again another area that we're seeing with more interprofessional teamwork. This is all about nursing. I'm your host, Dr.

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You're listening to All About Nursing, live in the BBM Global Network and Tune In Radio. I'm Dr. Joyce Batchler, the host of the show. Before the break, we were talking about the focus that organizations have on trying to be sure that they've got a really positive work environment for their teams to be working in.

The focus being on Joy and the workplace and bringing meaning back into the organization so that I call it people and leadership need to be kind of like the shock absorbers so that the individuals that are working can really be able to concentrate on the kind of cure that they came into their professions to deliver. So you'll see a lot of organizations focused on also healthier habits in terms of eating and exercise. And many organizations are starting to put incentives in place if they may get some kind of reduction on their premium or some kind of benefit of some sort if they in fact are doing a good job with their health. And I think we're going to continue to see more and more employers doing some sort of incentives like that.

I think when there's 3.64 million nurses in the country, we are, I think, again, back to the American Nurses Association's Healthy Nurse Healthy Nation trying to look at if we could get the 4 million nurses in the country really healthy and having good habits. I think that we can sort of see some decreases in our healthcare costs. Unfortunately, that is not necessarily what nurses are doing right now. We sometimes don't take care of ourselves the way we should.

I think nurses tend to do a really good job taking care of others and forget themselves in the process of that. And so I know there's a lot more focus being put on really having assistance for like resilience workshops, stress reduction, yoga, and things of that nature. So it's a holistic approach to people managing their stress. So all that said, you know, there's, I think in order to prepare for meeting those challenges, there are some different initiatives occurring that I'd like to just give you some highlights.

I do have plans for future radio shows to have some guests on with me that are actually involved in some of this work to give you even more detail. But I wanted to just give you some insights around the fact that we don't sit and go, wow, these are really big problems. I wonder what's going to happen. There's a lot of people that get very engaged on trying to figure out how to address these things proactively.

And that's the kind of stuff that I've been more and more engaged in that I find really exciting. So I always had this little thing that if somebody sends this report and says you should do these things, it's like who made these recommendations up if I always say to myself, if you really want to know you need to get involved. And so in many cases I have. So one of the first ones that I would share with you, and this is fairly new, and I think you heard that this was going to be launched on one of the radio shows just a few weeks ago.

But the National Academy of Medicine is now working on the 2020-2023 future of nursing report, really taking a look at how do we chart a path for the nursing profession to help our nation really come up with a culture of health. There are, because there's 4 million nurses in the country, nurses can have a huge impact if we could figure out better ways to utilize nurses, look at whether or not we're really using nurses to the top of their license that they've been trained in. And really, again, nurses work in so many different settings, but how do we really leverage the fact that we've got a very large workforce and we're trying to change and not just be focused on sick here, but really getting into more of the preventative and managing chronic diseases and staying out of hospitals. And so I think that's pretty exciting.

And the other piece is also looking at how to reduce some of the health disparities that we see. I think there's a lot of concerns as co-pays and deductibles have gone up. I hear nurses telling me all the time, especially those that work in the emergency departments that people are reading much longer before they'll come in because they're afraid of the cost. And sometimes when they come in, they're so much sicker because they didn't get the care when they should have, and it ends up getting to be even more complicated.

And so we know that there's also areas where people live, there's socioeconomic status, that we've got to make some changes because if kids can't play outside because it's too dangerous or they can't walk to a store and find an apple, but they can certainly find a lot of candy and chips and things of that nature that if we don't change some of those things, it's got to be again a cyclical cycle in terms of continuing to have bad and healthy habits. And then the other piece is just looking at how do we improve the health and well-being of the population in the US in the 21st century. So that group is meeting, they actually have meetings that are coming up that are open to the public, they do this in person and they try to rotate where they're going to be located, but they also have it on the internet so that people can still participate. And so there's one coming up on Wednesday, July 24th that will be at the University of Pennsylvania School of Nursing.

The theme of that one is vulnerable populations and paying for care. I think that there's a lot of concerns about how do we continue to make sure that we're able to care for those that are funded or underfunded. And then they've already had one meeting that was in Chicago that was focused on education research and practice. And then the third meeting that's open to the public in all is going to be in Seattle on Wednesday, August the 7th, and that's from 830 to 12 on Pacific time at the University of Washington.

And the theme of that one is high-tech, high-touch. So when I was sharing with you having robots and wearables and telehealth and how do we have that high technology but still have that high touch with patients and families where they can still feel free. That human factor of caring because it's so important when it comes to the psychosocial, my body spirit, and so I think those are going to be pretty exciting. If you go on the internet and you type in the National Academy of Medicine 2020, 2030, Future of Nursing, all that information pop up so that you could register and then be able to listen in on those sessions and give your input because I think it's really important for people to know that there's a lot of really smart people working on this as a way to make sure that we're steering things in the right direction to meet the needs of the public in general.

So I'm pretty excited about that. The other thing I wanted to share that's on the horizon is the American Academy College of Nurses and the American Organization of Nursing Leadership has a community that's working on innovative practice academia partnerships. We know that not only is our workforce retiring in the hospital, ambulatory, and clinical settings, but also academia side. And again, you talk about expertise for being faculty.

It's very important. And so there's a lot of concern about how do we make sure that we have innovative partnerships going on between both so that perhaps some of the people that are working in the hospitals would do some academic work if they could in fact have some kind of assurance that their benefits with their organization would be able to do that. So there's a lot of work that's going on with that. And I believe that it's time for a break.

So this is all about nursing and I host Dr. Joyce Bachelorette. We're live on the Vegan Global Network Intune and Radio and we'll continue this conversation to come back. There are artists and then there's Alice Asmar.

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Joyce Batchelor, and all about nursing. We're live on the VBM Global Network in Tune and Radio. And prior to the break, I had started to share with you that there's work going on by the American College of Nursing and the American Organization of Nursing Leadership on Innovative Practice Academic Partnerships to take a look at how to assure that we have enough nurses and also have enough faculty and be able to figure out how to close the gap between when people come out of school and end up starting to practice. Along with that, they're also revising all of what they call the essentials, or what are the key areas that nurses must be able to accomplish when they're in school, for their baccalaureate, their masters, doctorate levels, et cetera.

So I think there's going to be a lot more exciting stuff going on. That's actually work that I'm on a committee that meets all day tomorrow to start planning how we're going to pull people together and have a summit here in Texas because we're very concerned about these issues because Texas is growing. And we know we don't have enough staff now and we're potentially growing to where I can tell you in the Austin area alone, there are three new hospitals being planned. And so we've got to make sure we get ahead of some of the things that we know are going to be challenging.

The other part that's happening is our Board of Nursing at the national level is revising the testing exam and really for new graduates looking at how to have to become more competency-based and can accurately evaluate students' clinical judgment skills. And so that's going to be a new focus, which I think actually is pretty exciting. And the fact that 2020 is going to be called the Year of the Nurse. This is the celebration of the 200th anniversary of Florence Night and Gail, who really is our founder for nursing.

It'll be the year that nurses celebrate worldwide. And there's an initiative right now going on called Nursing Now. And it's really a look at how to impact healthcare across the world. That nurses are working together.

I know that I actually plan to have two people that are very much involved in this on one of our future, all about nursing radio shows to be able to give a lot more detail on it. But it's pretty exciting to see that the kind of goals that I've been sharing with you tonight in terms of looking at improving the care for others and looking at health disparities and how to really change our system to be more focused on proactive and preventative care, not just the sick model, is pretty exciting. And I think, again, because of the numbers of nurses, we're being seen as a key part of that strategy. And nurses share a lot of these common issues across the world and other parts of the world have even in some places, many more challenges that we do here in the US.

But we definitely believe that working together and collaboratively will be able to really make a difference. And I'm pretty excited because I shared a conference that's going to be held in November in LA. It's an international association of leadership science and nursing. It's a pretty unique forum where academically I practice people come together to talk about the latest research around nursing leadership and what's needed as we go forward.

And it's kind of like the who's who when it comes to some of the research gurus in nursing. So it's going to be pretty exciting. And I also am really excited because we're going to have a panel there to talk about our lack of visibility in the media. And I think on one of our private shows, I had a colleague that was on that talked about the fact that we have actually nursing has gone down in terms of being visible in the public eye.

And with 4 million of us, that should not be the case. So we're going to be talking about that and then what we need to be doing to change that so that nurses get more comfortable being in front of the media, proactively reaching out so that we can tell our stories and be used as experts because there's so many nurses that I have as friends that I can just tell you aren't just amazing experts in so many ways. And I think you heard that when we talked about getting more nurses on different boards. So the getting nurses on board coalition is just again part of like how to really spread the expertise of nurses and impact a lot of the different challenges communities may be having.

So I think along with all of that, we're also looking at how do we prepare people in terms of being able to handle all of this. And I think I would end by just telling you that learning agility is going to become a very key competency where we can really learn a lot faster and also unlearn things that no longer is pertinent. So I really appreciate all of you listening with us tonight. You are listening to all about nursing live in the Vegan Global Network in Tune and Radio.

I'm always back to the host of the show and I hope that you'll tune in next week. Thank you. You've been listening to All About Nursing with your host Dr. Joyce Bachelor.

Tune in each week and get a daily dose of nursing and the health care services they provide and how nurses are finding innovative ways to address the key health care issues they're facing today. Here on Dr. Joyce Bachelor's All About Nursing. You've been listening to the VBM Global Network.

The ideas, views and opinions of this broadcast are those of the participants of the program and are not necessarily the ideas, views and opinions of the VBM Global Network Company.