All About Nursing (40)

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Welcome to All About Nursing with your host, Dr. Joyce Bachelon. Executive nurse advisor, Dr. Bachelon, will present the significant role nurses play in providing health care in the 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. So please welcome the host of All About Nursing, Dr. Joyce Bachelor. Good evening.

I'm your host, Dr. Joyce Bachelor, and all about nursing and we're live on the BBM Global Network and Tune in Radio. I have a special guest with me this evening and I'd like to tell you a bit about her. My guest is Dr.

Amy Anderson, who is an assistant professor in the Harris College of Nursing and Health Sciences at Texas Christian University and is the Health Policy and Advocacy Lead for the Texas Christian University and University of North Texas Health Sciences Center School of Medicine. Dr. Anderson serves as an idea, factory fellow at TCU, working to support design, thinking in the health professions. She's also a former Health Policy Fellow at the Heritage Foundation in Washington, D.C.

Her media and policy work include publications for the Heritage Foundation, The Washington Times, Big Idea Column, as well as interviews with the Wall Street Journal, HealthCareFinanceNews, Nurse.com, and Regional Radio. Dr. Anderson is an International Council of Nurses Global Nurses Leadership Institute Fellow and works actively as a national consultant for organizations such as AARP and American Association of Nurse Practitioners on Advanced Practice and Health Policy Issues in the United States. So welcome this evening, Amy.

Thank you, Dr. Bachelor. I'm happy to be here. So let's start with you maybe getting the audience a little bit of background on how you decided to become a nurse.

Okay, well, I think for a lot of people they feel like they have known it all along. They were going to be a nurse. And for me that really wasn't the case. It was really a choice that I made.

When I was in my undergraduate program, I actually started out as a business accounting major and I just felt like it wasn't a right fit for me. And so over the summer between my freshman year and my sophomore year, I had to make a decision about where I wanted to do and how I wanted to move forward. And I really was considering both teaching and nursing. And at some point it just hit me.

I have a lot of medical people in my family. My mother was a director of a managed care organization in California in the 1990s, worked in insurance underwriting and with physician relations. And my father worked on the pharmaceutical and the medical sales side. And that just felt like where I needed to be.

And I had compassion for people and had had an experience in the hospital that made me really want to be a nurse. That's wonderful. You certainly have a very different kind of career path. You're currently a health policy strategist and consultant.

What made you want to specialize in health policy? Well, this also sort of stemmed from a personal experience. One of my children was in the hospital and we spent a good deal of time in the hospital, both in ICU and on the unit. And then went through process afterwards.

And I had some significant experience from a master's level prepared nurse trying to negotiate the system, financially, as well as just from an administrative standpoint, we had some issues that came up in the hospital. And knowing that I had this information and I still was having difficulty negotiating this, it made me want to go back to school to get my doctorate and figure out how to really make a change in the system that was positive for patients and families. And so immediately after all of the health care concerns were completed, I applied for my doctoral program that I went to at Texas Tech. And during that time at Texas Tech, we got many opportunities to look at different areas of potential practice post-doctoral work.

And one of my experiences took me to a government organization where I had actually had many conversations, bond with a director, and I won't tell exactly where it was. But about the health care reform that was coming down at the time. And the response that I got really was, it's not our, you know, it's not, we don't get to decide what we feel about it. We just have to do it.

It's whatever regulation or legislation comes down and we're supposed to put it into place. And it sort of light bulb and off. Okay. I need to go further up.

And really the legislative portion and the regulatory portion is what impacts what we do at the bedside and what's done within the hospital system. And so at that moment, I started looking for policy fellowships or any way to get involved in health policies to help influence the decision makers at the table. And that really, you know, was at the national and state level. Did you have mentors along the way or reach out to have other colleagues assist you as you were going into the specialized area?

Absolutely. Dr. Alexia Green, who has been a dean at Texas Tech and really has been a great mentor to me. She's worked in the state of Texas, very heavily in health policy and also works with University of New Mexico and our RWJF Pro-PHD program in health policy.

She's been a great mentor to me. And on the outside of nursing at the Heritage Foundation, I really worked closely with Dr. Robert Moffat, who works within the Reagan administration, working on health policy and reform. And he was just a superb mentor during my time just sort of getting like eat wet in the policy arena.

And have you had any other experiences? I mean, did you have any kind of, I was curious about the fellowship that you were involved in? Can you say a little bit more about that? Absolutely.

So I had quite a fellowship at the Heritage Foundation and spent that time in 2013 in Washington, D.C., really doing policy analysis. I went out in Washington to different government organizations, nursing organizations, and really spoke to some leaders in the field about their expertise, what their opinions were, what they were finding in research, what their evidence was. The support the direction that they were personally supporting for reform. And to use in my analysis of the Affordable Care Act, my paper was impacted with the Affordable Care Act on the healthcare workforce.

I really talked to issues that we as health care workers are facing when health care reform comes down, whether it's the HCA or other health reform and the issues with workforce shortages and rural health and where providers are placed. And the fact that if you're in there not able to practice to the full extent of their authority and other low, you know, not in every state. And so how we're going to deal with that? The stress and burnout that was coming for physicians, the lack of funding in certain areas of medical education, how we could continue to support workforce, reauthorizations and that sort of thing.

So it really was wonderful experience to be able to get out in Washington, D.C., and really talk to those big influencers and help policy and understand how reform came about and how we could help advance positive portions of reform and support our nurses as well. That was a big piece for me as wanting to support the nursing profession if I was able to in any work that I did. That sounds very exciting. And I would assume that you were finding that there were a lot of people that really didn't need help understanding more about the decisions they were making or the policies they were making in terms of bringing your nursing expertise.

Is that accurate? Yes, absolutely. I mean, even when I, the first week I was in my office in Washington, I had people coming in saying we're so glad to have a nurse's perspective here because you understand what's really happening on the ground within the unit, within the hospital, within the system, and can provide great knowledge to that. And, you know, there are not a huge number of nurses that really stepped into the policy arena.

And so it isn't a place that we as a profession can work to influence. It's very exciting to hear all of this, Amy. Right now we're going to need to take a little break. This is all about nursing.

Dr. Joyce Bachelor, we're live on the Beacon Global Network and we'll be back in just a few minutes. According to the American Nurses Association, there are approximately three and a half to four million nurses in the United States. So where do all these nurses work?

What kind of roles do they have? What kind of education and training help to prepare them for so many different settings? What kind of impact do nurses have on patient outcomes? The World Health Organization has announced that 2020 will be the year of the nurse honoring the 200th Earth anniversary of Florence Nightingale.

An international initiative called Nursing Now is underway to raise the profile of nursing. The National Academy of Medicine has convened a committee to create the future of nursing 2020 to 2030 that will focus on how the nursing profession can create a culture of health, reduce health disparities, and improve the health and well-being of the U.S. population. Learn more and join Joyce Bachelor on All About Nursing, Wednesdays from 7 to 8 p.m.

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Thank you. Welcome back everyone. You're listening to All About Nursing, live from the BBM Global Network and Tune in Radio. I'm Dr.

Joyce Batchlef, host of the show. My guest is evening is Dr. Amy Anderson, who was sharing with us a lot of very exciting work that she's been leading around getting involved in health policy and advocacy. Her experience is certainly very impressive.

Just before the break, Amy, you had started to talk a little bit about how your expertise as a nurse and the knowledge that you had was very helpful to the people that were making decisions to try and understand health care reform. Could you say a little bit more about that? Because I think you mentioned that sometimes nurses are not at the tables as much as perhaps we need to be, and you could see the value of that. Yes, absolutely.

We are valued as a profession. We certainly are the most trusted profession, as many surveys over the many years have shown, and people want to know what we think. And it's really important as a profession that we are educated in what's happening in current events, what's happening in politics and policy. And I think as a nursing profession, sometimes we don't value ourselves as much as others do in this arena, and that if you could really see how important it is for the decision-makers to know what's happening, because they can't be experts in all things.

I mean, they're dealing with things that are outside of our fields, and they have to know so much about so many different areas of the economy, of different businesses, different professions, but they really need us as experts to present information to them. So they have that boost on the ground perspective on how it impacts people, which turns into their constituents, which they want to please as much as possible, of course. But they really have to have the facts and the stories and the information to go with it. And we as nurses have wonderful stories to tell, good stories, bad stories.

And we also have facts and information about the impact of that legislation or regulation on what it does to us when we're trying to care for people. And I think that we see that across medicine, that really legislation and regulation influences and guides almost all decision-making when it comes to a system and process issues, and that really we're seeing that. And a lot of times making those connections and connecting those dots for nurses, I think if we can do that and make sure that they're really aware and educated about that, then in turn, they can present that information to their legislator or other decision-makers in order to greatly influence it. How things go and help here?

That's wonderful. And prior shows, we've talked about the fact that there's like about three and a half to four million nurses in the country. And somehow, if we could really get all of their voices being heard around some of the things that need to change when we look at social determinants of health and just the impact sometimes of all the regulations, et cetera, I think there could be such a huge impact. But we haven't quite gotten there in terms of all being aligned.

But I was curious, you know, what are some of the highlights of your policy career? Because it sounds like you've done a lot of very exciting work. I've really enjoyed it. And it sort of just sort of come by naturally from the work that I did at the Heritage Foundation, a consultant out of West Virginia contacted me.

They found my piece at the Heritage Foundation that supported APRNs, and they're working to the top of their license and asked me to consult and strategize on how we could move legislation forward in West Virginia. I developed a couple of policy briefs and actually went to West Virginia and went and talked to the lieutenant governor and the speaker of the house there and other members of their legislature. You know, employing them, talking to them about the importance of how the importance of APRNs within rural healthcare, how they could provide access points and decrease costs. And for West Virginia, that was a really essential moment in their legislative history.

They had a flip from one political group to another within the legislature. And so it was a great moment for them to, they were having difficulty with their budget. And it was a wonderful opportunity to present it to them what it was that nurses could do to help in the state. And so that was a wonderful opportunity working with ARP and the consultants and the nurses associations really just sort of helping outline how to move forward and advance legislation as well as advance health care and outcomes for the state.

So really for me being there on site and just being able to ask questions, providing them facts and figures and information about what APRNs do and how they are educated and all that was a great opportunity for me and I really enjoyed it. And that really led to some work with ARP, the RWA of Foundation on the Future of Nursing Campaign, doing workshops around the country on how to speak to a diverse set of stakeholders and really ensuring that we were hitting all sides of the political debate on issues related to APRNs. And there that sort of naturally moved to me working doing some work for AANP, doing workshops regionally to make sure that nurses, nurse practitioners prepared to make the case for what they wanted within the state that they are living in. And from an international policy perspective, I was very interested in getting better understanding of global health and how we were working within the global arena from a nursing perspective on policy.

So my opportunity to go work with an international council of nurses and other global nurse leadership institute fellows on issues that are international and speaking with leaders from around the world about many things are very similar. Our systems are very different. But the kinds of things that nurses are dealing with around the world for some countries are very similar for others very different. So it was a very exciting thing for me to do.

I recently from that made some colleagues who Lisa Darshot of Shenandoah University as well as Kathleen Murphy out of UTMB, Galveston, and we recently started an alliance called the Global Nurse and Social Alliance. And we're doing additional international work with non-governmental organizations helping work on nursing policies, doing one-on-one mentorship of nurse leaders internationally. And so that's just begun and we're about to launch our website and really trying to just help provide some support as well as that mentoring and coaching for individuals in nursing around the world. That's really exciting.

And I think that your timing is really wonderful when we're looking at 2020 being the year of the nurse in nursing now USA and all of that. So we'll talk a little bit more about that after a break right now. We're coming to your live from the P.B. Global Network in Tune Radio.

This is all about nursing. I'm Dr. Joyce Bachelor and again, we'll continue this conversation when we come back. Are you looking for employment in the Los Angeles Orange Riverside and San Bernardino counties?

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That's J-O-B-S-A-N-N-E-X.com. Welcome back. We're about to launch our website and it will be the G-N-C-A.com. Anyone can find me on LinkedIn.

Also on Twitter, my Twitter handle is amiandersondmp.com. From me, my personal consulting work, advocacy for national professional organizations. I provide policy briefs, policy workshops. I also look at curriculum development for health policy and nursing education and provide educational presentations for universities.

I'm also able to do strategic planning sessions for any legislative action that might be coming up. You just need another idea or thought about. I would be happy to help anyone that would like to contact me to advance health care really as my purpose and ensuring that we have better out for patients and families is really my goal. Anything that's related to that I'm trying to work on.

I really think that nursing education needs an additional element of policy threaded through it. That's where my academia presentations come from. As you were speaking, I was thinking, my gosh, the American College of Nursing is looking at the essentials for the baccalaureate masters and doctors of nursing practice. Boy, they ought to be talking to you about what kinds of things should be in there or when it comes to health policy and advocacy.

Those are areas, as you said, that we could really do a little bit more focusing on. I was just curious if you had a chance to be involved in any of that. Absolutely, yes. I was part of the AACN faculty policy think tank and worked for some great individuals from around the country making really looking at the state of policy education and nursing sort of assessing where we were at, discussing the essentials and really just trying to come up with recommendations for the board on how to advance that particular agenda and ensuring that our nurses are coming out better educated in policy to deal with the issues that we're seeing with healthcare reform consistently changing with new regulations and legislation.

It's just a time period where we need to be and enter the future too. It's just really aware and have a greater understanding of the big picture in health care so that we don't have that tunnel vision and we're just thinking about what's happening on our patients' room. But really what's happening out there externally really influences what happens internally. So that was a great experience to work with some experts around the country and really make those recommendations to the board, which were, I believe I remember correctly all accepted, and the recommendations are available on the AACN website.

And there are many webinars that have come out in the last year and a half on those policy recommendations. Dr. Nancy Short and I began the webinar just talking about the process and what the recommendations were to the board. That's very exciting to hear.

And I was starting to also say before the last commercial that you're timing on this with the year of the nurse being 2020 with Florence's 200th anniversary and really looking at nursing now, USA, I went to a meeting in Chapel Hill just a few weeks ago and how we really begin to raise up some of the things that we can be working on collectively. And I was pleased to see that Sue has another was at that meeting and really looking at the National Academy of Medicine's 2020-2030 work. And it just seems like we're starting to have conversations about how to make all of this connect, which is very, very exciting. And are you involved in some of that work as well, Amy?

Yes, I have been involved as a D&A-Y, that's our acronym for Global Nurse Leadership Institute as a fellow there. Working with the International Council of Nurses, I've made a lot of contacts around the world. We spent time at the World Health Organization speaking with some of their nursing experts and the World Health Care experts. We were aware of the state of the World Nursing report last year.

We knew that it was going to be 2020, it was going to be named the year of the nurse. And we were so thankful for Dr. Tedros. I cannot pronounce his last name, but he's just wonderful.

Heading up the World Health Organization and ensuring that nursing was a part of what is happening to advanced healthcare internationally and him putting into place, Dr. Lizat Iro. They're at the Chief Nurse of the World on really helping to guide some of that discussion, as well as ICN's Howard Caton and also Barbara Steelwell at Nursing now. There's a lot of connections being made there to really ensure that next year is really focused on nursing from a world perspective and what nursing does to advance healthcare and care for people.

And so it's just a wonderful opportunity right this minute. And this is why it's so important that nurses get involved in policy because we have this opportunity to be very visible. In the next year internationally around the globe and hopefully here in the States. And that way we can really make our voice known and sort of reestablish our positioning at the policy table.

I think it was when Sue Hassmuller was on one of the prior shows, or it might have been Pamps at Priana, but they said something about their approximately 10 million nurses across the world. And I thought, wow, can you imagine what would happen if we could really do as you're saying, really be involved and influence a lot of the changes that nurses don't need to happen. So it's very exciting to hear. We are coming to you live from the B-Binkle Little Network in Tune Radio.

This is the All About Nursing Show. I'm Dr. Joyce Bachelorette, the host. And we are going to take a break and be right back.

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I'm Dr. Joyce Bachelor, the host of the show. And prior to our break, Dr. Amy Anderson was telling us about a lot of the exciting work that she's been leading and launching her own consulting company called Global Nurse Consultant Alliance and the kind of impact that they're really trying to have not just here in the US but across the globe, which has just been very, very exciting.

I thought it might be helpful to kind of talk a bit more too about the fact that you do a lot of academia teaching on health policy to both nursing and medical students at the Harris College of Nursing and Health Sciences at TCU and the Department of Medical Education at TCU and UNT Health Sciences Center. So what is the importance of doing this kind of policy education and health care and really getting our nursing and medical students much more aware of what to do? So it's been really a great opportunity. I enjoy education and I have all of my career, even at the hospital.

I always wanted to have students because I thought it was important for them to understand how to do things, why we do them and all of that. So it's been really enjoyable to teach in academia and really bring that policy piece to them and really hopefully inspire some action on their part. And so for me getting to teach both nursing and now just being appointed to work in the medical education arena and teach, you know, lead that health policy advocacy has been phenomenal. I would say our new medical school has got some really unique and new methods of teaching and I think it's really going to impact the kind of graduates that we're seeing out of medical school.

I think it's sort of a movement within medicine to make some changes and really the purpose there is to find an empathetic scholar when they graduate so that there's really more understanding of not only the patient experience, well the patient experience, the family experience, how other factors are affecting them, how policy affects, you know, their business, licensure, regulatory, the impact that has on their business and really just the day-to-day operations. But really I think we also forget about the fact that I want to influence the nursing community as well, is that we're taking care of patients and we always talk about a holistic view of them, but somehow we forget that little piece of financial help. And we know that finances cause significant stress and anxiety in many American households and the health care issues piece of that. And so when people are wanting to enter the medical community because they have issues, there's fear related to that.

And then on the other side of it, there's fear waiting for the bill to come in the mail. And so, you know, for me it's wanting to explain how the system functions, number one, so that there's understanding of that, explaining how that impacts patients that they're working with and trying to, you know, really bring to them how we can make some changes to our current system that will be more patient-friendly from a financial perspective. And so that greater understanding of how the system functions, what other systems there are around the world, how that impact practice either in medicine or nursing, it's just essential to being in all around good professional in the medical arena. That's my perspective.

You know, you bring up the cost of health care and I read a story a couple weeks ago about a young man who died because his family didn't have the money for his insulin. And, you know, you're kind of, you're taken aback when you read something like that and think, you know, that should not be happening in our country. And yet you're absolutely correct. We know lots of times people will make the decision to keep food on the table and not get their medications, their prescriptions filled.

So you've raised a really good point. It kind of goes with the push for transparency on prices, which I know we're still working on and trying to get better at. But it definitely is a huge issue. So it really is.

And it's a difficult decision to make, especially for family like for many families across the country. And with that increase in deductibles that have come across in the last few years, that has really impeded people from entering the medical arena. And I think long term that it's enough activation outcomes and we're going to see that research showing up later. I mean, for the price of pharmaceuticals are very high for us in the U.S.

I think I read recently that it was anywhere from two to eight times that of what spent in other countries on medicine. And if you look at the UK and they're spending twice as much on medication that we are in the U.S., U.S. Americans aren't making twice the salary of those people that live in the UK. So we've got some real significant issues that need to be addressed.

Both in price transparency, knowing what you're getting into when you walk into a doctor's office or a provider's office or hospital or clinic or wherever you happen to go. But also on the back end just really saying, are we being ethical in the decisions that we're making? Can we keep our doors open? What can we do to help that financial health of patients and families?

Well, and that kind of goes to the mergers that we've been seeing that I think are going to potentially be disruptive when you look at CVS buying that couple insurance company and the whole merging of like Amazon working with Berkshire Hathaway and all of that. I mean, I think we're going to see other people outside of healthcare potentially trying to disrupt and make significant changes to address what you've just been speaking of. Are there some other ways that the nursing community can increase visibility and influence in health policy decision making? Absolutely.

I mean, we sort of touched on the increase in policy education and nursing. I think that's essential that our graduates are walking out with a better understanding of how the system works, how legislation comes into play, how regulation administrative ruling impacts what they're doing and how they can have an opinion about it, provide comments to organizations like Health and Human Services or CMS as these schools are coming down or in the legislative arena going out and talking to legislators and decision makers and giving them some detailed information of the impact that that legislation has. Of course, we need more nurses on state and national health committees and so the connections that people can make within their political organizations or through their professional organization so that they can get on those committees to provide a voice for nurses and really for patients and families that quite see it is really essential. And then we can always use mourners as an office.

I mean, we have one in our Congress. There are many a classic country within the state legislatures and that voice is really essential really to provide to many aspects of what goes on within the state related to either health and human services or other areas of expertise that they can use, whether it's business or whatever it's their particular background is. One of the things that I'm smiling about is you're talking about this is that we have a problem where nurses are still invisible in the media and that's something I know people are really starting to raise more and we can certainly explore that a little bit more. This is all about nursing.

I'm your host, Dr. Joyce Bachelor. We're live on the Beebe and Global Network in Tune and Radio and it's time for us to take a short break. Wicke Wags brings Harmony back into your home for male dogs and their owners.

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There are approximately three and a half to four million nurses in the United States. So wait while these nurses work. What kind of roles do they have? What kind of education and training help to prepare them for so many different settings?

What kind of impact do nurses have on patient outcomes? The World Health Organization has announced that 2020 will be the year of the nurse honoring the 200th birth anniversary of Florence Nightingale. An international initiative called Nursing Now is underway to raise the profile of nursing. The National Academy of Medicine has convened a committee to create the future of nursing 2020 to 2030 that will focus on how the nursing profession can create a culture of health, reduce health disparities and improve the health and well-being of the U.S.

population. Learn more and join Joyce Bachelor on All About Nursing, Wednesdays from 7 to 8 p.m. Central Standard Time on the BBM Global Network. Welcome back everyone.

You're listening to All About Nursing, Live From The BBM Global Network, in Tune & Radio. I'm Dr. Joyce Bachelor, the House to the Show. And before the break, my guest Dr.

Amy Anderson, who's been telling us a lot about the wonderful work she's leading around health policy and advocacy, was sharing ways that nurses can become much more visible in influential health policy. And I had raised the issue that we seem to be lacking visibility in the media, though. And I know that Amy has done a lot of work around this, and it was one of the reasons that sort of drove me to doing this radio show, because people don't seem to know what nurses do, how specialized and have all the different places that we work. So I don't know if you want to say a little bit about that, because I know you do a lot of work around trying to really enhance our image in the media.

Yeah, I'd love to. And here you were, Dr. Bachelor on Radio Show doing an excellent job increasing visibility for health policy and all things health care. So thank you for your interest in doing that and having this show and having you on the show.

From a media perspective, some of the nurses, or whoever our listeners are, may know about a study called the Woodhulls Study, and that was done by several nursing leaders in the health policy and media, one with Witching Dynamason, who was also one of the lead people who I worked with on Global Nurse Leadership Institute for the ICN, really working on policy work from an international perspective, but really pulling that media piece in and talking about why our nurses not, you know, people aren't coming out asking us about things. And that Woodhulls Study showed that over the last few decades, how we really have an increase in visibility and have gone down, I think it was 4%, and that was down to 2%, and that was over several decades. And so I'm not really sure what the driver is behind that, but what I do know is that we have got to make more connections with individuals within the media, whether it's a journalist on radio or a journalist newspaper or a journalist in television, that we have to make those personal connections in order to be able to have the opportunity to respond to interest stories, whether it's healthcare related, health policy reform or individual patient stories, and so they need to get to know us, and so we have to get ourselves out there and really tell what we know. I mean, we know a lot about what's happening, we understand this impact that everything that happens in the healthcare arena has on patients and families like we've been talking about.

And so the onus is on us to get out there and say, here we are, here's what we know, we can provide expertise, you don't always have to go to a medical doctor, you don't always have to go to a PhD in public policy, but that there are a lot of leaders in nursing that can provide excellent information, facts, figures, and stories for those investigative stories or other types of stories that are, you know, it's really important. The weather's too paper and you're writing op-ed or, you know, trying to get some time on TV or here on a radio show, we, again, have to make those connections. And so I think that if we start knocking on doors and sort of saying, here we are, here's what we know, here's our expertise level, that we can start moving that percentage of stories that have nurses included, you know, back the right direction in a positive direction. And that's great.

I wanted to ask you a little bit about your Global Nurse Leadership Institute Fellowship at the International Council of Nurses. What are some of the major initiatives that are being focused on internationally? So we talked a little bit earlier about that. You, the Year of the Nurse and the Partnership really with World Health Organization.

From an ICN perspective, there were some thrills that have them come on and decide that they would do the Year of the Nurse being 2020, as well as the state of the World Nursing Report, which is being worked on heavily by individuals both at the World Health Organization and the non-governmental organization, as well as the ICN and other professional organizations providing information so that the report can be written. I, you know, I know that for me, I would recently ask to be a volunteer for the editorial portion for Jupygo, which is an NGO, and that came from having a colleague at GNLI as a fellow colleague who was working on the report. So, you know, everyone is actively trying to get a better picture of nursing around the world, really look at significance of what we are doing and accomplishing, as well as what our workforce numbers are truly around the world. What are the task-enrolled nurses are doing around the world?

Because from country to country, it varies. And so, understanding how licensure and regulation, knowing some countries don't have regulation, some countries don't have licensure, and so just really understanding what the big picture is on nursing globally and how then we can strategically plan how to impact specific areas of concern or highlight areas of things we are doing very well. That's wonderful. Thank you for sharing that.

The other thing I wanted to ask a bit more about is this idea of Factory Fellow at TCU. We explore design thinking and application of future healthcare. What are some of the things that you are looking at to try to improve the efficiency of healthcare and bring the costs down? So, the things I've looked at really from a design perspective, I mean, really just understanding the design process is a very different arena than healthcare and healthcare education.

And so, how can we work in a professionally with different students across campus or across both UNT Health Science Center and TC Med School, as well as into the business school, graphic design, other areas of university. What are other people seeing, maybe not just in healthcare, but in academia. We're looking at different types of design challenges, including healthcare design challenges. For me, it's just always staying a prize of current thoughts.

Looking at innovation, and I know we all throw the word innovation around, but really looking at from a technology perspective, from just an awareness of artificial intelligence and telehealth and how, and mobile health and how all those things can work together to increase access and ensuring that we maintain quality in all of that, but potentially reducing costs for patients and families in the United States. I also see us looking at how we are going to as a profession re-evaluate the task and rules within all of the professions in the medical arena, and saying, you know, we all need to be working at the top of our licensing and maintain efficiency. And by maintaining efficiency, we're also talking about improving quality and reducing costs, and that's one of the many things that we drive for. We're trying to advance these ideas, and we have to be willing to give up a little here in nursing that we think is our territory, but it's something that someone else could actually accomplish and do well and do safely.

Then we need to be working on the things that we know that are nursing centric, that need to be our arena, and the same for medicine. And that's part of the reason that my work for the Heritage Foundation talking about HRNs and the importance of allowing them to function at the top of their license is still important around the country, and that's really to improve access as well as efficiency. That's wonderful. This is all about nursing.

I'm your host, Dr. Joyce Bachelor. We're live on the BVN Global Network and Tune in Radio, and we're going to continue this conversation when we come back. Certified professional coach Pamela Reeves can help you with your relationships.

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We're live on the PAM Global Network and tune in radio and I have my guest, Dr. Amy Anderson, who's doing a phenomenal job of sharing a lot of the very exciting work that she's working around the globe actually to influence health policy changes and advocacy and her work with academia. And the idea of the fact that she's working on innovative ideas, I think which is very, very exciting. As we're talking about everything tonight, I was just curious, if you could help us look at what are some of the major issues that you believe nursing will be facing in the near future?

Thank you for having me back. I also think that nursing is going to continue to face a major event facing over the last few years and that we're for shortage is something that we're going to face for some time due to the baby boomers starting to hit that peak of chronic disease and needing care. And so I think that that's an issue that we're going to continue to be working on for several years to come, as well as the social determinants of health. It's truly a public health issue and then I think nurses really are out there and wanting to address those social determinants of health.

I also think that we'll be looking more focused on people-centered care and stress and burnout. It's one of the things I actually talked about years ago in that paper, one of the paper-shirt heritage foundation is really stress and burnout of workers and how institutions and systems are going to have to look at, continue to look at how to improve conditions for the workers, both nurses and physicians, and ensuring that the environment is healthy for them as well so that they can in terms of more efficient in their care. They have to care for themselves before they can care for everyone else. I think nursing will continue to have a discussion about how we can end up youth in the healthcare arena.

I think that's been a big topic for many states on how we can prevent violence in the workplace. It's widely known that it's a significant issue and hopefully we can continue to move some legislation forward that helps protect nurses around the country as well as physicians. Health care is an area where there's a lot of anxiety. People are uncomfortable, fearful, and that sometimes results in maybe sometimes uncharacteristic behaviors, but dangerous behaviors that we have to address and make sure that we are safe.

I don't think there's a lot of huge changes coming other than the technology wave, which we're beginning on, and seeing where that goes. Obviously, we've got EHRs in place in many places, but interoperability is a problem, and so that's something that we're going to be intersaying and trying to work that out and how we can ensure that everything is talking to each other, so that we can be more efficient. Of course, that creates some proprietary issues, and I don't want to say how that will be resolved, but I do think that there's a push to ensure that we can figure out how to be more efficient in our technology use. Again, I think we're pushing more patients outside of the hospital, so nursing is really going to have to change that focus to the outside setting versus the ambulatory setting versus that in hospital setting.

I think that's kind of exciting, especially if you look at the wearables and all the things that we can start to use to really help with more prevention and managing people outside of the hospitals and getting better quality and hopefully also simultaneously decreasing costs. One last question that I have, Amy, is we're getting close to the primaries and the 2020 elections. Healthcare is always a contentious debate. What health policy issues do you anticipate will be important to voters in this election?

Yeah, I think you're right. Politics tends to be contentious, and health care has been contentious for many years now, and I think again, it's just going to be that sort of war of ideology. Are we wanting big government, are we wanting private sector and health care or hybrid of it, and we currently have a somewhat of a hybrid system? And so really, what do the people of America think, and how are they going to respond to the issues that we're facing, the surprise medical billing that we're dealing with?

I mean, that increased over the last few years. I think there's a recent Stanford study sent 30% to 2%. People ended up with surprise medical billing, and six years later, it's 42% so that's really concerned, price transparency that costs the pharmaceuticals, choosing their own provider, and really, prices, the cost of high deductibles are really impacting families. I think these are all going to be issues that are talked about both in the primary and the general election.

Thank you so much. It's been wonderful having you on the show this evening. I think that you've just shared a whole lot of great information with our audience, and thank you again for being here. You have been listening to All About Nursing Live from the Beebem Global Network in TuneIn Radio.

I'm Dr. Joyce Bachelou host of this show, and hopefully you'll tune in again next week. Thank you. You've been listening to All About Nursing with your host, Dr.

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