Episode 2: The Power of Virtual Nursing with Kristen Dickens

Today's guest is Kristen Dickens MBA, BSN, RN, CENP! Kristen is the Director of Nursing Practice and Innovation at Prisma Health. In this episode we learn how she arrived at nursing via a communications background, her passion for innovation, and how the health system's new virtual nursing program facilitates a better workplace experience for nurses and better care for patients. 

Transcript

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Right because I think you have to have the right mindset to be able to say, hey, you know what? We can't just continue to do things we've done because we've done them this way for 100 years. We have to look at new, novel, innovative approaches to how we take care of patients, and we can't be afraid to try something and fail. You Emily, welcome back to tell me why I'm Emily O'Sullivan, manager of workforce experience for sbha, and I'm joined today by my colleague, Kristen Hill. She's the manager of strategic relationships for solvent networks, which is a division of fcha. Our guest today is Kristen Dickens, Director of Nursing Practice excellence for Prisma health, and she's joining us today to talk about their virtual nursing program. Kristen, thanks so much for joining us today and welcome to the podcast. Thank you. Thank you for having me absolutely. Well, to start off, we'd love for you to just tell us a little bit about your healthcare journey. How did you get into healthcare, and then how has that kind of led you to your current role at Prisma? Wow. So that could take the 30 minutes. So, so my journey into healthcare is actually, I think, although I think becoming less unique at the time. You know, 21 years ago, when I became a nurse, it was pretty unique. So I am a second career nurse. So when I graduated from high school, I actually intended to be a nurse. I thought, this will be great. I'm going to go in and be a nurse. Well, my aptitude for science, did not agree. So I got into my into my nursing school at George Mason University in Virginia, and actually did not make the cut to get into the nursing program. So I said, You know what, I'm not going to stay in school for another four years. So I switched and actually graduated with a bachelor's degree in communications. Didn't really know what I was going to do with that, but when I got out, I did a lot of public relations marketing, the things you do with a communications degree, and ended up stumbling upon a project management job in a small it, startup company, so in Virginia at the time. And so I actually became a project manager and decided I loved it and loved everything about it. It fit my fit my personality really well. Well during the course of that, both of my parents became ill, both by now, but my dad spent some time in Johns Hopkins, and my mom spent some time in a nova fair Fox hospital. And as I was taking care of them and spending times in those institutions, I really became acutely aware of some of the really great things about healthcare, but really a lot of opportunity around healthcare for process improvement. So I decided, You know what, I'm going to try again, and I enrolled in George Mason's actual first second degree accelerated nursing program. So I went to nursing school for 12 months and came out with a BSN, terrifying to say the least. I actually went right into a fellowship program at Inova Fairfax in their ED and trauma and that's where I began my nursing career. I knew when I came out that I knew emergency nursing is what I wanted to do. I wanted to go into what I perceived as one of the more challenging specialties in nursing, and really hone my skills, and it gives you the opportunity to see really all facets of nursing come through the ed. So I also knew I wasn't going to stay at the bedside, and that's an interesting thing, because not a lot of people will put voice to that, but I knew that when I went into nursing, my goal was to change workflows and processes in nursing. Now, did I know how I was going to get there at that point? I did not, but I have been acutely blessed over my career to have leaders and mentors that saw the potential and strategically placed me in positions that would allow me to do that. So over the course of my 16 years At PRISMA health, I have had the opportunity to be in just a variety of different roles to make a variety of different impacts on the organization, from magnet designation to decreasing turnover in our nurses to where I am now in all things nursing practice. So again, not your typical journey, but one that I think fully prepared me to be in the role that I am in now, and fully prepared me to really take hold of new, innovative models for nursing. Because I think you have to have the right mindset to be able to say, hey, you know what? We can't just continue to do things we've done because we've done them this way for 100 years. We have to look at new, novel, innovative approaches to how we take care of patients, and we can't be afraid to try something and fail. And I think that's the big that's what I've been blessed. To have in my career, the ability to try new things, to fail, and still be able to continue on. I love that. I love that you had that vision from the very beginning, that you didn't necessarily want to stay in bedside nursing, but you wanted to approach things from more of a systems and operational level, to make things easier for other nurses. One thing that we like to ask all of our guests, because why stands for work harmony, you and because, you know, this podcast is called, tell me why you kind of touched on this a little bit already, but what would you say is your WHY for doing what you do? So my why, first and foremost is the nurses. And I say this, and this has been something that I've hold, held very dear to me through my whole career, is I will know that we have done the right thing when a nurse will leave a 12, 1314, hour shift and say, I feel like I cared for my patient in the best way possible, and that I was able to complete everything that was expected of me, and I can tell you that is rare for any nurse to walk out and say, I feel like I did what I was supposed to do today as a nurse, and that's my why, because we have become our profession has become so wrought with just copious challenges, the amount of documentation burden, the staffing challenges we find, the acuity of our patients. I mean, patients are sicker and sicker and sicker, the pace at which technology is coming at us and their their need to pivot and adopt and there's just a lot of challenges in our workforce. And I, I am here to advocate for nurses, to be the voice for nursing, and to really help design systems and processes that get them back to being with and taking care of patients, because that's ultimately why people go into nursing. They don't want to you hear it all the time. They don't want to nurse the computer. They want to nurse the patient. And the more we can become efficient and innovative the more time we give back to them to be able to do that. So that is my why, and my second Why is we live in this I live in this community, right? So the nurses in these hospitals take care of my family and have taken care of my family, and actually have taken care of one of our youngest members of our families that passed, and the fact that my family can speak of that in a positive manner speaks to the work that we do, and that that is my why I love that. Thank you for sharing. That was beautiful. That was very inspiring. Thank you. Good. This is, this is Kristen Hill talking to Kristen Dickens, so we have given a little sneak peek to our audience and our members at scha and talked about virtual nursing. And we've had a little bit about Prisma and our communications, but we'd love to hear a little bit more. We're curious as to what was the genesis for implementing virtual nursing, particularly at Prisma, and if you were, like, filling a gap or a need, then you designed it, yeah. So really, it's an innovative care model. So we started some work. Gosh, it's been years now, you know, before COVID, and then took a little kind of detour when COVID happened. But it actually, for all the negative things we talk about COVID, it had a lot of positives in terms of our ability to leverage technology and and helping people feel more comfortable for that. So I think it truly did set a foundation for virtual nursing in a way that we may never have had before COVID So, so we had been looking at Team nursing models. We had looked a lot of different staffing models over the over the last few years, and tried a lot of different things. You know, we've really been intentionally bringing LPNs back into our workforce and really elevating their scope of practice, because if you're allowing them to work at top of practice, you're allowing our end then to work at top of practice. So we had been looking at that for some time, and I had become very interested in virtual nursing myself and my CNO at the time, and actually had, she had come from an organization that had done it successfully. So really, just it was all the stars aligned, is the best way to say that so, and we have a extremely supportive CIO in our organization as well as I just can't say enough about our IT team and their ability to think outside the box and be willing to try new things and move things forward. So really it was looking at, how do we provide some extra support for nurses? Really around that documentation burden. So if I had to say, kind of where were we focused? A lot of it towards, as we evolved over time, became around that. So, you know, we started with with one model and ended up with another model, and one model was very focused on patient rounding as well as the admissions and discharges. And then as we added more patients to the virtual nurse, it really became more focused on admissions and discharges, which, from a clinical nurse standpoint, has a high documentation burden. There's a lot of things that have to be completed. During admission and discharge process, and many of those things don't require you to physically be with the patient at the bedside. So so that was really the genesis, if you will, of it is to really look at all of those things a nurse does in her daily work that don't require that face to face interaction with the patient, and then how do we leverage a virtual support, a virtual nurse, to really help relieve some of those duties and allow the nurse more time back to spend time with the patient and be at the bedside. So that's really kind of how this all evolved. You mentioned admissions discharges. What are some other ways you utilize your virtual nurses? Or what? What is your relationship like? Yeah, so we've used so a lot of different things. We've used them for dual verification for medications. We've used them to make sure that our care planning is up to date. So, you know, as nurses, we we have nursing diagnosis, and we plan care for our patients and and we look at, you know, their progression as they go through the hospital. Are they meeting these milestones that we have set for them? So the virtual nurse is a big overview. Looks at all of these things and says, Okay, this person's on track, or, Hey, we're missing this piece. So really, as a partner in the care, they're also the nurse that gets the critical lab values that then touches base with the physicians. They help set up consults. So a lot of those things, again, that pull nurses away from the bedside. It's really great to hear, especially how it's just evolving, yeah, and, and we really, so I have actually been talking to others around our system that other campuses on kind of what's next for us. And it's so fascinating just to hear the different ideas they have for this. So, you know, ICU settings and and even more care planning, like, how can we actually bring our patients into the care planning process? Right? So how do we make this a true partnership? To say, this is not just me Kristen saying, This is what your goals are, but it's it's Kristen and Kristen, or Kristen and Emily, saying, Hey, these are what's important to me as a patient. So let's collaboratively make those goals, set those milestones, so that we can be achieving these together and get them back to their optimal state of health, which ultimately is our reason for being as nurses is to get you back to that optimal state of health, whatever that looks like for you and for each patient. Did it take a while for your team members to gain like trust in the virtual nurse? I mean, it's a big step to make Yes, yes, yes, it did so. And that's one of the things that when people ask me, because I've presented on this many times, when they ask, you know, what is your number one pearl of wisdom, or what is the number one thing that has to be there for this to be successful? And it has to be trust. And one of the things that we did to ensure that we could kind of facilitate that relationship is we actually had our virtual nurses spend time on the unit they were supporting and work side by side with the nurses, because we you would not be successful if a nurse that nobody knew just came up on the screen one day and said, Hey, I'm here to To help you. Because when you think about nursing, traditionally, we do not share care of our patients, except in some really rare circumstances, right? So, like a code everybody's coming in, or if you're supporting an LPN on some of the things that are not within their scope, you're sharing some care. But physicians, that's very that's very normal for them, right? So they will bring in a cardiologist, an oncologist, or whatever specialty is needed. And we do that to some extent in nursing, but it's still not a a normal space that a nurse lives in. And nurses really, you know, they become very protective of their patients, right? And they want to make sure that, you know, they have a plan of care for them. They know what they want this patient to achieve and and it's been really interesting to see them kind of open up to, hey, I do have someone here that can support me, and this is how we're gonna how we're gonna build and leverage that relationship. So trust is key. Because the number one thing they will ask you is, why can't we just have another nurse on our unit? And you really have to be able to paint the picture that a virtual nurse provides a different kind of support. So if we give you another nurse on the unit, yeah, they may be able to take five extra patients, but you're still have the same documentation burden, the same burden, all those things that are taking you away from the patient that we're trying to give you that time back. So it's really in how you help them understand the resource that's being provided. Christen, could you speak a little bit to some of the logistics in terms of, like, how many virtual nurses do you currently have? And it's specifically you're utilizing them at just one campus right now. Is that correct we are so we have two virtual nurses right now. We have a full time virtual nurse and a part time virtual nurse, and we are using them 12 hour shifts Monday through Friday to support two units on our to me campus, and in all of our rooms on those two units are hardwired. Now we are exploring, meaning the camera and everything is fixed in the room. We are exploring, looking at some mobile solutions too. You know, I I have some reservations about a mobile solution, only because one of the kind of North Stars for us when we did this was we didn't want to inadvertently create burden for the clinical nurses, so having them have to go get something, bring it in the room and set it up for the virtual nurse to be able to engage with the patient is an extra step for them, but there are ways that that can be done quite successfully. That's just not the model that we chose for our first go at it. But we are looking at, you know, where are some opportunities that maybe we could bring in a mobile solution, and what could that look like? Because then really you can extend the reach of those, those virtual nurses so and and have them look at different things, because there are some hospitals that may not have a need for admissions and discharges because they have an admission discharge nurse, but then there may be a hospital that is really struggling with with their quality indicators. So how can we leverage the virtual care partners to make sure that all of our interventions are in place on every patient and when they're not helping them, to say, hey, we noticed this bed alarm is not on or or something to that effect. So the sky truly is the limit with virtual nursing, and I think that's why I love it so much, because it doesn't have to look the same. It doesn't it can look different. It can look one way at two. Me a different way at Richland, a different way at Baptist Easley, but it's meeting the unique needs of that patient population, that team and that and ultimately that community. So I think that's what's so great about it, is how versatile it can be. And there's so many people doing work in this space, and we're all so open to kind of talking about it and learning from each other. And I think that's huge, because that's how we're all going to help take at the end of the day, we're all here for the patients. That's what we're here for. We're here for the patients and for our teams, and the more we can collaborate and learn from each other, the better this is going to be moving forward as we continue to evolve in this space, absolutely so our why initiative with SHA is it's all about restoring harmony to the relationship between work and the people who do it, which is pretty much what you verbalize when you were talking about your why for trying to make things easier, trying to to make the work, you know, seem more seamless, so that the nurses and other clinical folks can focus on their patients and not all the other stuff that gets in the way. And so we know that, you know, one underlying cause of burnout in healthcare is lack of flexibility and work life balance. Can you talk a little bit about how virtual nursing has helped to foster more work life harmony and satisfaction with your workforce, both with the virtual nurses, but also with the bedside nurses. Absolutely So for our virtual nurses, I think it's an opportunity for them to continue to use their nursing skills, but also be able to do that in a remote environment. So I think that's a huge for you know, there's many nurses that, for one reason or the other, you know, have to leave the bedside, or decide to leave the bedside for various reasons that some are out of their control, and with that, you lose so much knowledge and tenure. So one of the benefits of having them transition into a virtual nurse position is you've retained that knowledge and that benefit, and then they can serve as these incredible mentors and preceptors and all of that for the clinical team on the flip side, for our clinical nurses at the bedside, I think too a lot of them, we have a very young workforce, right? We know that, so you now have a tenured virtual nurse on the other end that you can call and ask questions, and is there to be there to guide you and and that can be very reassuring for a new nurse, because there is probably nobody more scared on a unit than someone who is just starting nursing, because they truly one. They don't know what they don't know. They're still new in the profession, and everyone around them is a resource for them, because they're still learning, and that can cause a great deal of stress, and if you don't support a new nurse effectively through that first and second year that stays with them the remainder of their career. So that is such a pivotal point in the career of a nurse that first two years that the more support and and guidance and mentorship you can provide them, the more chance they are going to move into their third year and beyond successfully, not burnt out, confident in their practice. So I think it's all those things, and I think ultimately to. To harmony is created when, when a nurse is able to really feel like they have taken great care of their patient, like that is what you want a nurse to walk out of with every day. Is that you know what? I did a great job today taking care of my patient. My patient is hitting these milestones. They are getting to where they need to be, and we are going to be able to transition this person back to their to their home or or wherever their environment is that they're coming from. And that's ultimately what every nurse wants, that's that's what they want. So the where you can take some of that burden off and allow them to do that, I think that helps reduce the burnout and helps really give them that harmony in their work. And like you've mentioned, it just makes for an overall better patient experience. Absolutely so in addition to the benefits to the workforce and to the patient's experience, are there any other outcomes that you have achieved related to virtual nursing? Any financial savings? Yeah, so we have looked at, we have, you know, reduced our length of stay on these units. We've also increased our time from the discharge order to discharge right, which is huge. So we're able to get our patients out, we're able to get them back home. We're able to get new patients in. So really, length of stay and that time to discharge have been the two big indicators that we have really seen a lot of success in moving around and again, patient experience as well, and we also did on our last engagement survey, we actually did make some significant improvement around nurses feeling like they had the resources to do their job. And that is a that's a hard metric to move. It really is. So the fact that they really felt like, hey, you know, this is an added layer of support is is extremely positive. So, you know, but there's so many every day i i read on virtual nursing, I look out there and see what other people are measuring and their metrics, and it's just, it's just evolving every day. So I'm always thinking about what are new metrics we can look at. You know, we did look at some metrics about time given back to the nurses at the bedside. So lots of different things were kind of, we're looking at as a whole to try to really show the value of this program. And again, one of the things that I do often tell people that ask me about the program is it's really important to begin with the end in mind. So when you're looking at how you want to design your program, you have to understand first what outcomes you want to achieve, because your how you design your program will be fully informed by what you're looking to achieve. So if patient experience is really a challenge for for an area, having those virtual nurses focus on patient rounding and response to patients and education that will move that metric, okay, if you're really challenged to get people out of your hospital in a timely manner because you're seeing discharge delays or things are, you know, things that are necessary for discharge are being overlooked. So then it delays that patient's discharge that day, like they were supposed to see PT or OT, and that didn't happen. Then you need a virtual nurse that's focusing on those things. So it really is important to to understand what your organization wants to impact, and then build the program to support that. And like I said, that doesn't have to be one thing for all of Prisma health. That could be very individualized for each area and for each campus. You are a wealth of knowledge. We do have a question in regards to the lessons that you've learned when, when implementing the virtual nursing program, and what do you want to share with our other hospitals and health systems that might be interested in implementing a similar program? So the first thing, as with anything we do, the need to be interdisciplinary, right? So you need this is a, this is a program that will touch literally every portion of your workforce, so making sure that they are part of the design of this of the program is imperative. It has to be multidisciplinary. It has to be driven by the nurses that do the work. So they have to be included in the conversation. You have to understand what, what they would say are their hassles every day, what they are looking to achieve, because they need to be it needs to be built with them, not for them. And that is incredibly important. In addition the trust piece, as I've already talked about, that's huge, because if you don't have that, I don't see how the program could work if they don't trust the person that's on the other side of the screen. I think it's really important to understand your patient's perspective. So we were able to survey. Um, some of our patients around virtual nursing before we started the program, and that really did help inform some of our marketing materials and the education that we provided to our patients. So hearing the voice of your patient is is crucial, and it may look different based on what your normal population is for that unit. And then I think, just again, being change management. So that's the one thing I can say too, is, I think it's really important, as you're rolling out this process, that you really are aware that this is a change, and there is so much information out there, both negative and positive about, you know, AI and where we're going in the future. And you know, there won't be a need for nurses anymore, and that could not be further from the truth, but you have to be able to to help them navigate that change and help them understand that this is a support, not a replacement of you, because they will never that will never happen there. There is we will always need nurses, and this, this role, helps us get nursing back to what nursing was intended to be. That truly, that art and science of nursing and really helps that nurse on the unit be that, that conductor of this orchestra that's happening every single day when they're taking care of their patients, they are the person keeping all of that together, synthesizing all of that information, and ultimately helping that patient get back to their optimal state of health. And this is just an additional resource to help them do that effectively. I feel like you could write the book, Kristen, write the book. That's all great advice and feedback. So thank you. Thank you. Yes. Thank you so much, Kristen. As we wrap up today's episode, are there any questions we didn't ask you that you wish we would have, or do you have any final thoughts that you'd like to leave with our audience? No, I would just encourage you know, if anybody has questions or is thinking about doing this, I love to talk to people about it. I've had the opportunity to do that on just so many occasions. Actually, just presented in Canada at the Academy of Medical Surgical nurses on the program, and that was just that, that was such an incredible presentation, and just the feedback we got. So just want to make sure that, you know, especially as this is through the SHA that it's, you know, we are all here together. We're all doing this work, and we need to be able to learn and collaborate and grow and share and help understand. Hey, these were the things I tried that didn't work, but this one worked really well for us, because again, at the end of the day, we're here to take care of our patients and our team members. Kristen, what's the best way for people to get in touch with you? If they'd like to find out more, probably email. I would. I pride myself on being very responsive to email. So email would definitely be the best way. And of course, if they want to have a meeting after I've done that many times too, so just reaching out via email and then we can kind of figure out what the next steps look like. Okay, sounds great. And as Emily mentioned in the opening, I am the manager of strategic relationships for solvent networks, and that's a division of sdha, and we support hospitals and health systems across the state by delivering innovative solutions to operational challenges. And just talking today, after this conversation, I wanted to be able to highlight two of our endorsed partners to this audience, COVID and Virtu ally. They have partnered together to offer a comprehensive virtual nursing solution as part of qualibus is full suite of Workforce Solutions. So this partnership allows for a seamless integration of staffing and technology without the need for a separate contract, and really it's a turnkey solution that enhances healthcare delivery in a virtual space. So if you're already working with qualifies, we encourage you to talk to your representative and set up an interest meeting. But if you're not currently partnered with qualifish and would like to explore additional support for your operational needs. Please contact me in solvent networks, at s, p, H, A, and it like, like Kristen said, if you would also like to continue conversations with her, I can help connect you with with Kristen Dickens, Thank you, Kristen, for sharing that with us. And Kristen Dickens, thank you again, so much for being with us today and for sharing your ex your experience and your expertise with our audience. If you're comfortable with it, I'll leave your email address in the show notes and for our audience, we do have a case study on Prisma virtual nursing program. It's posted on our website at SC one. Y.org where you can learn more about virtual nursing, and you can learn all about our BI initiative. And we also invite you to follow sbha on social media, and please like and subscribe to this podcast and be sure to join us for our next episode. Thanks so much for listening. You