A Nurse First

Footmark

• Sigma Nursing

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Out of 800 applicants, Jitana Benton-Lee was one of 30 selected to participate in a digital innovation boot camp, a collaboration between the American Association of Colleges of Nursing and Apple. The proposal? A visionary app to track nursing students' core competencies, moving away from archaic paper methods to a dynamic, digital solution.

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In, I think it was 2021, the American Association of Colleges of Nursing put out a call of action to nursing faculty. The new essentials are the core competencies for nursing practice. The new essentials changed. Before we had like the MSN essentials, we had the DNP essentials for the nursing program, but now we moved into just the essentials and it was broken down to pretty much like an undergraduate and a graduate level essentials. And they wanted to identify ways to incorporate those essentials into the nursing program because this is a major change, right? And so they sent out a call to action to faculty across the country. to submit proposals on things that they could do. So I submitted a proposal to the AACN to work with Apple and the AACN through what they called a digital innovation boot camp. And my proposal was centered around specifically looking at how nurses meet those core competencies. So I wanted to create this visual dashboard. I was really focusing on a tracking mechanism because I wanted to be able to identify how Welcome to A Nurse First. This is Jitana Benton-Lee, Right now, we do a variety of different things. We are capturing this information, but it's all paper. It's all in a filing cabinet somewhere. So we were not able to do comparisons. We're not able to get statistics unless it's a huge manual process where we're looking at hundreds of files over several years and doing a manual process. So I wanted to look at creating a technology that once it's entered, once that we can run reports on. But I also wanted to create this tool in that it would allow nursing students to be able to not only identify where they need to focus their practice or professional practice to get skills, but also that we're incorporating this health equity piece. Because one of the things with nursing practice, we know through literature that we want to have nurses who are either well-trained in health equity, and we want to diversify our workforce. So I think there was like, I don't know, close to 800 people across the country that applied and only 30 of us were selected. When I was selected to participate in this digital innovation, I received an email and I was thrilled. I was thrilled beyond, I mean, just super excited about it. I really want to make a difference. And now I have an outlet to be able to make that difference. I think my peers at the university were pretty excited as well. It was just something that we were looking to make some changes to how we were doing our system. So this provided an opportunity for us to be able to capture data that we couldn't capture. It's like sometimes we were in meetings where it's like, okay, we need to capture this information. We knew that we were collecting it, but we didn't know how to get it in a usable form. We center everything on our students. And that was the most important for us. And so me getting this opportunity provided an opportunity for us to center more on our students and to be able to provide them with better and positive experiences. I was really intimidated by the idea of creating an app, even though we needed it. So I had this idea of what I wanted, but I didn't know how to get there. Imposter syndrome is something that I feel like I've suffered from most of my life. So going into creating this app, I clearly had it. I knew that I had it. I had a little anxiety about doing this particular work. And so one way that I overcome it is educate. I always over-educate myself. If you're going to see someone who's going to overcome a challenge of imposter syndrome, it's going to be me. I feel like if I have enough facts or if I have enough information on the topic, then it kind of quiets that anxiety that I have a little bit. You know, I use Apple products every day, but do I feel as if I knew it well enough to be able to create technology? So I got my iPad, I got my MacBook, and I just started working on these particular activities. The first meeting that I had with Apple was via Zoom. We had a conversation with the educational leader about what the program entailed. So we talked about what the expectations were going to be, how we would meet deadlines. It was a lot. It was like, OK, I'm in this now. For me, I kind of sit back and I kind of evaluated who was all in the room. I think it was really important. I think it's important to evaluate who you can collaborate with later. But I also wanted to know about other people's projects because it kind of helps you kind of center yourself and know what you're going to do as well. I realized that there's some things that I needed to do differently. And initially, we thought, OK, I could do this work as a numbers document, which is kind of similar to an Excel spreadsheet. But the more we talked about it, we realized that it was more advanced than just creating an Excel spreadsheet. You know, sometimes with nurses, we kind of have low-hanging fruit. We thought, like, we'll create a checklist. We'll create an Excel spreadsheet. But we're not thinking on a grand scale, right? With Apple, they have what they call directors of education, and they're from all different backgrounds. And so the one that we worked with is a nursing. She was a former dean at UNC. And so she understood nursing, but she understood technology. So it was about working with her in a meaningful way because she understood the nursing side. She had a general good, strong understanding of the technology side as well. So she was able to bridge the gap. When we start looking at the app, we looked at functionality. How did we want it to work? And so the university that I worked at was pretty much the model for it in the sense that I knew how we interacted with our students and how we wanted them to meet the essentials and how they document it now, which is an entire paper process, right? So it's like lots of scanning, lots of signatures, lots of sending things back and forth. But creating something where we're getting that information of how they're meeting things is key. We need to make it automated. I wanted to make it so that not only the nursing faculty and the students can see it, but our students have to do preceptorships or they have to do clinical experiences. And I want those mentors in those health facilities to be able to see it and sign off too. So digitizing it as an app was probably one of the best things for us to do because a lot of different people can see it if we give them access to After her initial Zoom meeting with Apple and AACN, Jitana flew to Dallas, Texas to meet with the team in person. The entire meeting focused on the what could it be, rather than limiting ideas to existing technology. And We're in a room and we're working with Apple and we're working with the AACN. They really kind of pushed you to think deeper, to have these dreams. I always call it pixie dust, right? Like if I could sprinkle pixie dust in the room, this is what I would have. So it's like having that pixie dust discussion of things that you could do if you could. This app really truly is the first of its kind, specifically because there's no other technology out there that is targeted to nursing in the core competencies. I really struggled to come up with a name, and I kept beating around the idea of monitoring or tracking or this, that, and the other. And so I eventually landed on Nursing Footmark, and that, you know, the footmark is the blueprint, right? And so I'm hoping that this particular technology would be the blueprint for the future. But also when you think about tracking and footmark, you can track someone's footmark, right? So you're making that imprint on someone's life or their exposure. And so that's why we went with the name of Nursing Foot Mark, because that footmark is the blueprint of how we want to see nursing perform in the future. So what I'm hoping to do with this particular app is to create a standardization of how we track information because we need to be able to do that in order to compare across the country what our students are doing. Maybe they're doing something in Hawaii that we need to be doing here in Kentucky that we don't know anything about. So what I'm hoping to do is create this app that is a strong tool that could be endorsed by schools of nursing as this one-all, meet-all application that will allow us to do some benchmarking. We've got some semi-automated processes that certain organizations have created, but they don't work efficiently. Basically, it's driven by the student. So the student will go in and put in their activities. They will go in and they will select the domain that they did the activities in. They can select more than one domain because there's a lot of crossover in the activities. I may be doing patient care, but the patient care may also hit technology, right? And so they can select multiple domains and they can select multiple subcategories. So they can say, I'm at domain three, which is patient-centered care. And this is how I did it today. I took care of a patient that had a fistula because they put in a note. They put in a note of what they've done so the faculty can see it, but also they have to put in the day of the activity. They have to put in the time spent because we need to know they spent one hour, two hour, three hours providing this level of care. We also want to know what type of facility that they did this work in? Is it a hospital base? Is it like acute care or is it ambulatory? Is it medically underserved areas? Is it a community center? So they fill out like a template at the beginning of it that identifies what specific things they are doing in the healthcare facility. And then they draft a little note, a little narrative to let us know what they've done. Depending on the specialty that you're going in, you have to meet so many clinical hours. So for the state of Kentucky, I know our MSN have to acquire 500 clinical hours. So we need to know what they're doing and how they're doing it. And faculty member can go in and say, yes, this is an approved activity. You're going to get the two hours for this. Or they can say, no, this is not an approved activity. I can't give you clinical hours for that. Our doctoral students need 1,000 hours. So it not only tracks what they're doing and categorize it according to the domains, but it helps us identify if they're meeting their clinical hour requirement as well. So it was developed to be a systematic tool to tie the nurses' thoughts or nursing students' thoughts to the actions that they're doing. So more of what we call a theory to practice. They're doing this work, but they're putting it into practice. So as a faculty member, I should be able to see all the students that I'm advising, but the administrator of the app will be able to see every student. With this particular app, we have to keep our data for a significant amount of time, and so they'll be able to keep their data usually on their servers. from the app so that they can show their accreditation, how their students are meeting it. So it's really nice in that not only does it help with that tracking component that faculty have, but then they have this reproducible thing that they can print out reports and activities that they can show to their credentialing bodies that their students are actually meeting those core competencies and how they're meeting those core competencies. And hopefully it will give us data that we need because right now with a lot of it being a paper process or a manual process, I can't compare what my students are doing to a school in New York or Washington, D.C., but as we get more people on board and they're using this technology, we should be able to compare to see what people are doing to give both teachers and faculty greater insight on how to expand their knowledge and their nursing skills. I really think that this technology is something that could be adopted by all health science programs. And what I'm talking about is like your physical therapy, your occupational therapy. We can also look at it in medicine as well because they have specific skill sets that they have to learn as well. And so I think starting out using this technology in nursing, refining it, will open the doors to be able to use it in other areas. That's the idea about having a customizable technology is because those core competencies for nursing is very different than it is for speech therapy. And so can we embed those competencies for speech therapy in there that they can document, they can Your app is almost three years in the making, but you're almost ready for the rollout. What challenges have you faced along the way? What keeps you motivated to In developing the particular app, of course, you always meet challenges. So technology is one of those things that you're constantly changing and you have revisions. But it is key to ensuring that you have the best quality project. You know, I tell people I deal with belly buttons and heartbeats. And so I had to learn a little bit more about coding and IT technology and those kind of things that I wasn't comfortable with. So that was my greatest challenge, was saying, I'm not comfortable with this, or give me the for dummies version. I was like, well, give me the for dummies version of coding, because what you're saying to me does not make sense. It's like we're speaking two different languages. So we had to figure out how to communicate with each other in a way that we understood each other, because the coders and the IT folks, they see in numbers, and then I see in people. And I wanted to make sure that this particular app had a heart and a soul, because nursing is a heart and a science. And so I didn't want it to be just so scientific that our nursing students, our faculty didn't have the leeway to be able to have the soul in it, to have the heart in it. I developed a team with people outside of Apple to help me work on developing this app, and I wanted them to have skill sets that I didn't have. To source the team, what I did was attend many what they would call tech weekends. So really it is about what they talk about getting out there, walking the ground, talking to people, interacting with people in a different way, and networking. And I usually say I'm the anti-networker because I really like my work to show for itself, but I really had to change my mindset on how I did things. And I really had to go to the people to be able to network. So I really created this wall of people around me that was invested in this project as much as I was, and that had skill sets that I didn't have. And then we had to lean into each other. Sometimes people bring people that are very similar to them to the table and they don't get anywhere. So if you have someone who's very diverse, a group of individuals, you really do make better traction because you're seeing things differently. You have that varying perspective. Additionally, I think working with people that are in the industry doing the work, and there's a lot of people that are creating apps every day that don't have that background, but they're creating apps that we're using in our day-to-day lives. And I think it is about realizing that you can learn new things, you can learn new skills, and you have to be willing to do so. One of the obstacles that I'm facing now with the app is curriculum. So right now it is set up for those core competencies, those essentials, but faculty need something to balance out their curriculum. And what I mean is that when you start looking at your nursing program, you have your program outcomes, And then you have your course outcomes, and it's trying to create that customizable portion of it. So it's about looking at how to incorporate those program and course competencies in a way that can be tracked by those essentials. So the essentials are kind of built into our programs, and so it is about building that customization in place. to meet the organization's needs based on their program and their course curriculum. And so when you're looking at a feature that is customizable, you're looking at what options you should be able to change and what things that should remain constant. Not impossible by no means, it's just going to look very different. But it is a labor of love. So I truly appreciate it. And I think that for me, because I'm so passionate about this work, it's not work. I have truly felt as if I'm working in my purpose. And I Thank you for listening to A Nurse First from Sigma. If you loved this episode, do us a favor and subscribe, rate, and leave us a review. It is very much appreciated. For more information about A Nurse First and Sigma, visit