WEBVTT 00:00:04.240 --> 00:00:10.850 position:50% align:middle - [Maryann] I'd like to introduce to you my illustrious panel of speakers today. 00:00:10.850 --> 00:00:15.230 position:50% align:middle First of all, virtually is Robyn Begley. 00:00:15.230 --> 00:00:20.090 position:50% align:middle She is the Chief Officer of AONL. 00:00:20.090 --> 00:00:27.470 position:50% align:middle To my left is Joan Stanley, the Chief Academic Officer of AACN. 00:00:27.470 --> 00:00:30.710 position:50% align:middle Also virtual is Loressa Cole. 00:00:30.710 --> 00:00:35.680 position:50% align:middle She is the ANA Enterprise Chief Executive Officer. 00:00:35.680 --> 00:00:45.230 position:50% align:middle And finally, two people down from me is Linda Christensen, the Chief Legal Officer from the National 00:00:45.230 --> 00:00:46.710 position:50% align:middle League of Nursing. 00:00:46.710 --> 00:00:54.120 position:50% align:middle And I cannot forget the person to my right, David Benton, the CEO for NCSBN. 00:00:54.120 --> 00:00:57.950 position:50% align:middle I'm Maryann Alexander, and I will be moderating this session. 00:00:57.950 --> 00:01:01.260 position:50% align:middle Well, thank you all for joining me today. 00:01:01.260 --> 00:01:10.292 position:50% align:middle I'd like to begin with a pretty perfunctory question, and I'm going to first direct it to Robyn and Loressa, 00:01:10.292 --> 00:01:15.540 position:50% align:middle but then, of course, the rest of the panelists can join in. 00:01:15.540 --> 00:01:21.440 position:50% align:middle Let me ask you, Robyn, Loressa, is there currently a nursing shortage, 00:01:21.440 --> 00:01:26.910 position:50% align:middle or is the shortage regional or institutional? 00:01:26.910 --> 00:01:28.512 position:50% align:middle Robyn, would you like to begin? 00:01:28.512 --> 00:01:29.880 position:50% align:middle - [Robyn] I'd love to start off. 00:01:29.880 --> 00:01:33.230 position:50% align:middle Thank you, Maryann, and it's great to be here with you all today. 00:01:33.230 --> 00:01:39.370 position:50% align:middle I wish I could be in person, but virtual provides us the opportunity to be in two places at once. 00:01:39.370 --> 00:01:43.580 position:50% align:middle I would answer your three-part question with a three-part answer. 00:01:43.580 --> 00:01:45.200 position:50% align:middle Yes, yes, and yes. 00:01:48.106 --> 00:01:51.140 position:50% align:middle There is definitely a nursing shortage in the U.S. 00:01:51.140 --> 00:01:57.110 position:50% align:middle This is one of the primary issues that we are seeing in our workforce across the country. 00:01:57.110 --> 00:02:04.731 position:50% align:middle However, we are observing that there's variation as we look at regions across the country and, of course, 00:02:04.731 --> 00:02:07.660 position:50% align:middle by organization or by healthcare institution. 00:02:07.660 --> 00:02:10.430 position:50% align:middle This is not just a hospital and health system issue. 00:02:10.430 --> 00:02:16.344 position:50% align:middle This really permeates all areas where nurses practice. 00:02:16.344 --> 00:02:22.073 position:50% align:middle I know my colleague, Loressa, probably, and ANA has some wonderful statistics. 00:02:22.073 --> 00:02:29.160 position:50% align:middle You know, in preparing for today, you know, there is just such a wealth of information, 00:02:29.160 --> 00:02:34.460 position:50% align:middle and the statistics that we find are confusing. 00:02:34.460 --> 00:02:43.560 position:50% align:middle However, you know, in trying to find the most current information, 2022, I think it's important that we 00:02:43.560 --> 00:02:49.450 position:50% align:middle look at, you know, different aspects of the data. 00:02:49.450 --> 00:02:53.920 position:50% align:middle Researchers of the McKinsey Institute estimate that the U.S. 00:02:53.920 --> 00:03:00.700 position:50% align:middle will have a 10% to 20% nursing gap by 2025 as the number of patients needing care exceeds the 00:03:00.700 --> 00:03:02.260 position:50% align:middle number of nurses. 00:03:02.260 --> 00:03:08.300 position:50% align:middle I can tell you that at AONL and AHA, we are working with a company called 00:03:08.300 --> 00:03:17.790 position:50% align:middle Prolucent who is actually on a daily basis scrubbing the hospitals and health systems postings. 00:03:17.790 --> 00:03:27.540 position:50% align:middle And the number of healthcare organization vacancies for registered nurses is very significant in many 00:03:27.540 --> 00:03:30.040 position:50% align:middle organizations in the double digits. 00:03:30.040 --> 00:03:31.940 position:50% align:middle Loressa, I'm going to kick it to you to see if... 00:03:31.940 --> 00:03:37.097 position:50% align:middle I know ANA also does a wonderful job at collecting stats. 00:03:37.097 --> 00:03:39.060 position:50% align:middle - [Loressa] Thank you, Robyn. 00:03:39.060 --> 00:03:42.890 position:50% align:middle Certainly, I agree with Robyn, ANA agrees with Robyn. 00:03:42.890 --> 00:03:51.140 position:50% align:middle This staffing shortage has been referred to in communications that ANA has sent out, including to HHS, 00:03:51.140 --> 00:03:56.911 position:50% align:middle the surgeon general, and many others as a crisis. 00:03:56.911 --> 00:04:01.370 position:50% align:middle And we'd like to, I think, sometimes say, "Well, it's a crisis for hospitals." 00:04:01.370 --> 00:04:05.220 position:50% align:middle Otherwise, people are doing okay. 00:04:05.220 --> 00:04:07.300 position:50% align:middle And I really disagree with that. 00:04:07.300 --> 00:04:15.480 position:50% align:middle And ANA does have some statistics that speak to the general population and numbers of nurses that suggest 00:04:15.480 --> 00:04:16.930 position:50% align:middle that we're losing ground. 00:04:16.930 --> 00:04:22.830 position:50% align:middle And we've encountered, historically, of course, we all know this, nursing shortages over the decades 00:04:22.830 --> 00:04:25.380 position:50% align:middle for a variety of reasons. 00:04:25.380 --> 00:04:31.040 position:50% align:middle But I certainly think that with the statistics speaking for themselves, we're headed for a shortage, 00:04:31.040 --> 00:04:33.860 position:50% align:middle unlike perhaps something that we've never seen. 00:04:33.860 --> 00:04:36.150 position:50% align:middle There's a variety of reasons for that. 00:04:36.150 --> 00:04:42.384 position:50% align:middle Hospitals do account for a large portion of the shortage as they approach about a 00:04:42.384 --> 00:04:46.110 position:50% align:middle 20% vacancy nationwide. 00:04:46.110 --> 00:04:49.616 position:50% align:middle But when you take a look at just what's happened through the pandemic, 00:04:49.616 --> 00:04:55.880 position:50% align:middle in 2021, nursing supply dropped by about 100,000 nurses in this country. 00:04:55.880 --> 00:05:04.460 position:50% align:middle And we certainly are not in a time with the aging of Americas, our baby boomer nurses dropping 00:05:04.460 --> 00:05:09.130 position:50% align:middle out of the workforce, we're not at a time where we can lose any ground such as that. 00:05:09.130 --> 00:05:13.697 position:50% align:middle And certainly, I know one of the questions coming will speak to the effect of the pandemic. 00:05:13.697 --> 00:05:20.550 position:50% align:middle But we have to consider that a large number of nurses under the age of 50 dropped out of the 00:05:20.550 --> 00:05:21.900 position:50% align:middle workforce last year. 00:05:21.900 --> 00:05:25.790 position:50% align:middle And that number is actually larger than the number of retirees. 00:05:25.790 --> 00:05:30.800 position:50% align:middle So, I think we all have cause for significant concern. 00:05:30.800 --> 00:05:33.550 position:50% align:middle And I will just echo what Robyn said. 00:05:33.550 --> 00:05:39.260 position:50% align:middle There's a variety of reasons as there has been for all of the shortages that we've encountered 00:05:39.260 --> 00:05:48.030 position:50% align:middle over the decade, but the pandemic certainly has been a factor that has escalated this problem. 00:05:48.030 --> 00:05:50.272 position:50% align:middle It's significant. 00:05:50.272 --> 00:05:52.791 position:50% align:middle - Anyone else have anything to...? 00:05:52.791 --> 00:05:58.630 position:50% align:middle - [Joan] I would just add that...Loressa mentioned this, some of the reasons for the shortage, but also, 00:05:58.630 --> 00:06:03.730 position:50% align:middle I would add that this is something that is going to continue to grow as we look at the increased need 00:06:03.730 --> 00:06:09.632 position:50% align:middle for nursing care, which if you look at what's occurring in our healthcare system, 00:06:09.632 --> 00:06:17.730 position:50% align:middle the increasing focus on prevention and population health and the increased chronic disease 00:06:17.730 --> 00:06:23.240 position:50% align:middle and management, in addition to the aging of the population, but if you look at those two areas, 00:06:23.240 --> 00:06:33.080 position:50% align:middle those are areas which nursing needs to be able to focus on and will increase the numbers of nurses needed and 00:06:33.080 --> 00:06:37.006 position:50% align:middle worsen the shortage if we don't come together and do something about it. 00:06:37.006 --> 00:06:41.600 position:50% align:middle - David, do you want to weigh in and also give us a global perspective? 00:06:41.600 --> 00:06:44.024 position:50% align:middle - [David] Yeah, thank you very much. 00:06:44.024 --> 00:06:54.870 position:50% align:middle So, I actually think this is a bit like the blind group of people trying to figure out what an elephant is. 00:06:54.870 --> 00:07:00.770 position:50% align:middle They all get a little different perspective on this and, you know, some people think it's a wall, 00:07:00.770 --> 00:07:05.440 position:50% align:middle some people think it's a pipe when they're touching the trunk, etc. 00:07:05.440 --> 00:07:14.159 position:50% align:middle And I think part of the problem is that we don't have the right data connected together. 00:07:14.159 --> 00:07:20.970 position:50% align:middle Now I know that some of the work that NCSBN has been doing in terms of the NCSBN ID number gives us the 00:07:20.970 --> 00:07:22.950 position:50% align:middle potential to do that. 00:07:22.950 --> 00:07:28.980 position:50% align:middle And if it's embedded within the patient record, then we start to get real numbers in terms of who's 00:07:28.980 --> 00:07:32.640 position:50% align:middle actually providing service at a point in time. 00:07:32.640 --> 00:07:40.650 position:50% align:middle But I don't want to just focus on the numbers issue because certainly, at a global stage, 00:07:40.650 --> 00:07:45.490 position:50% align:middle they're starting to recognize is that you've got to look at the numbers. 00:07:45.490 --> 00:07:52.250 position:50% align:middle You've got to look at the quality and scope of the practice of the practitioner. 00:07:52.250 --> 00:07:56.870 position:50% align:middle You've also got to look at the distribution, are they in the right place? 00:07:56.870 --> 00:07:59.670 position:50% align:middle And how often are they moving around? 00:07:59.670 --> 00:08:09.640 position:50% align:middle So, if you think about where countries like Brazil has been able to move from only 20 years ago, 00:08:09.640 --> 00:08:16.220 position:50% align:middle they really only had healthcare in their large urban centers. 00:08:16.220 --> 00:08:25.770 position:50% align:middle And by going through a process of thinking about progression so that you could start as a support worker 00:08:25.770 --> 00:08:32.430 position:50% align:middle and you could move through the system, they have now been able to cover the entire nation 00:08:32.430 --> 00:08:37.050 position:50% align:middle with a model of care that has that focus on primary care. 00:08:37.050 --> 00:08:45.980 position:50% align:middle So, I think part of what we need to do is really rethink how we pull all this data together to get a 00:08:45.980 --> 00:08:48.177 position:50% align:middle much better understanding. 00:08:48.177 --> 00:08:55.330 position:50% align:middle A recent report from the U.K. government identified some of the variations. 00:08:55.330 --> 00:09:05.570 position:50% align:middle And if I was to be in the treasury at the moment here in the U.S., I would be asking questions about, well, 00:09:05.570 --> 00:09:18.200 position:50% align:middle how come our health outcomes are in terms of the international space so poor compared to the amount 00:09:18.200 --> 00:09:19.350 position:50% align:middle of money that we spend? 00:09:19.350 --> 00:09:25.210 position:50% align:middle So, have we got people doing the right thing in the right place? 00:09:25.210 --> 00:09:35.140 position:50% align:middle And are we educating them in a way that actually is fit for tomorrow, not for yesterday? 00:09:35.140 --> 00:09:37.213 position:50% align:middle Demographics are shifting. 00:09:37.213 --> 00:09:41.750 position:50% align:middle That point was made by Joan around aging population. 00:09:41.750 --> 00:09:52.420 position:50% align:middle The number of people coming into the programs over time is going to decrease because of the falling birth rate. 00:09:52.420 --> 00:09:54.260 position:50% align:middle And these are global trends. 00:09:54.260 --> 00:09:57.700 position:50% align:middle These are not just about the U.S. or Canada. 00:09:57.700 --> 00:09:59.420 position:50% align:middle And working patterns are changing. 00:09:59.420 --> 00:10:01.320 position:50% align:middle The way that... 00:10:01.320 --> 00:10:07.680 position:50% align:middle When I went into nursing, I envisioned that I would be in nursing for the rest of my career. 00:10:07.680 --> 00:10:13.370 position:50% align:middle That's not the way that people think these days, and therefore, that mobility factor also needs 00:10:13.370 --> 00:10:13.920 position:50% align:middle to come in. 00:10:13.920 --> 00:10:19.550 position:50% align:middle So, I think it's a big challenge, but I think there are solutions out there. 00:10:19.550 --> 00:10:25.940 position:50% align:middle We have actually got to put our pride aside and say, "What can we learn from everyone else?" 00:10:25.940 --> 00:10:31.190 position:50% align:middle And that might be learning from North Dakota, or it might be from Saskatchewan, 00:10:31.190 --> 00:10:32.700 position:50% align:middle or it may be from Thailand. 00:10:32.700 --> 00:10:33.770 position:50% align:middle It doesn't matter. 00:10:33.770 --> 00:10:38.926 position:50% align:middle Let's look at it all and figure out what is going to provide the service for the future. 00:10:38.926 --> 00:10:45.590 position:50% align:middle - Okay, David, I want to pick up on one of the things you said about applications to nursing programs. 00:10:45.590 --> 00:10:50.030 position:50% align:middle And that's a big question I'm asked quite frequently. 00:10:50.030 --> 00:10:54.238 position:50% align:middle Joan and Linda, do you want to weigh in on that? 00:10:54.238 --> 00:10:57.870 position:50% align:middle What does application numbers look like? 00:10:57.870 --> 00:11:04.100 position:50% align:middle - Well, let me just clarify that, you know, when I was in...and Maryann said that I was with AACN, 00:11:04.100 --> 00:11:10.140 position:50% align:middle and I want to clarify that I'm with the American Association of Colleges of Nursing and are members 00:11:10.140 --> 00:11:12.270 position:50% align:middle of the baccalaureate and graduate schools of nursing. 00:11:12.270 --> 00:11:17.410 position:50% align:middle Sometimes we get confused with the other AACN, which is the critical care nurses on the West Coast. 00:11:17.410 --> 00:11:20.450 position:50% align:middle So, I just wanted to clarify that. 00:11:20.450 --> 00:11:26.320 position:50% align:middle We've been called the AACN of the East versus the West. 00:11:26.320 --> 00:11:34.620 position:50% align:middle So, we do an annual institutional and data system survey which collects data on the enrollments and 00:11:34.620 --> 00:11:39.010 position:50% align:middle graduations of all baccalaureate and higher degree programs. 00:11:39.010 --> 00:11:44.730 position:50% align:middle So, what I want to share with you is some of the data, and these are primarily enrollments. 00:11:44.730 --> 00:11:50.700 position:50% align:middle Now, we have been told that the applicant pools have decreased somewhat, but what we're looking 00:11:50.700 --> 00:11:53.230 position:50% align:middle at is the enrollments. 00:11:53.230 --> 00:12:01.450 position:50% align:middle And the good news is that enrollments in entry-level traditional baccalaureate programs continued to go 00:12:01.450 --> 00:12:03.160 position:50% align:middle up this past year. 00:12:03.160 --> 00:12:15.300 position:50% align:middle It went up 3.3%, and the increase also enrollments in Doctor of Nursing Practice programs increased by 4%. 00:12:15.300 --> 00:12:26.003 position:50% align:middle And then the not-so-good news is that the enrollments in master's programs did go down approximately 4% 00:12:26.003 --> 00:12:34.953 position:50% align:middle this year, and we continue to attribute that probably to the increased enrollment in the DNP programs. 00:12:34.953 --> 00:12:42.732 position:50% align:middle But also then applications or enrollments in Ph.D. programs continue to decrease this year 00:12:42.732 --> 00:12:45.420 position:50% align:middle but only by slightly less than 1%. 00:12:45.420 --> 00:12:52.994 position:50% align:middle But that trend has been going on for about the past 13 years, so then enrollments have dropped, 00:12:52.994 --> 00:13:01.520 position:50% align:middle and I can check the number, but I believe it is about 13% over the last 13 years. 00:13:01.520 --> 00:13:08.580 position:50% align:middle Also, the one group of programs that experienced the highest decrease in enrollments this past year, 00:13:08.580 --> 00:13:15.630 position:50% align:middle and this is a trend that's been going on for the past five years, and that is RN to BSN or RN to MSN programs 00:13:15.630 --> 00:13:18.430 position:50% align:middle that are designed for already licensed nurses. 00:13:18.430 --> 00:13:24.270 position:50% align:middle So, I think when we look at the solutions and what's happening, we don't want to go backwards in our 00:13:24.270 --> 00:13:30.100 position:50% align:middle enrollments and the numbers, but that population is a little disconcerting in those programs. 00:13:30.100 --> 00:13:37.430 position:50% align:middle And we hear anecdotally from our practice partners that this is probably due to burnout and for individuals not 00:13:37.430 --> 00:13:42.600 position:50% align:middle wanting to take on another expectation or requirement. 00:13:42.600 --> 00:13:46.466 position:50% align:middle However, this trend did start prior to the pandemic. 00:13:46.466 --> 00:13:48.000 position:50% align:middle - Linda. - [Linda] Yes. 00:13:48.000 --> 00:13:53.650 position:50% align:middle I represent National League for Nursing, where we have programs from LPN, LVN, 00:13:53.650 --> 00:13:55.610 position:50% align:middle all the way through graduate. 00:13:55.610 --> 00:14:02.530 position:50% align:middle And our surveys are showing absolutely similar trends, similar data. 00:14:02.530 --> 00:14:08.890 position:50% align:middle We do know that it depends upon types of programs as you know, whether the enrollments are up and down. 00:14:08.890 --> 00:14:14.950 position:50% align:middle Some of the key pieces of data that we have pulled out, a lot of whether or not the nursing programs are 00:14:14.950 --> 00:14:17.920 position:50% align:middle getting filled has to do with the number of faculty. 00:14:17.920 --> 00:14:24.980 position:50% align:middle Faculty are leaving and faculty are resigning as other nurses are resigning, 00:14:24.980 --> 00:14:29.840 position:50% align:middle and that is putting up a barrier in terms of the numbers of students that can come 00:14:29.840 --> 00:14:31.450 position:50% align:middle into nursing programs. 00:14:31.450 --> 00:14:36.840 position:50% align:middle The traditional issues have been with the number of clinical sites that are available, 00:14:36.840 --> 00:14:38.940 position:50% align:middle and things are easing up with COVID. 00:14:38.940 --> 00:14:45.773 position:50% align:middle That did put an extra burden on clinical site availability for a while. 00:14:45.773 --> 00:14:52.120 position:50% align:middle That has eased up according to the reports and the information that we are receiving. 00:14:52.120 --> 00:15:01.600 position:50% align:middle There, of course, is still issues with numbers of faculty and prepared faculty in the educational arena 00:15:01.600 --> 00:15:05.556 position:50% align:middle to really educate the students that want to come in. 00:15:05.556 --> 00:15:06.680 position:50% align:middle - Right, thank you. 00:15:06.680 --> 00:15:13.880 position:50% align:middle I think you've given us a very good look at the current environment, but now I want to project ahead 00:15:13.880 --> 00:15:15.030 position:50% align:middle a little bit. 00:15:15.030 --> 00:15:23.490 position:50% align:middle So, NCSBN data, the last time we collected it in 2020, although we have a new study going on right now 00:15:23.490 --> 00:15:28.860 position:50% align:middle of the workforce, but in 2020, it showed us, if we look at those data, 00:15:28.860 --> 00:15:35.650 position:50% align:middle that there were an equal number of nurses retiring as there were entering the workforce. 00:15:35.650 --> 00:15:43.510 position:50% align:middle If we look at NCLEX data plus the retirement data from our study, will that be enough to sustain us 00:15:43.510 --> 00:15:44.540 position:50% align:middle for the future? 00:15:44.540 --> 00:15:49.300 position:50% align:middle Can you look ahead and tell me what does the future outlook look like? 00:15:51.520 --> 00:15:52.400 position:50% align:middle Anyone? 00:15:52.400 --> 00:15:54.920 position:50% align:middle - So, Maryann, it's Robyn. 00:15:54.920 --> 00:15:59.341 position:50% align:middle You know, that number is from 2020, correct? 00:15:59.341 --> 00:16:00.050 position:50% align:middle - Correct. 00:16:00.050 --> 00:16:09.090 position:50% align:middle - And I'm just worried that the last two years are not going to reflect what we saw in 2020. 00:16:09.090 --> 00:16:15.010 position:50% align:middle We know from, you know, the hospital and health system side that the number 00:16:15.010 --> 00:16:20.840 position:50% align:middle of retirements has absolutely escalated. 00:16:20.840 --> 00:16:24.740 position:50% align:middle Anecdotally, you know, in the very beginning of the pandemic, 00:16:24.740 --> 00:16:31.410 position:50% align:middle we did see and we heard from some, you know, planning to retire baby boomer nurses that they would 00:16:31.410 --> 00:16:32.970 position:50% align:middle hang in there for a little while. 00:16:32.970 --> 00:16:37.940 position:50% align:middle And they got through perhaps the first wave or the second wave of COVID. 00:16:37.940 --> 00:16:44.800 position:50% align:middle But particularly in '22, starting the end of 2021 but also into this 00:16:44.800 --> 00:16:56.330 position:50% align:middle current year, our hospitals and health systems have reported very dramatic rises in rate of nurses retiring 00:16:56.330 --> 00:16:58.940 position:50% align:middle but also of other clinical disciplines. 00:16:58.940 --> 00:17:06.430 position:50% align:middle I mean, it was almost as if the team members hung in there, you know, for the beginning but now that it is 00:17:06.430 --> 00:17:16.580 position:50% align:middle very evident that the pandemic was not going to be a short-term one-and-done situation that people continued 00:17:16.580 --> 00:17:18.450 position:50% align:middle with their plans and are retiring. 00:17:18.450 --> 00:17:23.770 position:50% align:middle The American Hospital Association is actually in their current survey that is going out for this year tracking 00:17:23.770 --> 00:17:30.764 position:50% align:middle that information, and so it will be very interesting to see what was anticipated versus what was actually 00:17:30.764 --> 00:17:38.410 position:50% align:middle realized and if people left prior to the traditional retirement age of 65, you know? 00:17:38.410 --> 00:17:43.280 position:50% align:middle Were we seeing early retirements at 62 or even earlier than that? 00:17:43.280 --> 00:17:49.060 position:50% align:middle Remains to be seen, but that is what anecdotally we are hearing from the field. 00:17:49.060 --> 00:17:53.141 position:50% align:middle - Loressa, do you have anything to add to that? 00:17:53.141 --> 00:17:54.300 position:50% align:middle - Yes. 00:17:54.300 --> 00:18:00.090 position:50% align:middle I think I'll tag on to what we know, what we have anticipated for several years now, 00:18:00.090 --> 00:18:02.451 position:50% align:middle and that's the retirement of baby boomers. 00:18:02.451 --> 00:18:10.487 position:50% align:middle If you look at our friend, Peter Buerhaus' numbers, he will tell you that projected is about 650 RNs will 00:18:10.487 --> 00:18:16.200 position:50% align:middle exit the workforce between 2020 and 2030. 00:18:16.200 --> 00:18:25.440 position:50% align:middle And that's, as he says, about 2 million years of RN experience exiting the workforce. 00:18:25.440 --> 00:18:27.340 position:50% align:middle Those are scary numbers. 00:18:27.340 --> 00:18:34.280 position:50% align:middle But I do think, as Robyn said, that's probably a low estimate because we are encountering nurses. 00:18:34.280 --> 00:18:41.690 position:50% align:middle We all can name someone I'm sure who had a later planned retirement date and is really reevaluating. 00:18:41.690 --> 00:18:46.950 position:50% align:middle I think the other thing that we're not really anticipating are all the new jobs. 00:18:46.950 --> 00:18:55.370 position:50% align:middle When it comes to the availability of nurses, you know, there's just jobs that we never anticipated our 00:18:55.370 --> 00:18:56.530 position:50% align:middle nurses would have. 00:18:56.530 --> 00:19:04.290 position:50% align:middle I don't know how many of you saw the article a week or so ago that ER nurses are leaving for Botox, 00:19:04.290 --> 00:19:10.190 position:50% align:middle to inject Botox, and these medi spas are cropping up all over the place with jobs available 00:19:10.190 --> 00:19:11.830 position:50% align:middle for registered nurses. 00:19:11.830 --> 00:19:16.710 position:50% align:middle I mentioned this to a young audience I was speaking to this past week and asked how many of them knew a nurse 00:19:16.710 --> 00:19:18.490 position:50% align:middle that had gone to a medi spa. 00:19:18.490 --> 00:19:23.088 position:50% align:middle And I was astounded that more than a dozen hands in the audience went up. 00:19:23.088 --> 00:19:28.910 position:50% align:middle And we just heard from Amazon about a pipeline of nurses that they need for their healthcare coverage. 00:19:28.910 --> 00:19:37.270 position:50% align:middle So, we really don't have a handle on demand, I guess is my point, and where nurses might go in the future. 00:19:37.270 --> 00:19:44.230 position:50% align:middle But when we consider, as I said before, that last year, this past year, the number of nurses under 50 leaving 00:19:44.230 --> 00:19:50.900 position:50% align:middle the profession outpaced the number of retirees, then I think we have to consider that. 00:19:50.900 --> 00:19:53.570 position:50% align:middle We really don't have our heads around these numbers yet. 00:19:53.570 --> 00:19:58.240 position:50% align:middle The projections are going to change, and they are likely to be much more dire 00:19:58.240 --> 00:20:00.200 position:50% align:middle than what we've anticipated. 00:20:01.590 --> 00:20:04.380 position:50% align:middle - David. - Yeah. 00:20:04.380 --> 00:20:10.530 position:50% align:middle Again, I think just numbers in and numbers out actually hides a lot in between. 00:20:10.530 --> 00:20:17.690 position:50% align:middle So, I think there's a number of things that we need to think about in terms of getting this right. 00:20:17.690 --> 00:20:24.620 position:50% align:middle Are those entering the workforce now going to make a 40-year commitment to the profession, 00:20:24.620 --> 00:20:29.510 position:50% align:middle or are they going to maybe do that for a few years, then do something different? 00:20:29.510 --> 00:20:36.423 position:50% align:middle And what does that mean for our workforce model, and importantly, for us as regulators? 00:20:36.423 --> 00:20:44.350 position:50% align:middle How do we facilitate them coming back into the profession at a later stage having been absent from the 00:20:44.350 --> 00:20:50.280 position:50% align:middle profession for some time in terms of their continuing competence and fitness to practice? 00:20:50.280 --> 00:20:53.590 position:50% align:middle So, I think some of these shifts are important. 00:20:53.590 --> 00:21:05.810 position:50% align:middle One of the things that we saw during COVID was because of providers having difficulty recruiting into, 00:21:05.810 --> 00:21:15.650 position:50% align:middle for example, emergency room areas, the use of emergency medical techs and practitioners 00:21:15.650 --> 00:21:18.590 position:50% align:middle as a substitute for nurses. 00:21:18.590 --> 00:21:25.960 position:50% align:middle And as we have moved down the route...and Joan and colleagues at AACN have very much been at the vanguard 00:21:25.960 --> 00:21:31.030 position:50% align:middle of pushing forward the concept of competency-based education. 00:21:31.030 --> 00:21:37.040 position:50% align:middle The thing about competency education is that you can then actually move across different disciplines as part 00:21:37.040 --> 00:21:37.710 position:50% align:middle of that process. 00:21:37.710 --> 00:21:41.100 position:50% align:middle So, do we know whether we've got a shortage or not? 00:21:41.100 --> 00:21:45.240 position:50% align:middle The answer is we probably have, but we can't actually pin it down. 00:21:45.240 --> 00:21:52.870 position:50% align:middle And until we get things like eNotify, which enables employers to sign up their practitioners 00:21:52.870 --> 00:21:58.890 position:50% align:middle into our database so we can start to track this at a much more granular level, 00:21:58.890 --> 00:22:05.300 position:50% align:middle we really don't have a workforce planning model that is fit for purpose. 00:22:05.300 --> 00:22:12.053 position:50% align:middle I know from looking at the data, that those people that are going through the relicensure system, we're not 00:22:12.053 --> 00:22:15.110 position:50% align:middle seeing a drop-off at all in that. 00:22:15.110 --> 00:22:17.400 position:50% align:middle But the question is, are they actually...? 00:22:17.400 --> 00:22:22.780 position:50% align:middle Although they've got an active license, are they using that license to practice? 00:22:22.780 --> 00:22:26.860 position:50% align:middle And therefore, is there a hidden shortage that we don't know about? 00:22:26.860 --> 00:22:29.580 position:50% align:middle These are some of the things we need to deal with. 00:22:29.580 --> 00:22:32.390 position:50% align:middle And, of course, the other big issue is scope of practice. 00:22:32.390 --> 00:22:40.650 position:50% align:middle Some of you know that recently, I was in hospital and, you know, I was really quite surprised at how limited 00:22:40.650 --> 00:22:45.000 position:50% align:middle compared to some other countries the RN scope of practice was. 00:22:45.000 --> 00:22:51.680 position:50% align:middle And again, some of the questions that we need to ask is about, are we using nurses for the right thing and 00:22:51.680 --> 00:22:53.840 position:50% align:middle to their maximum ability? 00:22:53.840 --> 00:22:56.170 position:50% align:middle Because it may not be about numbers. 00:22:56.170 --> 00:22:59.677 position:50% align:middle It may be actually about getting people to do the right thing. 00:22:59.677 --> 00:23:04.384 position:50% align:middle And, you know, that's where technology might come in as well to take some of the burden off. 00:23:04.384 --> 00:23:04.998 position:50% align:middle - Okay. 00:23:04.998 --> 00:23:07.860 position:50% align:middle So, David, you've brought us right... 00:23:07.860 --> 00:23:08.831 position:50% align:middle Joan, do you want to add to it? 00:23:08.831 --> 00:23:13.770 position:50% align:middle - Well, I can either add to it or I can wait until your next question and get to it. 00:23:13.770 --> 00:23:20.700 position:50% align:middle But David did address a number of things that I wanted to expound upon or say because, no, 00:23:20.700 --> 00:23:26.060 position:50% align:middle having more nurses leave the profession than are entering is not sustainable, 00:23:26.060 --> 00:23:31.610 position:50% align:middle but I do think there are things that David you alluded to that we do need to take notice of and 00:23:31.610 --> 00:23:32.530 position:50% align:middle do something about. 00:23:32.530 --> 00:23:39.960 position:50% align:middle And the first thing is that we, as a profession, need to come up with a unified vision for what nursing 00:23:39.960 --> 00:23:44.320 position:50% align:middle is in the profession and what professional nursing role is. 00:23:44.320 --> 00:23:51.500 position:50% align:middle And that includes academia, practice, and regulation needs to come together. 00:23:51.500 --> 00:23:57.100 position:50% align:middle And I think you alluded to that yesterday when you made some comments, but it was already something that was 00:23:57.100 --> 00:24:01.411 position:50% align:middle heavily on my list of to-dos that we really need to do. 00:24:01.411 --> 00:24:07.740 position:50% align:middle And not only do we need to come together with a vision, but then we need to say what is and define the 00:24:07.740 --> 00:24:09.500 position:50% align:middle professional role of a nurse. 00:24:09.500 --> 00:24:11.060 position:50% align:middle What is a professional nurse? 00:24:11.060 --> 00:24:14.830 position:50% align:middle And what do they need to know and do at the top to...? 00:24:14.830 --> 00:24:16.920 position:50% align:middle And you talked about scope of practice. 00:24:16.920 --> 00:24:24.630 position:50% align:middle We need to elevate that role, elevate that benchmark, and then define what it is we expect them to do to be 00:24:24.630 --> 00:24:29.390 position:50% align:middle able to address the healthcare needs not only of our country, but globally, 00:24:29.390 --> 00:24:36.810 position:50% align:middle and also then to fill in the gaps and address the healthcare needs and improve outcomes. 00:24:36.810 --> 00:24:39.570 position:50% align:middle We can't forget the safety and the outcomes. 00:24:39.570 --> 00:24:45.810 position:50% align:middle So, David, you mentioned one thing about the transition to competency-based education and the ability for that 00:24:45.810 --> 00:24:50.570 position:50% align:middle to measure and look at progression over time. 00:24:50.570 --> 00:24:56.200 position:50% align:middle One thing that AACN has done, and you may or may not be familiar with it, 00:24:56.200 --> 00:25:03.110 position:50% align:middle but we revised and approved a new essentials document, our membership did, and that document really 00:25:03.110 --> 00:25:08.940 position:50% align:middle is transformative, not just change, but transformative as far as nursing education goes. 00:25:08.940 --> 00:25:17.270 position:50% align:middle And we are moving to a competency-based education and assessment model for nursing education, 00:25:17.270 --> 00:25:23.640 position:50% align:middle and that does allow, hopefully, the goal is that we defined behaviors that everybody has agreed to. 00:25:23.640 --> 00:25:26.870 position:50% align:middle And it was developed by both practice and academia. 00:25:26.870 --> 00:25:30.860 position:50% align:middle We didn't just sit down and write it, although it might have been faster, you know? 00:25:30.860 --> 00:25:38.960 position:50% align:middle It was a three or four-year process to get agreement with practice and academia on what are the behaviors 00:25:38.960 --> 00:25:45.300 position:50% align:middle that are needed to be demonstrated for an entry-level professional nurse, and what needs to be demonstrated 00:25:45.300 --> 00:25:47.940 position:50% align:middle at higher degrees, at a graduate level? 00:25:47.940 --> 00:25:54.760 position:50% align:middle So, that is in place, and that is, we hope, will transform as we heard yesterday the definition 00:25:54.760 --> 00:25:58.680 position:50% align:middle of transformation, and will allow progression and measurement across time. 00:25:58.680 --> 00:26:02.830 position:50% align:middle But I do want to say that we are not at this point where we are saying that it should 00:26:02.830 --> 00:26:04.880 position:50% align:middle be time-variable education. 00:26:04.880 --> 00:26:08.940 position:50% align:middle We still believe that programs should have a certain limit, certain requirements, 00:26:08.940 --> 00:26:14.690 position:50% align:middle certain expectations until we get to the point where we all are in agreement that when we assess somebody, 00:26:14.690 --> 00:26:16.530 position:50% align:middle then we know what we're looking at. 00:26:16.530 --> 00:26:19.460 position:50% align:middle So, we've got a lot of way to go, but we are saying that. 00:26:19.460 --> 00:26:24.250 position:50% align:middle So, that is the unified vision and one thing that I believe we certainly need to do, 00:26:24.250 --> 00:26:26.760 position:50% align:middle and that is to come together with a definition. 00:26:26.760 --> 00:26:32.200 position:50% align:middle Because if we can define what professional nursing practice is, then we can figure out what the 00:26:32.200 --> 00:26:37.300 position:50% align:middle competencies are and what they need to be able to do, and how to demonstrate them. 00:26:40.658 --> 00:26:46.760 position:50% align:middle - I want to continue on this for just a moment and talk more about strategies. 00:26:46.760 --> 00:26:49.960 position:50% align:middle So, Linda. - Absolutely. 00:26:49.960 --> 00:26:58.860 position:50% align:middle When we think of where the nursing shortages are right now, and I think Loressa alluded to the past, the 00:26:58.860 --> 00:27:04.310 position:50% align:middle changing roles and the expanded roles, the expanded settings that nurses can be on, 00:27:04.310 --> 00:27:09.520 position:50% align:middle it makes me wonder and question, where are we going to be in 5 years or in 10 years? 00:27:09.520 --> 00:27:14.260 position:50% align:middle Where will additional expanded roles be? 00:27:14.260 --> 00:27:20.610 position:50% align:middle We have nurse architects, we have nurse attorneys, we have nurses working in all sorts of areas. 00:27:20.610 --> 00:27:28.110 position:50% align:middle So, the numbers, David mentioned, what kind of numbers versus the hidden numbers? 00:27:28.110 --> 00:27:34.700 position:50% align:middle We may have a certain number of licensed nurses, but how many of those nurses are practicing 00:27:34.700 --> 00:27:36.400 position:50% align:middle in areas of need? 00:27:36.400 --> 00:27:42.180 position:50% align:middle And what is it going to take to really have nurses practicing and attracted and maintained in those 00:27:42.180 --> 00:27:44.140 position:50% align:middle areas of need? 00:27:44.140 --> 00:27:49.990 position:50% align:middle And what are the competencies surely of the nurses that need to be in those areas? 00:27:49.990 --> 00:27:54.060 position:50% align:middle These are all parts of looking at futuristic, where are we going to go? 00:27:54.060 --> 00:27:55.920 position:50% align:middle What's going to be needed? 00:27:55.920 --> 00:27:57.040 position:50% align:middle Are we planning for it? 00:27:57.040 --> 00:27:59.500 position:50% align:middle And how are we going to get to it? 00:28:01.036 --> 00:28:09.563 position:50% align:middle - Robyn or Loressa, any thoughts in terms of strategy from the practice point of view? 00:28:09.563 --> 00:28:11.875 position:50% align:middle - Well, I'll start. 00:28:11.875 --> 00:28:16.310 position:50% align:middle On behalf of ANA Enterprise, I can't leave the session and not talk about what ANA 00:28:16.310 --> 00:28:21.620 position:50% align:middle has learned through the pandemic about the work environments of nurses. 00:28:21.620 --> 00:28:30.800 position:50% align:middle Certainly, one strategy has to be a clear and profound focus on the obstacles that nurses are encountering 00:28:30.800 --> 00:28:31.650 position:50% align:middle in the work setting. 00:28:31.650 --> 00:28:34.710 position:50% align:middle We know that violence is an issue. 00:28:34.710 --> 00:28:41.930 position:50% align:middle We absolutely know that nurses have a fatigue factor right now that is unprecedented. 00:28:41.930 --> 00:28:49.690 position:50% align:middle And through a series of surveys conducted by the American Nurses Foundation called "Pulse of the Nation 00:28:49.690 --> 00:28:56.850 position:50% align:middle Survey" done throughout the pandemic, we absolutely know that mental stress is a significant 00:28:56.850 --> 00:29:02.790 position:50% align:middle factor that is, of course, affecting nurses staying in the workforce and affecting 00:29:02.790 --> 00:29:07.730 position:50% align:middle nurses' ability to provide competent care if you will. 00:29:07.730 --> 00:29:10.490 position:50% align:middle So, certainly, we have to be focused. 00:29:10.490 --> 00:29:15.924 position:50% align:middle There are national initiatives from the surgeon general to the National Academy of Medicine coming forward 00:29:15.924 --> 00:29:26.820 position:50% align:middle with a plan to address not just nursing distress and mental fatigue and illness but all 00:29:26.820 --> 00:29:28.050 position:50% align:middle caregivers right now. 00:29:28.050 --> 00:29:30.532 position:50% align:middle We have to pay close attention. 00:29:30.532 --> 00:29:33.420 position:50% align:middle - Yeah, I would totally agree with Loressa. 00:29:33.420 --> 00:29:40.280 position:50% align:middle And in addition, I think some of you may be aware that AONL has conducted a longitudinal study and, in fact, 00:29:40.280 --> 00:29:43.300 position:50% align:middle next week, we are going to do our 4.0. 00:29:43.300 --> 00:29:50.770 position:50% align:middle But our nurse leaders, in particular, our frontline nurse managers report that they are 00:29:50.770 --> 00:29:52.190 position:50% align:middle not emotionally healthy. 00:29:52.190 --> 00:29:59.550 position:50% align:middle So, you know, this impacts our nursing leadership ranks as well at all levels, very distressing. 00:29:59.550 --> 00:30:01.210 position:50% align:middle We've spoken before. 00:30:01.210 --> 00:30:04.840 position:50% align:middle I mean, the work environment needs to... 00:30:04.840 --> 00:30:07.870 position:50% align:middle We have a lot of work to do there, needs to improve. 00:30:09.700 --> 00:30:14.800 position:50% align:middle And you may ask if COVID created these issues. 00:30:14.800 --> 00:30:20.060 position:50% align:middle And I think, in many cases, we're seeing that COVID exacerbated or perhaps 00:30:20.060 --> 00:30:28.800 position:50% align:middle accelerated some of the concerns that we see from nurses right now, but it didn't necessarily cause it. 00:30:28.800 --> 00:30:31.760 position:50% align:middle So, just certainly heightened the awareness. 00:30:31.760 --> 00:30:36.800 position:50% align:middle Underscore the violence in the healthcare setting issue. 00:30:36.800 --> 00:30:45.710 position:50% align:middle When we look across the country, again, this is one of those challenges where we don't have great data. 00:30:45.710 --> 00:30:51.970 position:50% align:middle First of all, there's no consistent definition for incidents of workplace violence in healthcare. 00:30:51.970 --> 00:30:59.260 position:50% align:middle So, we find as we query, you know, our healthcare organizations, that there's a very 00:30:59.260 --> 00:31:04.071 position:50% align:middle diverse array of definitions if you will. 00:31:04.071 --> 00:31:11.390 position:50% align:middle And we know that it's very underreported and, in fact, many of our nurses and other caregivers, unfortunately, 00:31:11.390 --> 00:31:17.228 position:50% align:middle have expressed that this is part of the job, that they've been exposed to physical as well 00:31:17.228 --> 00:31:21.940 position:50% align:middle as verbal violence/abuse, and it's part of it, you know. 00:31:21.940 --> 00:31:24.020 position:50% align:middle This is just something that they've come to expect. 00:31:24.020 --> 00:31:25.440 position:50% align:middle Totally not acceptable. 00:31:25.440 --> 00:31:29.680 position:50% align:middle So, a lot of work needs to be happening in that area. 00:31:29.680 --> 00:31:37.130 position:50% align:middle We know when there's, unfortunately, you know, a mass shooting or a very violent, you know, 00:31:37.130 --> 00:31:43.240 position:50% align:middle incident that results in loss of life, but there's really a whole spectrum. 00:31:43.240 --> 00:31:50.550 position:50% align:middle So, we are working on that spectrum, but also to define what that is and what are some 00:31:50.550 --> 00:31:53.030 position:50% align:middle strategies that can help mitigate? 00:31:53.030 --> 00:31:59.650 position:50% align:middle I think we can't expect our healthcare system, in general, to be different from our society, really. 00:31:59.650 --> 00:32:05.792 position:50% align:middle We are seeing an uptick in violence across our society in many areas and regions. 00:32:05.792 --> 00:32:13.420 position:50% align:middle Of course, we would then see that if you will, you know, bleed into our hospital's healthcare system, 00:32:13.420 --> 00:32:16.810 position:50% align:middle you know, outpatient settings, really wherever care is delivered. 00:32:16.810 --> 00:32:19.900 position:50% align:middle And it's a societal issue. 00:32:19.900 --> 00:32:26.790 position:50% align:middle I was fortunate to attend the International Hospital Federation Congress last year. 00:32:26.790 --> 00:32:28.670 position:50% align:middle And this is an international issue. 00:32:28.670 --> 00:32:32.787 position:50% align:middle This is not just an issue that we are seeing and experiencing in the U.S. 00:32:32.787 --> 00:32:41.550 position:50% align:middle So, you know, the International Council of the Red Cross has this as one of their main topics of focus. 00:32:41.550 --> 00:32:46.630 position:50% align:middle And again, as David mentioned earlier, this is something that I think we need, you know, 00:32:46.630 --> 00:32:52.600 position:50% align:middle global heads around to address the problem. 00:32:52.600 --> 00:32:53.510 position:50% align:middle And we need to start it. 00:32:53.510 --> 00:33:00.120 position:50% align:middle It is not okay that our nurses and other healthcare, you know, workers are subjected to this. 00:33:00.120 --> 00:33:03.410 position:50% align:middle - You know, I just want to follow up on that. 00:33:03.410 --> 00:33:07.740 position:50% align:middle I know you're talking about violent acts towards nurses, but, you know, 00:33:07.740 --> 00:33:17.080 position:50% align:middle the issue of lateral violence and nurses bullying other nurses is certainly an issue that has driven some 00:33:17.080 --> 00:33:19.170 position:50% align:middle nurses out of the workforce. 00:33:19.170 --> 00:33:25.734 position:50% align:middle Should there be a no-tolerance policy in hospitals, or how can that be handled? 00:33:25.734 --> 00:33:27.240 position:50% align:middle - Well, I'm just going to start that off. 00:33:27.240 --> 00:33:28.740 position:50% align:middle I'm sure others have opinions. 00:33:28.740 --> 00:33:31.450 position:50% align:middle Absolutely, there should be zero tolerance. 00:33:31.450 --> 00:33:36.830 position:50% align:middle And, you know, you mentioned nurse on nurse, and unfortunately, we've heard that I think since I 00:33:36.830 --> 00:33:41.620 position:50% align:middle became a nurse many years ago that, you know, "nurses eat their young." 00:33:41.620 --> 00:33:44.580 position:50% align:middle I think it's part of a leadership issue. 00:33:44.580 --> 00:33:46.700 position:50% align:middle There can be no tolerance for that. 00:33:46.700 --> 00:33:54.110 position:50% align:middle And, you know, I remember my CNO days and, you know, I spoke with my nurse leaders, you know, 00:33:54.110 --> 00:34:00.310 position:50% align:middle and we worked on this for a number of years and those nursing students and the new nurses are your colleagues 00:34:00.310 --> 00:34:06.250 position:50% align:middle or your future colleagues, and working together will only, you know... 00:34:06.250 --> 00:34:12.810 position:50% align:middle The hazing and, you know, the abuse or the subtle lateral violence is 00:34:12.810 --> 00:34:15.912 position:50% align:middle not acceptable, and people have to be held accountable for it. 00:34:15.912 --> 00:34:21.920 position:50% align:middle It's part of the behavioral expectations of our nurses and of all of our, you know, caregivers. 00:34:21.920 --> 00:34:26.071 position:50% align:middle It needs to be addressed and we need to hold people accountable. 00:34:26.071 --> 00:34:26.922 position:50% align:middle - Thank you. 00:34:26.922 --> 00:34:33.460 position:50% align:middle - I would like to add to that point about incivility in the workplace. 00:34:33.460 --> 00:34:36.700 position:50% align:middle There's a large body of work that ANA is participating in now. 00:34:36.700 --> 00:34:37.514 position:50% align:middle We're co-leads. 00:34:37.514 --> 00:34:43.360 position:50% align:middle We're not leading with minority nursing organizations looking at the prevalence of racism 00:34:43.360 --> 00:34:45.030 position:50% align:middle in our own profession. 00:34:45.030 --> 00:34:53.850 position:50% align:middle And when we think that still 80% of registered nurses in the United States are Caucasian, 00:34:53.850 --> 00:34:59.130 position:50% align:middle then we know that our population is not representing the communities that we serve, 00:34:59.130 --> 00:35:04.880 position:50% align:middle and a solution to secure the pipeline is to have a more diverse workplace. 00:35:04.880 --> 00:35:11.240 position:50% align:middle We're not going to have a more diverse workplace if we do not make sure that nurses of color are treated 00:35:11.240 --> 00:35:15.800 position:50% align:middle better in our organizations and work environments. 00:35:18.188 --> 00:35:25.900 position:50% align:middle So, I just want to highlight the work of the national commission to address racism in nursing. 00:35:25.900 --> 00:35:28.480 position:50% align:middle You can go to nursesworld.org and read about that. 00:35:28.480 --> 00:35:31.030 position:50% align:middle But again, ANA is not leading. 00:35:31.030 --> 00:35:36.690 position:50% align:middle The minority nursing organizations in this country are at the table with ANA to help address this problem, 00:35:36.690 --> 00:35:40.090 position:50% align:middle and I hope that you'll engage with the work, be informed about the work, 00:35:40.090 --> 00:35:45.722 position:50% align:middle and accept the fact that racism in nursing is a critical issue. 00:35:51.939 --> 00:35:58.200 position:50% align:middle - I would just like to add to what Loressa said, and she's brought up an extremely important point. 00:35:58.200 --> 00:36:04.020 position:50% align:middle But the somewhat good news is, and we are progressing and continue to work on it, 00:36:04.020 --> 00:36:10.650 position:50% align:middle but when I looked at the statistics, over 40% of our current baccalaureate enrollments are 00:36:10.650 --> 00:36:13.280 position:50% align:middle from underrepresented minority populations. 00:36:13.280 --> 00:36:19.350 position:50% align:middle So, we are moving forward, when you look at strategies, one of the strategies that I was going to bring 00:36:19.350 --> 00:36:24.880 position:50% align:middle up about trying to increase the diversity and also increase the numbers of applicants. 00:36:24.880 --> 00:36:31.230 position:50% align:middle If you look at the holistic admissions process and implementing that and making sure that the individuals 00:36:31.230 --> 00:36:36.740 position:50% align:middle coming into our programs are a good fit for nursing, that they will be successful, 00:36:36.740 --> 00:36:41.480 position:50% align:middle and that the process really goes beyond just a GPA or test scores. 00:36:41.480 --> 00:36:47.410 position:50% align:middle So, we are actively promoting that and working with schools and other organizations 00:36:47.410 --> 00:36:49.450 position:50% align:middle around the holistic admissions. 00:36:49.450 --> 00:36:59.210 position:50% align:middle But getting back to Maryann's question about what can we do about the attrition rates and the shortages? 00:36:59.210 --> 00:37:03.070 position:50% align:middle I have a couple of suggestions broken down into different categories, 00:37:03.070 --> 00:37:06.510 position:50% align:middle and I just wanted to share a couple of them with you. 00:37:06.510 --> 00:37:12.730 position:50% align:middle I think there are some low-hanging fruit and some more short-term things that we can do and also long-term. 00:37:12.730 --> 00:37:19.200 position:50% align:middle And one of them is really we've talked about identifying and addressing the role of the nurse 00:37:19.200 --> 00:37:20.570 position:50% align:middle and defining it. 00:37:20.570 --> 00:37:27.810 position:50% align:middle The public and other health professionals need to understand what that role is and the impact that we 00:37:27.810 --> 00:37:35.480 position:50% align:middle make on care, but also then recognizing the importance of nursing, and that needs to be in the forefront so 00:37:35.480 --> 00:37:40.980 position:50% align:middle that people are interested and want to come into nursing and understand their career trajectories. 00:37:40.980 --> 00:37:46.300 position:50% align:middle Also, we need to better prepare our nurses for addressing wellbeing, 00:37:46.300 --> 00:37:51.930 position:50% align:middle not only in themselves but to be able to lead and work with team members and to address wellbeing and 00:37:51.930 --> 00:37:53.980 position:50% align:middle resilience in their team members. 00:37:53.980 --> 00:38:01.400 position:50% align:middle I think those are fairly easy on the relativity scale of easy to difficult. 00:38:01.400 --> 00:38:07.470 position:50% align:middle One of the other things that I think we need to do is we need to...having defined the role of nursing, 00:38:07.470 --> 00:38:14.480 position:50% align:middle but we need to provide opportunities for nurses to advance their careers and their career trajectory 00:38:14.480 --> 00:38:18.030 position:50% align:middle without stepping away from the point of care. 00:38:18.030 --> 00:38:23.120 position:50% align:middle And I use that term as opposed to at the bedside because we're really looking at nurses working 00:38:23.120 --> 00:38:24.700 position:50% align:middle across the continuum. 00:38:24.700 --> 00:38:26.960 position:50% align:middle So, we talk about at the point of care. 00:38:26.960 --> 00:38:33.990 position:50% align:middle But there should be an option, an education option, certificates and/or an education option for individuals 00:38:33.990 --> 00:38:42.210 position:50% align:middle to advance their education, potentially a master's degree that somebody can go 00:38:42.210 --> 00:38:47.230 position:50% align:middle on and get a master's and stay at the point of care in their particular area, 00:38:47.230 --> 00:38:52.890 position:50% align:middle take on additional responsibilities around quality improvement and care coordination and overseeing 00:38:52.890 --> 00:38:56.430 position:50% align:middle interprofessional teams without becoming an APRN. 00:38:56.430 --> 00:38:58.560 position:50% align:middle And some people say that's blasphemous. 00:38:58.560 --> 00:39:03.470 position:50% align:middle I am a nurse practitioner by education, but not everybody needs to be an advanced 00:39:03.470 --> 00:39:05.100 position:50% align:middle practice registered nurse. 00:39:05.100 --> 00:39:10.047 position:50% align:middle We need nurses who are educated at a higher level who are staying at the point of care and 00:39:10.047 --> 00:39:11.230 position:50% align:middle overseeing that care. 00:39:11.230 --> 00:39:16.740 position:50% align:middle So, that is one thing that I think we need to do both as educators and practice. 00:39:16.740 --> 00:39:20.010 position:50% align:middle And the other thing is getting back to the faculty shortage. 00:39:20.010 --> 00:39:27.500 position:50% align:middle I think some of the things that we can do fairly immediately, and that is, you know, our record show, 00:39:27.500 --> 00:39:31.560 position:50% align:middle just as Linda has said, that we are currently at the highest vacancy rate 00:39:31.560 --> 00:39:35.220 position:50% align:middle for faculty, and it's at 8%, was the last year. 00:39:35.220 --> 00:39:38.196 position:50% align:middle And that's the highest it's been. 00:39:38.196 --> 00:39:46.910 position:50% align:middle And some of the things that come to mind are if we had more joint appointments between academia and practice, 00:39:46.910 --> 00:39:54.810 position:50% align:middle that would allow faculty to have higher salaries, it would enable them to stay current in their practice, 00:39:54.810 --> 00:40:00.100 position:50% align:middle and they would be engaged and familiar with a particular institution or health system. 00:40:00.100 --> 00:40:06.410 position:50% align:middle And I think one of the things that we saw during COVID, some places, was faculty and teams of students actually 00:40:06.410 --> 00:40:12.650 position:50% align:middle were allowed to go in and were assigned a particular unit or a group of patients and provided care depending 00:40:12.650 --> 00:40:14.520 position:50% align:middle upon the level of the students. 00:40:14.520 --> 00:40:19.810 position:50% align:middle Now we hear that COVID's over, that's being withdrawn, and they're not allowed to go in and do that anymore 00:40:19.810 --> 00:40:21.760 position:50% align:middle in some of those health systems. 00:40:21.760 --> 00:40:28.790 position:50% align:middle But if you had teams of faculty and students, that would help not only address the clinical shortage 00:40:28.790 --> 00:40:34.149 position:50% align:middle areas for students but also the numbers of individuals providing care to patients. 00:40:34.149 --> 00:40:39.373 position:50% align:middle It would also help with the faculty shortage and it would attract more individuals. 00:40:39.373 --> 00:40:44.670 position:50% align:middle And also sharing of resources, allowing faculty to teach across programs. 00:40:44.670 --> 00:40:48.670 position:50% align:middle Every program does not need an expert in every single area. 00:40:48.670 --> 00:40:53.010 position:50% align:middle And with technology now, we heard about the transformation of technology. 00:40:53.010 --> 00:40:58.960 position:50% align:middle There's ways that you should hopefully be able to share courses and faculty and other resources. 00:40:58.960 --> 00:41:05.570 position:50% align:middle So, I think we need to think innovatively about how we use technology and also the role of the faculty 00:41:05.570 --> 00:41:07.390 position:50% align:middle and education models. 00:41:07.390 --> 00:41:09.000 position:50% align:middle - I would absolutely agree. 00:41:09.000 --> 00:41:14.270 position:50% align:middle The role of the faculty has been defined, but how do we facilitate it? 00:41:14.270 --> 00:41:15.570 position:50% align:middle How do we support it? 00:41:15.570 --> 00:41:20.550 position:50% align:middle I look at the certified nurse educator data very frequently. 00:41:20.550 --> 00:41:25.280 position:50% align:middle Three, four, five years ago, if I would look at what competencies faculty really 00:41:25.280 --> 00:41:29.760 position:50% align:middle performed the best on, it was on the basic teaching, it was facilitating nursing. 00:41:29.760 --> 00:41:31.410 position:50% align:middle It was evaluating students. 00:41:31.410 --> 00:41:36.100 position:50% align:middle And I'm talking about classroom testing and the clinical evaluation, etc. 00:41:36.100 --> 00:41:43.800 position:50% align:middle Faculty did not perform well when it was being part of a university or even the scholarship part of being 00:41:43.800 --> 00:41:45.060 position:50% align:middle a faculty member. 00:41:45.060 --> 00:41:46.850 position:50% align:middle That has changed. 00:41:46.850 --> 00:41:52.040 position:50% align:middle The last one to two years, what we have seen is the worst place, 00:41:52.040 --> 00:42:00.550 position:50% align:middle the worst competency that faculty are performing on a certification exam to be a certified nurse educator is 00:42:00.550 --> 00:42:03.120 position:50% align:middle in facilitating nursing. 00:42:03.120 --> 00:42:07.600 position:50% align:middle And that, I find, very, very alarming. 00:42:07.600 --> 00:42:16.660 position:50% align:middle They are testing better on university program evaluation than they are evaluation in the classroom or 00:42:16.660 --> 00:42:18.000 position:50% align:middle with a student. 00:42:18.000 --> 00:42:26.510 position:50% align:middle So, providing support to the faculty, and faculty can teach across programs or across different places. 00:42:26.510 --> 00:42:28.290 position:50% align:middle Clinical educators. 00:42:28.290 --> 00:42:35.900 position:50% align:middle There are so many excellent clinicians that with some guidance and some support can really foster and promote 00:42:35.900 --> 00:42:38.780 position:50% align:middle the clinical learning that students are doing. 00:42:38.780 --> 00:42:44.920 position:50% align:middle And the faculty in the classroom, again, the support of how do you maximize that time? 00:42:44.920 --> 00:42:50.220 position:50% align:middle If you only have a couple of hours a week with a student, how are you going to maximize that time? 00:42:50.220 --> 00:42:56.714 position:50% align:middle And here's where we get into pedagogy and effectiveness of teaching and teaching strategies. 00:42:56.714 --> 00:42:57.280 position:50% align:middle - Yeah. 00:42:57.280 --> 00:42:59.290 position:50% align:middle And I would just add to what Linda said. 00:42:59.290 --> 00:43:04.170 position:50% align:middle Of course, I would argue that maybe you need more than a couple hours a week for students and faculty to be 00:43:04.170 --> 00:43:09.280 position:50% align:middle able to practice, and that's why we're also talking about more extensive immersions and opportunities, 00:43:09.280 --> 00:43:10.490 position:50% align:middle but yes, what Linda said. 00:43:10.490 --> 00:43:18.240 position:50% align:middle But also the DEU, the dedicated education units, allow expert and nurses identified within the healthcare 00:43:18.240 --> 00:43:23.800 position:50% align:middle system to help oversee students, and those models work extremely well where 00:43:23.800 --> 00:43:26.552 position:50% align:middle they're implemented well. 00:43:26.552 --> 00:43:34.060 position:50% align:middle - So, a couple of thoughts I think is important to consider as well is that we...and I fully agree 00:43:34.060 --> 00:43:38.941 position:50% align:middle with the point that Joan made around needing to better define the profession. 00:43:38.941 --> 00:43:44.530 position:50% align:middle But we do have some solutions that we know actually facilitate people getting into practice. 00:43:44.530 --> 00:43:47.790 position:50% align:middle The Nurse Licensure Compact has made a huge difference. 00:43:47.790 --> 00:43:54.200 position:50% align:middle Some of the data that we've seen in responding to natural disasters where there has been a focus point 00:43:54.200 --> 00:44:00.854 position:50% align:middle has enabled rapid deployment and reorganization of resources as a result of that. 00:44:00.854 --> 00:44:09.580 position:50% align:middle And I, for one, think that we really do need to have a compact nation where that level of mobility is 00:44:09.580 --> 00:44:13.190 position:50% align:middle available to all so that we can respond much more quickly. 00:44:13.190 --> 00:44:18.810 position:50% align:middle And I say that because if you listen to some of the experiences of some of our military families, 00:44:18.810 --> 00:44:26.480 position:50% align:middle in particular, where they know that they're going to be moving, but the process of tracking down their records 00:44:26.480 --> 00:44:31.210 position:50% align:middle and getting through that process, etc., can be very disheartening for them, 00:44:31.210 --> 00:44:35.950 position:50% align:middle and it's a loss to service in terms of capacity to deliver care. 00:44:35.950 --> 00:44:40.800 position:50% align:middle So, I do think the NLC as a compact nation is really important. 00:44:40.800 --> 00:44:43.530 position:50% align:middle I think we could do more with technology as well. 00:44:43.530 --> 00:44:49.130 position:50% align:middle We at the moment have a tendency to always go back to the beginning. 00:44:49.130 --> 00:44:54.330 position:50% align:middle Well, with blockchain and other types of technologies, you can capture the data, 00:44:54.330 --> 00:45:02.450 position:50% align:middle know that it has been securely accessed, and therefore, signed off so that people can then actually follow it 00:45:02.450 --> 00:45:05.440 position:50% align:middle through their entire career rather than having to constantly go back. 00:45:05.440 --> 00:45:13.950 position:50% align:middle I mean, when I got my registration in Spain, I had to go back to my original program, 00:45:13.950 --> 00:45:18.800 position:50% align:middle which had been quite some time ago, and getting those records was a nightmare. 00:45:18.800 --> 00:45:24.080 position:50% align:middle And for people moving around, I just think that there's a huge amount of efficiency 00:45:24.080 --> 00:45:27.810 position:50% align:middle that we could put in there that would actually facilitate them. 00:45:27.810 --> 00:45:34.780 position:50% align:middle I think the other point that we need to...and this is kind of linking back a little bit to the previous 00:45:34.780 --> 00:45:41.790 position:50% align:middle discussion about violence, is that violence can manifest itself in all sorts of different ways. 00:45:41.790 --> 00:45:50.540 position:50% align:middle And we know the issues around mental health in the workforce just now and the way that nurses can often 00:45:50.540 --> 00:45:58.000 position:50% align:middle fall foul of substance use, etc., is something that we really need to be mindful of and 00:45:58.000 --> 00:45:59.590 position:50% align:middle deal with in a very humane way. 00:45:59.590 --> 00:46:06.240 position:50% align:middle And I think some of the work that Maryann and our team have been doing about finding out what the key factors 00:46:06.240 --> 00:46:11.100 position:50% align:middle are in terms of the alternative to discipline processes. 00:46:11.100 --> 00:46:14.000 position:50% align:middle So, we're not putting people through something that's going to fail. 00:46:14.000 --> 00:46:20.530 position:50% align:middle We're putting them through programs that there's a very high chance of being successful. 00:46:20.530 --> 00:46:25.400 position:50% align:middle So, I think we've got to come at this from multiple angles as part of the process in terms 00:46:25.400 --> 00:46:26.550 position:50% align:middle of moving it forward. 00:46:26.550 --> 00:46:29.850 position:50% align:middle Regulators have a role to play, the providers have a role to play, 00:46:29.850 --> 00:46:35.304 position:50% align:middle education has a role to play, but together, we are actually going to get a better solution. 00:46:35.304 --> 00:46:43.440 position:50% align:middle - So, I want to talk now about another role integral to nursing, LPNs. 00:46:43.440 --> 00:46:45.850 position:50% align:middle Should we be expanding what they do? 00:46:45.850 --> 00:46:52.340 position:50% align:middle In some states, we're seeing a decrease in the number of LPNs and LPN programs. 00:46:52.340 --> 00:46:58.490 position:50% align:middle In some states, we see more of a restricted scope of practice. 00:46:58.490 --> 00:47:01.405 position:50% align:middle I'd like to know your thoughts on the LPN. 00:47:01.405 --> 00:47:09.290 position:50% align:middle And should we be growing their role and using them more effectively outside just the 00:47:09.290 --> 00:47:12.901 position:50% align:middle skilled nursing facilities? 00:47:12.901 --> 00:47:18.547 position:50% align:middle And I open that up to anyone who wants to jump in. 00:47:18.547 --> 00:47:19.770 position:50% align:middle - I'll take that first. 00:47:19.770 --> 00:47:25.600 position:50% align:middle You know, from a practice perspective, should we be expanding their roles? 00:47:25.600 --> 00:47:33.600 position:50% align:middle I think I would respond by saying as with all other licensed nursing roles, you know, our RN licensure, 00:47:33.600 --> 00:47:40.830 position:50% align:middle our APRN, you know, certification and practice and I guess we consider that a licensure. 00:47:40.830 --> 00:47:46.090 position:50% align:middle I think we have to examine, are they working to their full scope? 00:47:46.090 --> 00:47:52.660 position:50% align:middle You know, as David mentioned earlier, when he encountered some RNs in his care, you know, 00:47:52.660 --> 00:47:57.700 position:50% align:middle he was very surprised about the scope with which they practiced. 00:47:57.700 --> 00:48:03.870 position:50% align:middle Sometimes it's a licensure issue, and quite frankly, sometimes it is an organizational issue because when 00:48:03.870 --> 00:48:09.350 position:50% align:middle you look at the delta between what an organization, a hospital, for example, 00:48:09.350 --> 00:48:17.130 position:50% align:middle allows their nurses to do versus what's the scope of practice, the Nurse Practice Act, 00:48:17.130 --> 00:48:18.960 position:50% align:middle there's variation there. 00:48:18.960 --> 00:48:28.915 position:50% align:middle We see that, of course, you know, on the APRN side, but I think we see that as well in our LPNs and our RN 00:48:28.915 --> 00:48:34.134 position:50% align:middle licensures and folks that practice in those roles. 00:48:34.134 --> 00:48:38.160 position:50% align:middle And to your point, Maryann, I think that there's a wide variation as I cross the 00:48:38.160 --> 00:48:40.320 position:50% align:middle country and talk with my colleagues. 00:48:40.320 --> 00:48:45.083 position:50% align:middle I mean, the scope of practice for an LPN, for example, in one state versus another, 00:48:45.083 --> 00:48:51.560 position:50% align:middle that there's discrepancies there. 00:48:51.560 --> 00:48:53.300 position:50% align:middle So, that's one issue. 00:48:53.300 --> 00:48:59.300 position:50% align:middle You know, you mentioned LPNs in post-acute care. 00:48:59.300 --> 00:49:04.690 position:50% align:middle I know there are many hospitals and health systems, and I know this to be very controversial but are 00:49:04.690 --> 00:49:10.460 position:50% align:middle looking at the role, what is the appropriate role for the LPN in acute care? 00:49:10.460 --> 00:49:15.100 position:50% align:middle And there's several large systems that are in that process right now. 00:49:15.100 --> 00:49:19.470 position:50% align:middle And I would say that from, you know, the folks that I've been in touch with, 00:49:19.470 --> 00:49:25.290 position:50% align:middle they're doing a very thoughtful not only implementation but analysis. 00:49:25.290 --> 00:49:32.210 position:50% align:middle So, I think the jury is out there a little bit, but I think 20, 25 years ago when basically, you know, 00:49:32.210 --> 00:49:37.084 position:50% align:middle we told nurses, you know, the LPNs that there's no room for you in acute care, 00:49:37.084 --> 00:49:41.420 position:50% align:middle we're going to move you to our ambulatory settings, I see the trend reversing. 00:49:41.420 --> 00:49:48.930 position:50% align:middle This is also though, of course, had a big impact, you know, on our nursing homes and our post-acute. 00:49:48.930 --> 00:49:56.940 position:50% align:middle So, you know, there's always I guess that chain reaction when we look to, you know, 00:49:56.940 --> 00:49:59.037 position:50% align:middle "bring nurses back." 00:49:59.037 --> 00:50:07.430 position:50% align:middle I don't think I can let this conversation end without the work that is being done around the country on care 00:50:07.430 --> 00:50:16.390 position:50% align:middle model redesign, and whether that is including, you know, as David mentioned, technology in the mix, 00:50:16.390 --> 00:50:19.820 position:50% align:middle but also, you know, what is the team of the future? 00:50:19.820 --> 00:50:28.340 position:50% align:middle Is the "modified" primary nurse model that I learned back in the 1970s as the way to deliver nursing care, 00:50:28.340 --> 00:50:30.380 position:50% align:middle I mean, is that...? 00:50:30.380 --> 00:50:34.550 position:50% align:middle And it's been pretty much taught that way since that time, you know? 00:50:34.550 --> 00:50:37.780 position:50% align:middle Is there a better mouse trap here? 00:50:37.780 --> 00:50:42.090 position:50% align:middle And, you know, I don't know in the next few years given the challenges we are facing in our 00:50:42.090 --> 00:50:46.469 position:50% align:middle healthcare organizations, you know? 00:50:46.469 --> 00:50:54.370 position:50% align:middle The only other solution would be because if we don't have enough nurses, we are going to have, you know, 00:50:54.370 --> 00:50:59.640 position:50% align:middle "nurse-patient ratios" that are not safe, that are way too high, 00:50:59.640 --> 00:51:08.460 position:50% align:middle that I'm afraid going to lead to more burnout and more exhaustion and more exodus from the hospital point 00:51:08.460 --> 00:51:13.800 position:50% align:middle of care or, you know, bedside, you know, as we refer to it. 00:51:13.800 --> 00:51:17.370 position:50% align:middle So, that whole model of care analysis... 00:51:17.370 --> 00:51:25.140 position:50% align:middle I know, again, there's organizations that are evaluating not only in hospital models but hospital 00:51:25.140 --> 00:51:26.450 position:50% align:middle at home models. 00:51:26.450 --> 00:51:34.090 position:50% align:middle Around 200 organizations around the country have pilots that are delivering, you know, 00:51:34.090 --> 00:51:38.120 position:50% align:middle acute level care in a patient's home. 00:51:38.120 --> 00:51:44.070 position:50% align:middle I mean, I forget who said it before, but, you know, just imagine in five years where nurses are going 00:51:44.070 --> 00:51:49.852 position:50% align:middle to be practicing, and I think that's all levels of nurses. 00:51:49.852 --> 00:51:58.650 position:50% align:middle - So, Maryann, I think you cannot look at the licensed practical nurse in isolation from how you deliver 00:51:58.650 --> 00:52:01.400 position:50% align:middle nursing in its entire continuum. 00:52:01.400 --> 00:52:08.029 position:50% align:middle So, the comments that Joan made earlier about really starting to define what nursing is all about, 00:52:08.029 --> 00:52:13.570 position:50% align:middle I think you've got to actually look at the entire continuum as part of this. 00:52:13.570 --> 00:52:20.320 position:50% align:middle Certainly, when I was working in medical and surgical wards, we did have licensed practical nurses 00:52:20.320 --> 00:52:21.900 position:50% align:middle there in Scotland. 00:52:21.900 --> 00:52:29.090 position:50% align:middle They had often many, many years of experience and it was often their own 00:52:29.090 --> 00:52:35.330 position:50% align:middle personal histories that had actually prevented them going further because they weren't able 00:52:35.330 --> 00:52:37.010 position:50% align:middle to access education. 00:52:37.010 --> 00:52:44.410 position:50% align:middle So, part of what we've got to think about is how you articulate from support worker, 00:52:44.410 --> 00:52:49.610 position:50% align:middle licensed practical nurse, registered nurse, APRN in a continuum, 00:52:49.610 --> 00:52:57.181 position:50% align:middle and people can actually progress through that at a pace which suits their life circumstance. 00:52:57.181 --> 00:53:04.160 position:50% align:middle And I think the more that we come out of COVID, life circumstance is actually going to be one of the 00:53:04.160 --> 00:53:09.630 position:50% align:middle key factors in terms of retaining and recruiting nurses. 00:53:09.630 --> 00:53:14.030 position:50% align:middle And I think as part of that, we need to have regulatory framework that actually 00:53:14.030 --> 00:53:25.300 position:50% align:middle embraces that entire continuum so that we can make sure that people with the right skills are safe to practice, 00:53:25.300 --> 00:53:35.540 position:50% align:middle whatever that practice is, across the cradle to grave community to tertiary service. 00:53:35.540 --> 00:53:39.400 position:50% align:middle And we've got to work that out because that's the reality of where we are. 00:53:39.400 --> 00:53:47.840 position:50% align:middle - And David, I'd like to build on what you and Robyn have said, and that is the importance of teams. 00:53:47.840 --> 00:53:55.830 position:50% align:middle And if we define what it is that the professional nursing role is and then we figure out what it is that 00:53:55.830 --> 00:54:03.320 position:50% align:middle is needed, what other support services are needed within that team, they may be non-professionals, 00:54:03.320 --> 00:54:09.460 position:50% align:middle they could be other health professionals from other disciplines, they might be nursing. 00:54:09.460 --> 00:54:18.510 position:50% align:middle But I would add that currently, we have a very... and I'm being a little bit of a devil's advocate here. 00:54:18.510 --> 00:54:23.290 position:50% align:middle And those who know me know I love to debate and be analytical. 00:54:23.290 --> 00:54:32.570 position:50% align:middle But we have a system right now that has so many different types of pathways to get from here 00:54:32.570 --> 00:54:35.470 position:50% align:middle to there to nursing. 00:54:35.470 --> 00:54:41.390 position:50% align:middle We have multiple different credentials, we have different kinds of education programs, 00:54:41.390 --> 00:54:47.620 position:50% align:middle and that is extremely confusing for students who are interested in coming in. 00:54:47.620 --> 00:54:50.060 position:50% align:middle It's confusing for the public. 00:54:50.060 --> 00:54:56.650 position:50% align:middle It's confusing for nurses themselves and other health professionals about that scope and how people are used 00:54:56.650 --> 00:54:58.360 position:50% align:middle and what that credential means. 00:54:58.360 --> 00:55:05.360 position:50% align:middle So, I definitely agree that we need to be clear about what that scope is, particularly if we figure out what 00:55:05.360 --> 00:55:07.870 position:50% align:middle it is that we want for professional nursing. 00:55:07.870 --> 00:55:14.800 position:50% align:middle We know we don't have enough professional nurses or will not in the future to address all those needs or 00:55:14.800 --> 00:55:18.010 position:50% align:middle to provide all the care, but we need to figure out what it is that the 00:55:18.010 --> 00:55:22.610 position:50% align:middle professional nurse needs to do in leading the team, no matter where they are, 00:55:22.610 --> 00:55:25.260 position:50% align:middle and then what other support workers there are. 00:55:25.260 --> 00:55:30.330 position:50% align:middle The other thing that I would point out, and we do need to figure out ways to allow individuals 00:55:30.330 --> 00:55:36.610 position:50% align:middle to progress across, whether it's through competency attainment but across their trajectory. 00:55:36.610 --> 00:55:43.070 position:50% align:middle But I would point out, and it's always concerned me, that if you enter and let's say you have somebody 00:55:43.070 --> 00:55:49.230 position:50% align:middle who's...because I got in this discussion with somebody last week about they were trying to find monies to help 00:55:49.230 --> 00:55:57.040 position:50% align:middle support students to go to a certified nursing assistant program and then to move on to do an LPN program and 00:55:57.040 --> 00:56:01.480 position:50% align:middle then to move on to an ADN program and then to move on to a BSN program. 00:56:01.480 --> 00:56:08.140 position:50% align:middle And if you figure out how many resources that individual, how much time, how much effort, 00:56:08.140 --> 00:56:14.530 position:50% align:middle and how much that costs that individual, is that the way we want to help them progress? 00:56:14.530 --> 00:56:21.280 position:50% align:middle I do understand that there are certain circumstances that may prevent somebody from moving directly into a 00:56:21.280 --> 00:56:26.250 position:50% align:middle certain type of education program, but I think that we can do better. 00:56:26.250 --> 00:56:31.030 position:50% align:middle I think by defining what nursing is, we can attract individuals to the profession. 00:56:31.030 --> 00:56:36.360 position:50% align:middle We need to provide more scholarships, more loans, more loan repayments. 00:56:36.360 --> 00:56:37.616 position:50% align:middle Maybe they can work off. 00:56:37.616 --> 00:56:43.530 position:50% align:middle I went to school as I worked off a loan working in an underserved area. 00:56:43.530 --> 00:56:47.570 position:50% align:middle And also mentorship to help folks transition. 00:56:47.570 --> 00:56:54.150 position:50% align:middle But I think when we're constantly trying to put people into programs and think they can progress out, I mean, 00:56:54.150 --> 00:56:58.780 position:50% align:middle if you think about it, that's going to take them 10 years and how expensive that is. 00:56:58.780 --> 00:57:05.600 position:50% align:middle Maybe there are some internship programs where you take a semester off and you work with a faculty or you do 00:57:05.600 --> 00:57:08.401 position:50% align:middle an internship somewhere and you can make money. 00:57:08.401 --> 00:57:13.940 position:50% align:middle There are already several programs that are designed that way in other disciplines, 00:57:13.940 --> 00:57:18.070 position:50% align:middle specifically engineering, but also in nursing so they can make money, 00:57:18.070 --> 00:57:23.220 position:50% align:middle they can progress, they can attain certain competencies, and then they come back for a semester 00:57:23.220 --> 00:57:25.490 position:50% align:middle and they learn some more and then they work. 00:57:25.490 --> 00:57:29.320 position:50% align:middle But this needs to be done in conjunction with academia and practice. 00:57:29.320 --> 00:57:34.900 position:50% align:middle But I think there are strategies that we can put out there to help move these people through and provide the 00:57:34.900 --> 00:57:37.200 position:50% align:middle opportunities that they need. 00:57:37.200 --> 00:57:39.310 position:50% align:middle - We have three minutes left. 00:57:39.310 --> 00:57:42.800 position:50% align:middle I'm going to give the final words to Loressa and Linda. 00:57:45.113 --> 00:57:46.200 position:50% align:middle - Thank you. 00:57:48.051 --> 00:57:53.990 position:50% align:middle I would simply say that I think that priorities for nursing right now, and we've not talked a lot about it, 00:57:53.990 --> 00:57:58.910 position:50% align:middle but if you ask most nurses what's the priority, it's staffing. 00:57:58.910 --> 00:58:03.020 position:50% align:middle So, we've, you know, alluded to it by talking about the pipeline, 00:58:03.020 --> 00:58:06.180 position:50% align:middle the shortage, the impact of COVID. 00:58:06.180 --> 00:58:10.830 position:50% align:middle But I really do think that there has to be attention given at a national level, 00:58:10.830 --> 00:58:17.100 position:50% align:middle from a regulatory perspective, a policy perspective of defining what is safe staffing, 00:58:17.100 --> 00:58:22.680 position:50% align:middle and how are we going to get there, and why is it so variable from one part of the country 00:58:22.680 --> 00:58:25.220 position:50% align:middle to the other, one organization to another? 00:58:25.220 --> 00:58:32.720 position:50% align:middle So, I just want to put that on the table, there's work that's underway in a variety of venues that we really 00:58:32.720 --> 00:58:37.930 position:50% align:middle don't have time to talk about today, but I think it is the elephant, using your terminology, David. 00:58:37.930 --> 00:58:43.320 position:50% align:middle It's the elephant in the room, and it's what nurses want to hear us talking about, is 00:58:43.320 --> 00:58:46.040 position:50% align:middle how are we going to shore up safe staffing? 00:58:46.040 --> 00:58:47.440 position:50% align:middle And how do we define that? 00:58:47.440 --> 00:58:50.978 position:50% align:middle And how can we reduce the variability? 00:58:50.978 --> 00:58:55.550 position:50% align:middle And I just wanted to also mention about the LPNs. 00:58:55.550 --> 00:59:01.490 position:50% align:middle I think we have devalued LPNs in the past, and there is a place for them when we talk about the 00:59:01.490 --> 00:59:07.010 position:50% align:middle tasks that RNs are doing that they should not be doing that could be delegated elsewhere. 00:59:07.010 --> 00:59:11.748 position:50% align:middle Certainly, the LPN can play a role as can other providers, but it really is part of the 00:59:11.748 --> 00:59:15.140 position:50% align:middle interprofessional team in understanding the roles of each. 00:59:15.140 --> 00:59:19.340 position:50% align:middle If we bring them back into the acute care settings, and I'm well aware that that's happening, 00:59:19.340 --> 00:59:21.590 position:50% align:middle then we have to do better than we did in the past. 00:59:21.590 --> 00:59:22.930 position:50% align:middle They have a value. 00:59:22.930 --> 00:59:26.960 position:50% align:middle We should define what that value is, and we should make sure that they're not practicing 00:59:26.960 --> 00:59:28.092 position:50% align:middle beyond their scope. 00:59:28.092 --> 00:59:36.230 position:50% align:middle And we also need to consider that as the LPNs were disinvited from the hospitals in their training because 00:59:36.230 --> 00:59:41.610 position:50% align:middle there weren't an adequate number of clinical sites, they've been trained in a different way. 00:59:41.610 --> 00:59:44.307 position:50% align:middle They've not been trained in the acute care setting. 00:59:44.307 --> 00:59:49.786 position:50% align:middle So, we have to consider and shore up what those gaps might be as we bring them back in. 00:59:49.786 --> 00:59:50.230 position:50% align:middle - Thank you. 00:59:50.230 --> 00:59:51.570 position:50% align:middle Linda, final word. 00:59:51.570 --> 00:59:57.230 position:50% align:middle - In order to find workable solutions, I think you have to identify what are the issues, 00:59:57.230 --> 00:59:58.660 position:50% align:middle what are the questions? 00:59:58.660 --> 01:00:05.340 position:50% align:middle And I think forums such as this and gathering such as this brings additional issues to light and additional 01:00:05.340 --> 01:00:07.890 position:50% align:middle facts about the issues to light. 01:00:07.890 --> 01:00:14.400 position:50% align:middle With the focus of the nursing organizations, and by that I mean not just the organizations 01:00:14.400 --> 01:00:19.700 position:50% align:middle represented on this panel today, but I mean the multitude of nursing organizations 01:00:19.700 --> 01:00:27.250 position:50% align:middle working together, I think we can come up with solutions that are going to answer many of the issues that are 01:00:27.250 --> 01:00:28.570 position:50% align:middle going to be facing us. 01:00:28.570 --> 01:00:34.740 position:50% align:middle Those issues are going to change and we're going to have to adapt and we're going to have to be flexible, 01:00:34.740 --> 01:00:42.730 position:50% align:middle but we have how many thousands of nurses and that amount of creativity and that amount of looking at the 01:00:42.730 --> 01:00:49.690 position:50% align:middle future and looking at what the needs are and being creative has to propel us to help meet the needs 01:00:49.690 --> 01:00:54.487 position:50% align:middle of where we're going to be in the next 5 years, 10 years, 20 years. 01:00:54.487 --> 01:01:01.700 position:50% align:middle - Well, I'd like to thank my panelists for all your wisdom and insight into this.