7 Must-Read Stories for CNOs

HealthLeaders' most popular stories for nurse executives for Q3 2023 range from big data and staffing ratios to robotic nurses.

Though a handful of state legislatures have enacted or are considering mandating nurse-to-patient staffing ratios, staffing should stay in the hands of nurses, Robin Begley, CEO of the American Organization for Nursing Leadership (AONL), told HealthLeaders in a story that ranked No. 1 in readership for the year's third quarter.

Besides staffing, nurse executives also were most interested in stories about technology, LGBTQIA+ care, recruiting and retaining, big data, and rural healthcare. Here are HealthLeaders' top seven nursing stories by ranking:   

1. AONL's Robyn Begley: Just Say No to Mandated Nurse-to-Patient Staffing Ratios

Legislators working to mandate nurse-to-patient staffing ratios may have good intentions, but the process of a nurse-patient ratio is antiquated and out of alignment with healthcare delivery today, says Begley, DNP, RN, NEA-BC, FAAN.

"In particular, it does not consider advanced capabilities in supportive technology, or what we're seeing across the country right now, which are interprofessional team-based care models," she says.

Additionally, staffing is complex and best understood by experienced and expert care teams—not policymakers, she says.

"The way of determining the staffing ratio is a very static method. It's a tool that is at a single point in time," Begley explains. "At the beginning of a 12-hour shift, for example, the activity, the patients, their conditions, and the staffing of a floor can look very different than what's required throughout that 12-hour period. That nurse-patient ratio fails to acknowledge that care needs can change on a dime in a hospital."

An unintended consequence of mandated ratios is less access to care for patients, Begley says.

"If a hospital or health system has to close several units because they don't have the prescribed number of nurses to care for patients who would have been in those beds, patients are unable to make it past the emergency department, or they may be transferred to other facilities that that are not close to their home," she says. "So, those are serious concerns that need to be evaluated before something as dramatic as a mandatory nurse-patient ratio is implemented."

2. New—and Sometimes Nontraditional—Ways to Attract and Keep Nurses

As hospitals and health systems continue to seek solutions to workforce staffing—particularly nursing—many are veering away from traditional methods and embracing new ways of attracting and retaining employees.

Nurse hiring and retention now entails upskilling, collaboration, and nontraditional support.

For example:

• Geisinger, a Pennsylvania healthcare system, is filling critical nursing roles through its Nursing Scholars Program, which awards $40,000 in financial support to each employee pursuing a nursing career, providing that nurse commits to working five years as a Geisinger inpatient nurse. The program is open to any employee who is not already an RN, physician, or advance practice provider, and begins on day one of their employment. 
• Allegheny Health Network, based in Pittsburgh, launched Work Your Way, a mobile internal staffing model that provides flexibility for nurses to choose how and when they want to work. Mobile nurses work rotational, six-week shifts in emergency medicine, telemetry, critical care, and perioperative care at eight of AHN's 14 hospitals. Those traveling more than 50 miles to work receive premium pay and mileage reimbursement; those traveling more than 75 miles also receive lodging reimbursement. Options to work weekends and night shifts are included.
• Northwell Health offers eligible employees as much as $5,000 in financial assistance to purchase a home on Long Island. 

3. The Exec: How Artificial Intelligence Benefits Nurses

The AI wave comes at a crucial time in nursing because it can effectively train nursing students, improve patient care management, and adjust nurse workloads, which ultimately helps to reduce stress and burnout—and that's just the tip of the iceberg for the emerging technology.

AI can resolve nursing's pain points such as burnout, says David Benton, RGN, PhD, FRCN, FAAN, who just this week retired as CEO of the National Council of State Boards of Nursing (NCSBN).

"One of the things we need to think about is if nurses are asked to do things that technology could do more efficiently or more effectively," he says. "There's no need for nurses to be doing that kind of work when a machine can do it much more quickly, more efficiently, and in a less-stressful manner."

Indeed, nursing needs to be a partner with technology and consider it like any other tool, he says.

"If you think about years gone by when we were using mercury thermometers to take people's temperature, we didn't think anything about it; it enabled us to get an accurate value in terms of whether someone might have an infection," Benton says.

"Nowadays, we've got different technology that does that in real time, and we think nothing about it," he says. "AI needs to be a partner with us in terms of delivering safe, effective, and efficient healthcare into the future."

4. Can AI-Powered Robots do the Work of a Nurse?

The concept of AI-powered robots in nursing isn't far-fetched anymore—Baptist Health in Jacksonville, Florida, is using Moxi, a robot, to help with tasks that might otherwise take up time away from patients—but issues remain whether they are capable of providing quality nursing care, a new study says.

Researchers from three Japanese universities examined whether AI and robots have the ability to perform nursing tasks as well as humans.

Nurses' human touch establishes meaningful connections with their patients. That's why nurses have ranked first for 21 years as the most-trusted profession in America.

The researchers examined whether current advancements in robotics and AI can implement these human qualities by replicating the ethical concepts attributed to human nurses, including advocacy, accountability, cooperation, and caring.

While AI can inform patients about medical errors and present treatment options, "the researchers questioned its ability to truly understand and empathize with patients' values and to effectively navigate human relationships as mediators," according to Tokyo University of Science.

Robots may not fully replace human nurses anytime soon, but it is a possibility, the researchers note. If that time comes, "their deployment requires careful weighing of the ethical implications and impact on nursing practice."

5. University of Pittsburgh Nursing School Creates Tools and Learning for LGBTQIA+ Healthcare

When students of Brenda Cassidy, DNP, RN, CPNP-PC, at the University of Pittsburgh School of Nursing expressed uncertainty about how to respectfully ask patients about sexual orientation and gender identity, a consult with her colleagues found their students felt the same hesitancy.

Cassidy and those colleagues—Betty Braxter and Andrea Fischl—set about to develop a unique interactive learning module and resource toolbox to provide best practices in LGBTQIA+ healthcare to those students—and all healthcare providers.

The unprecedented resources are available to any healthcare provider who wants to approach patients in a welcoming and inclusive manner, Cassidy says.

Despite the American Association of Colleges of Nursing's initiative to improve academic nursing programs' ability to prepare working nurses for a diverse patient population, including LGBTQIA+ individuals, fewer than 20% of nursing students get such preparation, and one-third are ill-at-ease when attempting to provide care for LGBTQIA+ patients, according to the association.

Most providers aren't deliberately prejudiced, but instead harbor unconscious bias, says Cassidy, a pediatric nurse practitioner whose specialty is adolescent healthcare, particularly sexual reproductive health.

Consequences of unconscious bias can be devastating for LGBTQIA+ patients, Cassidy says.

"Unfortunately, it results in discrimination and stigma toward this population who's already vulnerable," Cassidy says. "Negative experiences that they have had creates hesitancy on their part to delay seeking care, which then delays diagnosis and treatment, and that results in negative consequences."

"Inclusivity is about making people feel comfortable to say who they are, being who they are," Cassidy says, "and we really have made wonderful, great strides, but our work is not done."

6. Why Nurse Practitioners Are a Solution to Rural Healthcare Challenges

With more than 100 million Americans lacking access to primary care, employing more nurse practitioners (NP) and allowing them to practice at the top of their license is critical to making healthcare more accessible in rural areas, NP leaders say.

NPs could ease "care deserts" created by physician shortages and rural hospital closings. Nearly 80% of rural U.S. counties are medical deserts, according to the National Rural Health Association.

"There are many people who don’t see a doctor or get healthcare on a regular basis, and when they are really sick, they go to the emergency room for their care," says April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the American Association of Nurse Practitioners (AANP).

NPs' holistic, wellness-centered approach to primary healthcare—health promotion, prevention, and chronic disease management—is particularly beneficial to rural patients who must travel long distances when illness requires acute care.

"One really valuable thing they bring to rural health is the approach to healthcare, which differs a bit from the medical model," says Michele Reisinger, DNP, APRN, FNPC, a working NP and assistant professor of doctoral nursing at Washburn University in Topeka, Kansas. "Nurse practitioners are trained to look comprehensively at the individual."

"Nurse practitioners in rural areas wear many hats," she says. "They may be seeing primary care patients; they may be tasked with extended care rounds in nursing home facilities, which requires extensive geriatric management; or they may be in a setting that requires knowledge of trauma. So, we try to prepare them in a way that is global in that manner."

7. Getting Nurses Comfortable With Big Data

How comfortable are nurses with mining Big Data?

"Zero, zero, zero, zero," responds Roy Simpson, DNP, RN, DPNAP, FAAN, FACMI, assistant dean of technology management and clinical professor at the Emory University Nell Hodgson Woodruff School of Nursing.

That's why Simpson and Vicki Stover Hertzberg, PhD, FASA, a professor and director of Emory's Center for Data Science, helped create an online, self-paced data science certificate program—to help nurses use Big Data to solve problems in healthcare settings.

Big Data is a relatively new concept for nursing—it's been around two, perhaps three years, Simpson says—but its capabilities are unlimited in developing patterns of patient care.

"To compare six patients and 10 patients and 30 patients and 400 patients is not a good indicator of evidence. You need large trillion data sets," Simpson says.

Getting comfortable with Big Data can only help nurses in their clinical practice.

"Every specialty in nursing has a component of informatics, and the weakness of those disciplines is the lack of informatics in their discipline," Simpson says. "For nursing to be successful in the future, we have to embrace it. We have to understand it and know how to use it."