When technology promises to lighten the load but instead adds to it, what’s really going on? Katie Boston-Leary, PhD, MBA, RN, NEA-BC, FADLN, FAONL, Senior Vice President for Equity and Engagement, American Nurses Association, joins us to share her journey from aspiring accountant to national nursing leader – and explores how AI, virtual care and innovation can actually empower nurses instead of overwhelming them.
Guests:
Katie Boston-Leary, PhD, MBA, RN, NEA-BC, FADLN, FAONL, Senior Vice President for Equity and Engagement, American Nurses Association
Host/Producer: Carol Vassar
Announcer:
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Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar, and now that you are here, let’s go.
Joining me right now on the Nemours Well Beyond Medicine podcast is Dr. Katie Boston-Leary. Katie is the Senior Vice President of Equity and Engagement for the American Nurses Association, and she’s asked me to call her Katie. Usually I call folks doctor, but I’m going to call you Katie because you asked me to. Welcome, please.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Thank you. Thank you for having me, Carol.
Carol Vassar, podcast host/producer:
We’re going to talk about a lot of things having to do with AI and nursing in the future of technology within the profession, but I want to start with you. You were on track, not to become a nurse, but to become an accountant. I’m curious how you made your way from accounting into nursing and then into clinical leadership roles like you have now.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
First of all, thank you so much for having me. I’m honored to be on your platform, so thank you. So I was following my dad’s footsteps. I was a numbers person. My mom was an entrepreneur. She owned a number of hair salons, and I was the one that was helping with, when I got to a certain age, the finances, making deposits at the bank and everything. I felt that I was a numbers girl with what I was doing with my mom and my dad being an accountant, and I loved seeing how he showed up for… He presented himself every morning, and I kept thinking that I would be the female version of that.
And I was good at math. I studied accounting in high school, and I thought that was going to be my major. And then I decided to take a gap year. And during that gap year, I had a cousin who was a roommate of mine who was applying for a position at a nearby nursing home where we lived as roommates, and they gave us both clipboards with applications on it to fill out. And she said, “Fill it out.” And I said, “Okay.” She was older than me. And I filled it out, and they hired us both on the spot, even though I already had a job, a part-time job working at the plant shop. And the rest is history.
There was a gentleman that I was working with who was a lot older than me, old enough to be my dad, and he felt that I was a lost young person. He looked at me and thought, “I don’t want her to become me.” And he told me about an opportunity for a scholarship in the county that we were living in, in Virginia, for people to go into Allied Health careers. I then said, “No, no, it’s not for me. This is not a good time.” And he threatened me and told me, “You better not be here tomorrow without information from the college.” I reluctantly went. I was running late for work, ended up in a shorter line, because I was going to look into a fun job, which was occupational therapy, but I had to go to work that afternoon. I went in the shorter line, and that was a line for the ADN program for nursing. So that’s how I became a nurse.
Carol Vassar, podcast host/producer:
Fate took hold.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Faith took hold. Absolutely. So after a number of years, starting off as a staff nurse, going to the operating room, which was a place that I thought was for me, and it was. It was my home for years. I started being seen as a leader even before I saw it, and preparation ensued. And the rest is history.
I spent most of my years in the practice setting, working in hospitals, as a charge nurse, supervisor, manager, director, senior director, and chief nurse. And then I pursued my doctoral degree and decided I wanted to do something bigger, more impactful on a broader level. Jumped off the hamster wheel as a chief nurse because I needed to finish my doctorate; otherwise, it was going to cost me a lot more than it has already cost me.
While I was taking that time out, which felt very lonely, I started going through old emails, and I saw where an amazing friend of mine who worked at the American Nurse Association had asked me whether I knew someone that might be interested in a director role at the organization. And I looked at this email that was two months old, and I said, “This looks like me.” And I applied for the role, and the rest is history. I started as a director of nursing programs and then became the senior director of nursing programs, and ultimately, within five years, I am now the senior VP of equity and engagement. So a lot of work, and it’s necessary work given the state of the world right now.
Carol Vassar, podcast host/producer:
I would argue, given your background in accounting, your expertise in math, that that served you well along the arc of your career, particularly now. Talk about that.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Oh, absolutely. Especially when it came to the role that I was in, the specialty I was involved in. Because all specialties have a business aspect to it, but you’re introduced to it a lot earlier in the perioperative specialty because it’s a business. It’s run as a business. You’re dealing with supply services, and in terms of costs and managing that. And one of the major indicators of success for a perioperative leader is managing that supply budget, dealing with vendors, doing contracts, doing contracts with physicians.
I remember as a chief nurse, I had to oversee the anesthesiology department that had all these different physicians with different contracts that I had to manage. And at the end of the day, the numbers had to make sense. And I could write a variance report like nobody’s business. Give me a report or two, and I will be Inspector Clouseau and I can track down easily, well, I shouldn’t say easily because the systems don’t work that well or efficiently where you could just put one report and see everything, but I was very good at really drilling down to why we would have a variance expense, what the projections would be, all the financial aspects of that as required for people to lead in that setting. So yes, those were transferable skills that led to my success in that area.
Carol Vassar, podcast host/producer:
And even more so now as we look at nurses and technology. Now, we met at ViVE in Nashville this past February.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Yes.
Carol Vassar, podcast host/producer:
I don’t know if it was you that said this, but somebody said, and I’m quoting, “Technology has not been particularly kind to nurses.”
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
That was me.
Carol Vassar, podcast host/producer:
That was you, okay. So talk about the impact, both positive and negative, at technology on the practice of nursing.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Sure. And this is one of my one-hit wonders that I roll out every now and then, depending on where I’m in, but it’s very true. I think enough attention has not been paid between the gap between the perception of the effectiveness of technology and leaders compared to the people that actually use the technology.
In some respects, and I’ll use the HR as an example, I remember as a chief nurse and even as a senior director, I remember they used to drill in our heads that the one big indication that the system is working is when you drop your first bill, without consideration of what it takes for that first bill to drop and how it’s impacting the people that have to use these systems.
And I remember out of frustration as a chief nurse, we had a supposed successful go-live. It was a big bang rollout where all the departments went live the same day, had a group that we had assembled, emergency response that we usually use for disasters response to manage issues and concerns. And I remember sitting in a room where we went live, and there was a celebration that it was successful. And in the same room where that discussion was happening, I saw this pile up of tickets from nurses and people using the system, indicating all the things that wasn’t working for them. And that was my first clue about how, sometimes, as leaders, we pay attention to the wrong things. Yes, patients are moving through the system, yes, work is getting done, but at what cost?
And that was my indication in a larger way, but it also got me to look at a number of different other things that I’ve been a part of implementing as a leader, and that there was a feeling of us as leaders being tone-deaf to the concerns that are being raised by the people that have to use these systems, what it’s requiring of them. And when you really go back to the promises of electronic health records, there was an expectation that there wouldn’t be a physical chart. There was an expectation that we will be able to decipher everything; we don’t have to go through a lot of issues with handwriting and all that. Yeah, some of those things were taken care of, but there are a lot more that got added onto the plate that we haven’t fully reckoned with when it comes to technology.
Carol Vassar, podcast host/producer:
What would you have done differently on that go-live day? And for anyone who’s not been through a go-live day like that, that affects everybody throughout a healthcare system for whom this work involves, from marketing/communications, to the nurses on the front line, everybody is tense and waiting for that go-live. It’s a very intense day. What would you have done differently?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
I think one of the things I would’ve done, that’s a great question, would’ve been to reset the indicators of success with the people that really were the ones that had to use these systems. I think we should have a mutual agreement of what those indicators are and mutual agreement on what resolution looks like.
Because I also recall there would be all these tickets submitted for things that were concerns, and those tickets will get closed. So I’m thinking these issues are resolved. And then I’ll go to the floor, and nurses will say, “No, it wasn’t. And I got a call, and someone came up and they heard me, and they told me that, “Unfortunately, this is the way it’s going to be. Try this other way.” And then the tickets get closed.
So mutual understanding between the users and the leaders is very important. And sometimes there’s crossover in between, because the leaders have to use these systems as well. But they use it for different reasons. They use it for reports to understand various things, performance, financials, and all that. But from a user perspective, we should set indicators of success or measures of success that they can also ascribe to and believe i,n and not just set it up at the leadership level.
Carol Vassar, podcast host/producer:
I’m guessing that, as AI is coming to the fore across healthcare systems and nurses using AI technology, you would make that same recommendation. How can we better prepare nurses to use IT, emerging IT, and AI technologies as they work toward their ultimate goal, which is patient care?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Same thing. And it’s quality patient care, right?
Carol Vassar, podcast host/producer:
Right.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Because care will be delivered, but what type of care are we giving, given all these things that we’re challenged with? I just saw research today, and I think it was in Becker’s about, that it said, “Only 40% of healthcare institutions or systems leveraged AI in a large sense.” But I do believe it’s everywhere. Whether you were intentionally implementing it or not, it’s everywhere, particularly as it relates to generative AI.
But for us to see it as a way for us to address a lot of the concerns that we have with delivering care is where I think, particularly in nursing, because we’re seeing the impact on the medical provider side, the physician side, we have not seen it manifest as much on the nursing side, even though we’ve seen it with care coordination a lot more. But when you think about what we have to deal with from a workload perspective and given what I just mentioned in terms of electronic health records, I think there’s opportunity there.
But we have to move away from the boogeyman syndrome that we have with this that is going to take something, take away our jobs. I’m not saying that there’s not a likelihood that that could happen, even though in research it indicates also that it doesn’t impact empathy facing type roles like nurses, like teachers. So the likelihood of that is very slim right now. It’s 2025. This might not age well in 20 years, where it will be very different. It’s kind of like… I don’t know if you remember the clip that they show of Bryant Gumbel and Katie Couric on the Today Show years ago, talking about the internet. Like, “What is this internet?”
Carol Vassar, podcast host/producer:
Exactly. They sound very, to our ears today, uninformed.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Exactly. So that could be the case here. So let’s consider where we are right now. I don’t think we should see it as a threat. I think we should see it more as a promise for us to build it to the way that we want to and the way we need to.
And I’ve seen some really good information come out, particularly with Mayo Clinic, where they’re looking at how AI can help reduce documentation workload in nurses. And I think if we focus there heavily and deal with that and every institution around the country, I think it would create a seismic shift in how nurses are able to deliver care more effectively, more compassionately, be more present when they are engaging with patients.
I’ll just close with this. I saw someone post for Nurses Week a gift of an arm bracelet that is a bracelet that you can write on and erase, where you can make notes on, erase, and continue to make notes on throughout your day as a nurse. And they were promoting it as a place where you can document vital signs, so you won’t have to commit it to memory, so you can put it in the computer later. That is an indication about how dated our thinking is sometimes in how we deliver care. We should not be doing that in 2025. A product like that should not be marketable at this time.
Carol Vassar, podcast host/producer:
As a helpful gift during Nurses Week.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Yeah, exactly. But it is, because a lot of nurses are still writing, noting a lot of their information on paper towels, on pant legs, on clipboards.
Carol Vassar, podcast host/producer:
On their hands.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
On the backs of their hands. This should not be happening right now. We have to really push the needle as it relates to information being uploaded in real time while care is being delivered.
Carol Vassar, podcast host/producer:
I have two questions in relation to that. Let’s assume that I’m a mid-career nurse and I’m hearing all about AI, I’m hearing about generative AI, and how it’s going to change my job. What should I do now to educate myself so that I am able to continue in my career to that leadership role? And also, what is the role of nurses in the innovation sphere as they work toward the future of healthcare deliver,y personally and professionally?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Great question. I do think that there are so many different ways for us to educate ourselves on AI. So this is such a hot topic. You can’t go to a conference where it’s not a front-and-center, top-of-mind discussion topic. You can’t go on your feeds, your professional social media feeds, and not see something there. There are also institutions that offer programs. LinkedIn has free courses that they offer. I mean, there’s so much out there, you’ll probably get tired, because there’s so much being offered that you won’t have to pay for it. They will help you with educating you on this topic.
I remember a few months ago, a couple months ago, I went to New York, and there was a conference on building a world as a society of social good. It was about AI, and I was thinking, “Wow, it seems like a paradox. Let me go see what this is about.” Because you see, you hear all the bad things and not-so-good things. And they set up this entire four-hour, five-hour conference, us seeing what the future could bring and how you can create the best of both, where we can be intentional about creating the best of what technology has to offer as it relates to AI and the best of what we can offer as human beings to layer onto how we can build the best healthcare system that we can.
I’m excited about that, and I look for opportunities to learn more about how I can contribute to that. So we have to all get to a point of being excited about what it can offer, even though we’re mindful about what the other side could look like as it relates to people using it for evil and not good, particularly from a consumer sense. So we have to assume our rightful places in making this technology work for us and not run from it.
As far as innovation and nursing, nurses have always been innovators. We were innovators before the term became sexy, or even before innovation became a thing. And we’ll continue to because of our collective passion to deliver the best care possible, and hopefully in the most efficient way that we can. This is under the guise of necessity as a mother of invention, and nurses throughout their day come up with different things to make things better. Even in a discussion with nurses, you can have a discussion about something you struggle with, and someone or a couple people would say about what they did and how they adjusted the system to work for them. We hear it also, even with EHRs, that there are a number of different ways to use the EHRs in systems because people find different ways. So we have to fuel and really fertilize the ground for nurses to innovate and reward them for being innovators because this is part of our DNA. We innovate all the time. This is who we are, this is what we do.
Carol Vassar, podcast host/producer:
You never know what you’re going to be faced with in any given moment when you’re on the floor.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Absolutely. Absolutely.
Carol Vassar, podcast host/producer:
I want to talk about virtual nursing and the term virtual nurses, which some will say there is no such thing as a virtual nurse. How do you define virtual nursing, and what kinds of rules of the road are in place in this regard?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Great question. So let me start with this. I usually try to emphasize that we should be talking more about virtual care. And I say that because the hesitancy to invest in this technology, which is our future, which is here, has been because we’ve called it virtual nursing. It’s being seen as technology to help nurses. And it’s not that at all. I think it’s more about how we can improve access to care and do it more efficiently and do it more effectively, given all the things that we’re facing in nursing.
One of my other one-hit wonders that I roll out when I present is, “What happened to the easy patient?” There was a time that we would have a cadre of relatively easy patients that will be walkie-talkies that wouldn’t require too much of us, but they need to be watched, and monitored, and cared for. Now, of course, we don’t want patients that don’t need to be in acute care settings there longer than they should, because that’s the highest cost that you could incur to the patient and to the system overall.
But the point I’m trying to make is that patients are a lot sicker. Care is more complex. Things that we thought we put to bed in terms of disease processes are coming back, like measles. So there are all these complexities that we have to deal with, and I do think that virtual care is the answer for a lot of things that we’re struggling with right now as it pertains to care delivery. And virtual care is not only being delivered by nurses, it’s being delivered by physicians, it’s being delivered by caseworkers, social workers, case managers. There are so many opportunities for it if we just thought about it in a more broader sense. So that’s what I say when we talk about virtual care.
However, there are nurses that engage in providing virtual care. There are some institutions that embrace the term virtual nursing. There are organizations that wants to see it as a specialty. Maybe it’s okay for now, but it is emerging technology, and if it becomes a standard, then every nurse will be called a virtual nurse, possibly, right?
So my interest in this space is to make it a standard and for it to be seen as how we deliver care for the future, which is here and now, and how we can be better for the patients that we’re supposed to serve, because we’re opening the door for a lot of different layers of care delivery, not just with care at the bedside and right there in front of you, but also with care from a distance that’s remote from a different room. And also care that we can provide in other settings, like a school setting, or long-term care. There’s so many opportunities for this if we just open our minds a little bit more.
Carol Vassar, podcast host/producer:
You are an amazing high-profile leader of the American Nurses Association. Your title includes engagement. I want to discuss your role in engaging nurses across the nation, especially in this time where five years out from when COVID began, a lot of people fled the field. We see new nurses coming in who perhaps don’t stay in the field. How do you keep nurses engaged? What does that aspect of your role entail?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
It’s a moving target, and I hate using violent language, so I should find something else. But it really is something that we have to continue to stay adept at and be mindful of the different needs, different strokes for different folks, and how we need to break open a little bit the buckets we’re putting people in because of the generations that they belong to, based on when they’re born. Because I do think that everyone engages in different ways, and they require different things. And the way to know that is to be amongst the people.
So part of what I try to do is to get out there more, not just conferences, but even for Nurses Week, I went to institutions, talked to nurses, talked to nurse leaders. I have this incessant hunger to learn where people are and what they need and how their concerns or needs can be addressed in a different way. And I think as a leader, that hunger needs to be always be there and never think that we figured it out because we read a report.
I remember a great leader told me once, who was a mentor of mine, she said, “A nurse is always only as good as their last shift.” Like, you can talk to a nurse today, and based on what they may have faced later in the day, when you meet them tomorrow, their needs are very different. And you can’t assume that what you knew then is holding for a 24-hour period. So we have to stay tuned in and plugged into what people need on an individual basis, in addition to a larger level from a collective and broader.
But that’s part of my role is to continue to get out there and learn what nurses need, what their concerns are, because I want, as a megaphone in a number of ways, in a number of circles, I want to make sure that I’m saying the right things. And I want to make sure that I’m not sounding tone-deaf, and I’m not saying A, but the issues are B, C, D, and E. So that’s why I feel with this title, it’s my role to continue to connect with nurses at a human level in every way and any way that I can.
There’s not a single nurse that’ll reach out to me, and I might be doing something that’s going to create more work for me by saying this, but there’s not a single nurse that’ll reach out to me and say, “Can I have a few minutes of your time?” And I say, “I’m too busy.” I always make time, even if it’s not that week, it’d be two weeks from now, three weeks, what have you. Because that’s how I learn as well, in addition to providing them a service that they may be looking for based on what they think that I can provide them.
Carol Vassar, podcast host/producer:
What are you hearing from the field?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
I’m hearing that the gap between nurses and nurse leaders is widening.
Carol Vassar, podcast host/producer:
Okay.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
I think there is still a concern about staffing, not as critical as it was during the pandemic, but still, nurses don’t feel that their staffing is safe on a consistent basis.
Also, hearing the concerns about workplace violence, also hearing about what we just talked about with artificial intelligence and what it means for them. Also hearing about their concerns about some of what’s happening in the social political arena and how it’s impacting their lives, not only on a personal level, but professional level too, and how do you marry the two? Which is nuanced, because the old adage is that’s that and this is this. But it’s all spilling over into our spaces where we work. So how can you continue to say that? But for leaders, how do you manage these conversations, especially given how polarized we’ve become in society? All those things.
Carol Vassar, podcast host/producer:
Are you hearing anything about burnout? Because this is a field that is prone to burnout. What are you hearing?
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Well, this is the thing. All roads lead to burnout. All the things that I just mentioned to you lead to that. All the things that we talked about earlier lead to that. The technology issue, the documentation issue, all these things lead to burnout. And the big question is, why does it have to be so hard for me to practice as a nurse? When can there be some focus on simplification and having me focused more on things that I should be doing versus what I have to do because nobody else will? I talk about how we’ve talked to nurses about “Never say you’re just a nurse,” and they say, “Well, can I just be a nurse today? Why do I have to take on all these other things?”
So all these things that we just talked about lead to burnout and well-being issues. Absolutely. And we have to start seeing it as such, versus it being in one of the buckets that we manage and carry in terms of issues for nursing. All these things lead to what nurses have continued to have issues with: the burnout. And when people say, “Well, why is that? It doesn’t make sense.” Well, when you really think about it, we are a lot wiser, a bit wiser, I shouldn’t say a lot, but we’re a bit wiser since the pandemic, and we started making wellbeing in nursing a thing. And we’ve done some things strategically, structurally, to adjust nurses’ wellbeing, and yet, we’re still here where nurses are feeling burned out. When you really think about it, it probably is because we haven’t looked at the systems that we’ve created around nurses to work withi,n and whether those systems are creating illness versus wellbeing and wellness.
Carol Vassar, podcast host/producer:
So, examining the systems, that’s where you’re going to find the solutions.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
Completely. And I’m not necessarily talking about pathological illness, but you’ve heard about Sick Building Syndrome, right?
Carol Vassar, podcast host/producer:
Yes.
Katie Boston-Leary, Senior VP, Equity and Engagement, American Nurses Association:
I’m here and I want to give my all, and I can’t. I want to do these simple things. I couldn’t. I leave at the end of the day. I couldn’t leave on time. And then at the end of the day, when I’m trying to lay my head on my pillow, something hits me that I committed, I promised a patient or a colleague that I’ll do X, and I never got there. I never did it. And you feel this distress. So all those things are what impacts burnout in nursing and nurses well-being.
Carol Vassar, podcast host/producer:
Dr. Katie Boston-Leary is the Senior Vice President of Equity and Engagement for the American Nurses Association.
Thank you, Katie, for sharing your personal story and your expertise in nursing in an AI world. And thanks to you for listening.
AI is just one factor beyond clinical walls affecting the health and well-being of all of us, including our kids. There are so many others, and we want to bring it all to you. Have an idea for the podcast? Share it with us via email. [email protected], is that email.
Again, [email protected], or by leaving a voicemail on our website, NemoursWellBeyond.org. That, of course, is the place to subscribe to the podcast, to subscribe to our monthly e-newsletter, and to listen to any episodes you may have missed. That’s, once again, NemoursWellBeyond.org. You can also find all of our episodes on your favorite podcast app, your preferred smart speaker, and on the Nemours YouTube channel. Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Alex Wall. Video production by Britt Moore. Audio production by Steve Savino and yours truly.
Join us next time as we celebrate Hispanic Heritage Month by profiling a Latina who defied the naysayers and the odds to become one of the nation’s leading pediatric surgeons. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
