Nurses are the backbone of health care. Yet as artificial intelligence gains a foothold in the day-to-day work of nurses, the way they practice is changing. What does the influx of AI technology mean for the future of nursing? Nurse innovator and futurist Dr. Bonnie Clipper shares her insights.
Watch the video of this podcast episode on the Nemours YouTube channel.
Guest:
Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, Founder & CEO, Virtual Nursing Academy
Host/Producer: Carol Vassar
TRANSCRIPT
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Carol Vassar, podcast host/producer:
Nurses are and long have been the backbone of healthcare, advocating for patients, delivering hands-on direct care, and making critical decisions every day. As artificial intelligence gains a foothold in the day-to-day work of nurses, how is this changing the way they practice their craft, and what does the influx of AI technology mean for the future of nursing? Who better to answer that question than nurse innovator and futurist Dr. Bonnie Clipper? Dr. Clipper is an author, a fellow of the American Academy of Nursing, and founder of the Virtual Nurse Academy. We met up with her at HLTH in Las Vegas to get her take on AI platforms that can be used in patient care by nurses, how nurses can and should be part of AI technology development from the start, especially if nurses are the end users, and why she believes there is no such thing as an AI nurse. Here’s Dr. Bonnie Clipper.
Dr. Bonnie Clipper, CEO, Innovation Advantage:
There’s some really neat stuff going on in the nurse world. We are certainly seeing some different approaches to mentorship through electronic platforms and apps. We are seeing some different approaches to using AI to predict and assist us with better schedules. We are seeing communication tools that can help us connect caregiver to caregiver, or caregiver to family. I think there’s a lot of really neat stuff out there. The question is always, what problem does it solve, and how do we begin to translate that really amazing technology into practice?
Carol Vassar, podcast host/producer:
Let’s talk about nurses at the center of innovation. What’s the importance of that?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
Well, when you think about it from an overall perspective, there are 5 million nurses in the U.S. There are five times as many nurses as physicians and about eight times as many nurses as pharmacists, so think about it from the perspective of not only mass, in terms of number, also the fact that nurses are the ones that spend the most time with patients and their families. When you think about it being an ecosystem, healthcare is a team sport. It takes all of us in every single discipline to come together for things to go well and for us to provide the best care to our patients in our communities. Each of us has a specialty, but I think there’s a lot of opportunity for us to continue to collaborate and work together. From a nursing perspective, they’re quite often the end users that begin to see where the systems break down and where the problems are, particularly as it pertains to the patients directly.
Carol Vassar, podcast host/producer:
As we talk about nurses in the innovation space, how can nurses who want to be part of that space position themselves to be there?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
Some of this is…we have to remove some of these self-imposed constraints that nurses feel, and some of this is stuff we do to ourselves. We have the opportunity, especially nurses that are employed as a nurse in a hospital, or a clinic, or home care, in any of those environments, to be an entrepreneur, which means we have the ability to invent, to innovate, to problem solve in our capacity, and share those ideas internal to make our workflows, our processes, our patient care outcomes, our efficiencies, our read to do that any day, all day. The other part of it is, if you think about this from an external perspective of being an entrepreneur, nurses all know where the systems break down. They know where the problems are, and nurses have amazing ideas when it comes to, how can you put together a product or a service or a solution and do your homework to see if there’s a need in the market, and how do you begin to explore that to create your own business, your own solution, and go external with that?
Carol Vassar, podcast host/producer:
As we look at healthcare today, a lot of innovation, a lot of what we call digital transformation is occurring. What skills can nurses bring to the table? What skills do nurses need, and are we being served well in the nurse education area to provide those skills for new trainees?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
As nurses, we have a very, very unique skill set in that we are trained to think not only about the entire patient as a whole, other disciplines are as well, but we really have a perspective that’s a little bit different. We’re incredibly good on our feet problem solvers, pulling together information and thinking about what that means and what that translates into, how we should respond and react and make adjustments in our care plans or what we’re doing for our patients. We have a front-row seat here. We have the opportunity, really, to push into that space more. I think from a what do we need perspective, just like all healthcare professions are evolving, whether it’s medicine or nursing, we really do have to educate not only our pipeline but also our incumbent workforce on data, analytics, building AI. Where do these models come from? How are these models trained? How do you know if the model is biased? How do you know if AI really does what people say it will do?
It’s one of the big things here, being at HLTH, it’s such an amazing opportunity to walk around and see 800 new things. It’s really important to get a sense of, are those things really going to do what they are selling you, what they’re telling you? I think from a nurse perspective, I wouldn’t say nurses are fearful of AI. I think that they’re rightly cautious to make sure that all of these new tools and things that are on the market, what if they don’t work as planned? The nurse is still responsible for the patient. They’re the ones that are the license holders. We are the ones that are still that last line of defense, and I think our colleagues and physicians are having the same conversations about, look, we’ve been hearing about all these predictive analytics and amazing AI tools for years. They don’t do what they’re supposed to do, and we’re the ones responsible for these patients.
I think nurses look at this with a healthy skepticism. We want to see successes. We want to see where things make sense so that we have tools to adopt, especially because we are staring down a shortage that isn’t going to get better. We need to make sure that we are offloading the things that we should not be doing, particularly nurses that are direct care nurses, but we need tools and technology that we can trust that really does what it should do.
Carol Vassar, podcast host/producer:
You alluded to nurse shortages. Can AI be brought to bear to help with that, at least alleviate some of the stress that direct care nurses, in particular, are experiencing at this time?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
I would say I’m pretty outspoken that this is a yes and a no. AI is not going to give your patient medications. AI is not going to turn your patient and check their backside for pressure injuries. AI just ain’t going to do them. Where we have opportunities to offload things and help reduce maybe cognitive load or help reduce some of the stress we get from being distracted and pulled in so many different directions because of alerts or information, that’s really where we can begin to leverage technology and AI, and what it can do.
For example, in the mornings or in the evenings, where we run lab values on patients and we have to go out and look at labs before we give medication, there are already tools out there, and some of our big EHRs already pull these tools in, but the ability to help me as a direct care nurse, and say, “Hey, here’s something that you need to think about, but this is something maybe you don’t need to think about,” those are all just good little notifications, and reminders for us that as we’re going through the course of providing patient care, if there’s something I need to be concerned about, a lab value that I should withhold a medication for, that would be incredibly helpful.
We also can’t overplay the AI hand, because it isn’t going to provide care to patients. It’s just not doing it yet. There isn’t a future in the next three to five years that AI is going to be turning patients over, looking for pressure injuries on their butt. Someday? Sure, maybe, but today, we’re not there. I think a lot of the healthy skepticism is well deserved, and I think we have to really understand what the technologies are, what they’ll do. My vantage point on this is, let’s flip the script so that we find technologies that solve a real problem instead of the technologies that are really sexy, shiny, and cool, and then find a way to work them into our facilities. I think that’s a fool’s errand.
Carol Vassar, podcast host/producer:
As you talk about the problems that AI can resolve, or has the potential to resolve, where do you see a need for AI to step in and maybe resolve some of the problems that nurses are facing, especially direct care nurses?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
This is a really good question, Carol, and a lot of times, organizations will reach out to me because they want to have a conversation of, “Hey, we realize we need more AI. Can you help us pick what we need?” That’s not something you want to touch with a 10-foot pole, because what I’m more curious to learn is, what are the problems that you’re trying to solve today? Let’s see if there are solutions out there. More importantly, this is almost like creating a framework. Most organizations today have electronic scheduling tools for their staff, for their nurses. Have you maximized that, and are you utilizing the predictive portions of that? Are you aware of tools that you probably have in your organization to predict your senses in terms of admissions, discharges, and transfers? That exists, and many, many hospitals already have it. My question, when people ask about what AI should they buy, are you even using the tools that you have that you’ve already paid for?
And then, let’s take the next step and start to look at what are things that are going to be helpful to nurses? Think about all of the nurses around the country that literally, we’ll call them quality nurses. They’re doing chart audits, they’re gathering information and they’re running reports, pulling things out of our EHRs, exporting data, and essentially, they’re doing so many manual steps, and the goal of that is to create actionable insights so that someone does something to change behaviors. We can offload three-quarters of that work now. Instead of employing nurses in those roles, that’s stuff that we actually could have artificial or augmented intelligence do, and then hand off these reports, if you will, that allow us now to pick up and determine, what are the behaviors that we have to change to improve the fall rate? What are the behaviors that we have to change to reduce the CAUTI or CLABSI, or HAPI rate? Don’t monkey around with all of the work that is needed to extract data and pull reports.
That can be done, and as we start to make improvements in terms of what we should have nurses focus on, I don’t know that there’s a mass out there, but I think it also starts to help us free up nurses to pull them back towards a clinical side in some way, shape or form. When it comes to direct care nurses, there are some really amazing tools out there right now. Again, I think, what problem are you trying to solve? Are you trying to make sure that you are preventing falls, or reducing sitter hours? Are you trying to reduce documentation? Are you trying to make sure that your patients are positioned properly on a regular basis to prevent HAPI? You just really have to think about what you’re looking for, and then identify tools to help with that.
One of the things that quite often is at play…there’s some fruit that feels like it’s a little bit low hanging in this space to use AI, whether it’s around fall prevention, whether it’s around sitter reduction, also, early alert systems that help us identify patients, particularly at risk of sepsis, that all exists. There’s 10 of them out there today. That all exists. Figure out how you actually are going to utilize that technology, and then leverage the heck out of it so it really does benefit your patients, and you also really want to see the returns on the investment that you’ve made.
Carol Vassar, podcast host/producer:
We hear a lot, and I’ve seen a couple of vendors here, there may be more who are doing the smart hospital role with wearables, and virtual nurses offsite popping in virtually to look in on patients, and maybe consult with the direct care nurses on the floor to help with the health. What’s your take on that? It’s a new, shiny tool. What are your thoughts about that?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
It’s absolutely the direction that we’re going, and it’s absolutely the direction that we need to go. It’s going to be a matter of, how do we bring hospitals along to get there? This is probably going to be a 10-year journey. This technology, while it’s incredible, it’s going to continue to get even better and better and better. It’s also going to continue and come down in price point. Just like our Mac Books have, and our Apple Watches have, everything is going to come down in price point at some point in time, but we’re moving in that direction for a variety of reasons. I think it’s going to help us better capture data, which will tell us what we do successfully and what we need to change in terms of patient care.
Also, I think it’s going to help us identify workforce needs and potentially help us spread the supply and demand issue based on where we have clinicians. Where do we have nurses, or respiratory therapists, or even hospitalists? Where are people at? Where are they practicing? Where is the need? I think there is a lot that is going to continue to mature in these models that we are going to learn. In my perspective, we are literally just at the first turn of many as we continue to go down the road of smart hospitals and connected care.
Carol Vassar, podcast host/producer:
We talk about smart hospitals, AI technology, generative AI, virtual reality. I’m curious, from your perspective as a nurse, are we at risk of losing the humanistic touch, of losing the empathy? How do we maintain that in care moving forward?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
This is always a fascinating question, and I get this one a lot. I’m going to share my opinion, which is not always a favorite. I’m prefacing that for you, Carol, but the technology is not going to make us any less empathetic. I don’t feel like it’s an either/or, either high-tech or high touch. I think it’s an “and.” It has to be both. Where I absolutely do see things changing is not a result of the technology. It is a result of different generations in the workforce. It is not uncommon, when I’m in hospitals, to hear from managers and directors that their young staff, that have literally been out of school for a year or two, want to move into another role because they want to get away from direct patient care. It’s too hard, it takes too much time. They don’t like sitting down and talking to patients. They try to minimize some of that interaction.
It’s not a one or two hospital glitch. It’s probably a bit more prevalent than we think. I don’t mean to paint it as a bad picture. I think some of it is generational because the way that generations communicate is different. I have two Zers. They communicate with their friends and their work colleagues through their device, through their phone. They don’t need to have a phone call. They don’t need to have a direct conversation. That doesn’t change just because you’re a nurse and you have a patient in front of you. I think some of this is generational, how we’ve socialized, and how kids have matured into adults. Really trying to continue to bring people back to healthcare, at some point, no matter how techie it is, it requires us to interact with human beings. It requires us to be empathetic and show compassion, and be there in that moment with them. I don’t see the technology negatively impacting that.
Carol Vassar, podcast host/producer:
It requires touch, it requires empathy, it requires that humanistic element, for sure. What am I missing here? What’s the future bringing for nursing in terms of innovation and technology?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
I think the future is going to be really cool. We are going into uncharted waters here. We really don’t know, and I think that the visions that we’ve had all continue to shift and change based on the capabilities of artificial intelligence, what it can do, what it might do. In my opinion, the visual that I like to create is literally that we are the Flintstones trying to become the Jetsons. We are trying to figure out, how do we adopt the appropriate AI? Think about how amazing a world it would be as we continue to move into voice-to-text documentation. We know that’s happening around the country today, and this is where caregivers and nurses, and to some degree physicians. We also have to get better at how we use these technologies. We have an opportunity to teach this in nursing school, to really make sure that we are educating the future generations of nurses about these technologies, because literally, if you’re in nursing school today, you are going to emerge in a standard of care that looks like virtual nursing, virtual care for your inpatients, probably for your hospital home patients.
How are we growing and developing these newest generations of physicians, of respiratory therapists, of nurses, PTs, of OTs to adopt technology? We know workforce challenges are across the board for all the disciplines, so we’re going to have no choice but to leverage technology, and what does that look like? That’s where the clinicians have to be involved to create the solutions.
Carol Vassar, podcast host/producer:
Are we looking at some point where wearables in the home will also be something that we see on a regular basis?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
Yeah, we already have that today. When you think about home models, it’s very common that you would actually be sent from an ED to your home, admitted as an inpatient, and the unit is your home address. What we’ll send you is a kit, and in that kit might be a blood pressure cuff, a thermometer, you might find a glucometer, you might find a scale, you might find an iPad, or a tablet, and essentially, it can be set up for you. We’ll have a nurse go to your house within a certain window, a couple of hours from the time you actually hit the ED to the time you are admitted to your home, and essentially, they’ll set up that technology kit for you. We can do a certain number of check-ins, we can monitor your blood pressure, your glucose, we’ll observe you taking your medications.
We can do any of those things. We document in your EHR what we see. We can also supplement that with a physician or a provider visit. That’s already happening today. I absolutely think that’s a way that we’re going to continue, because it’s not only very expensive to build bricks and mortar hospitals and towers, and additions, but also, while we’ve resisted this for many, many years, hospitals are not the place that every patient can receive the best care. Hospitals are absolutely the best place for emergent patients, for surgical needs, for procedural needs, for critical care, intermediate care needs, maybe even for patients with certain conditions for telemetry, but there’s also a bolus of patients that can be appropriately cared for in their homes. That’s what I think we are going to be pushed more and more into. Whether it’s through value-based purchasing that gets us there or technology enhancements and improvements that make it easier, that’s absolutely the direction we’re going.
Some of this is also evidenced by, as a hospital, we are incented to keep patients in the hospital, because that’s how we are paid, and that’s our model. That sometimes feels a little bit conflicted with what’s actually best for the patient. There are some really neat models of care out there that have emerged that are collaborating with the hospital, that aren’t owned by the hospital, and the benefit is almost like a risk-based model, where the patient receives all the care that they need to receive, and the goal is keeping them well enough. We’re caring for them so that they don’t have to go to the hospital, where it’s more expensive to provide that same level of care.
Carol Vassar, podcast host/producer:
Real quick, and I know this is not a quick question or answer, data. We are seeing lots of data coming in with the wearables, with AI, generative AI, and a continual influx of data. Using that for research is something that I know is happening. What’s going on in the research space for nurses and using all of this data?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
Yeah, that’s an excellent question as well. Thank you for asking. I was actually at a dinner last night and we were talking about this, and it was some data scientists, and what they were talking about is how we have just leapfrogged the ability to generate new medications because of how robust our databases are. If you think about that, things that used to take years can now actually be more compressed, and we’re being able to compress it more. That’s fascinating. I don’t know that that is any different from a nursing perspective or a medicine perspective or a pharma perspective, or anything there. I think where we have opportunities as nurses is certainly to educate more PhD and DNP-prepared nurses to help do some of that translation backwards into hospitals, into health systems, so that nurses understand not only how things are created, but also that we have nurses that are properly educated and prepared involved in design and development of some of these treatment modalities and therapeutics, and where things are going.
Carol Vassar, podcast host/producer:
Some fascinating, exciting innovations coming our way in the area of medicine, and particularly nursing. Anything else you wanted to share with us today, Bonnie?
Dr. Bonnie Clipper, CEO, Innovation Advantage:
I always love my time with you, and I think if nothing else, it’s certainly important for people to continue to remember that as a team sport, nurses contribute a lot to this equation. The more that we can reach out and hear those opinions and those thoughts, it’s incredibly powerful, because they are closest to the patients, and we want to make sure that we represent not only the patient perspective, the nurse perspective as well, as well as the medicine perspective, and all of the others, so really trying to find a way to equalize all of those in terms of how we move forward, especially in an AI world. We touched on this a little bit around AI, there is a lot of hoopla around how AI is going to replace physicians, or replace nurses. That’s not true. I think the more that we as disciplines can work together and collaborate, we have a whole lot more in common than not.
I think the opportunities there are to figure out, how do we design and develop things that work best for our patients, and remain aligned around that? I’ll give you a quick story. I had somebody reach out to me here that’s a CEO of some AI company, and wanted me to meet with him because he wanted to show me his AI nurse. He messaged me on LinkedIn, and I responded, “There is no such thing,” and he responded back to me that he wants to show me because it’s the best one out there. Let’s just say in my haste, I deleted that. However, I went on and created a post on LinkedIn, and what I reminded people is that the term nurse, just like the term physician, is a protected term. There’s a definition, and the American Nurses Association says we must receive training from accredited bodies, and we must be license holders to be called a nurse.
I posted this on Wednesday, and it has 40,000 views and 100 comments, and I don’t even know how many reshares because it’s struck a nerve for people. I think there’s amazing technology here that we all want to understand, we all want to learn more about and potentially adopt, but it’s not to replace us. It’s to supplement us, support us, and actually help us, because at the end of the day, there aren’t enough nurses, there aren’t enough physicians, so let’s find ways to make lives easier so that we can continue to care for patients.
Carol Vassar, podcast host/producer:
Dr. Bonnie Clipper is the founder of the Virtual Nurse Academy and a fellow of the American Academy of Nursing.
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Well Beyond Medicine.
Carol Vassar, podcast host/producer:
Thanks to Bonnie for another great conversation, and thanks to you for listening. Great conversations abound on the Well Beyond Medicine podcast, and you can make sure you don’t miss any of them by visiting our website, NemoursWellBeyond.org, and subscribing to the podcast. We put out a new one each Monday, so start your week off right by listening. While you’re there, be sure to leave a review for the podcast or an idea for a future episode. That’s NemoursWellBeyond.org.
Our production team for this episode includes Cheryl Munn, Susan Masucci, Lauren Teta, and Sebastian Riella. Join us next time as we learn how a unique educational model is shaping the way preschool educators are identifying and helping their students cope with trauma. I’m Carol Vassar. Until then, remember, we can change children’s health for good well beyond medicine.
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