Empowering Nurses Through Education: Reducing Burnout, Building Leadership, and Elevating Care

[00:00:00] Speaker 2: I'm Jennifer Dr. Jennifer Shepard. I am currently in my role at the ANA is the director for nursing education and product management. And my role is really related, directly related to to nursing continuing education and professional development.

[00:00:14] Speaker 2: My team designs. All of the educational, the accredited education content that the ANA and the entire enterprise actually put out. So if it's got C& E with it, then it is comes out of my department. We also design products, workshops. Provide the CNE for conferences and really start to work on developing not just products for revenue, but also following the the strategic goals of the enterprise to put out education that also reaches nurses even in rural communities providing access to that, but also, related to relevance.

[00:00:52] Speaker 2: For example, our 2025 Code of Ethics for Nurses just got released today, as well as educational courses. So that comes from, those educational courses are built and by my team collaborating with the team of ethics at the ANA. And Sean and I work together directly as well on the advanced practice for, so for things for advanced practice nursing and the continuing education courses that they need as well.

[00:01:13] Speaker 2: That's what I do. Sean. Yeah.

[00:01:16] Speaker 3: Thank you very much, Alex, for having us. My name is Sean DeGarmo. I'm the Director of Advanced Practice Initiatives and Certification Outreach. I started here literally four years ago, April 20th of 2020, right in the middle of the pandemic, and immediately had to deal with 46 of the CMS waivers.

[00:01:37] Speaker 3: That was extremely important, and so that leads to A huge portion of my job is being a subject matter expert and resource across the enterprise for any and all issues that impact advanced practice nurses. So a good portion of my job is I work to support our government affairs team, where we look at legislation and policy and see if, again, if it's the right context making sure that we identify the key players and make sure that it's what for advanced practice nurses that we want.

[00:02:19] Speaker 3: I also support certification and. We have five current advanced practice nursing certification, and we also have twelve active specialty nursing certifications. I believe in total we have, including our retired certification and portfolios. I think we've got about forty three. And then I support Jen and ANA as well as the foundation when it comes to highlighting all the hard work that Jen and her team as well as the rest of the enterprise do to [00:03:00] support not only advanced practice nurses but all nurses.

[00:03:05] Speaker 3: So those are a few of the things that I do.

[00:03:09] Speaker: So the ANA is a huge enterprise and does a lot of different things. Jen you mentioned the code of ethics. Can you share a little bit about what's changed there or what might be different for 2025?

[00:03:24] Speaker: You're on mute. I was

[00:03:28] Speaker 2: worried my dog would bark, so I muted myself. Oh, that's okay. As you can imagine, so the Code of Ethics itself is is updated every 10 years, as it stands right now. That's been the history and the legacy of that. And it is updated by nurses ethicists, nursing ethicists in the field.

[00:03:46] Speaker 2: So it's a huge huge endeavor. They are, there are committees, there's advisory boards, it goes, passes through the board, there's edits, there goes through publications. It's a huge thing. And quite frankly, we've been working on it for over a year. And as you can imagine the changes that's happened in the last decade with especially the highlight, Of the ongoing issue related to burnout and lack of resources and education for nurses that we learned during the pandemic, but I should say it was highlighted during the pandemic and it all had always existed, but it put a spotlight on it.

[00:04:19] Speaker 2: It demanded the code then really demanded changes related to those types of things that were more specific to allow nurses the autonomy to not just care for their. So it's not only the doctors that put their patients and put their patients first, but some of the changes now also direct nurses putting themselves in their well being first.

[00:04:42] Speaker 2: There's some technology language that's in there that is talking about the ethical use, fair, making sure that we're, we've got fair practices in place, policies, protected health information or any actually, whether it's P. H. I. or P. I., like how we are, how we're dealing with that.

[00:04:57] Speaker 2: and I'm ensuring nurses, are not just having a seat at the table, but have the the, again, the ability to ethically stand for the advocacy for patients and families and who we take care of every day. So it really has language that is giving. to the actions of ethics. It's a living document.

[00:05:21] Speaker 2: That it's not just here's the code. It's a piece of paper or a book. It is, this is the code that now has, this is how you use it. It's the application of what we're doing. So just the code itself is. Again, like I said, something that's living that nurses can take and really read to be able to have to understand when they get into ethical dilemmas or any type of situation that they have something that they now have ways to apply it.

[00:05:48] Speaker 2: And then the educational courses themselves dive even deeper into each provision and provide those types of case examples for that. And then the website is up and then we've got again, the book, the ebook. [00:06:00] the whole thing. So yeah it's quite extensive and it's ongoing. We're not done with all the education courses and we're not done with a faculty toolkit.

[00:06:07] Speaker 2: So those are to come for 25 and beyond.

[00:06:12] Speaker: So you're wrapping a lot of education around the release of something like a code of ethics and Yeah, we're the only ones that

[00:06:17] Speaker 2: do it. We are the source, the primary source for the code of ethics for nurses. Any type of standards or ethical code or any type of change in ethical standards is branching from that.

[00:06:27] Speaker 2: I wouldn't even call it a change. I would call it a branch off of a code. So from other nursing associations and specialty organizations, where the foundation document for them to create specialty ethics, things like pediatric oncology, those types of things. How do you deal with that?

[00:06:43] Speaker 2: Those guidelines and those ethical guidelines are branched from that core document of the code of ethics. It's pretty much the biggest and the most important thing we do, in my opinion.

[00:06:52] Speaker: So how do you approach planning and delivering and evaluating the education that wraps around something like the Code of Ethics?

[00:07:01] Speaker 2: You go backwards first. Just like we always do when we're assessing what to do next, any type of product, project, planning, it's just process improvement, quality improvement. You go backwards to look to then set your path forward. So what worked when we're, what were the gaps in the code itself?

[00:07:19] Speaker 2: And I don't want to, my colleague, Dr. Liz Stokes and Kara Curry, they are really the ethicists behind this. And they were the programmatic, they did all the programmatic work with the commission and the advisory boards. To put this together, so not speaking for them, but recognizing that the work I want to recognize the work that they've done in this, that was 100 percent collaborative that those committees, those advisory boards, we all work together to identify.

[00:07:46] Speaker 2: What were the gaps in the code that change has changed in the last decade when we look specifically towards the education programs we did the same, but we use like customer like evaluation and feedback on were you able to apply this just by course help you apply this and we would, really dive into what that looked like was.

[00:08:09] Speaker 2: Were the applications effective, did they feel confident in being autonomous in their practice and using and applying the code? And whatever those gaps were, then we created together a product and a project plan to make sure that. Whether it was the publication side, creating the book, it was marketing that had to create new logos and marketing messages for the code itself, whether it was the code team and the ethics team that was actually creating the content.

[00:08:39] Speaker 2: Whether it was our use of subject matter experts to build the courses like it's, IT or the designers it's a very large process and I would argue that our and it ties in with everything that we do here at, across the enterprise. . So our collaborative group for the launch of the code, I would say it was.

[00:08:57] Speaker 2: Probably 50 people just in that collaborative work [00:09:00] group that was helping to make sure that all the puzzle pieces were fitting together and moving at the same time. So pretty big. That's a large collaborative group. Oh, yeah. Yeah. And we set a date for today. Today actually happens to be the day of the release.

[00:09:14] Speaker 2: So we set that and we had really tight goals that we needed to get to, to make sure, because flinch on the date. We were like, this is the hardcore date, no stopping. Everything has to be done. Because that's how, ready the, not just us, and we knew that it was updated, but we knew that nurses were ready to get a new code.

[00:09:33] Speaker 2: We know it, we, it's been outdated. We had to get it out there. So it was important to get it out in 25 on time.

[00:09:40] Speaker: I'm really excited to, to read it. You've been talking about gaps that have driven this process of developing and updating the code of ethics. What are some of the wider kind of pressing gaps that you see in professional development for nurses?

[00:09:55] Speaker 2: Oh my goodness. So I think that there's. specialty skill gaps that's always going to be there, or just skill sets that's always going to be there. But I think one of the gaps On the larger scale in for nursing education as a whole, is that we're not really investing in nursing education as much as we probably should be.

[00:10:20] Speaker 2: And allocating that funding, which is a thing that I remember, I'm sure Shawn, you remember too, and Alex, you probably also as an educator know. That the budget is the budget, and then the education is there, but if the budget is too tight, then education gets cut, and how do we, who are, those of us who are in hospital associations, or sorry, hospital organizations, or in clinical, organizations, how do we protect that budget and that education strategy and the budget behind it, because you don't then allow nurses to It's just that the main reason we're talking about that is to help you know, to up skill, or to update their professional development.

[00:10:56] Speaker 2: Then you're going to lose, either you're going to have turnover, because they can go to another facility and get more, or the worst case is it's detrimental to patient outcomes. How do we balance that with, and I'm very, like I said earlier, I'm in the middle of budget right now, so I'm well aware of the really hard decisions to make, but one of the things that I've made sure is I locked down professional development for my team now.

[00:11:24] Speaker 2: Different conundrum because I'm not a hospital administrator and I'm not a a nurse leader that's, managing those types of expenses. It's an association. So different beast, but it, whatever I have to do to protect that. And I just, I wish that there was a way to really help Organizations, clinical organizations really have the the power to just say no and, or create the argument that, we've got to make this investment that's that this is the low end.

[00:11:51] Speaker 2: This is the place that we don't touch and involve nurses in that involved nurses in that decision making when you have budget, Things like what do you [00:12:00] need to upskill to move your career forward? And what do you need to maintain? And if, and anything outside of that, maybe, that's a change that can happen or something that's flexible.

[00:12:10] Speaker 2: But the things that you need to continue on your career path and the things you need to maintain your, what you're doing in your job must, they have to have a hard stop with. So that's probably the biggest, the big 50, 000 foot. Thing that I would say is the biggest problem in nursing education right now.

[00:12:27] Speaker 2: And it's also related to affordability and access for, for rural healthcare systems, again, they don't have those budgets. So that's a whole, to me, it's just money. To me, the biggest gap is money and the wherewithal to see, how that needs to be really sacred and not touched to help nurses

[00:12:44] Speaker 3: grow.

[00:12:44] Speaker 3: Yeah, and Alex, I'm going to add something in there. And, both Jen and I have done a lot of work in burnout. And I actually, way back when in 2006, I wrote my master's thesis in burnout and the reasons nurses pursue graduate studies. And one of the biggest things that I found through the literature and through my thesis was continuing education was the only thing that actually retarded burnout.

[00:13:14] Speaker 3: And, I practiced that when I became a Director of Advanced Practice, making sure that my APPs went to conferences that were off site, out of town, so that they were around like minded people. And one of the biggest things that we found was my turnover rate was one of the lowest, as well as our engagement went from Second or third to the bottom to second to third to the top when there were 46 different other different departments rather, and, what I asked of them was to come back and they would have to do a presentation on something that they learned, either to the direct care nurses or to our advanced practice council and then If they had a great idea, I had them present it in front of leadership.

[00:14:11] Speaker 3: And as a matter of fact, one of the individuals who did that, she learned about about practice to transition and fellowships. And I'm proud to say that ended up becoming the basis for her her DNP project and she ended up launching that. And, they have full blown fellowship and now she actually talks about that and she'll be presenting that at our practice to transition conference, but it's things like that, that people tend to, they forget how important education is and we saw it during COVID and, when you start cutting education people people forget that.

[00:14:53] Speaker 3: They don't have anything to refill their cup because they don't have [00:15:00] an opportunity to learn how to deal with those situations, whether it's in real time or if you're, Hey, look, I learned this new technique or, what's the new drug that's coming out there? What are some of the positives?

[00:15:16] Speaker 3: Where are some of the negatives, but also how to protect themselves? How to properly dawn and doff a PPE. It just frustrated me hearing people say, oh you nurses keep getting sick, but you guys have all the masks. The problem is it was, we were put in masks that we were only supposed to wear once and, having to take them on and off and, it's setting us up for those critical situations where we're at risk.

[00:15:44] Speaker 3: And then if we're at risk, so is the public.

[00:15:46] Speaker 2: Yeah, and I think, Sean's point, I was going to tack on a little bit to that about, the inclusion of these programs and not. Letting them, go, get cut, really does help promote, I think one of the, are the arguments that I would use is it's helping establish nursing influence on healthcare outcomes.

[00:16:05] Speaker 2: If you start from that, then the argument becomes more clear because, it's 1 of the reasons why, you know magnet. Hospitals, put this emphasis on on education and advancement of certification because it positions nursing education and certification as integral to the system wide improvement.

[00:16:24] Speaker 2: Having those bigger conversations and, not just, at nursing at all levels. So part of the education that we should be promoting is also educating nurses on how to. Advocate for education and their own, career trajectory. And what the, an allocation of those funds and what's reasonable, what's unreal, like educating them on those types of things so that they have the better capability to have those.

[00:16:51] Speaker 2: Those more strategic conversations on what they the reasoning is those programs and, initiatives need to stay in place. So it's like this weird two sided coin, like we need to educate them, but we need to also educate them and give them the tools that they need to advocate for themselves to be educated and continue that.

[00:17:09] Speaker 2: Because I don't remember where I saw it, but. I'm sure it was a meme or something like that, but it was something silly that said something about, or maybe it was just a post that said something about health care systems. Should be wholly responsible for the journey of their nurses on the professional journey.

[00:17:27] Speaker 2: And I don't necessarily, disagree with that, except when you think about we do ethically have an ethical obligation to also be engaged in that. So you need to be able to have the words that advocate for yourself to go to your employer and say, these are the things that I need. Help me get there.

[00:17:46] Speaker 2: So it can't be this just they're responsible or we as nurses are responsible because we can't do it all right. We have to have some sort of employer thumbs up or backing that helps us get there. So it's that two sided coin that [00:18:00] really helps create that journey for the nurse. And so I think one of the, things that I like to touch on when I, go to speak, especially nursing students is, and newer nurses is, they're, the hospital's not necessarily going to come to you.

[00:18:14] Speaker 2: They're, you're, they're waiting for you to tell them what you need because everything's different. Everything's different for everybody and their journeys are different. So I don't know, that's where I come from. It's also

[00:18:23] Speaker 3: doing more with less. Constantly, when there's a bus you've got to do more with less, but there are certain things, like if you show them.

[00:18:32] Speaker 3: That the education, part of being a health care consultant I used to show them, look if you employ the education, you invest the money into these people, it will reduce your turnover rates and it will help re engage them. Because that's one of the biggest challenges. If you're not feeding them.

[00:18:57] Speaker 3: If you're not growing them, they're going to leave, they're going to go someplace else because that's one of the things that, as nurses, we have options and, one of the things we constantly talk about, it's not always, it's not always about money and it's about how you help them in many times on their professional journey and a big piece of that is that continued education So that they grow both personally and professionally.

[00:19:28] Speaker: There are so many things that you both just talked about that I want to dig into, but we do some, have some other things that we said we were going to focus on, but just to reflect back to you, some of the things that I heard that I think are really. powerful. One is the focus on well being.

[00:19:43] Speaker: And it does seem like we are having some more conversations about the role of education in supporting and sustaining well being than perhaps five or certainly 10, 10 years ago. And we're hearing this from the American Medical Association as well as some other organizations. And the way you described it, Sean, that's got to be a good thing.

[00:20:02] Speaker: The other thing I heard was that in the way you I have I've structured education is in a way to allow nurses to feel seen and heard. They feel seen because you developed those programs offsite and allowed them respite and a safe space and they feel heard because then they have to come back and share what they've learned with peers and others.

[00:20:28] Speaker: I think that's very, it's a powerful reminder of. How good education design can really support that learning journey. And then of course the other pieces is advocacy. And I do want to ask, I trained a hundred years ago back in the eighties and certainly advocacy, when I was training, the advocacy conversation was only about advocating for parent patients.

[00:20:49] Speaker: And what I'm hearing from you is that strong emphasis on advocating for yourself. But I, I. My immediate question is why is it so difficult for nurses to [00:21:00] advocate for themselves?

[00:21:01] Speaker 3: Yeah, so it's funny I'm gonna take lead on this because that's the whole reason why I got into leadership One of the big challenges that was frustrating me was Many times as nurses and advanced practice nurses.

[00:21:19] Speaker 3: We want to go work. We want to take care of our patients We want to go home and take care of our families But what I found was, especially at the advanced practice role, what is an FPP? What's an OPP? How does this new piece of legislation? How does that impact us? And in so many terms, if we had looked at position.

[00:21:42] Speaker 3: To interpret this and we're like, and what I found was they didn't know or you would go to medical staffing and they were trying to tell us what our scope of practice was. Fortunately I had an amazing chief nursing officer Victoria King, who said, look, this. This is a challenge.

[00:22:02] Speaker 3: And, one of the big pieces that I saw was I care for those who are caring for others so that they can touch more patients. And one of the big pieces is I see myself as an advocate. This isn't about Sean. This is about advanced practice. And we always joke my hashtag is.

[00:22:25] Speaker 3: I don't go by doctor or anything like that. It's always Sean, because at the end of the day, it's about the nurse, the advanced practice nurse, the patients and their families. And we have to work together as a team with our physicians and collaborate and everything. But at the same token, we're the goalie.

[00:22:45] Speaker 3: Nothing should get into that patient unless we understand why. And that there is, there needs to be that teamwork that, that's done in order to make sure that we understand what's going on and not just like the old adage cause I'm the parent and I said, so no that's not right.

[00:23:07] Speaker 3: The big pieces we've got to advocate, we need to say why, because if we don't, then who ends up losing is the patient. So we can't take care of our patient if we can't advocate for the things that we need. And so one of the big things, how I do it a little bit differently, is I do it from a healthcare economic standpoint.

[00:23:33] Speaker 3: I start looking at the cost effectiveness analysis. I look at, because the CEOs and, or CFOs have one pot of money. So you've gotta show why your program deserves a bigger piece or more of that money and why, where they're going to take it out of something else. And so I think one, that's one of the biggest pieces is to advocate and [00:24:00] say, look, I understand that you guys need this, but if we don't do this, here's how it's going to impact not only our organization.

[00:24:11] Speaker 3: But our patients, and then you'll also start losing your nurses, you'll start losing revenue, you'll start losing all these other pieces. And I think once you start talking to the bean counters, and start showing them from that aspect, because it is about quality outcomes. But at the end of the day, you've got to have the right people and they have to be educated properly.

[00:24:37] Speaker 3: And they have to, it's not like you get educated once, it's continual. So I think that's the biggest thing. And making sure that, when you have people who are saying you're not doing this right, you're not doing this right, you say, so here's how and why we're doing this, but we also know that no matter what it's a continual process and I don't care who you are, you can always learn something and you can always be better at what you're doing.

[00:25:08] Speaker 3: So that's all that I have of, yeah. Our nurses and our advanced practice nurses.

[00:25:14] Speaker 2: I think it even goes further back than that, Sean. I think it's because nurses, we get into the profession because, we're the most trusted profession now forever, like over 20 years now, but I, and I think that's because at least from why I got into it, because we have a sense of altruism and that we want to do the right thing.

[00:25:33] Speaker 2: And we want to take care of people. It's about self sacrifice and, if yeah. Even if you're exhausted and there's a snowstorm then you're gonna stay like it's just this whole thing where we're just like, okay, for some reason we self sacrifice because it's deeply rooted in.

[00:25:50] Speaker 2: I don't know if it's, we want to talk, female like things because female dominated. I don't know if it's. It's, related to, to actually being taught how to self advocate, like what we would say, what you're saying, Sean, about how to do that, because it's not something at least I got in school about how to negotiate, how to talk for better salaries, how to talk your schedule instead of just accepting this is your schedule, Jen, this is, you got to do it, and I'm like, what?

[00:26:18] Speaker 2: Like I don't know how to have that conversation with a charge nurse or a manager because of it. I don't know what I can say because then I feel bad and I feel guilty. The whole thing, I just, I don't, I think it's deeply rooted in nursing's you know, altruistic nature that we just give and give.

[00:26:38] Speaker 2: But, I think we've pivoted and again, spotlight on even though it was happening pre covid, the light is shine, just exposed a whole lot of nonsense about it because now it's okay, but now we physically can't now. And when nurses were being asked to come in Even if they were positive, like at one point, nurses, they were we had such [00:27:00] a, everybody, I don't need to dredge up all those horrible memories.

[00:27:03] Speaker 2: But even when I was practicing in this bedside during COVID, it was, you're, nobody shows up because now the nurse has COVID. And do we go and get them from home and make them come in and, potentially expose more people? They don't have it that bad, like that type of thing.

[00:27:19] Speaker 2: But what we've pivoted towards and what I'm actually quite proud of as a profession is that we took a page out of the flight attendance book, right? Put your mask on first before you take care of others. And that has been a way that I've been able to help educate on what self advocacy is and what it's not.

[00:27:43] Speaker 2: saying no to somebody, you're saying yes to yourself so you can better help them, as Sean said before. And I think that messaging gives them, gives nurses the permission to say, okay that, cause it's like something that we all, if you've been on an airplane, it's the first thing that's, it's one of the most important things that you're listening to is if that oxygen mass drops.

[00:28:09] Speaker 2: You can't help two people if the first person isn't putting their mask on first. You need to do that. So that I think it's rooted in that too. And and lastly, and I'll just say just the exhaustion. If you have cognitive overload or physically and emotionally exhausted, you have mental burnout.

[00:28:26] Speaker 2: You are not going to sit in a negotiation and advocate for yourself. You're going to be like, look, I just need to go get some sleep. So it's prioritization of that too. So I think there's lots of mental health factors and just, the profession itself historically of why we see nurses have a hard time advocating for themselves.

[00:28:46] Speaker: Thank you for bringing that so beautifully back to the question because you both provided a lot of rich information there we're. We're 20 minutes from the top of the hour. I don't want to push you to the end of the hour, but I did have a couple of other questions that I would love to ask.

[00:29:02] Speaker: So I'll ask them. You can respond to either or both of them. One question came out from came up from What you both shared there actually is scope of practice, because it seems that there's a lot of misunderstanding about what scope of practice is for nurses. And of course, there are different designations for nurses.

[00:29:21] Speaker: And I wondered if that's something that you might be interested in talking about for a field of continuing education for health professionals who sometimes lump nurses all together and don't necessarily fully. Understand what it is that nurses do. And I guess the subtopic for the sub question in that question is something you said, Jen, about altruism, because that focus on altruism can mask skills.

[00:29:51] Speaker: Yeah. And one of the things that we that I think it is really challenging for a lot of people to see is the skills that nurses [00:30:00] develop in order to provide effective nursing care. And then the other question, I guess there are two other. Questions. So you don't need to answer all three of them.

[00:30:09] Speaker: I'm just flagging them so that you can use within your time. The second question is about collaboration and collaborating with the wider field of continuing education and where you See yourselves in relation to that and where you could get more support for nurses from this field. And I, the third question is just around approaches to education, where do things like simulation and outcomes driven and learner centric models of education sits in, in relation to the work that you do at ANA.

[00:30:43] Speaker: If you have time. All three of those questions. If not, pick your question and we'll just go with it. I

[00:30:52] Speaker 2: mean, I can start on the outcomes education focus. I think that there's like a, there's just a big shift in it. And it's always been a challenge with nursing education because, as a previous clinical educator inside hospital systems, it was always this weird.

[00:31:10] Speaker 2: Everybody remembers the skills fair where we had to do it every year, and it really wasn't it didn't really show what that affects. We never were able to really show what the effects of those skill fairs were. We never really measured it because we just crossed our fingers and hoped our Q.

[00:31:24] Speaker 2: I. R. Data was fine. And so now that we're making this shift to it, that is more learner centric outcomes based, you can still incorporate it in those types of skills fairs. But you're now we're asking nurses to really measure and connect it to our to those quality outcomes and quality initiatives that we all have to do our reporting on.

[00:31:48] Speaker 2: So it's been like that for a little while where we're trying to move that needle a little bit more. I think you know, one of the dynamics that We do that. My team does at the enterprise is clearly focused on what can be done from a virtual or e learning digital platform.

[00:32:09] Speaker 2: How are we pivoting towards that in for distance education? Because It's really important for us to not just meet nurses in, urban settings, but how do we also create the same outcomes, the same learner centric stuff on, for those that are in rural settings that don't have those resources. But would they still require the same type of, quality outcomes?

[00:32:32] Speaker 2: We're making that shift to doing that. A. I. Is helping us do that a little bit. So that way they feel like it's more professionally focused on what their area of need is. And then they can go back and take back to the employer or they could take, a continuing education course and then they've got, this activity that shows, how they implemented it.

[00:32:55] Speaker 2: And then they're able to report back on what that outcome was, whether it's linked to patient care or not. [00:33:00] It's hard for the enterprise to do that right now because, but, link linking up or connecting with hospital systems that's taken a workshop or something like that from us or a course it's really important for us to start to connect those dots because.

[00:33:13] Speaker 2: It's, it has, everything now has to be measured. It also ties back to then showing the value of it in order to put it in the budget. I like to connect dots as much as I can. But to me that those innovations, those outcomes based learner sector education that we're pivoting towards, if you connect that then connects it back to the funding.

[00:33:36] Speaker 2: And specific professional practice goals. For nurses that leads to then retention. So to me, it's all interconnected. Not necessarily pivoting, towards something that is, we haven't wanted to do. It's just about how these kind of. These types of CE models can benefit, like you said, the question is how those, approaches, benefit nurses and health care systems itself.

[00:34:03] Speaker 2: It's all about having those dots and those puzzle pieces connect to me.

[00:34:08] Speaker: And in hospital and health systems, Jen, do you see how much Connection do you see between continuing nurse education and, CME departments who are running. It depends. It depends

[00:34:19] Speaker 2: on, yeah, it depends on where you are.

[00:34:21] Speaker 2: I had, I was at most actually all of my clinical, except for when I was in acute care hospice, there are magnet facilities. I only worked in magnet facilities when I was in acute care tertiary centers. And those. I was in two centers that I got lucky enough to where CME and CNE were together. I ended up, I taught PALS, TNCC, everything that had, I was teaching residents, medical students, nurses, CNAs, LPNs, like everybody.

[00:34:52] Speaker 2: And, and It's, those two, I got lucky. That's at the end of the day, that doesn't always happen. But when there's a focus on interdisciplinary education, then in a prioritization of that, it doesn't matter who's teaching the class. And I received that from two of the hospital systems I worked at.

[00:35:08] Speaker 2: In hospice, As everybody probably can imagine, palliative care and hospice teams themselves, by nature, are intercollaborate. They are interdisciplinary. All of the education, because all of the quality measures are not nursing specific. They are all related to the team dynamic itself and how that moves. So everything that was taught and is taught in hospice, Is interdisciplinary.

[00:35:32] Speaker 2: So you've got social work, medicine, pharma, nursing, you've got all of these, CME or, CPE providers that are doing. All of this together on purpose. So it's doable. It's just you have to have the support and the process in place to get it done and the resources to get it done because it's but the support is the biggest thing.

[00:35:50] Speaker 3: The advocacy. Yeah, that's right. If you don't have the advocacy because I've worked at a number of institutions that were not and even some of those that [00:36:00] were had magnet designation or were on the pathway. One of the big pieces was. The medical education tended to be more expensive when they were going to conferences and stuff, but, especially as advanced practice nurses, a lot of times, I wanted them to go to the same exact conferences because we're, we're caring for patients in similar aspects while we're doing it from an advanced practice nursing role, not as a Physician or medical role.

[00:36:32] Speaker 3: I it's really important for us to be there doing those so that we are showing the collaboration so that we are showing that we're part of the team and the other part is making sure that when we do things, I was part of the G and E or the graduate nurse education 200 million dollar.

[00:36:58] Speaker 3: Demonstration to increase the number of advanced practice nurses. We were one of the five sites and, 43 million. We are the second most utilized institution there. And, one of the big pieces was trying to make sure that we got our advanced practice nursing students into the right settings and making sure that the populations that.

[00:37:24] Speaker 3: that they were being educated on matched with the the role and the certification that they were playing. Eighty five percent of that GME demonstration went to increasing the numbers of advanced practice nurses caring for the primary care population. And that, where you go back to scope of practice, I, I always laugh because I'm the delegate for the ANA on the LACE network.

[00:37:52] Speaker 3: And one of the things everybody automatically assumes is if you're a family nurse practitioner, you cannot practice in a hospital. And I'm like, no, that's not what it says. It is patient population based, not setting based. Because Alex, as we have plenty of patients who depending upon where you're at, they might go home with a vat.

[00:38:19] Speaker 3: And is that somebody who, you want a family nurse practitioner or adult nurse practitioner who has not had that formal education and develop those competencies caring for? No. The lines between. Primary care and acute care, they've blurred because our patients are getting sicker.

[00:38:38] Speaker 3: They've got so many more comorbidities, plus our treatment options. We have so many different things that, that are going on out there, but it also depends on where you're at. If you're at a critical access hospital, do you know how to take care of patients who have that. But it depends on your scope of practice.

[00:38:57] Speaker 3: And again, it goes back to advocating and [00:39:00] educating people, not only our nurses, but those around us, our medical staff and making sure that as nurses, when we come out, we actually know what our scope of practice is, and that it's educating. the organization to make sure that we're practicing to the top of our license and to the top of our scope of practice, because so many times they don't realize the things that we can actually do.

[00:39:29] Speaker 3: And it ends up becoming a burden on people because they're not allowed to. to work to the top of their scope of practice, but also they're like, this wasn't what I was educated in for, and then who loses? The patients end up losing because they're not being cared for by people who are practicing at the top of their, They're like,

[00:39:56] Speaker 2: and I think that Sean's point, as well taken.

[00:40:00] Speaker 2: I think the action, though, in that is leadership. I think engaging leadership and healthcare executives that get it is how that's done. And quite frankly, it's also done with data. You can't we can't if we're going to engage our physician colleagues, our social work colleagues or pharmacy colleagues, any of our clinical professional colleagues.

[00:40:23] Speaker 2: In advocating for nursing, continuing education, you're going to need to show the data and show why those work and why they should advocate. It's not, it's really, it's not always again, I said I got lucky, but it's not always a given that they understand the, how C& E actually helps. In patient outcomes and the return on investment, generally speaking, so it's got to be engaging leadership and giving them that the

[00:40:59] Speaker 3: data you need to help

[00:40:59] Speaker 2: them to give the data so that they want to collaborate.

[00:41:03] Speaker 3: So until the story, and as I'm working with our government affairs team, and when we're meeting with the lobbyists and our congressmen and women who are asking like Dan Crenshaw, he's asking, Hey, so what can we do? And I said, first and foremost, we need to increase. The access to quality care.

[00:41:22] Speaker 3: There are enough physicians out there. They're not enough advanced practice nurses or physician associates that are out there. But as a team, if we've got the largest population that's retiring, and so many of them are health care providers themselves. There are groups like we're collaborating with AAPA on Health Force and 40 other different organizations who help identify, how are we going to care for this largest segment?

[00:41:53] Speaker 3: And at the end of the day, it's working together. And, that's one of the biggest pieces. I [00:42:00] hear the scope creep and I hear all these other things. At the end of the day. I want to make sure that we're all working together because that could be my loved one that needs to be cared for, and I want to make sure that they are properly educated and that they have the resources in order to care for that loved one.

[00:42:22] Speaker: And that seems like a great place to wrap up. Jennifer Shepherd, Sean DeGarmo, leaders, educators, advocates, collaborators, nurses. Thank you so much for sharing your wisdom and insights with listeners of Write Medicine.