What does it mean to be a nurse in the 21st century who builds bridges and serves as a liaison between technology and patient care? How can nurses gain a seat at the table by leveraging their skills, knowledge, and natural ability as expert problem-solvers? There is much to learn about the intersection of healthcare and technology, and nurses willing to take a deep dive may find great rewards.
Lifting the Veil of Tech
When it comes to being a 21st-century nurse, there is much to learn, communicate, and build. Technology is a tool, and nurses have the opportunity to embrace the rapid expansion of the tech paradigm in the interest of their own careers and the improvement of healthcare as a whole.
Diane Cannon, DNP, MHA, BSN, BS, RN, is an educator, nurse entrepreneur, and consultant who encourages nurses to see the opportunities in the intersection of technology and nursing. As the Director of Clinical Education and Innovation at Xapimed, a clinical competency management platform for nursing professional development, Cannon understands the importance of bridging the gaps between nurses and their relationship with tech.
Cannon states, “Being a nurse in the 21st century means being an advocate, a communicator, an innovator, and a visionary. I work to honor nursing’s history, understand our present situation, and envision a future where our profession can be improved to make a difference in patient care and our healthcare system.” She continues, “I try to articulate that vision to others to advocate for change through collaborative partnerships. Within these relationships between the people working in healthcare and the people working in technology, I see the greatest opportunities for change.”
Dr. Cannon insists that nurses need to improve their connection with health tech in the interest of patient care and professional development.
“If we nurses, as end users, don’t understand the back end of health tech, how can we utilize it to its fullest potential? How can we troubleshoot problems and find solutions that work for us?”
Cannon is adamant that nurses have what it takes. “We all had to take anatomy & physiology, microbiology, and other sciences. Without that foundation, we couldn’t fully understand how the human body works, and we couldn’t practice with authority and autonomy — our practice would suffer, and patient care would suffer.”
Cannon continues, “This goes for health tech, too. If we don’t understand how things work, we lose that power to someone else who does. This goes for finance, economics, politics, etc. If we don’t ‘lift the veil’ on how the things that impact us directly work, we’re beholden to those with that knowledge. As they say, knowledge is power!”
Nurses on the Learning Curve
If a nurse wants to understand the tech world but isn’t ready to commit to a degree program, there are ways to get involved and dip their toes in the tech waters. And if it interests them, there are plenty of ways to dive deeper.
“Nurses can volunteer to work on a tech pilot project at their organizations,” Cannon advises. “They can do their reading and research on topics they’re passionate about and find out how technology can help their units or departments.”
And Cannon believes there are always more ways to learn and grow. “You can watch a live or recorded webinar, listen to a podcast, read a journal article, and then contact those nurses for mentorship. The ANA has a wonderful mentorship program that puts nurses with leaders in their chosen fields for advice and guidance. I’m part of that and mentor nurses outside the ANA’s program; people can reach out to me because I’m happy to support my fellow nurses.”
There are plenty of ways for nurses with a facility interested in technology to learn on a more formal level.
“There are many different ways to go down this path [of learning],” states Cannon. “There are certificates, virtual courses, and courses through organizations like Microsoft and Google.”
Cannon is also an advocate of degree programs when they make sense for the individual. There are formal degrees that include nursing informatics and tech courses, like an MSN or DNP, but wonderful degrees outside of nursing are extremely valuable.
Cannon continues with her own story. “My master’s degree is in Healthcare Administration, and it included courses on informatics, finance, marketing, and much more. I have colleagues with degrees in informatics, medical informatics technology, educational technology, and cyber security. And the cool thing is that so many of these educational offerings are virtual, making them easily accessible and completely doable while working full-time.”
When it comes to combining tech and nursing degrees, she shares, “Many of the careers that come with combining a nursing degree with these cutting-edge degrees are also virtual and highly valued.”
Nursing Identity in the Tech Space
For nurses who are concerned about maintaining their identity as a nurse if they no longer provide direct patient care, Cannon has a simple response.
“To answer the question [of nursing identity], one must first answer the question, ‘What is a nurse?’ We currently don’t have one overarching definition of what nursing is,” Cannon states. “We don’t have a clear and concise statement of the meaning of the word nurse or what a nurse does or looks like. For me, I think a nurse is exactly what I said previously: a nurse is an advocate, a communicator, an innovator, and a visionary who works in healthcare.”
Cannon adds, “Because this is how I define nursing, I’ve never lost my identity as a nurse. Providing direct patient care is just one of a myriad of skills and competencies that nurses do, but it is certainly not who we are.”
“MacGyvering” the Future
Cannon shares what interests her most in these days of rapid technological advancement: “I’m most excited to see the evolution of nursing as a driving force within health tech. Nurses are inherently problem-solvers; we are the ‘MacGyvers‘ of finding workarounds for issues that come up because for so long we’ve been forced to make jetpacks out of seatbelts and a power washer because that’s all we had.”
Nurses are indeed innovative problem-solvers who know how to make do with what they have on hand. Many nurses can likely relate to Cannon’s metaphor about making jetpacks out of whatever happens to be in the supply closet.
Cannon sees nurses as having accomplished so much in this regard. “Look at what we did during the pandemic,” she concludes. “To me, that’s the most exciting part about the future of nursing and health tech, and I can’t wait to see what we’ll ‘MacGyver‘ next!
When Jean Andres, DNP, RN, arrived at the parking garage at Luminis Health Anne Arundel Medical Center in Annapolis, Maryland, she instantly heard the “very distinct scream” delivery room teams recognize. As the hospital’s labor and delivery director, she leaped into action.
Dr. Janelle Cooper, an OB/GYN, was delivering Elsa Artunez’s baby in the backseat of a truck.
Artunez’s grandfather was rushing her to the hospital. He stopped the truck in the parking garage by an entrance, which would have put Artunez only a few feet from the front desk, where a wheelchair would have transported her to the delivery unit.
But there was no time to put the car in park because the baby was coming.
When Dr. Cooper reached the truck, the baby’s head was already out, and Andres heard the scream.
“I put my lunch bag down and called the team to let them know we had a delivery in the garage. And I proceeded to assist Dr. Cooper with the delivery that she had performed.”
Daily Nurse honors Jean Andres as the Nurse of the Week for providing exceptional care and exemplifying the hospital’s #RISE values of Respect, Inclusion, Service, and Excellence toArtunez and the newborn.
Artunez gave birth to a healthy baby girl, Yesenia Patricia, and surprisingly, for a first-time mother, Doctor Cooper noted, it went quickly. “She did really well.”
Once Yesenia was born, Andres dried her off and kept her warm until the medical team came and took the family to a maternity room in the hospital.
“The fact that it was in a garage was very unconventional, but it was not chaotic,” Andres says.“It was a very beautiful birth.”
Baby Yesenia isn’t the first to be born in the medical center’s parking garage, Andres and Dr. Cooper note, nonplussed. “We delivered a baby in the elevator this week.”
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It is not unusual for nursing and other healthcare professions to run in the family, but sometimes the connections that lead a new generation into nursing can be almost eerie.
Tara Wood, DNP, CRNP, NNP-BC was a NICU nurse when she gave birth to twins Jade and Taylor England. Her newborns weighed less than two pounds and spent their first 87 days in a NICU. At some point, it seems to have been written that at least one daughter was destined to return one day.
“We had central lines,” says Jade England, who is completing her BSN degree at the University of Alabama Birmingham School of Nursing. Both sisters have a permanent souvenir of the constant care they needed from birth: “We still have that scar from where they were placed. It’s just crazy to see that we have actual proof of what we’ve been through.”
That scar is the only physical reminder of their journey. England knows how lucky they are to not have any complications from being born prematurely. Growing up, she saw the pictures of their tiny bodies covered in sensors and tubes. When she decided to become a nurse, she knew she had to return to where her story started—the NICU.
“You have to have compassion for those babies. You just have to be called to do that,” England said. “I want to be able to be that nurse to let the parents know that I was in their child’s place. I just want to provide the best care possible and hopefully sharing my story will make a difference in their stay in the NICU. I don’t want to give them false hope, but I also want them to know that miracles happen.”
“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister.’”
Jade England graduated in April and now works at UAB Hospital in the Regional Neonatal Intensive Care Unit. Her mother, Tara Wood – who is a member of the faculty at UABSON hopes her daughter will be able to give families the comfort she remembered needing.
“They’re going to be told all the bad, but when you can see a living example of success, I think it’s going to be amazing. I can’t wait to see what she does,” Wood said.
England will be working with one of the nurse practitioners who cared for her at the hospital where she was born. During her clinical at UAB, they made the connection.
“She literally walked me around the entire unit and was telling everybody, ‘this is my baby, I took care of her and her sister,’” England said.
“I think I found healing by helping others.”
Wood remembers not being able to hold her children for months. During that time, her lifeline to her girls was the nurses and nurse practitioners.
“My world was rocked,” Wood said. “My babies were really sick. Both of the girls were on the ventilator for weeks. Their organs were premature, and you’re faced with all the things that can go wrong. Just knowing that every minute mattered, it really put you in a constant state of terror and panic, of not really knowing how your babies are going to survive, much less thrive.”
She had planned on becoming a teacher, but the twins’ experience in the hospital changed her life. She realized she wanted to be a nurse so she could care for other families.
After working as a NICU nurse, Wood earned her Master of Science (MSN) in Nursing and Doctor of Nursing Practice (DNP) from the UAB School of Nursing. The journey came full circle for her as well. She’s now an Assistant Professor at the School and the Coordinator for the Neonatal Nurse Practitioner Specialty Track, teaching and preparing nurses to care for infants and families.
“Being a NICU mom 22 years ago we didn’t really talk about post-traumatic stress disorder and things like that that really lingered. I think I found healing by helping others,” Wood said.
Taylor England, Jade’s twin sister, also graduated from UAB this spring with a major in psychology with a minor in legal affairs and a certificate in mental health.
Jade wants to follow in her mother’s footsteps and plans to return to school next year to start the Post-BSN to DNP Nurse Practitioner Pathway to earn her Doctor of Nursing Practice degree. One day, she hopes to teach alongside her mom.
“I’m a proud mom and I want to share them with the world because I think that they were born to do great things,” their mother says. “They have servants’ hearts, and they want to help and do good.”
When Ingrid Johnson, DNP, MPP, RN, FAAN was an undergraduate, she wasn’t really sure if she was on the right path. At the time, she was pursuing a Bachelor of Science in nursing.
“I was ambivalent as a BSN student and early on questioned my decision to be a nurse as I wasn’t sure I really fit in the box of what a nurse was supposed to be,” Johnson said.
Pursuing a DNP presented Johnson with the usual stresses and challenges: she continued to work a full-time job throughout and juggled job, parenting, and school duties. She recalls, “One day, my youngest approached me and said, ‘Mom, we never see your eyes anymore. You are always studying or working.’ It knocked me off my feet and I realized I needed to figure out some different habits so I wouldn’t miss my kids’ lives.” But the experience was also a game-changer: “Now I have a job that didn’t even exist when I first became a nurse. More education is never bad. I am so pleased I didn’t stop learning.”
Johnson, who is the president and CEO of the Colorado Center for Nursing Excellence, continued to work full-time at the center (though in a different role) during her time in the DNP Innovation Leadership program.
Her DNP project was focused on growing programs for advanced practice registered nurses in rural areas. Johnson’s passion for that work carried over to her day job after graduation. “I continued to work on that and brought in several million dollars of funding to support building APRNs in rural and underserved communities across Colorado,” she said. The United Health Foundation read my initial article on the project in Nursing Administration Quarterly and we have now expanded the project from an FNP focus to add PMHNPs.”
Even as she was promoted, Johnson remained committed to the program, and in 2021, she was inducted into the American Academy of Nursing on the power of that work.
Johnson has always understood the importance of lifelong learning for a nurse and sounds almost like a Greek philosopher when she says, “The real reason I sought a doctorate was that I knew education teaches us to think differently and ask different questions. One of the hardest realities for me was identifying that the more I learn, the more aware I am of how much more there is to learn.” Her DNP, she adds, “reminds me of that as I continue to learn new things from my staff and the world around me on a daily basis. It has been humbling and very gratifying.”
“We were not only permitted to think outside the box, we were also expected to do so and seek the evidence to support it.”
For herself, Johnson’s DNP journey helped her find her place as a nurse innovator. In her very first DNP course, “[Faculty members] Kathy Malloch and Tim Porter-O’Grady… pulled no punches and told us to think bigger, more creatively, and get out of our own way. I realized that in my whole career as a nurse and life as a student, we were told to follow the evidence and only do what we were told to do. Nurses follow evidence-based practice, so there was never the space to think outside the box. Now, we were in an innovation leadership program and we were not only permitted to think outside the box, but we were also expected to do so and seek the evidence to support it.”
To Johnson’s mind, “It was scary because over the years, I had been slapped down for not fitting the mold or for thinking of alternative ideas. When they told us that our job was to stop being a linear thinker and to find evidence around other less obvious solutions, it was incredibly freeing. I think we are born creative, and in an effort to learn evidence-based care and practice, we lose that, and often we are not permitted to find that side of ourselves again.”
The learning experience behind her DNP, Johnson remarks, also has made her a more perceptive nurse leader. Her doctoral work “opened my heart to look outside my own ideas and better listen and learn from those around me so we can innovate to support… I didn’t have the tools to really do that prior to this degree, but now I often have the right tools, and if I don’t have the right tools, I have the resources to figure out what tools I need and how to get them.”
What advice does she have for current and future DNP students? “Enjoy the process and embrace the reality that for the rest of your life, you will have more questions than answers … and that is OK. Stay curious. Remember that when you get feedback that doesn’t feel warranted, listen for what is true in the feedback. It can be your greatest gift. Even if only 2% of the negative feedback is correct, it may be exactly what you need. If you knew everything and did everything perfectly the first time out, you wouldn’t need to be there!”
Missouri faces a shortage of primary care physicians, particularly in rural and underserved communities, making it challenging for residents in some parts of the state to access health care services.
Advanced Practice Registered Nurses (APRNs) can provide an alternative because they are trained to assess, diagnose, treat and prescribe for medical conditions in much the same way optometrists are trained to assess, diagnose, treat and prescribe for eye-related conditions.
But rules in Missouri restrict APRNs to practicing within 75 miles of their collaborating physician and require an initial one-month direct observation of practice between an APRN and an MD or DO and regular medical record reviews of the APRN from the MD or DO. What’s more, MDs and DOs cannot have collaborative practice with more than six full-time APRNs or physician’s assistants, and APRNs cannot conduct video visits or write for home health orders.
“I think it is very important to hear from nurses on the frontline,” said Pamela Talley, an MSN-DNP student in the College of Nursing who practices at CHIPs Health and Wellness Center on North Grand Ave. in the city of St. Louis. “We see the issues daily. We became nurses to take care of people, in response to seeing people suffer. Nurses have an ethical responsibility to advocate on behalf of those underserved populations. I believe it is a social justice issue and we must advocate for access to health care for all people.”
The students and faculty spent Tuesday morning talking to legislatures such as Sen. Steven Roberts and Sen. Brian Williams about access to health care, including for Talley’s clientele at CHIPS, a nurse-founded, free medical care clinic where most providers are volunteers in what is considered a medical-provider shortage area.
“I’ve been practicing as a pediatric nurse practitioner for over 30 years, mostly in the emergency department,” Kuensting said. “Children are a vulnerable population, often without health insurance, leaving the emergency department as their only source of health care. Organizations such as CHIPs and other nurse-led clinics in medical provider shortage areas can facilitate health maintenance and avoid episodic care visits for individuals and their healthcare needs, but the barriers APRNs face in Missouri make providing care extremely difficult.”
Talley had the opportunity to describe how restrictions impact her ability to care for patients in her community.
“It was great meeting with state legislators to discuss the need to reduce practice restrictions,” Talley said. “These restrictions are a barrier to vulnerable populations in both rural and urban areas. The current collaborative agreement creates restrictions to fundamental access to health care for people to manage their health and to live a quality life.”
She added: “If nurse practitioners could have greater independence and a less restrictive practice they would be able to provide much needed care in those areas where there are the greatest needs.”
There is precedent. Missouri temporarily lifted these restrictions for nearly two years during the COVID-19 pandemic with no adverse events, though that temporary lift expired on Dec. 31.
More and more states have also taken to permanently grants APRNs full-practice authority. On April 10, New York became the 25th state to take such action, and the Veterans Administration issue full practice authority to APRNs, regardless of the state they practice in, about two years ago.
“This course, and particularly this experience, is important for our APRN students to understand why being aware of the issues affecting our practice matter,” Kuensting said, “and more importantly, how to advocate for change.”
Photo at top includes U Missouri St Louis College of Nursing faculty members and students (from left): Laura Kuensting, Pam Talley, Marina Fischer, Marie Turner, Brooke Shahriary, Louise Miller, Kate Skrade, Carla Beckerle, Taylor Nealy, Ann Mwangi-Amann, Paige Bernau, Lucy Kokoi and Tammy Vandermolen at the Missouri Capitol last Tuesday to take part in the Association of Missouri Nurse Practitioners Advocacy Day. (Photo courtesy of Laura Kuensting)
Evidence-based practice is at the heart of nursing—and most of that evidence is based on quantitative research. For nurses who are merely competent in math, though, interpreting the numbers can be a challenge. And if your own facility with statistics is middling, trying to mentor semi-numerate DNP students may leave you feeling helpless at times.
Help is on the way. On May 19, data analysis expert James Lani, Ph.D., MS is hosting a free webinar specifically aimed at faculty members who mentor graduate students for dissertation, thesis, or scholarly projects and are seeking to take their command of statistics to the next level to better guide those students.
Dr. Lani, the CEO of Intellectus Statistics, has been helping faculty and graduate students with their quantitative research for over two decades.
In his upcoming webinar session, Dr. Lani will use mock data to work through faculty and students’ research questions, prepare and graph data, select and conduct the correct statistical analyses, and demonstrate how to appropriately present results. He will also cover sample size and power analysis, data management, and visualization techniques, and at the end of the presentation, he can even provide faculty with project-specific help.
James Lani holds a Ph.D. in Clinical Psychology from Miami University in Oxford, Ohio, an MS in Psychology with an emphasis in Experimental Methods from California State University Long Beach, a Bachelor of Science in Electrical Engineering, and minors in Mathematics and Human Services from California State University, Fullerton.
Who can attend: Faculty members in nursing, social work, counseling, public health, psychology, and health administration at any stage of their research or faculty who mentor students’ research as they pursue their degree (i.e., Dissertations, DNP Project for Nurses, Fieldwork and Supervision for Behavior Analysts, etc.)
Help is on the way. On May 19, data analysis expert James Lani, Ph.D., MS is hosting a 