If I were to ask you the question, “when does healthcare start?”, what comes to mind?

I have asked this question many times to different audiences of nurses and healthcare professionals. I typically will get a silent pause to start.

That silent pause is an indication that thought is going into the answer (and perhaps there is some unknown as this may not be a common question).

Several years ago, when I first started asking this question, the most common answer was with one’s insurance card or at the hospital.

I know that I had that thought as well for the first decade or more of my career. As a registered nurse, I am considered a healthcare professional. Hospitals were the primary place of employment for registered nurses when I graduated from my undergraduate program at Georgetown. Hospitals are also the primary place of employment for registered nurses today.

However, one day I was listening to a presentation about healthcare that shifted my perspective. I am a person before I am a healthcare professional. As a person, I will have healthcare needs. I also have some agency around decisions I make each day regarding my health.

This agency is around what is called, modifiable risk factors. Modifiable risk factors are choices we can make each day that can impact our health in the short or long term. Examples include whether or not one smokes tobacco, drinks alcohol, is active or sedentary, and to some degree food choices. Non-modifiable risk factors also affect our overall health. Examples of non-modifiable risk factors include our genetic composition (e.g., inherited diseases and/or carriers for diseases), age, race and ethnicity.

As humans and people, our daily choices can influence our modifiable risk factors. Thus, our daily choices can influence parts of our health but not all of it.

In areas where we do not have the ability to modify our risk factors, healthcare expertise, diagnosis, treatment, care and intervention can be of great value. There are three levels of care: primary, secondary and tertiary care.

Often, when someone needs to go to the hospital, that is seeking out tertiary level care. Primary care is preventative in nature. The goal of primary care is to prevent or identify any potential health issues before the need for greater intervention.

Therefore, as you navigate your day to day, consider if there may be one action you take today, tomorrow or the day after that you think about as it relates to your short and long term health.

~ Dr. Kelley

Empathy is the first phase in the design thinking process.

Design thinking is a methodology used to develop innovative solutions.

Empathy refers to being able to understand the problem identified from the target market of who is affected.

Even better if you, the innovator, is part of the end user target market group. However, this is not absolutely necessary.

To be empathetic is to rely on your humanity. One cannot delegate that out to an algorithm 🤓.

~ Dr. Kelley

There are two phrases that I have thought about quite a bit over the last few months. The first is:

“Do more with less.”

The second is the opposite:

“Do less with more.”

Now, let me explain the first phrase before going to the second in the context of direct care.

As a direct care, bedside nurse, staff nurse or travel nurse (whichever phrase resonates with you the most), you are assigned a patient or group of patients for the shift. If in an Intensive Care Unit, Trauma Unit or other high acuity area where patients need one on one attention, you may only have one patient. All other areas typically have nurses assigned to multiple patients.

When I worked in direct care, I would have anywhere between 3 to 6 patients. The number varied depending on where I worked and also the acuity of the patients. Generally speaking, I knew going in for the day how many patients I may have for the shift.

Now, the purpose of this post is not to discuss the number but rather the many activities that are often “hidden in plain sight” to provide each of these patients the highest quality care.

Each patient requires assessments, vitals every set number of hours, medications, hourly checks (if not more frequently), and other patient specific interventions (e.g., tests, labs, therapies, transport).

As soon as the nurse finishes report with the off-going nurse, the day is a race.

A race to beat the clock.

At least that was how I felt nearly every single shift… (with some exceptions).

Have you ever tried to race the clock? What about every single day you worked?

This feeling is not ideal. You pick up your pace and it means that you have more to do than the clock can allow for at a normal pace.

Going into a shift, each nurse is prepared for this mindset. Where it becomes more challenging is when the clock gets tighter. This can happen when there are additional patients added on to an assignment or there is less help (e.g., clinical assistants, resource nurses, etc.) available that day to assist in the hunting and gathering that often is required to find the equipment, meds, and more for the patients.

This feeling of needing to do more with less can enter one’s mind.

However, what if we were able to do less with more?

My initial thought when I turned that phrase around was, ‘What does that even look like?‘

When I say do less, I do not mean less nursing care or less quality. I actually am referring to all of the “hidden in plain sight” hunting and gathering that eats away at a nurse’s day and contributes to this racing the clock mindset. Additionally, there is the mental struggle of deciding between “nursing the patient” or “nursing the computer” that nurses face multiple times a shift.

In the study, “Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study”, nurses’ spent 35% of their time in a patient room. Of the remaining 65%, the researchers found that 25% of the time was spent on EHR related documentation and 10% of the time on tasks that could be delegated out (e.g., the nurse is not required to complete). The remaining 30% was found to be related to communication interruptions.

While this is one study, there are many others that have recognized nurses’ time is not solely dedicated to patient care delivery with a larger than minimal percentage on other categories of activities.

So, how do we have nurses have more time for patient care and reallocate time from the other areas to do less of those actions?

I do not believe that this automatically requires more nurses. In some cases, likely yes. However, some activities could be improvements with technology. Some with workflow refinement and so forth.

This is what I mean by do less with more. Less interruptions. Less searching. Less hunting and gathering. Less documentation burden. With less of these activities, time gets freed up to spend more time on the top of license activities for patient care.

~Dr. Kelley

I recently read this article, “These warning signs are tied to nurses leaving hospitals” from Chief Healthcare Executive. Before I read it, I will be honest and thought I knew what I would read.

I thought I would see more emphasis on finding resilience, hardiness, and/or self-care as recommendations for how to address nurses leaving the bedside. Such recommendations do have a place at the individual level. However, I am one of those nurses that left the hospital after 3.5 years at the bedside.

I never went into nursing expecting to not work at a hospital. I only knew of that path at the time I entered nursing school and the profession. (Keep in mind, I was in school before the internet connected everyone to show what else one can do in the nursing profession).

I remember feeling as though it was just becoming too hard to manage all of the inefficiencies as an individual day after day while keeping the lives front of mind of the young children I cared for across the United States. “Why is this so hard?” I remember asking myself day after day. None of my other coworkers seemed to be as affected by the system challenges I found unnecessary each day at such a young age and point in my career.

I could not articulate it then but I can see now why I found it so hard. I was one person working within a system. We place so much pressure on the individual nurse to “do it all” and “find a way”. Take one more patient, one more admission, or one more discharge and do it within the timeframe of the 12 hour shift. Time is finite. To add more is to speed up or eliminate some aspects that would otherwise be done.

Then I found my way into the IT department as a clinical analyst. The entire structure was different at that time. Each person worked as part of a team with a set number of projects. Our capacity (amount that we could do each week) was measured by our managers. Projects were only taken on when there was capacity to develop and build the project. This opened my eyes that there are other ways to manage responsibilities and workload. I did not need to feel as though I had the world on my shoulders each day.

In this article, Claire Zangerle, CEO of the American Organization for Nursing Leadership (AONL) offers some insights I agree with and have expressed for years…

“It’s not because our nurses don’t want to solve the problem. It’s not an individual accountability problem. It’s not a work ethic issue of an individual. It is a system that hasn’t come together well… to fix the problem.”

The article continues on to share some potential warning signs for leaders to look for in nurses who may be at risk of leaving. These include: staying late, skipping breaks and refusing vacation days.

However, beyond these factors, Zangerle shares that the work environment needs to be invested in further: “What we can control is how we manage the work streams, the environment that our nurses are working in.”

So much time is lost in the process of preparing for something one needs to do in direct care. Just a few examples of this include:

• Finding bed linens when the linen cart is empty
• Preparing medications only to find one is missing and the nurse needs to call pharmacy
• Finding an IV Pump or Pole to hang a fluid bag
• Finding a syringe pump to hang an infusion medication
• Finding a wheelchair to transport a patient to radiology
• Returning the missed call (or calls) because you were in another patient’s room
• Trying to deliver medications for multiple patients all due at 8 am

These are just a few that quickly came to mind. There are so many others. However, just from this list, you can see how these ‘time sink’ activities are largely outside of the control of the individual nurse. Each one of these could be evaluated for system level improvements and new operational workflows.

Beyond identifying the operational workflows for improvement, is a need to revisit how we look at the environment and lead in a proactive way.

In a place where there is pressure to add more technology, it is critical that we as a profession understand where and how technology can support us, add value and give us back some time to deliver the human care that the patients depend upon. Otherwise, we will continue to cycle through burnout and see more ways that nurses workaround the operational inefficiencies outside of their individual control.

~ Dr. Kelley

Tiffany Kelley PhD MBA RN NI-BC FNAP FAAN

Last month, I had the honor of speaking to the Florida Organization of Nurse Leaders (FONL) at their Annual Conference in Daytona Beach. This conference was the 55th celebration of the organization’s inception.

The title of my talk was, Creating the Future of Healthcare through the Human Vision of Nursing.

In this talk, I covered three objectives:

1. To illustrate and imagine a future state of healthcare.
2. To demonstrate how to pivot in nursing toward new inspiration.
3. To propose how to embrace change through innovation.

Now, if you are reading this post, I want you to imagine what your ideal version of nursing looks like in the future. We so often reflect on nursing’s historical past to learn how far we have come as a profession. However, to imagine, innovate, and actively create the future to inspire others is also part of our current responsibility.

We know that every person needs healthcare periodically throughout their lives. We also know that healthcare delivery models are continuously changing as society evolves. After all, the only constant we have is change. As a profession, we are all aware of the expression, “we have always done it this way”. However, to evolve and thrive as a profession in this rapidly advancing digital age, and to expect do all things the way we have always done them, will most certainly leave us behind and vulnerable to the future.

Thus, I believe it should be us, nurses as a profession, individually and collectively, innovating a future for the profession that creates and incorporates new advancements in ways that keep the humanity in healthcare. Let us develop our future history through the work we do today, while inspiring the next generation of nurses to come.

Now you may wonder, how do I even start to imagine this future state of nursing? I would encourage you to take a few minutes away from your daily responsibilities and let your creative mind explore and ideate.

As you start, you may have thoughts enter your mind about barriers to an ideal professional nursing state. Park those thoughts to the side for now and let your imagination go.  Flip the known challenges and turn them into solved problems in the future.

As you make your list, I want you to consider yourself as part of this future. Imagine your ideal role in creating this future state of nursing. How would you get there? A critical part of advancing a profession is imagining, inspiring, and innovating for the future. 

We are in the last month of 2025. While January is often a time for planning the future for the new year, what if you started to consider that now?

Cheers to the remaining days of 2025. Sincerely, ~ Dr. Kelley