When does healthcare start?

January 13, 2026

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

To be a nurse.

November 02, 2025

Today, Sunday, I moved a bit slower through the day than normal. In doing so, I happened to notice this sign in my office. The sign has been on my wall for the last several years. I picked it up at a local gift shop one day during the height of the covid pandemic. I read through it again today and thought I would share here for others to have a chance to read and reflect on relating to their own experiences as a nurse, or perhaps as a patient that has had the opportunity to be cared for by a nurse.

Sincerely, ~ Dr. Kelley

Induction into the American Academy of Nursing

October 20, 2025    |   , ,

On Saturday, October 18th, 2025, I had the honor of being inducted as a Fellow into the American Academy of Nursing in Washington DC. I was honored alongside 300 other talented nurses from across the globe to join the 3400 Fellows in the American Academy of Nursing (FAAN).

The American Academy of Nursing (AAN)’s purpose is to serve, “the public by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. Academy Fellows are inducted into the organization for their extraordinary contributions to improve health locally and globally.” During the ceremony, I learned that there are over 3400 Fellows in the Academy who are accomplished and recognized leaders in policy, research, administration, practice, and academia. 

When speaking, teaching, or writing about nursing and associated topics of interest, I will often be sure to mention that nurses belong in all places where healthcare decisions are made. I share this statement so that one can imagine a career path that both suits the talents and interests while matching an aligned expertise need for society.

As I listened to my fellow inductee introductions, it was clear to me that the statement I have shared in an aspirational way to encourage others, is not only possible, but it is happening all around us across the globe.

There will always be new needs for nursing knowledge, expertise, interests, products, processes, services, roles. How we, as nurses, care will continue to shift as society evolves to further digitize healthcare. Yet, people need the care, knowledge, and expertise of nurses and healthcare professionals to truly deliver human centered care.

“If it is not documented, it is not done.”

October 16, 2025

As a nurse, this phrase holds the same meaning regardless of the clinical area where you may be providing direct care. The phrase is reflecting on the role of nursing documentation in nursing care delivery.

I am one of the nurses who began my nursing career using paper based charts and documentation records. Little time was spent on learning how to chart on the paper flowsheets, medication administration record (MAR) and nursing notes. The same is true of getting and giving report.

I learned from my preceptor during my first Registered Nurse (RN) role as a new graduate nurse. As a travel nurse, the orientation time was at most a day or two with another nurse. Thus, little focus was placed on how to document on the paper record for the patient.

Many of the nurses working today began their career on electronic nursing documentation. The choices of what one can document far exceeds what was visible on a paper based flowsheet. For a new graduate nurse, differentiating between all of the different fields and deciding which must be completed and/or which are not necessary for that patient is not easy to decipher when there is an underlying thought of:

“If it is not documented, it is not done.”

In Episode 8 of KnowMyVoice®, I discuss the context behind this phrase. I also explore how we may begin to shift away from something that feels like a “have to do” toward something that resembles a way to communicate through a digital form for the benefit of the patient.

Nursing documentation is a requirement but it is a requirement because of what the documentation provides to deliver the care patients need to make the best informed decisions as well as monitor progress and intervene as necessary.

Take a listen when time permits. Subscribe to the podcast and stay tuned for the next episode.

American Business Women’s Day

September 22, 2025

Today, September 22nd, is American Business Women’s Day!


Here you see me headed off to my 1st day of Kindergarten. However, the way I am carrying that Care Bear lunchbox may have been be a foreshadowing to the future.


I pursued an MBA at Northeastern while working on my MS in Nursing Administration to understand healthcare from a business perspective.

Why did care delivery feel so hard as a nurse? The time I got to spend with patients was never the incredibly challenging part. The challenging part was trying to get to the patient to deliver the necessary care. There was always some form of a barrier that made even the simplest of acts more challenging than they needed to be. I would often wonder why other industries did not appear as chaotic in the day to day.

I imagined that if I pursued an MBA and understood healthcare from the business lens, perhaps I could better make an impact on the nurses who are in the direct care delivery roles in the future.

All of that being said, I never imagined going on to start businesses after obtaining the degree.

Yet, it happened and the mindset instilled from my MBA Program at Northeastern helped me in so many ways both in and out of my entrepreneurial endeavors.

From a national historical perspective, there were over 12 million women who owned businesses in the U.S as of 2024. The day was formally recognized in 1986, nearly 40 years ago now.

~ Dr. Kelley

‘Dare to Dream’

September 21, 2025

I am in the heart of marathon training at the current moment. Thankfully, the humidity and outright heat has largely passed in Boston to better support the longer runs that are needed to prepare.

Yesterday, I geared my mind up for the longest run yet this season, somewhere between 10-12 miles. So, I planned a route that would support such distance and picked an area by the ocean.

Sometimes the mental lift of knowing that distance, time requirements and overall physical demands on the body could absolutely psych you out. I find this to often be the hardest part.

Starting, and knowing the challenge ahead for any big goal, can be paralyzing at the beginning. Paralyzing to the point that maybe you do not even start.

In the example of my run, the whole time I ran, I kept having to keep my mind on the goal, even when I thought it was hard. (Spoiler alert: it is ALWAYS hard for me ). I wanted to stop after 1 mile but if I did, I would then need to make up the distance today or tomorrow. I would then start down a spiral of discouragement, and disbelief in whether or not I could make the half marathon in 3 weeks.

It becomes a cycle. I am using running as an example here but apply it to any large goal.

You are often capable of more than you think. However, to hit that upper limit, sometimes referred to as a ‘ceiling’, of what is possible for your goals, you must depend on several different internal characteristics.

Some of these include:

  • A willingness to try,
  • Determination,
  • Discomfort in the work,
  • An ability to let the naysayers say what they might say to you or around you, and keep going anyway,
  • A desire to see what your ceiling may be at that time,
  • and so many others that do not photograph well for social media platforms 🙂 .

As I was running around the Marina yesterday, at a point where there was not a single human around me, I looked up and noticed this boat.

The boat’s name is ‘Dare to Dream’. I stopped, took a picture and then kept going.

Daring to dream includes the ability to think beyond your current moment and envision the future, no matter how big or small the goal may be. However, it also includes moving forward, both physically and mentally forward.

Sometimes, to begin to bring those dreams into fruition, it is literally taking one step in front of the other, embracing the uncomfortable stretch of the ind and body for whatever it may be…. Dare to Dream

Enjoy your Sunday,

~ Dr. Kelley