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

Every Nurse has a Place in Digital Health

July 01, 2025    |   ,

In Episode 4 of Know My Voice ©, Every Nurse has a Place in Digital Health, being able to contribute to what you need and are creating is an exciting opportunity. However, fear of not knowing enough or as much as others can often intimidate nurses and healthcare professionals from actively participating in digital health design and development in healthcare today for the future.

Take a listen here and let me know what additional topics and/or questions you may have that I should consider discussing and/or answering in the future.

I look forward to your thoughts and suggestions on other topics to cover in the future. More to come!

Sincerely,

~Dr. Kelley

Human Centered Technology

June 20, 2025    |   ,

Take a listen to episode 3 of the audio blog, Know My Voice ®, where I discuss the concept of Human Centered Technology in relation to how we should be approaching healthcare technology design. Concepts included in this episode include: human centered technology, push and pull of information, technology design, and the importance of the human in all of this with regard to how technology is designed for use.

Nurses Week 2025

May 07, 2025

Today, May 6th, marks the start of Nurses Week…

I started this journey as a candy striper volunteer at Jordan Hospital on the weekends in High School to help bring patients to their cars on discharge from the hospital. I wanted teh experience before nursing school at Georgetown.

I would often get asked why I wanted to become a nurse, and not a doctor. It turns out that you can be both 😉 (after a lot of years in higher education).

I have spent much on the last 20 years asking why and pushing the boundaries of what is possible in this profession. I can tire people out with my questions and vision for what should be, and not yet is, but I keep going…

My trajectory has given me the opportunity to speak to others in a variety of ways about how to think about the profession as well as creating one’s own personal trajectory.

Today, I reflected on Nurses Week as I recorded a promotional video for an upcoming event where I will serve as the Opening Keynote Speaker.

When I do speak, I often reflect back on what it was like as that new nurse and how much effort it took to get there. You can see me here as a nursing student in clinical at Georgetown in my starchy clinical outfit!

Nurses are the largest group of healthcare professionals in the world. There are 4x as many nurses to medical doctors.

Nurses are masters at knowing how to suggest treatments to doctors without making the doctors feel like it was not their initial idea (this helps build relationships 🙂 ).

Nurses are also masters at knowing something is off or not right with you (at work of course, but also with friends, family, and even strangers outside of work), without even saying anything… They will likely start trying to help you or ask you questions to figure out how they can help.

However, taking care of ourselves, as nurses, is hard at times. We have been trained to care for others first and literally put the needs of others before our own basic needs (e.g., lunch and bathroom breaks for example).

One way you can take care of yourself is taking that step forward that you have been wanting to take but have been nervous about making the move…

Maybe it is a new job, a new role, a new degree, a new specialty, a new schedule… Maybe it is not now but in the next few years.

Whatever you choose, embrace serendipity along the way….

~ Tiffany Kelley PhD MBA RN NI-BC FNAP

Who is putting the puzzle together?

March 24, 2025    |   ,

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So many data elements distributed across so many screens….

Pre-check online forms in texts…

Paper forms on clipboards…

Online forms in the waiting room…

Screening questions during the appointment…

Many duplicative questions asked by those who do not make the decisions on what to ask..

Existing answers to many of these questions already in the EHR….

For a patient this can be quite frustrating to experience.

Why is this data collection experience broken into so many pieces?

Who is putting the puzzle together?

How is this level of data fragmentation making the patient’s experience, patient centered or dare I say, person centered?

Patient-centered care is one of the six dimensions of care quality as defined by the Institute of Medicine (IOM, now National Academy of Medicine).

That term is defined as, “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”

After all, isn’t the premise of healthcare to provide care to the person who is seeking it for the person’s health?

~ Tiffany

Tiffany Kelley PhD MBA RN NI-BC FNAP

Founder & CEO

Nightingale Apps

Nurses are the most trusted for the 23rd year in a row.

March 23, 2025    |   , ,

Their patients come first, often even before themselves.

On January 13th, the Gallup poll released its data for the most honest and ethical professions as ranked by the public.

“Three in four Americans consider nurses highly honest and ethical, making them the most trusted of 23 professions rated in Gallup’s annual measurement.”

As a nurse, this is of course a great honor to continue to receive this recognition from the public for over two decades straight.

Nurses operate according to the American Nurses Association (ANA) Code of Ethics. The code of ethics has 9 provisions. The first provision is:

“The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”

A core principle of patient care delivery is providing individualized care. To deliver individualized care, nurses come to know their patients.

Individualized care differentiates the patient experience from feeling like a number or diagnosis to that of feeling like you are a person who is a patient in that moment.

We learn the role of ethics in nursing early in our undergraduate nursing educational preparation and it is continually reinforced throughout clinical rotations and in practice.

Ethics often supersede regulation requirements. What does this mean?

What may be possible to do through regulations (or the lack thereof), may not necessarily be ethical. Therefore, extra protections will often be taken on top of regulatory protections.

This will especially be of consideration for forthcoming artificial intelligence (AI) tools that aim to support consumers with answers to health related questions.

Another example may be the expectation to turn a patient every two hours. That would be the minimum. A nurse may find that another patient may need to be turned more frequently to optimally heal or relieve pain.

Nurses take great pride in providing optimal care for patients and to do so in an ethical manner. Their patients come first, often even before themselves. The public’s recognition of trust in nurses is of great value.

A link to the article from Gallup on this year’s released rankings can be found here.

~ Tiffany Kelley

PhD MBA RN NI-BC FNAP

Founder & CEO,

Nightingale Apps