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Nurses Week Special on Florence Nightingale and the Future of Nursing | Newsday with Lisbeth Votruba

Speaker 50: [00:00:00] Over 1200 hospitals rely on Ava Azure's AI enabled virtual care platform to enable their smart hospital strategy. It's the eyes and ears in the room. Scalable, clinically grounded and built for enterprise impact that translates into smarter labor optimization and improve throughput where it matters most.

Find out more at this week, health.com/asure.

I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

Bill Russell: Alright, is Newsday, and today we are excited. Uh, I'm gonna start with Drex. We're joined by Drex de Ford, the incomparable. Uh, and let's see if I can get Lisbeth, uh, name correct for the first time. We've completely loaded up [00:01:00] the, uh. The blooper reel, but it's Lizbeth VBA with, uh, with AvaSureture Chief Clinical Officer, uh, Lizbeth.

Welcome. And hopefully I don't have to say the last name anymore. I, I could say Lisbeth as, as often as you want.

Would

Lisbeth Votruba: yes.

Bill Russell: Nurses Week, so, give us a little bit of your. Your nurse background and I don't know, uh, tell us a little bit about your family as well.

I mean, we were just talking about that earlier.

Lisbeth Votruba: Thank you for having me and, uh, I love celebrating Nurses Week. I am a third generation nurse and the chief clinical officer for AvaSure. Um, and I. Have a background. I was trained as a nurse practitioner, was always gonna stay in acute care. I love that. Acute care nurse practitioner. I love that setting and the excitement of it.

Um, but also I have kind of this entrepreneurial spirit in me and really started about 15 years ago, leaning into how virtual care can really support nursing care and um, patients. And, um, that has changed the trajectory of [00:02:00] my career. In a very exciting way. So, um, I've been with Asure for 14 years, um, from a very small startup to where we are now in 1200 hospitals across the, across the United States and Canada.

Bill Russell: Wow, that that's, uh, so now you're a big startup.

Lisbeth Votruba: Yeah. Not a startup anymore.

Bill Russell: it still feels like it has that culture though. I mean, 14 years, and yes, you are large, but when I talk to people, it still has that sort of like, uh, you know, figuring it out with the, uh, organizations that you work with and you know where they're going. And I, I, maybe some of that's just due to the, the transition

Lisbeth Votruba: That's the market. It, that's the market. It's such a dynamic market right now. And we were well established pre COVID, um, and, um, really supporting, especially patient safety then. But then, as you can imagine, it just really accelerated during COVID and then we got, um, some investment from. Private equity, Goldman Sachs in 21 and um, have really taken it to the next level since then.

And [00:03:00] the opportunities are kind of endless with the virtual care platforms now, with the capital P.

Bill Russell: So direction, you have a little bit of a, a nursing connection as well.

Drex DeFord | This Week Health: I do, I'm married to a nurse, a pediatric ICU nurse at Seattle Children's.

Lisbeth Votruba: Wow.

Drex DeFord | This Week Health: She's always, you know, I think all nurses are a big fan of, of the week and all the things, um, that go on. What are some of the interesting things that you're kind of hearing about how organizations are celebrating? Holding up nurses as kind of the key to the operation when it comes to.

To the delivery of care for patients and families.

Lisbeth Votruba: I'm gonna nerd out a little bit. So it's based on Florence Nightingale's birthday, which is May 12th. Um. 1820 And, um, she was not only, I mean, we, I think people think about her as handwashing and really, um, changing the way patients were cared for in developing nursing from the Crimean war, but she was [00:04:00] also a data geek and the inventor of the pie chart.

Did you guys know that?

Drex DeFord | This Week Health: She invented the pie

chart

Lisbeth Votruba: The pie chart. So she was just very good at documenting and analyzing, um, what worked and what didn't work, and really making change quickly and assertively. She was not meek at, at all. Um, and so, yeah, that's why I, I. Kind of love the origins, um, that it's around Florence Nightingale.

She's a model for all of us. But, um, what I'm kind of seeing in, in health systems is, um, in, in nurses is that I am seeing some positive signals. Right now, um, the nursing turnover rates have gone down. Um, the need to use agency nurses has kind of gone down for health systems this past year or so, and what's going up is nurses professional development, the certification rates for nurses continue to [00:05:00] grow.

Um, and so I'm seeing some positive signs and that's, that's exciting.

Drex DeFord | This Week Health: We still see a, a fair amount of, um, I guess in the news and, you know, whatever you believe in the news, but there's still a fair amount in the news about, um, there's a nursing shortage and there's gonna be a nursing shortage. It appears to be. gonna be the case for a while. Uh, what, what are you hearing or what are you seeing?

Are those legit trends that I'm hearing about or is there something else we need to know?

Lisbeth Votruba: Well, I graduated from nursing school in 94 and um, we have been hearing that my whole career, so, but I, but I'm not, I'm not denying that there is a mismatch, um, as, as the workforce. Continues to age and, um, but I, I look at it as an opportunity and I'm kind of excited about how technology can support nurses and really my

my vision is to get back to old fashioned nursing care with the support of [00:06:00] technology. Um, my mother and grandmother didn't have, uh, a wow computer between them and their patients. Um, and I think we're getting back to that. Um, and I think we'll get a chance to talk about ambient documentation and, and some of the ways that AI can really help.

So let taking the lessons we learned with High Tech in that, uh, the implementation of the electronic health record, which I lived through, um, as a practicing ICU nurse and, um, doing it in a new way now.

Bill Russell: we are doing our first CNIO summit with the 229 project and it's

Lisbeth Votruba: Great.

Bill Russell: completely, packed and I'm looking forward to that conversation. One of the things that we're hearing as we went, we go around to the, the city tour dinners and other things. When we talk about ambient documentation, especially in the area of nursing, we get a lot of different, we get pushback.

We get like, oh, they'll never, but my area will never be like that. And there, there are specialties within healthcare [00:07:00] that really struggle with ambient documentation. Are we, you know, are, are you hearing that same thing? That there's, there's areas where it's like, you know, that's not really gonna help. If that's not really gonna help where I practice or how I practice, but other areas are excited about it.

I mean,

Lisbeth Votruba: Um. I, I'm of two minds with ambient documentation, so I, I think. I'm excited about a path forward for it, but it is just not simply replicating the way that it is used with and has been used very successfully with physician documentation. And that's just simply because the, um, nursing, the way nurses document and what they document is very different and more structured versus narrative.

Um, and, and there's this whole concept of caring out loud that would have to happen then. Where you're verbalizing what you're doing in order for that to get captured. And part of me loves that because then I think like [00:08:00] so much of what is valuable in what nurses do, um, isn't recognized and maybe families, patients would start to understand what is going on and how nurses are so holistic.

But on the other hand, it could be very awkward. So, I mean, imagine. Walking in, I'm imagining myself walking into a patient room and saying, um, the patient appears to be less, uh, cognitively oriented than they were previously, um, and slightly lethargic and not following commands as well. Um, so this will warrant further investigate.

You know, that's like, could be very awkward. And so we wanna make sure that the tools are. Trained to serve the nurses, not the nurses having to be trained to serve the tool.

Drex DeFord | This Week Health: It is interesting, right, that docs are really used to, I think even in their training, right, they dictate, they, they learn to dictate. And that's kind of like the way that [00:09:00] they, um, they are oriented.

Lisbeth Votruba: Yes.

Drex DeFord | This Week Health: Uh, and, and I think like you said, for nurses, a lot of it is they do the work. They think through the process.

They're, they're doing the work, but they don't, they're in the training. It's not. Say everything out loud, and it would be great if there was a better way to sort of capture all that and

Lisbeth Votruba: Yeah.

Drex DeFord | This Week Health: sure that they

Bill Russell: What, but what about video? I mean, doesn't the combination of audio video do that?

Lisbeth Votruba: Yes. And so I think, I think that's where we need, it's going to, it's, it's counterintuitively more complex to support at the nursing workflow than the phys physician,

um, workflow. Um, but for example, um, we are now doing ai, computer vision ai, um, for. Fall prediction. So you can see earlier when a patient's about to fall just based on how the pose estimation, how they're moving their body.

Not a simple outline drawn around the bed. That just would be a very fancy bed alarm that causes fatigue. But, um, [00:10:00] Peterson Health just, um, was sharing at A ONL once they used their computer vision AI for, um, fall prediction, they decreased their. Alarms, uh, by 38% for falling. So that's less noise at the bedside, less alerting the bedside.

That's alerting the virtual nurse or virtual, um, uh, safety attendant who can then intervene upstream of, uh, potential safety events. So that, that's computer vision, ai. Another one is, um, the. The ambient listening for, um, safety, uh, issues. Um, so awake word for when a. A nurse feels, um, afraid for their safety.

They could just say, Hey, and then whatever Wake word call, um, like is, is often what it's called. Or Bert, which stands for Behavioral Emergency Response Team Bert. Um, so, and, and then also what I'm really excited about, and we're partnering [00:11:00] on this, we're not trying to develop it ourselves, is, um. Uh, computer ambient listening to hear from patient's voice if they're aggressively escalating or potentially getting towards violence.

So, for example, workplace violence prevention, um, is a wonderful way that AI could really support nurses.

Drex DeFord | This Week Health: It's so big in healthcare right now too. I mean, the workplace violence

Lisbeth Votruba: I would say.

Drex DeFord | This Week Health: to escalate. There's, I mean, I know it's a conversation I have regularly with my

wife and her friends. So

Lisbeth Votruba: Mm-hmm.

Drex DeFord | This Week Health: that, anything that you all could do to create the situation where, um, uh. the behavior in the room, the ability, like you said, to use a keyword

Lisbeth Votruba: Mm-hmm.

Drex DeFord | This Week Health: to draw the right people into this, um, that's, that's gonna be great for patients and families and obviously for nurses who are in those tough situations.

Families under a lot of stress. A lot of things are going on. Yeah.

Lisbeth Votruba: Yeah. You said your wife is in the pediatric ICU?

Drex DeFord | This Week Health: Yes.

Lisbeth Votruba: Yeah, the, I can't think of a more. Tense, [00:12:00] stressful situation for families and, and that, you know, sometimes they don't handle it gracefully, but just because, you know, and I think nurses have historically said, well, that's not their fault. You know, or even Alzheimer's patients have, um, fear aggression, um, and they can't help it, or it's not their fault.

But that doesn't mean that you have to tolerate it.

Bill Russell: Early on in the AI journey, there was a California nurser, a nursing strike, and they actually cited AI as one of their concerns. Um, it it, is that still pretty prevalent concerns about AI and how it's going to be utilized or is as we start to see it and feel it, is that starting to abate a little bit?

Lisbeth Votruba: It is starting to abate a little bit. That was around, um, epic's, uh, sepsis AI algorithm. So they're just pulling parts of the electronic health record and alerting for sepsis. And I think nurses were thinking, you know, we [00:13:00] are critically thinking and we can do it better than the algorithm.

And the fear is, and this is just the same with physicians that, um. If you, if the, if the AI alert is wrong, um, do you, are you liable for that? Or if the AI alert is correct and you don't follow it, are you liable for it? So who, you know, whose practice is that? The ai, but

Bill Russell: You

Lisbeth Votruba: um,

Bill Russell: We Like to say we haven't worked out the liability thing, but we sort of have, we're putting it on the clinician. mean, I mean, without, without stating it, because we

Lisbeth Votruba: yeah.

Bill Russell: it hasn't really worked its way through any legal precedence or anything to that effect. saying human in the loop, and sometimes when we say human in

the loop we're saying it's on you, Lisbeth.

Like you, you were on duty and were supposed to check it, so

Lisbeth Votruba: That's true. Bill. Yes.

Bill Russell: It's, um, I think that's one of the big gaps. One of

Lisbeth Votruba: Yeah.

Bill Russell: is we have the, these AI tools and we're talking about etic and and [00:14:00] Epic has rolled out a hundred plus, tools around ai. And then we say, yeah, yeah, but don't worry about it 'cause we have human in the loop.

But there's this, there's this, uh, concept where if humans in the loop and. 97% of the time it's right. We just go, yes, yes, yes. And you almost train the person that you hit. Yes. But 3% of the time you're still liable. But the, or the health system's liable depending on how it's set up, but that 3% of the time that it expects you to check you don't, 'cause you're, you're human. And human nature is to say, well, it's been right the last 97 times, it's probably right this time.

Lisbeth Votruba: Yeah.

Drex DeFord | This Week Health: You don't, you don't necessarily have a ton of time in there too. Right, so those decisions are being made pretty fast. under a lot of stress to move things along. And so that amount of time, I was actually having a conversation with Claude last night about, um, you know, [00:15:00] being embedded in Pentagon targeting systems and what, how did.

Claude feel about that. And there was a lot of conversations around the, there's a lot of pressure and there's a lot of stress, and there's a lot of things that are happening. And the human in the loop only has a few seconds to really kind of look at the recommendation and decide yes or no. And they do definitely get into this routine of just saying yes to everything, and that leads to mistakes. So same

Lisbeth Votruba: It can, this is why we have the training and the education that we do. And I think. I, I, you're, you're all making me think of, um, just imaging advances and did people think this when M MRIs started? You know, that, um, just because the MR MRI or CAT scan is telling me something, I had to use my own clinical judgment and, and so I, I, I think it's something we need to talk about, but, um, not to make us

Bill Russell: Optimist. You,

Lisbeth Votruba: of, I, I'm kind of an Optim optimist.

Yes.

Drex DeFord | This Week Health: I.

Lisbeth Votruba: I'm, that's, yeah,

Bill Russell: you see the path through. Um,

Lisbeth Votruba: do.

Bill Russell: yeah. I, I, I do. As [00:16:00] I, I do as well. I mean, there, it's, it's interesting with these AI models is the, the ones that we're using over here, um, it feels like it's two steps forward, one step back, five steps forward, two steps back. sometimes you're using the model and go, Hey, we upgraded the model, and you go, Hmm, that didn't feel like an upgrade. I.

Lisbeth Votruba: Yeah. what I've been thinking about a lot lately too is, um, AI agents directly patient facing AI agents, and I mean like next level above chatbot. And, um, I think the path forward on that is to have a deterministic layer in there where they are leveraging evidence-based practice, like up to the minute.

Evidence-based practice and algorithms. But then the AI part is just the conversational part in the, in the listening. Um, I heard, um, uh, Katie Boston, LS from the American Nurses Association, and she was telling me that she listened to on AI agent talk to a patient, and the AI [00:17:00] agent had its goal, was to reschedule the patient's.

Doctor's appointment 'cause they had missed the doctor's appointment. And uh, they found out that, that they had missed the patient, missed the doctor's appointment 'cause their grandson had died and it was a grandson's funeral. And, um, so then she was thinking like, oh, this is gonna go south. And, um, but the AI agent said, um, what was your grandson's name?

Uh, tell me about your grandson.

Drex DeFord | This Week Health: Hmm.

Lisbeth Votruba: And yes. And then then like, is there anything that we can do to help alleviate any of this pain? And then slowly got around and got the appointment rescheduled and she asked the question to a room full of nurses. How many of us would've done better knowing that we had 17 other calls to make?

Um, to reschedule appointments and so, and, and that's where, that's where I'm kind of excited. But, and then the safety of [00:18:00] the, making sure that the clinical decision making is more deterministic, if that makes sense.

Bill Russell: I, I love that, that layer you're putting in there. We have probabilistic models. We have

Lisbeth Votruba: Yeah.

Bill Russell: models. Deterministic models. we can make mistakes on those to be sure, but we know those, we've been doing those

for the better part of, since

since

Lisbeth Votruba: yes. Yeah.

Bill Russell: have been here and we can, we can layer in the rules and whatever.

And if, if you marry those two well. seems to be the, uh, the, the, the magic sauce. It's like, let go ahead and let the AI do its probabilistic thing and then feed it to the deterministic and say, whoa, whoa, whoa. Do that again. 'cause I don't think that was right. And, um, and, and kick it out. If it's not, yeah, it'll, it, it'll be, it interesting to see how this, this, uh, continues to move forward.

Um, know, I wanna close with this, with this conversation and it's really around, are nurses at the table? Especially with regard to technology decisions, are you seeing more and

Lisbeth Votruba: Yeah.

Bill Russell: Because when I came into healthcare, [00:19:00] they weren't at the table. Like we weren't, Hey, we're doing this EHR, they were barely at the table.

Lisbeth Votruba: so I'm at the table. I am, I'm the chief clinical officer of a large tech company and, and I'm at the board meetings and I'm at the, you know, ELT meetings, um, and also very involved with, um, many of the organizations, the professional organizations, um, I think American Organization for Nursing Leadership.

Has really stepped into, uh, I the technology, um, and really working on, um, improving those competencies needed for nursing leaders. And then on the other side, I see, um, the, the IT professional organizations reaching out to, and em embracing more of the, the nursing, you've seen it too. The nursing leaders, like VI HIMSS HIMS had a great nursing informatics.

Pre-conference, so, and then I think when we're working with different health systems. [00:20:00] Something that works really well is, is a dyad partnership with the CIO. And the C-N-O-C-N-O has like the biggest, um, organization by far, uh, caregivers, uh, in a health system. Um, and so them bringing their clinical lens, Assuming that they have a seat at the table and bringing the folding chair and scooching in there, that's what I do.

Drex DeFord | This Week Health: I love that visual. Excuse me, please excuse

Lisbeth Votruba: Excuse me. Excuse me.

Bill Russell: Lisbeth, I want to thank you for, uh, coming on the show, sharing your experience of wisdom with us and. Uh, sharing this week with us. I mean, we're so glad, so glad to have a nurse on the, uh, the show. And, uh, Drex, and I'll go back to talking about the Pentagon and security and crazy stuff that's going on on the technology side.

But it's, it's great to celebrate nurses and uh. it is, it is really fun to, to see nurses at the table redefining these workflows [00:21:00] and, uh, being a part of what the future of medicine looks like. So thank you. Thank you again.

Lisbeth Votruba: Thank you.

Bill Russell: I.

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