WellSpan Exec Shares Strategies to Disrupt the Nursing Sector Status Quo

Chief nurse executive Kasey Paulus details how to bring the future of nursing to the present.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

Now is the time to innovate and move past outdated ways in which the nursing sector operates to better position the sector against workforce issues and care restraints.

It's time to disrupt the status quo of nursing, says Kasey Paulus, MBA, RN, CENP, senior vice president and chief nursing executive for WellSpan Health.

During an interview featured on the HealthLeaders Women in Leadership podcast, Paulus details ways that the York, Pennsylvania-based health system has innovated to bring the future of nursing to the present. She also shares how her background as a staff nurse informs the way she leads as a nursing executive.

This transcript has been edited for clarity and brevity.

HealthLeaders: In your current leadership role at WellSpan, how does your background as a registered nurse and staff nurse affect the way you lead today?

Kasey Paulus: As a staff nurse, I was very in tune with the inefficiencies I often experienced in my own practice and the profound impact that leaders had on my work environment. That really shapes how I lead and my decisions as a leader are focused on doing what's best for our patients [and] creating an environment where our nurses can do their best possible work.

We know nurses want to feel valued by the organization, they want to feel heard, they want a voice in their practice. My job as a leader is to make that happen, and that is what drives our approach to nursing leadership here at WellSpan.

HL: Based on past and current trends, where do you see the future of the nursing industry heading and what needs to change to enable a better future of clinical care?

Paulus: We are just beginning to see so many significant shifts that are going to be happening within healthcare and within nursing. It can be challenging to think of how we're going to lead and navigate all those changes, but I think it's exciting. It has to start with a commitment to innovation and challenging ourselves to move past "because we've always done it that way." We have to challenge the status quo.

We know we are headed for one of the most significant nursing shortages we've ever seen, and that is going to require us to figure out how to deliver care in new ways because we just simply won't have enough nurses to continue in our current models, especially as we look to having more and more patients requiring more care as the age. The math equation isn't going to work out, so we have to think differently.

We have to prepare for those new models of care. Historically in nursing, we often think of nursing spending most of their time in the acute care setting, and so we're going to likely see some pretty significant shifts in where we provide care. And so thinking about how we prepare the future workforce to provide nursing care in different care settings and it will be across the continuum from the acute care setting to at home and everything in between.

We're also going to have exciting opportunities to incorporate technology to help us provide and deliver patient care and taking some of that administrative and documentation burden off of our nurses. Frankly, nurses have been wanting to solve for this their entire careers. They want to spend time with their patients, they want to provide excellent care.

As an industry, we have to think differently about our current and future workforce and what they're looking for when it comes to flexibility. Historically, we have not always responded as we could from a place of flexibility. The last couple of years have forced us to all think differently and challenge the status quo around how else we can engage the workforce and allow them to continue to practice but have some of that work/life balance. Some exciting shifts [are] happening with ways to still engage as a nurse, flexible work options, scheduling options, making sure we're focused on well-being, and our benefits and total rewards.

Through all of this, we want to make sure we continue to make nursing an attractive profession that people want to come and practice as a nurse, and make sure that future nurses continue to look at nursing as a profession. That's just going to mean thinking differently, engaging with our academic partners, and going further upstream to recruit folks into the profession.

HL: Workforce shortages have been an ongoing trend, especially with nurses. In what ways is WellSpan working on building up that nursing pipeline and creating the future nurse workforce?

Paulus: It's about recruitment and retention and thinking through those two elements differently. They're two different words with two different strategies. On the recruitment end, going upstream partnering with our academic partners, thinking differently about how we can train the future generation. And a lot of that's going to come through some really strong collaborative partnerships. But also going further upstream connecting with high school students as well, and just really creating clarity for the pathways for getting into nursing. But then also looking at you know nontraditional students as well, and how do we make it easy for them to enter into the nursing profession. So we've got strategies and play around all of those avenues like many other health systems were we've been partnering. With international nurses as well, to help meet some of our needs and really. Looking ahead to the future.

On the retention side, how do we create an excellent, flexible work environment for our nurses where they want to continue to stay and practice, where they feel valued, where they feel that they have a say and a voice in their practice. We're piloting a lot of different staffing and scheduling options. Instead of your traditional three 12 hours shifts a week, trying to think differently and allow folks to continue to engage in the health system in non-traditional ways than they have in the past.

HL: How is WellSpan Health leveraging innovation to streamline nurses' work at the bedside?

Paulus: I'm so proud of the work we have underway here at WellSpan. In early August we are launching a pilot focused on virtual nursing and Tele-sitting using an AI capable platform called Artisight, and the model is based off of utilizing a camera and a microphone in a patient room, access to a smart capable TV or tablet, and then layering artificial intelligence functionality on top of the hardware. This will allow us to augment existing acute care delivery models with the virtual nursing staff who work alongside our bedside nurses and help support patient care, including completing admissions, discharges, patient education, documentation of care, and interventions to help prevent falls and improve patient safety. The model supports our nurses at the bedside, and going back to your other question, it also creates another option for working clinically that historically hasn't existed. It's another way of being able to keep our highly skilled and tenured nurses working clinically at the bedside.

Additionally, our colleagues in nutrition and food services are gearing up to pilot a robotic food trade delivery system. We know that nurses in the hospital spend about 3.8 hours of every 12-hour shift walking, and so partnering closely with our nutrition and food services and other disciplines, is one way we can automate some tasks, which frees up capacity for the entire care team and allows our nutrition and food services team to work differently and help support our nurses.

We were one of the first health systems to go deep in leveraging a software technology called DAX, which is a means of automating documentation through the use of ambient clinical intelligence technology. We've had physician colleagues using this in their practices for quite some time now and have had impressive results as a way of reducing that documentation burden. We are now getting ready to pilot that for nursing as well and we're going to be starting in our home care setting [to create] documentation efficiency for our nurses.

HL: What has your journey been like going from bedside nurse to chief nurse executive?

Paulus: My mom was a nurse, so she was certainly influential in my decision to pursue nursing. I started my practice, like many other nurses, in med-surge. Then I found my way into obstetrics and neonates, which I loved. From there I moved into quality and safety.

I was initially very hesitant to move into a leadership role. However, I had many colleagues who kept pouring into me and helping me grow my confidence and skills, and so eventually I said "yes" to leadership. My entire leadership journey evolved as a result of saying "yes" to opportunities that were outside of my comfort zone. It's been incredibly rewarding and that is certainly part of what has led me here to WellSpan.

I owe most of my career to mentorship and sponsorship. Our job as leaders is to grow and develop the next generation of leaders, and so that comes with mentoring and sponsoring others. As others continue to give me feedback, help me grow, give me stretch assignments, giving me exposure, that was what helped shape my career. In the process you grow your confidence, and it makes you a little bit more comfortable to take on that next assignment when it comes your way.

HL: What advice do you have for those who are looking to join the nursing workforce or to become nursing leaders?

Paulus: Nursing is such an incredibly rewarding career. It's challenging, there's no doubt about that, but it's so rewarding. For nurses who really want to grow as leaders, one of my favorite sayings is "bloom where you're planted." Within your current role, look for ways where you can grow and develop leadership skills. It might be serving in a formal or informal leadership position, maybe as a charge nurse, precepting others, working on committees or councils, and getting experience leading different small groups and small teams. There are many important skills within leadership, but high on that list for me is problem solving and the ability to partner with others.

We talked about the importance of mentorship—let someone know you want to grow as a leader and seek out a mentor. Most leaders are going to be more than happy to mentor someone, you just have to let someone know that that you're interested in doing that.

The reality is, and I've asked folks in a setting before, how many of you knew you wanted to go into leadership? And a few folks will raise their hands, but it's usually that folks didn't know they wanted to go into leadership and instead somebody went to them and said, "I see potential" and they start pouring into this person and giving them confidence. It's great if folks know they want to grow into leadership, but I think more importantly for the existing leaders, we have this responsibility to grow and develop the next generation. We need to be pouring into those folks where we see the potential and giving them confidence, giving them exposure, giving them the opportunities for them to grow.