Where the Healthcare Rubber Meets the Road (ft. Serena Bumpus)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx. Ed here, Digital Voices. Love the topic we have next because it's all about nursing, and I always believe that nursing is where the healthcare rubber meets the road. So Nothing gets done without nurses. Love nurses. I married a nurse. So thrilled today to introduce you to Dr. Serena Bumpus. She is the Chief Executive Officer at the Texas Nurse Association. Welcome, Serena.

Well, thank you, Oz. Thank you so much for having me today.

Yeah, really excited to dive deep into the Texas Nurses Association and all about nursing. Before we get there, producer Megan, have you ever thought about a career in nursing?

Yes. Yes, for a very long time, that's what I wanted to do with my life. It hasn't turned out that way, but I studied to be an EMT right after college, and they let me do a round in the emergency department, and they let me poke people with needles, and it was a lot of fun. But yes, definitely, I love nursing.

But it's never too late, right, Serena? I bet there's a lot of nurses that start their career late in life.

That's right, it's never too late. Megan, you can— we'll still take you. If you want to become a nurse because we desperately need them right now. And we have a lot of people who are, you know, who come into the profession as a second career. And there are usually tracks for individuals like yourself who may have a degree in something else and we can fast-track you through an undergraduate program just to get you ready to go and ready out there into practice. Something to consider. I will keep you in mind. Thank you. You're welcome.

As much as I'm a proponent of nursing, I don't wanna lose Megan 'cause she's, So we all have side hustles, Ed. Yes, that's true. That's true. Nursing is so practical though, too. That's what I love and admire about nurses. 'Cause it's like, especially Megan has one child already, may have some more, and it's so practical, right? Your kid's gonna bump into things and hurt themselves. And instead of like panicking and, you know, you can take care of them yourself. It's super practical. And then you can even get airline miles out of it. So my wife, who's a nurse, she recently, there was an emergency on the plane. She took care of the patient, passenger, everyone was fine. And then credit to American Airlines, they sent her 30,000 miles the other day. So practical.

Yeah.

And you get airline miles. But Serena, well, we'll get way into it. So we first met really just kind of online this year. I've seen you on LinkedIn and other places. And of course I'm in Texas myself. My wife's a nurse. we've already established. And I was like, wow, it'd be really interesting, especially in this time, 2022, just, you know, the importance of nursing and a lot of the issues going around related to nursing, you know, shortages and burnout and things like that. And I thought, man, we should just have you as our guest. But before we jump way in, people always wanna know about our guests, like what songs are on your playlist? What kind of music do you like to listen to?

Well, you know, so before I became a nurse, I was a music major.

Ah.

And was actually 2 semesters away from graduating with a music degree and just decided, man, being a band director is not what I wanna do. And being a musician full-time, I would just never make any money. So nursing was actually always something I'd wanted to do when I was a kid, but I digress. So my playlist is very diverse, if you will. And the music I listen to really just depends on my mood. I get dressed to music every morning. And so, you know, if I have a day where I have to really be focused and maybe kind of take a strong stance on something, I will put on a little bit of rap music. And that just kind of gets me in this mode of, all right, say you got to be a gangster and you're just going to go in there and you're going to do your thing. Versus if I'm feeling light and bubbly, it may be some good, just good old school country music. And if I need to calm down because I can feel that my anxiety is, or my stress levels are increasing, I will turn to the classics and just put some soothing classical music on to kind of just calm my mind a little bit. So though I have a variety of things on my playlist for sure.

That makes a lot of sense though. Yeah, depending on your mood, you'll have different musical tastes for sure. It makes, makes total sense. What about your passion or life message, mantras, or some Something that sort of keeps you focused on your North Star?

Last year, actually, it was this time last year, I had a friend who, very young in his 30s, who he was also the owner of the gym that I went to. He passed away from COVID And healthy individual, who would have ever thought that this, you know, this person would be impacted in that way? And he had a Bible verse posted in his office, which has kind of stuck with me since his death. And it was Proverbs 27:17. Which is the iron sharpens iron and one man sharpens another. And that has stuck with me over the last year because, you know, it's really about us building and growing relationships with other people in life. And we need people to help us rub off our own hard edges, right? And we need to help them rub off theirs. And we should always be sharpening one another to be our best selves. And that's exactly what this particular individual did with every person he met. And so that has been a mantra that I have set out to do. And I think especially in this new role that I have as the CEO of the Texas Nurses Association, it is critically important that I live by that mantra because there are a lot of people that I can influence and impact.

Yeah, no, I love it. I use that phrase from the scriptures quite a bit myself. Big believer in iron sharpens iron. That's awesome. So tell us a little bit about your story. We know a little bit about you already, that you thought about nursing when you were young, but you were a music major, and then you went back to nursing. So yeah, tell us a little bit about your journey, how you, how you got there. We'll get into the education stuff in a little bit, but tell us your general journey to where you are today.

So yeah, you know, so when I graduated high school, I got a music degree, which is sort of how I, you know, started out as a music major. But I came from a lineage of nurses in my family. My great-grandmother is a nurse. My aunt is a nurse. I have a cousin who's a nurse. And growing up, I got to spend a lot of time with my aunts in the hospital just as a volunteer. And I knew that at a young age, that's what I wanted to do. However, since I got this music scholarship to go, I had to be a music major. And my parents were just like, no, you need to do this. And being the good kid that I was, I did what my parents told me to do, right? But it wasn't until I was out on my own, still in school, and I needed to get another job. And so my aunt said, well, why don't you come work in the hospital? I think she knew that I was not meant to be a band director or a musician. And so maybe this was her way of giving me a reality check. So I went and worked in the hospital as a patient care technician and thought, oh man, this is That was when I realized that's not what I wanted to do. So, I immediately changed my major. And so, I took the long way out of college, if you will. But that's really kind of my story into nursing is that long route. But I worked as a patient care technician all through nursing school and then started my first nursing position as a staff nurse in a large tertiary care center here in the Austin area and worked as a staff nurse for several years in a medical surgical unit. It was an ortho, neuro, uro, ENT. I mean, you name it, we did it. And I ultimately turned into a staff development educator and did that for a little while. And then leadership was really kind of the path that I knew I wanted to take all along. As nurses, we impact one patient at a time when we're at the bedside. As a leader, my thought process was, if I can influence multiple nurses, I can make an impact on multiple patients at a time. So I became a nurse manager and ultimately went into a nursing director position. And now here I am as the CEO of the Texas Nurses Association.

That's pretty cool. What was the basic timeline? Like, are we talking 10 years, 15 years from that staff nurse?

Yeah, so I've been a nurse for 20 years. I just celebrated my 20th anniversary in May of this last year. And, you know, if you count If you count the time that I was a patient care technician, I've been in healthcare as a whole for around 26 years.

Yeah, well, I was guessing 10, 15, but you know.

Well, thank you.

I just thought people might be curious, you know, to go from staff nurse and all the things that you've done to be CEO today, just how long that might take. Yeah, let's jump into nursing and we'll come back to Texas Nurse Association in a minute. So you're a DNP. So let's break this down for our audience because not everyone's gonna know the different levels sort of nursing. So maybe we start at the associate's level, right? Like at an RN, then maybe take us up to generally speaking, you know, the typical sort of degrees that you might get to work up to a DNP. Can you share that with us?

Sure. You know, when I graduated nursing school, I was an associate degree nurse. And, you know, really that associate degree nurse is preparing you to, and really focuses on the clinical aspects of care. So you don't necessarily have a leadership component in there or any other, Community health components and that sort of thing. It is really preparing you to become a nurse in the hospital setting and giving you the clinical skills that you need to take care of patients. And then when you look at that, the BSN component, the BSN component does have that clinical aspect, but then it also starts incorporating some of those leadership skills into the degree program as well. And you are looking more at the holistic aspect of care because you're looking at community health and public health and even policy. policy for that matter within that part of the program. And so it really has a stronger emphasis on that leadership aspect. And then when you move into the graduate degree program, that's where you get to have a little taste of variety in the nursing profession because your graduate degrees are really focused on different specialties within nursing. So you have your advanced practice nurses in that master's level program. education, and you could become an acute care nurse practitioner, a family nurse practitioner, psychiatric mental health nurse practitioner. Then you have your certified nurse midwife and your certified nurse anesthetist. And so there's a huge variety and direction that you could go there, right? And then you also have master's degrees in nursing administration and nursing education. Now there are even public health nurse master's level programs as well. Then when you get to those terminal degrees, you have your Doctorate of Nursing Practice and then you have your traditional PhD. Your traditional PhD is the nurse scientist. They're the ones out there doing the research and developing those best practices that then we can turn around and implement into practice. In the Doctorate of Nursing Practice degree, what we learn in those programs is how to take that research and translate it into practice and implement it in practice. Those are the differences in those degree programs. The DNP also typically will have a track for your executive nurse leader and your advanced practice nurse as well. So, there could be a clinical focus if you want, or more of a leadership focus there.

Yeah, no, that's good. I watched my wife progress through all that, as you have done, and it was quite fascinating. And it was nice because I know healthcare as well, so we were able to always talk about it and things she was learning in the practicums and things like that. It's quite a great education. And is it local or is there a national trend for a desire for hospitals anyways when they hire nurses? Are they looking for BSNs? I sort of saw that for a while where They were sort of grandfathering in RNs, but they were sort of looking for BSNs. Is that a national thing, or is that just sometimes up to a specific health system?

So it has definitely become a national trend. You know, there was, there was a goal within the profession of nursing that was set, gosh, almost 15 years ago now, or longer even, that the BSN would be the entry-level degree. And there was a goal to have 80% of the nursing profession with a BSN by 2020. We did not hit that goal. We're close, right around that 60 to 70% range. So we've made some progress there. And then COVID hit. And COVID has really just shifted the trajectory of a lot of our previous plans that we've had as a profession to the point where hospitals are really having to rethink, do we just hire that BSN nurse? We're all short-staffed right now. And so, if we can get an associate degree level nurse who is a good fit with our teams, then we have to reconsider that. In addition, many hospitals are even reconsidering bringing LVNs back into the hospital, which LVNs left the hospital probably about 15 years ago. Hospitals stopped hiring them. And now we're back here full circle. Again, rethinking how we can ensure that our patients are being cared for and cared for appropriately.

Yeah, that's probably a good segue then into, you know, what you all do at Texas Nurse Association. And before we go there, because I want to talk about, yeah, the shortages, you know, the burnout, things that you're, you're dealing with— there's probably more than that— but tell us just generally for, you know, our audience about the Tex Nurse Texas Nurses Association and what it does, what you do.

So Texas Nurses Association is the largest professional nursing organization in the state of Texas. We are the voice of Texas nurses, if you will, and we're a constituent of the— a state constituent of the American Nurses Association. And our role truly is to not only advocate for the profession to ensure in Texas, to ensure that nurses are able to feel safe in their practice and to feel like they are providing good care to their patients, but then also to ensure that they have the education that they need to practice and understand the laws that are there to protect them and all of that. We— so we, we have a huge policy focus to some degree, but then also a focus on education and providing that professional growth and development to the profession as well.

No, it sounds like a The mission is great and, you know, very much needed. And so the Texas Nurses Association you mentioned is part of the American Nurses— under the umbrella of American Nurses Association. So each state has sort of a state constituency that comes under that broad umbrella. So every— all 50 states probably have something similar to Texas Nurses Association.

They do. There is a state nurses association in every state across the country, and, you know, those local state organizations are really there to help Support the practice of nursing in their individual state.

Okay, yeah, and you probably come together and then there's probably policy at the federal level that you all advocate for. So you're sort of handling the state level and policy at the state level, but at the same time, you know, at the federal level, you're doing everything you can to promote the profession of nursing.

Yes, absolutely.

So when I thought about some of the challenges facing nursing, I have 3 or 4 things, but I may be missing 1 or 2, and I would love to just see if I'm right. And what I'm missing, and then maybe we can pick one or two to talk about. But one is, we talked already, shortage, right? There's a nursing shortage, or has been for many years, but grew more acute, as you mentioned, during the pandemic. Violence against nurses, that's something fairly— it's been around a long time, but it also got more acute through the pandemic. Burnout, so dealing with clinician burnout. And then the whole issue may not be an issue for the Nurse Association, but I know on the provider side is all the traveler nurses, right? There's now more opportunities for nursing than traditional posts in the past. But then the traveler nurses, that was a challenge, at least on the provider side, like thinking from a hospital side, you know, because of the expense of it. But I can see why it was attractive to nurses. So did I hit most of the major challenges facing the nursing profession today?

You did. You hit on probably all of the hot topics that are top of mind for any nurse that you That you talk to, and I think they all kind of feed off of the other one to the point where, you know, we'll take workplace violence as that. I think especially considering the recent events that have taken place here in Texas and in other states, workplace violence has probably shifted to the number one issue in the profession more so than staffing.

Mm-hmm.

But in turn, workplace violence can also be exacerbated by the staffing shortage as well. There's evidence out there that shows if you're working short-staffed, then you typically will have a higher incident rate of workplace violence. And when you put it into context, we are a society of instant gratification. And so, we expect everything to be very immediate. And let's face it, there is nothing immediate about being a patient in the hospital. You lose your sense of control, you lose a little bit of your dignity, and to some degree, even your family members feel like they have lost their sense of control a little bit as well. And having to wait on someone to meet your needs, whether that is bathroom needs, pain needs, just to get up and move around. or shift positions. That's very frustrating when you're not able to do that yourself and you're dependent on other people to do that. And so that sort of elevates— that frustration can elevate people's emotions and to the point where some turn to— don't make the best decisions on how to cope with those emotions. And so they lash out at the staff, whether that's verbally, physically, or they make threatening, you know, idle threats and that sort of thing.

So we have definitely seen an increase in that over the years, especially with COVID and as our shortage has I know the last time where I served in a health system of 16, 17 hospitals, on our daily huddles, you know, we had to all the way up to the executive huddle, we would have at least 3 or 4 reports of violence against the staff. It's so sad. And I was always trying to think of a tech solution, you know, how could we leverage tech to help in any way? But yeah, it's, it's a major issue that we still haven't figured out how to solve.

It is. And there's recent evidence from Press Ganey who did a report report recently on violence in healthcare, and they had some very compelling data that said that 2 nurses are assaulted in the United States every hour. I mean, gosh, when you think about— and when you put that into perspective, that's pretty powerful. And I think many health systems are trying to figure out how to tackle this, and then some are just— I don't know if they have prioritized it or not, but it's time. This is one aspect of the things that we have to manage and deal with in healthcare that is causing our providers, both nurses and physicians and all of our other healthcare workers, to burn out and leave. It is a huge contributor to burnout overall.

And it's a horrible paradox that the people who are giving their life to serve you are the ones being Having violence perpetrated against them. It's really sad. I do think, and this is Digital Voices, our audience is a lot of digital leaders, always trying to think of how can we leverage technology to help with this. Some of the things we did was we created the ability to immediate notification if something was escalating. It didn't take much for the nurse to— where we knew exactly where they were. When they press the button on their phone. This is all mobile-enabled, so they could press something on them so we knew where they were, what was going on, and take immediate action. Even then, it's too late. Something has already started to happen. When you think about, Serena, these other issues that we talked about, challenges, how do you view technology? I don't know if the association has a point of view on it or if you have a point of view on it. A bunch of techies are listening now and digital people. Can we do something to help with burnout or shortage, or how can we be of service?

Oh my gosh, you have just asked me like the best question ever because I have a huge passion around this. And prior to taking my current position, my role was implementing virtual services in the acute care hospital setting. So it was putting virtual nursing services in place, implementing virtual sitters and all of the things that we, we called it the wraparound service of nursing. So anything that we could do To take that burden off of those frontline caregivers to allow them the opportunity to, and give them some peace of mind, if you will, so they can really take care of their patients. So when we think about what technology can do for our frontline workers, it is, we're losing our expertise at the bedside, right? So our baby boomers are, they're aging out. of the profession, and that is leaving us with, you know, we don't have that depth of experience anymore at the bedside. And so how do we keep those individuals who have 20+ years of experience at the bedside, how do we keep them in that acute care hospital setting? And when you think about virtual nursing services, for example, that is a great opportunity to provide these individuals who cannot physically provide care, At the bedside anymore, but their expertise is needed. We can put them in a call center or let them work from home, and now those young nurses who are at the bedside can phone a friend and say, hey, can you zoom in on this patient for me because I don't know if I'm seeing what I'm seeing? Or, they can help with some of just those mundane day-to-day tasks.

Mm-hmm.

Like admission paperwork and discharges and that sort of thing as well to ease the burden. The other thing that we have to figure out is how all of our technology that we currently work with in healthcare can integrate and talk to one another. We have an EHR that is absolutely atrocious, and I think COVID has proven that we probably don't need to document all the things that we have to document, but then we have We have IV pumps. We have blood pressure machines. We have our blood sugar machines. We have EKG machines. We have a multitude of technology and none of it talks to one another or none of it dumps into our electronic healthcare records. That, in and of itself, is a huge burden and we have to figure out how to work smarter, not harder. We haven't figured that out in healthcare yet.

Those are really profound insights. Our audience will get a lot out of it. First is, I like the example you were giving about some of the older nurses who still have a really important role to play as mentors and can leave the bedside, but still be very active in nursing through all the virtual capabilities that you spoke about. That helps with both burnout and nurse shortage. I love that whole solution, plus the whole virtual aspect. We're major proponents of to begin with. Then the whole integration piece, yeah, I think a lot of times my colleagues are thinking super futuristic, which I love and I'm a big believer in, trust me, like, hey, what's the next thing we can do? What else can we automate? But sometimes we forget the basics, which is, in fact, that not all of these hospitals today are integrated, like the example you were giving.

I know.

This goes back 3 years, but the last time I served, I would serve in anesthesia one shift a week. I was shocked, actually, that so many of the biomedical equipment and the clinical equipment did not talk to one another and did not interface into the EHR. This was a world-class organization. I was like, oh my gosh, and the opportunity for error as a result and manual entry and mistyping things and it's like, wow. So there's still a lot of basic stuff we need to get done, to your point, and at the same time be both. So I always say, you know, you gotta always be in the future and doing very futuristic things, but at the same time, you gotta make sure the basics are taken care of, especially when it comes to nursing so that we can help with the burnout, the shortage. And then, you know, most importantly, like you mentioned, you know, the violence in the workplace, like what can we do? So this has been super informative, Sarita. I know we could go on a lot longer going more in depth, but if you had one last thing to share, maybe something we already covered or something that we didn't cover yet, what would you say to our audience? What else can you share with us?

I would say that usually when a crisis presents itself, innovation surfaces, right? And now is our time. To take advantage of just how vulnerable we are right now in healthcare. And I think that no idea should be taken off of the table. We really have to look at how we're going to change the way we do our work in healthcare, how we're going to take the burden off of our providers. And I do think that technology can help with that if we do it right. As you've mentioned, over the years, We put all this great technology in place thinking, oh, look, we've given you something fantastic. But yeah, it doesn't talk to anything. So it's fantastic, but not fantastic by itself. So we have to really think about that and we have to ensure we're engaging the right people as well. So those frontline nurses and those physicians and other healthcare workers are really going to be the ones to provide those insights.

That's a really important point, Serena. I've always been a major advocate of making sure, if you're leading tech or digital, a good portion of your team better be clinical. I used to pride myself on 25% of my team were nurses, pharmacists, lab techs, radiologists, a couple of doctors, and they were the key because, yeah, we can think of great solutions from a tech standpoint, but we might be adding to the burden of nursing, which is I think is what we've done in the past. I think we're smarter now and getting smarter, but it's thanks to people like yourself providing some additional input and giving us a little bit more clarity in terms of the future. Surya, I just want to say thank you on behalf of our audience and Digital Voices for all that you do as a nurse, as a leader, and helping other nurses and advocating for them. Again, I have a heavy bias because my wife herself is a Texas nurse. But really believe in all that you do and helping to save lives and bring comfort to those who are are not doing so well. So thank you for all that and for being on our show.

Well, thank you. I appreciate you having me, and I hope we can talk again soon.

Yes, no doubt. And that concludes Digital Voices. Thank you for listening to Digital Voices Podcast with Ed Marks. If you enjoyed this episode, subscribe on your. preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.