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

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.

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?

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.

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.

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.

Lisbeth Votruba: Thank you.

Bill Russell: I.

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