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Keynote: Implementing Strategy, Leadership and Technology with a Chief Nursing Informatics Officer
Episode 55628th October 2022 • This Week Health: Conference • This Week Health
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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

At the end of the day, IT is a foundation. No one can do anything without the technology today. You can't take care of patients without understanding it, leveraging it, et cetera. And that's really why the CNIO has become such an important role.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

Today we're joined by Rosemary Ventura, Chief Nursing Information Officer at University of Rochester Medical Center, and I'm looking forward to this conversation so much that's going on in healthcare, and I'm just excited to have you on the show. Rosemary, thank you for being on the show.

Well, thank you for inviting me. I'm excited to be here.

I'm trying, Well, my commitment this year was to have more cno. On the show because we do interviews at the intersection of technology and healthcare, and no one lives there a as much as the CNIs. I mean, you're, you're right there at that intersection.

But before we go too far in the interview my listeners have reminded me over and over again, hey, have them tell us about their health system. Don't assume we know about it. So tell us about the about the University of Rochester Medical Center.

It's actually an interesting place and hear me out here. The University of Rochester, actually, in terms of the medical center, we still have an alliance to the university. So many organizations. Were one of only a few across the country that still have this structure because most organizations universities are on their own and the medical center is independent, but here it's all one. And so we roll into the university. So I see your reaction. You can probably tell there's, there's challenges.

No, I look, I, I've interviewed so many people and the structures are very interesting and sometimes that's a, a really awesome connection and there's value to it. And then other times there's bureaucracy associated with it that makes it a little harder to get things.

Both things are true, but it is, it is an interesting dynamic, especially for me. I've never worked in another organization that's structured this way, but at the end of the day, it's a humongous organization. We are the fifth largest employer. In New York state, which I don't think a lot of people realize we're in the Rochester region.

C N I O. And so we have about:

So it's quite large. And geographically, we our. Is in Rochester, but we have organizations or three hospitals that also are in the southern region of, of Western New York. And so it's a large space. But I guess if you talk about other organizations that have multi-state, et cetera, places, we're all in New York State.

So are you you consider. Urban or rural or both?

We have everything. One of our hospitals, I remember when I first came here, cuz I, I came from New York City One hospital itself, it's a critical access hospital is 15 beds. When Soma told me that, I was like, That can't be right. I'm like, What do you mean it's 15?

That's absolutely right. Yeah. You came from New York Presbyterian. How does the structure structure a little different at New York Presbyterian than it is in Rochester? ,

it's different in, in many ways the affiliations within the six hospitals. So one hospital, I said, I mentioned the smallest one here, the largest one's, 886, our flagship academic medical center hospital. And so, They're also affiliated differently. Meaning the politics of behind everything versus New York Presbyterian, which is one really, one we're all under the same umbrella, the same licensing, et cetera, et cetera.

That's different here. And then obviously the setting is quite different. N Y P is really all urban, all in the city, all of that sort of stuff. Even their smaller community hospital was almost 200. Where here the landscape is very different, where we are very in very rural areas, which just brings different challenges when you're trying to deliver healthcare in those smaller areas that are not as financially well off and sort of supported from a budgetary perspective. So you gotta be more creative almost. Yeah. When you're thinking about how to deliver healthcare in those rural area.

I was gonna ask you some of the demographics, but talk to me about the CNIO role at Rochester Medical Center. what's the focus of your role? What's the area that you focus in on?

It's all strategy. And so certainly at this, at this level, you are sort of that partner because it's quite funny. I didn't, I didn't do this on purpose, but right behind me, you'll see the strategic plan for nursing because at the end of the day, it is a foundation, I'm sure in your role, you've heard this over and over again. No one can do anything without the technology today. You can't take care of patients without understanding it, leveraging it, et cetera. And so I was fortunate in that this position didn't exist only three years ago. So I'm the first to have the position here, and it was because we got a new chief nurse at the enterprise level who said, I need that strategic partner.

Because she said I'd rather poke my eye out than do IT work. I repeat her. I repeat her all the time because at the end of the day, it is true. The CNIO owns these divisions, these nurses, that operational sort of component of the medical center. It shouldn't be. Their part-time job. They need that expert to really do that.

And that's really why the CNIO has become such an important role and it's become much more pervasive and popular, if you will, and funded most especially in larger in larger organizations. And so my job day to day is to really support that strategic plan. Make sure I'm working on the programs, the projects that at an enterprise level have the most importance and have been prioritized by our senior leadership. Yeah.

So, so is that plan. That's behind you. If people are listening on the podcast, I'm pointing to a plan behind her cuz it's right over her left shoulder. I'm sure when somebody sits in your office, they see that plan. Is that the nursing plan or is that the system strategic plan?

This is actually the nursing plan. Wow. Which is interesting because part of what I then need to do is how do I balance the work of me and my team to drive the nursing plan? As well as strategic initiatives for the organization. Back to your question, so what's the overall mission? How does this fit into the overall mission and goals for the entire organization?

They have to be in sync and we have to sort of leverage or I should say, understand our resources and prioritize. Because sometimes it's hard to get everything done, but certainly they, most of the time they're in concert anyway. So what's gonna need be, need to be done here then feeds that larger organizational plan.

That's an understatement. It's hard to get everything done. It's impossible to get everything done. The needs within a health system are almost insatiable. So what kind of things show up on a nurse strategic plan? Just a high level.

So one of the things is improve. I'll read it right here. Thank God I pulled it up cuz I can ask, see back there. Improve workforce safety, efficiency, and flow. So you talk about our workforce, I mean, it is, you can't talk to one CNIO today Or anyone without talking about the shortage in nurses and we don't have enough staff. We have to close beds. I mean, the cascade effect on these organizations is humongous.

And so my role is to look at that plan and be like, Well, what can I do? What can I do as a CNIO in partnership with it? Right? Because they look to us and be like, Whoa, what can we do for nursing? I'm like, Well, let me think about this. And so we think about things like tele sitter, which is something we stood up this year.

Because you're talking about flow, you're talking about workforce shortages, things of that nature. And so that's just one example of what you'll find in that plan. The other thing is like recruitment and retention. How do we as a nursing leader, keep the staff that we have? And funny enough, they'll turn around and one of the most important things that I'm working on right now came from my CNE that said, Rosemary, I need my nurses to have the best things possible from a technology perspective to support their practice, to keep them here so they don't walk across the street or they don't go to a traveling agency because they want, they need to want to work.

here And so we've talked a lot about modernizing some of the infrastructure or the technologies we've had that may have been put on the back burner from a budgetary perspective. Cio, it's technology's expensive. And sometimes unless you have a catapult, or something that really makes it come and be mandatory that we do it, it's put off.

Yeah, no, absolutely. It's interesting. You are absolutely correct. There isn't a group of leaders within healthcare that we get together now that is not talking. The workforce challenges that exist and it's across the board, it's, it staff, it's nursing, it's doctors. there was a survey done by the Bain Corporation and it said it, it's crazy.

25% of clinicians want out of healthcare. That's not, Hey, I wanna leave and go to a different organization. They want out of healthcare completely. That's a challenging. What kind of things can we do from an IT perspective? And I realize that there's an awful lot of things that go into the dissatisfaction and burn out and that's going on. But the percentage that, is it related? Can we simplify the documentation? What kind of things can.

A hundred percent. I mean, that's one of the top priorities. We've been talking about this at least in the nursing world for a long time. But guess what happens? It gets back burnered because who wants to clean all that up?

I'm telling you, it is a lot of work that needs to be done. And you know what the sort of the factor, the the biggest factor that we need to overcome is our own fear. Bill, because remember, we document, it's all cya. And so for you to take out something and then we always practice under the model of if you didn't document it, you didn't do it right.

And now to change that because we're so fearful of litigation, of regulatory requirements of all these agencies and all of that, that stuff around us, we've just created. A real challenge for ourselves in terms of documentation and being able to scale back. So it's hard to get people to take things out.

e list of what's happening in:

The documentation burden and optimizing documentation in the record. Because one of the things a lot of, I went to an academy event last week, funny enough to, of CNIs there we're all talking the same thing about how do we get over this? But one of the things that people are trying to understand is not only can we get rid of that stuff, they bring up the point that during the pandemic, A lot of those regulatory requirements were alleviated, right?

So you don't need to fill out a hundred workflow sheet rows because we know people are busy. We don't have nurses all that. So now everybody's like, Well, that's sort of state of the pandemic is over. We need to go back to our normal. And people are asking the question, Well, why? If you didn't see this, if we didn't document this in the chart, we took care of our patients, our outcomes looked great, things were still happening.

Why do we have to put it back? And so it, I don't know if we're just like if we are afraid that something's gonna happen, and it's always that one bad thing happens and then everything is just like, forget it. We have to we have to support that one bad thing, versus 99% of the time it's not gonna happen.

So I think that's really the fear here is that those days will be over and we will be insisted upon to go back to those regulatory requirements that are so, And so I'm trying to, and a lot of the CNIs I spoke to are trying to fight that to be like, if it wasn't necessary, demonstrate to us now that it has to be that we go back to that.

📍 📍 we'll return to our show in just a moment. I wanted to take a second to share our upcoming webinar. Cyber Insecurity in Healthcare, the cost and impact on patient safety and care. Cyber Criminals have shut down clinical trials and treatment studies cut off hospitals, access to patient records demanding. Multimillion dollar ransoms for their return. Our webinar will discuss it. Budgeting project priority, and in distress communication amongst other things. To serve our patients affected by cyber criminals. Join us on November 3rd for this critical conversation. You can register on our website this week, health.com. Click on the upcoming webinar section in the top right hand corner. I look forward to seeing you there.

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It's interesting, I'm looking at those six pillars behind you. Yeah. And one of the first things that we, we've already talked about the amount of work that needs to be done. How does the governance process work at your health system? How do you determine what we are going to work on? 4 20, 23 and then stay that course cuz there's always something else popping.

Yep. So there's two really important structures that we have here in terms of governance. One is the IT governance itself, and so in partnership with our CIOs here, the CMIO and our sort of senior leadership team, we have these advisory councils, which I'm sure is. Familiar maybe to you and your, and your audience here where we have a number of, We have about eight advisory councils depending on one is analytics, one is clinical, one deals with business systems, and we bring.

Proposals to those groups to say, meeting somebody puts in an idea, you know this, Oh, I would love to bring in a new AI system to help the doctors in the or. Ooh, sounds wonderful. Right? . So those sort of clinical stakeholders have to present. In that case, it's a clinical person would have to present their proposal.

And it gets on, it gets vetted through a project management office, which is also extremely important part of governance, which is you gotta fill out the forms that say, what is this for? Who's it gonna impact? Do you have a budget? All of those things. But depending on the project, it'll go to one of those advisory councils, so the senior leaders there will be like, Yeah, this looks like something we should do.

One of the most important steps that we've taken is to consider these enterprise. So if you're bringing a proposal, it's gotta scale. We can no longer just have these systems that

have one in one hospital and one in the next, and one in the. Yes. That that's death at this point.

Yeah. And they all do the same thing, of course. And so we've taken that out of the equation at this point. But that's been extremely successful because then the leaders will say, And you know how it is, we don't have enough IT staff either. So their time is extremely valuable. So their leaders the senior leaders in it will say, Well, this is the.

What comes off or what gets moved if you need something to be put to the top. And so we have those crucial conversations and in general it works out well, but sometimes things happen and you have to bump something down, but that's why you have governance.

Yeah, I've, I've never had anyone walk had that question and sit there and go, Our governance process is perfect. Let me tell you how it works because it's, it's, it's people. Discussing priorities based on limited resources, either time, talent or money. you don't have unlimited amounts of those things. And actually what we've proven is when we do have unlimited amounts of those things, we do silly stuff.

It's interesting. During the pandemic, one of the things I heard over and over again from leaders within health systems I mean, clearly the pandemic was terrible and challenging in, in many ways, but they said the one thing it did give us was focus and we were able to accomplish an awful lot in a very short period of time because we were so focused.

There was a governance was essentially, is that necessary to address this problem? And if it do, if it wasn't, it was like, yeah, just. But that outside, we'll come back to that later. did, Did you find that to be true? And, and, and if it was, how do you keep that sort of sense of, No, this, this is what's important.

I think for us it might be different because thank goodness during that time we had the structure to say it doesn't matter, like we have to realign the priorities of work during this time. And it was great because there was transparency of what that. It's very difficult. You talk about crucial conversations and competing for priorities.

Try doing that with multiple COOs that have their I really need this from my organization. It because it's different. It might be a different patient population, it, whatever it is, and then you're just on a list. A master list of things. And so it is very difficult when you're trying to prioritize and have those conversations.

But back to your point, the only way that it worked during the pandemic or why it was so good to have that support of that governance structure was because they could see everything oftentimes. I don't know if you've experienced this yourself, but people felt like there was a black hole whenever you contacted.

It or they didn't know where their stuff was. Like I asked for this. It's like I asked for that nine months ago, where is all of this? And this actually allowed a, a lot of the senior leadership to say, It's okay, this can get moved down because we need to prioritize these things during the pandemic.

And that went through. Certainly we weren't meeting as often and that's okay. But the work was continuing because we had to flex and then move towards those priorities and other things just had to be put on the back burner. But I have to tell you, that's caught up to us now because I. Post that time, I can't tell you, like this year it has been, we have to catch up on a lot of the initiatives that we had been trying to do, and the pandemic stopped, right?

Because we had to shift everything. And so this year has been really challenging to get everything done and, and prepare us for our strategic plan and put us back on track to where we wanted to.

let's talk about patients. The nurses interact with the patients so so closely in their day to day operation. Is there a part of the it strategic plan, part of the nurse strategic plan that has to deal with the patient experience and how we interact with the patients, how they experience the health system or how they flow through the health system.

Yeah, I mean here we're fortunate in that it's such a pillar, patient centered care. It's actually in that strategic, one of the pillars there because we really, we have a patient chief patient experience officer. I probably, but butchered that title, but someone in that sort of physician is a physician really looking. All of our technologies through that lens. And not just technology, but how does the patient experience our delivery of healthcare holistically?

And so I think it's been extremely valuable to have that person, because part of the thing is we talked a lot this year about access, having the front, digital, front door, making it easier for patients. I can't tell you how challenging it. To get our organization because we're very conservative.

To even open the digital front door for physicians to open their schedules was extremely like, What? I don't want that. It's gonna create chaos, et cetera. But we were able to really demonstrate that these, this is what our patients have told us. That they want, that would make their lives easier.

They, they want telemedicine, they want these conveniences, and we needed to figure out how to do that. That's really driven a lot of the progress that we've made in those digital spaces because a lot of the reluctance was on the part of the provider. And I'm not picking on physicians. It was even our nursing staff that when we talked about info blocking, I don't know if you, you probably talked about this on your show, The fear when I had to go tell those nurses that their notes were going to be shared with their patients. It was a lot of trepidation and it's a lot of education on our part, but we really, once again, have to go back to the patient is the center of what we do. This is their medical record, their part of our care team. And it's really delivering that message through that lens.

Yeah, I've sat in some of those conversations. It's not invalid to say, Hey, they're not gonna understand this note. They're going to misconstrue this. I mean, it's not, those are true. I mean, if, if the average person reads the note, they're gonna be like, I have no idea what this means. I get that and I understand that on the, on the flip side it is about my health.

And this, it's like the patients are like, I want the record. They don't necessarily know what's in it, but they want the record and it's going to. hopefully get them more engaged to ask the questions of, Hey, what, what does this mean in my note?

Right? And because ultimately in the end, it's gonna be benefit us for that patient to remain healthy, to be active in their healthcare. We talked about health home and programs like that. Keeping patients out of the, the hospital cuz we don't have beds quite frankly. But it really is all related. And my role is to put those pieces together for our bedside nurses who may not understand, they may be six months out of nursing school and don't understand why the patients are gonna have access, and now we're gonna actually ask more questions.

And so I think it's been enlightening to, to be able to tell people that story and once again, bringing it right back. The heart that our nurses and our providers have, which is really about delivering good patient care.

Let's go back to, it's probably not a topic you want to keep going back to, but the shortage of staff. And so I've, I've heard turnover rates at it's some systems pretty serious and I've heard some number of openings were pretty serious. Like we just can't find candidates to fill. The openings, How do you for, So let's focus in on the IT problem We're not gonna focus in on, Hey, how you gonna solve this problem?

Because we're all trying to solve this problem in some way. We have to source more people, we have to train more people. But from an IT standpoint, from a technology standpoint, how do we bring nurses right out of school and get them more? just get them ready to use the system and, and operating at the, their highest productivity as quickly as possible.

It's funny cuz I wrote that one down cuz I knew you were gonna be asked how are we, what are we looking at in terms of wellness? It's also in terms of onboarding, because you're a hundred percent right during this, this pandemic, it was like, the nurses hired today or outta school today, they gotta be productive tomorrow.

It's no more six months of orientation. We don't have preceptors. So how do we support them? To your point, I think what we've done is really think about what can we put in their hands quickly? Everybody's got a smartphone, What resources were available to them as reminders of, this is how you put in a Foley catheter or things of that nature.

So how do we provide them tidbits of education that are really focused on the topic of the day or the topic that's relevant to them? And the other thing we've been thinking about, is Almost different care delivery models or this, this topic of virtual nurse because of what a lot of people have been successful.

We haven't implemented this here, but we are thinking about it because if you have people that remember were trying to get out of the profession, they're tired. They're like, I can't do this anymore. I can't, I'm burnt out. We're trying to not let them leave and maybe putting them in as a resource.

So if you have that new nurse that's just hired that is like, I need help with something, this is like their virtual nurse that they can call. So it's services, it's an an economy of scale. It could be for all six hospitals. You have that nurse that has enough knowledge to walk you through something and things of that nature.

to Support you we're looking at putting in technology for that, because we have the cameras, we have those mobile sort of units. And so, so thinking about that along with how do we, what does the actual onboarding program of our EHR look like? What are we teaching these nurses during the pandemic? I have to tell you, we did a 180.

So let's say for example, when you started Orienta, your first week of hospital employment, you had to go to eight hours. Of EHR training. So the full day, Oh no. Nursing during the panel was like, I can't spare these people eight hours and think about sparing a traveler eight hours. You're paying these people like premium dollars.

They were like, No way. They have to be on the floor. So we did a 180. We put them into two hours of training, cut that back. But now we're realizing that that was probably too much on the other side where they're not supported enough. So we're gonna bring that back to, I think maybe somewhere more in the middle.

What's your EHR at this point? Epic. Right? So you're epic. I mean, at this point, when you're bringing in a traveler, I, I realize that every build is a little different. But if we're getting closer and closer to found, Yeah, most of these health systems, you would think we're getting closer to a point where they come in and they know how to use the system.

Yeah, you would think so. While we did it , we, One thing is you can test out because you're, you're sort of, the path that you take in your reasoning makes complete sense, right? So if I worked across the street yesterday, I'm coming in today, I should be able to use this instance of Epic so they can test.

So that's wonderful. If they pass the test, they're up and running. They're, they're around tomorrow. A lot of what is challenging is that, you said a key word, you said foundation. We're 11 years into Epic. We veered our foundation in some of the cases. I mean, certainly you could say a flow sheet's. A flow sheet, yes.

But I think it's the nuances of some of the more challenging clinical work. Flows that they don't understand. So we've developed highly specialized protocols for like heparin and other medications. Like they just don't know. And those are the details that is difficult for those nurses to learn.

I thought I heard you say we don't have any rooms. Is that, so the hospital's pretty full. Are you guys gonna build a new building? Are you doing hospital at home? What direction are you going? Buildings are full.

We are. So we everybody's talking about the we should be focused on home and keeping patients at home. That's great. Yes, that's true. But we still don't even have enough acute capacity. So we currently, and those projects were already underway prior. Prior to the pandemic. This has just been augmented now. Two new towers. One for our flagship in Rochester. Strong Memorial Hospital as well as then another one for our Highland Hospital campus.

Wow. How do you get involved in those, the new building projects? I, it's interesting cuz you don't do those all that often, so when they come down, it's sort of like, All right, I don't even know what I need to know. I mean, how are you involved in those?

It's interesting because we wanna make sure one of our models, especially for me, along with I S D or it is that if I have a nurse that practices in location, They should have the same technology as the nurse that may practice in location two in the southern region.

Yeah, but that's hard. It's hard. You're, you're getting this new building where you get all the brand new stuff and now you have multiple versions of things in different things at different hospitals.

We're running into that because you wanna be future thinking or thoughtful about what is this hospital, It takes five years to build it, or I'm, I'm being sarcastic.

It takes all of this time to build and the technology's evolving so quickly, it's really hard to predict. Based off of a potential future, what should be in there other than the standard. You gotta have access to the EHR and make it as easy as possible. , because some of those really, those ancillary like devices and things of that nature, it's, it's really challenging.

So we're doing our best right now to be forward thinking but really understanding what are the key or core foundations that has to be in there and standardizing those. So your bedside monitors. Don't go out and buy another vendor. Here's the one that we have most of.

Well, as you're building the new building, it's sort of a greenfield experience you get to Yes.

What's the coolest thing that you're looking at that's maybe that you feel like is gonna have the most impact on a. On a nurse's life,

I think one of the cool things is trying to use more voice. This might sound, you're gonna be like, Rosemary, we've been doing that forever. We're not in the nursing space.

We don't use voice a lot or dictation or any of those types of technologies that providers have. Forever. We don't. And so I think one of the things that would be interesting is if we could alleviate you talk about documentation burden, if we could alleviate some of that using some of those technologies.

And then the other one that is really exciting, I'm hoping we can get there. So we're not there yet, is really using some of that ai, or AI I should say to start augmenting the work that these nurses are doing because, They're not practicing at the top of their license and they're overburdened. They are just in cognitive overload all the time.

Think about it. Their ratios have gone way higher. They're taking care of more patients. You can't think the same. And an ehr alert. That's not gonna help me in this space. That's one thing. Don't get me wrong. Clinical decision support's important, but I'm talking about things that are much more predictive, can be much more helpful.

And also in a space that not a lot of people traditionally think about is more in the administrative pieces of the aspect of our work. Meaning like, can I do. Better at scheduling. Can I do better at finding equipment or dumb stuff like that. The nurses constantly are chasing their tail around. That would help a lot because then they could focus on the clinical.

yeah, it's really interesting the voice aspect of it. I was not, I'm one of those people who falls into a bad category here. I was not as aware of the fact as we have been doing clinical documentation for years on these, on these systems, and I wasn't aware of how deficient we've been in advancing that, the use of that technology in the nursing staff.

I, I, I just assumed that it was happening and the vocabularies and the stuff have not kept up and the technology, so hopefully we'll, some investment there. I think there's some things around cameras and AI as well that are gonna be pretty interesting. Let me ask you this. So you've been a CNO at two prestigious health systems.

There's gotta be somebody watching this right now who's saying, How do I get that role? I mean, what prepares you for that role? How do they get that role for a nurse who's listening to this going, she, she's got the role I.

It's so interesting because I've been in h I T now, if you think about it for almost 20 years, but it's much more prevalent and, and I wanna say easier, but there's more access to doing informatics because that's really the specialty is nursing informatics.

And quite frankly, a lot of nurses don't know about it, so I'm so glad that you asked this. They're like, What is that? I think we're getting smarter in terms of incorporating informatics into schools and curriculum because it's a foundation already. I mean, they learn to use Epic or other EHRs in school.

And so there's that sort of presentation of this is an aspect of nursing. You can. Over early on, and then in organizations such as mine you can get a Master's in nursing informatics or you can be part of the governance structure that supports these these systems. Because at the end of the day, I can't make changes that Rosemary thinks are good.

We have to go to the bedside nurses and understand how they're using things. How do you how can we improve this? And that really comes from them. And so it's really developing a partnership with our nurses, mentoring them. Maybe they don't know what they wanna do. Bill, I thought I was gonna become a nurse practitioner.

I fell into this completely by. And I was like, Oh, this is kind of cool. But it's really starting that and it's building relationships with our program directors, our nursing informatics and really get. Building a mentorship, as I mentioned. And I think that's the way to introduce our nurses to it.

Because you're right, some of them are like, I don't know what to do in my life. I don't wanna be a nurse manager. That's kind of hard too, and we don't want them to leave. And so if there is interest, this is another career path for you. And I think that's really our job is to promote that. A lot of 'em don't know.

And you're the person who stands between two worlds. Yeah. The nursing world and the IT world. And you have to speak both languages. So you're, you're bilingual if you will. You speak nursing, you speak you speak it. And and there, there is vocabulary in both of them. I come from the IT side and when I started talking to nurses, I, there's the whole bunch of things that I had to learn and doctors and clinicians as well.

But same thing on the, in the other direction, it's, it's saying, No, no, I know what you're asking for. Sounds simple. Change this box. Let me tell you what that means over here. It means we just changed these 15 things which implement, which has now impacted these 55 reports, which now has impacted the you just, and they sit there and go. Oh really? Well, like can you just put that box in there and not impact those reports? No, ,

I've said that before. it's so funny. It's probably like we've had these discussions probably at least a million times in our careers, and you're a hundred percent right. Sometimes it's telling nursing no, sometimes it's telling it no.

But I really believe that skill set is so important because I can't tell you how many. Someone has thought that they're saying the same thing. They're, they're having the same discussion and the outcomes, what they walk away with is completely different. Right. Yeah. And I'm like, it's our job to tell it.

So I say tell it like it is. So you gotta speak their language and translate it in both realms and it takes a long time to learn that. And it's, it's exciting both ways because sometimes I get tired of talking clinical and talking about I said bullies and Happys and all that other stuff. And on the other side, I get tired of talking about servers and access and security. .

Yes. No, I understand. Rosemary, phenomenal conversation. I really appreciate you coming on the show, sharing your wisdom with the community. It's greatly appreciated and hopefully we will run into each other in, in, in person, actually see each other at some point in the future.

And you know what, what's interesting about that, Rosemary, I did so many interviews through the pandemic and then I went to my first conference post pandemic, and these people were walking up to me and I'm looking at 'em. I know you . I just, I, and they, they just looked at me like, I was on your show. We let me like, talk via Zoom. I'm like, I'm sure we did, but I just, I don't know. It's just, it's interesting. This 2D aspect is not as not as true to life as you would think it is. It's,

it wasn't just you. Bill, I think I will tell you when you meet me, I'm taller on Zoom. That's my new joke. , I'm taller on Zoom.

Yes. But thank you. Yes, and I'm thinner on Zoom, so it works out pretty well. Rosemary, thank you for your time. Really appreciate it.

Thank you so much. Awesome to 📍 be here.

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