Bridging the Gap Between Nursing Education and Clinical Practice - Dr. Lisa Beals, Nursing Department Chair at Missouri Southern State University

Hillary Acer: Hi, I'm Hillary Acer welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. Today I'm happy to welcome Dr. Lisa Beals, the Nursing Department Chair at Missouri Southern State University, to learn about that program and get her perspective on challenges and opportunities in nursing education. 

Dr. Beals brings thirty-plus years of nursing experience, a master's degree, and a doctor of nursing practice to the role, which she assumed three and a half years ago. She also has a special research interest in simulation in nursing education, which we look forward to exploring with her. 

Thanks so much for being with us today, Dr. Beals. 

Dr. Lisa Beals: Thank you so much for the invitation.

Hillary: I'd like to start with learning more about you and what first got you interested in health care and particularly nursing. 

Dr. Beals: Well, as you relayed in that very nicely done introduction, I started in healthcare about thirty-four years ago actually -- way back in the 90s, if you can imagine that. I actually thought about this question...what piqued my interest in healthcare in general? And I would think it would have to be I had an interest piqued when I was a young kid. My parents took me to the movie The Fantastic Voyage. I don't know if you know that movie, but it's where they miniaturized a team and they went into the body and explored the body and all of that, and that really piqued my interest in learning about the body. 

Then, I went on to complete my undergraduate degree in biology and chemistry, and from there, I started working actually as a certified nursing assistant. I think that's really when my interest in nursing kind of came to fruition, working with that population of patients. So, I went on to get my degree in nursing and, of course went on to finish that on out with my doctorate in nursing practice. 

Hillary: Wow, what a journey! I'm not familiar with Fantastic Voyage, but I do recall getting inspired by TheMagic School Bus and Mrs. Frizzle going on several, inter-body explorations. So, I love that and yeah, you've had quite an amazing career. In fact, you've spent many years as a medical surgical nurse caring for patients before and after procedures. What drew you to that particular work?

Dr. Beals: Well, I think I knew where I wanted to start out in my practice, and that was absolutely at the bedside. I started out in a small rural hospital of about seventy beds and caring for patients. Mind you, this was back in the early 90s. From there, I just kind of progressed after I got some experience and actually ended my private sector career in the operating room. 

That's where I started to think about, well, what are the next steps for me, and ended up going back to school for my graduate work and worked actually as a clinical adjunct instructor.

Hillary: Thanks for sharing that, and I would love to actually just double click on your work in a rural hospital and how that may be different, or what some of those unique challenges might have been. Can you elaborate on that?

Dr. Beals: Absolutely, yes. I've actually experienced both working in a rural hospital and working in larger urban type hospital. And definitely there are challenges working in a rural hospital in terms of access to resources, not only for clinicians, but, for patients too. I think that's in the forefront nowadays in healthcare is, how to bridge that gap in terms of providing patient care in rural settings that will help their health and preventative health and on down the road. So, yeah, a lot of challenges being a nurse in a rural setting.

That actually brings to mind a memory that I have, back in the day...if you were the nurse on the med surge floor, you were it. You were there preparing medicines as, the pharmacy would nowadays, and just had to kind of be an expert on a lot of different things from emergency care to even obstetrical care. I remember having to go back and help with that as well when I was caring for patients on a medical surgical floor. Nowadays, that hospital has grown and become a fabulous center for the community where it's at, and I feel so fortunate to having started my career in that area. 

Hillary: It sounds like it gave you such a wide range of experiences and probably maybe more than you actually bargained for at times given some of the resource restraints.

Dr. Beals: Yes, absolutely. 

Hillary: I actually grew up in a fairly small town in Arizona, so I have a lot of respect for healthcare workers who do that work in rural settings, knowing how expansive their roles can, can get, depending on the resources. So, that's great. You mentioned also being a clinical adjunct instructor kind of later on in your career. How did you first get involved with nursing education and what are some of the highlights of working in that field over the past dozen years or so?

Dr. Beals: So that's a great question and that also kind of brings to the forefront and memory I have of working on that med surge floor. When I was early on in my career, I advanced to the level of a charge nurse pretty quickly and with that role, I actually mentored a lot of new graduates that would come on. I worked the 3-11pm shift. Of course, there's not too many places that have that shift anymore -- it's all twelve-hour shifts -- but I had just a great group of new graduates and mentored them in their, initial journey into nursing. That kind of piqued my interest with education and nursing education in particular. I would think that's probably where it all began, actually.

Hillary: It sounds like that was pretty fulfilling for you to mentor some of these new graduates. Is there anything in particular that you homed in on or maybe a certain wisdom that you passed along to them?

Dr. Beals: I think probably their desire to learn and to continue learning. A lot of times when you get out of school it’s like, ‘I am done with learning’ and that couldn’t be further from the truth in healthcare. I mean, you're constantly learning. Even up to now, I'm learning every day. Technology has advanced so, so much. I still have contact with that group of wonderful nurses on occasion and just their desire to help people and to learn and to be excited about that, I think was the highlight of that experience.

Hillary: It sounds like you had a pretty enormous impact on them. I'd love to come back to your mention of technology in just a little bit since that is exploding and that's one of the areas that we intersect with is trying to help revolutionize health education, patient education and make sure that it's more accessible. But before we get there, I'd love to get an overview of Missouri Southern State University's nursing program and what you think its strengths are. 

Dr. Beals: Yeah, Missouri Southern State University is actually located in Southwest Missouri in the town of Joplin. We probably don't have enough time for me to go through all of the great things that are happening here, and particularly in the nursing program. 

I think probably the strengths that we have as a program and as a university is our commitment to fostering a culture of caring... supporting students in whatever degree path that they choose in the nursing department, in particular, working with a fabulous group of faculty that, really care about student success and know how tough it is to go through nursing school. 

We have three programs. We have the traditional baccalaureate program; we have an LPN to BSN bridge; and then we have an online RN to BSN program that helps to support those nurses that maybe graduate with an associate degree or diploma degree but want to continue their education. I think just being in such a supportive environment can definitely impact student learning and their confidence levels in progressing in their plan of study. 

Hillary: I'm so glad you mentioned that that. A safe learning environment is so important for students and I'm curious just how you and your fellow faculty foster that culture of caring and if there's anything unique to how you approach your students or how you support them that we could highlight here? 

Dr. Beals: Well, one of our missions in the program and the department is to foster that relationship-building component of faculty to student interaction that, we're here to help them, to support them in whatever way that we can knowing that they face so many challenges, particularly now, to further their education and to enter into such a wonderful profession as nursing. Being there for them day in and day out pretty much seven days a week -- even though they probably wouldn't want me to say that publicly -- but they are there behind them 100% all the way in helping them to succeed. 

Hillary: Sounds like an amazing dedication that you and your faculty have to your students, and I love that you mentioned this relationship-building. It's actually something that Osmosis and our team has really focused on over the last several years, especially in a remote environment. We actually have trainings on how to foster relationships and we also really try to tie in our six core values, one of which -- and my favorite value -- is Start with the Heart, which really points to cultivating that culture of caring and compassion and empathy. So, there's a lot of alignment between our cultures, it sounds, and I'm really glad to hear that. It's kind of spreading throughout the education space, which I think has been more competitive and maybe cutthroat, and as you mentioned, our students are facing a number of new challenges today than they have in the past. So, congratulations to you and your team for doing great work. 

Dr. Beals: Absolutely. Thank you for that.

Hillary: Now, your program offers immersive learning opportunities. Can you give us some examples of those and how they impact your students? 

Dr. Beals: Absolutely. I think faculty in the department as a whole are really dedicated to trying to bridge that academic practice gap that is pretty prevalent even though active learning is growing in momentum, by incorporating such things as escape rooms and taking students into simulation. We have a wide variety of clinical sites that, help students to really build context. 

I would say at the core, that's one of the key things for students is building that context and, situational type learning of different situations in caring for patients. A lot of classes do the flipped classroom approach with audiovisual technology, and then our most recent immersive learning opportunity revolves around virtual reality and using that in simulation.

Hillary: I'm so glad you mentioned that. First of all, it sounds very creative, and you've got a really enriched learning environment that you're providing to your students across all these different opportunities... simulations, virtual reality, early clinical exposure and so on. But I'd love to double down on the high-fidelity simulations and kind of audiovisual technology and learning. 

In fact, you did some really early research and potentially ahead of its time research on this space in particular. Can you give us some highlights of what your research found and how it's now being implemented?

Dr. Beals: Yeah. So, you absolutely hit the nail on the head. I was pretty early in starting to think about how we could use audiovisual technology to enhance student learning and particularly to enhance their confidence in performing essential nursing skills, such as physical assessment, both in the clinical setting and in high fidelity simulation. That's the focus of my research. It was a quasi-experimental research study. And I found that definitely, there was significance in having students record themselves completing a physical assessment, watching that recording, developing those self-reflective skills -- which is very important if you're going to be providing mindful care for patients -- and then going into the high-fidelity simulation and performing that same skill and then on into clinical. So, almost like tiered approach. 

So, yeah, that was a very early use of audiovisual technology and how we're implementing it today at Missouri Southern is our students continue to record essential skills and be reflective, even do peer review. Faculty have the ability to give annotated feedback in the video. It's just like a constant motion or cycle of feedback, which the literature speaks to of being so important to develop student learning. 

Hillary: Wow, Dr. Beal, some would call you a pioneer in this space. It sounds like this program has really grown and expanded. For our listeners, we actually work with a number of institutions and universities and academic centers around the globe. What can they learn from Missouri Southern? Is there any advice that you would give to maybe other programs that are looking to enhance their audiovisual learning or simulation programs or things like that? 

Dr. Beals: That's a great question and I would think probably the key thing would be to not suppress your creative side. Think about things in different ways of how you can approach using audiovisual technology to help students, which will eventually help patients in the long run, to be that influence to use innovation and not be afraid of that, so to speak. A lot of people say, ‘oh, I'm afraid to use technology, or maybe I'm not, up to speed on certain technologies.’ Well, you'll never know how good you can get until you try. 

Hillary: That's great advice, leaning into that creative side. And it sounds like maybe even experimentation with the programs that you're developing, and maybe in collaboration with faculty and students as well. So, we'll definitely pass that along to our other partner schools and encourage them to learn from you all. 

On a similar note, we've seen this real explosion of artificial intelligence. Can you speak to the impact AI is having on nursing education and perhaps how you're preparing your students for practicing in an environment in which AI is being utilized for things like diagnostic support among many other applications? 

Dr. Beals: Yeah, so the impact of AI...I don't think we fully know what that's going to be yet in nursing education. I think it's kind of evolving as we learn more about using AI as a tool. I think we have to be very careful in going forward, in terms of protecting such things as student privacy. But definitely, like any tool, you can use it for good or maybe not use it for good things. But, I think using it as a tool and being very careful in how you apply it as a tool can definitely help both students and faculty. 

For example, with nursing education and helping offload some of that work that faculty do to AI might be an important part of that. I think it's a really important use of that tool. And of course, in healthcare, I think AI is just exploding, like you said, with diagnostic support and facilitating how we can think about healthcare from an upstream versus downstream type mindset, which is something we definitely I feel we need to work towards.

Hillary: So many important points you just made there. I think we're, we're all very excited at Osmosis and Elsevier about the possibility of AI, but also very cautious and wanting to make sure that it's used in a responsible manner. So, I think, helping faculty maybe find more efficiencies and potentially, assessing students’ performance or creating assessments or so on. And then, of course, in clinical practice, we are seeing many folks turn to it for diagnostic support. 

In fact, our partners at Elsevier Health have just released a ClinicalKey AI beta product, which we're really excited about, that is supporting the diagnostic side. So, I think we have a lot to kind of wait and see on AI. We're excited, but like you said, kind of cautious. I love what you said earlier about being creative and experimenting with some of these new tools and technologies. I think, we're learning a lot from our partners and, and other organizations around how they're trialing AI and also what to be cautious of and what to maybe double down on and continue to dig into, but it’s great to hear how you're thinking about it and also how you're integrating it. 

Dr. Beals: I think it's going to be a very important tool going forward with nursing education and healthcare education in general. Recently in the health science department, we received one of the anatomy tables. I definitely see that innovation being used in various ways in terms of building that patient context. I mean, I think about all the experiences I've had over the past thirty years and that's a wealth of knowledge and helping students to glean from that for me to help them do that. AI will, only enhance that, in building that patient context to make them better clinicians when they go into the clinical setting. 

Hillary: Definitely. One of the roles that I had previous to Osmosis was at a company called Khan Academy, and they've recently launched more of a Socratic tutor model with a tool called Khanmigo and it's been really interesting to see that use case where a student can ask this AI tutor a question and instead of just giving it the answer, it will actually kind of guide the student through a series of questions and help them find their own answer. So, I think there's a lot of really great applications and yeah, we'll kind of stay tuned on what's around the corner for all of these emerging technologies. 

Dr. Beals: Yeah, absolutely. We use Socratic questioning frequently when we're giving feedback in the classroom. Absolutely.

Hillary: That's great. We are a teaching company and one of the things that we love to do is fill in knowledge gaps, with or without AI. So, is there a topic that you think Osmosis should make a learning video about or educational materials about that would fill in a gap that's of particular interest to you? 

Dr. Beals: Well, of course, I get excited anytime you say high fidelity simulation. So, helping educators to be better at what they do maybe would be something that could fill in that gap. We're pretty innovative in our program. For example, right now, we actually do a hybrid type of simulation where we take a patient in virtual reality, have them run through that scenario and then expand upon that same patient scenario in high fidelity simulation. So they're experiencing both worlds, and then augmented virtual reality is another up and coming thing. So, just helping us to be better healthcare educators, I think, would be an interest that I would have.

Hillary: Well, potentially, there's an opportunity for us to partner with you and your teams on creating content like that. It's definitely an area that we focused on around evidence-based learning science. We have a couple of courses for educators on how to how to teach especially in a hybrid environment or sometimes a fully remote environment or utilizing Osmosis to flip your classroom and so on. But certainly, we haven't gone into the details of things like augmented virtual reality or even high-fidelity simulation, so there's a big opportunity there and we'd love to collaborate with you further. 

Dr. Beals: Yeah, I think that would be awesome.

Hillary: Dr. Beals, we have many students and early career health professionals in our audience. What is your advice to them about meeting the challenges of this moment and approaching their career in healthcare?

Dr. Beals: That question requires some thought. And in thinking about that, we are hyper aware of the experience we went through with the pandemic and the challenges that we faced in healthcare with that and also, in healthcare education. So, what little advice I could give to them is to be patient with yourself. I mean, learning is difficult, and it can be very frustrating when you're not instantly getting something. So, being patient with yourself. Being persistent with your learning, being intentional with your learning is so very important, especially when you're learning new concepts and certainly, the audio-visual component of that and what Osmosis provides only can help students bridging those challenges.

Hillary: That's really great advice and it reminds me actually of Carol Dweck and Angela Duckworth's work on the importance of having that perseverance in learning, especially because we know that the learning process can be up and down and there can be challenges and there can be times when you feel like you're just not getting it right. So, I think that's great advice to our students. And then on the flip side, what you capture there is just being compassionate with yourself and patient with yourself, and I think that just goes back to the culture that you've created at Missouri Southern State and how you and your team have really approached learning. It seems like it's just really capturing the holistic view of students, including their emotions and making sure that they have a psychologically safe space to learn.

So, we'll make sure that our learners and our audience keep that in mind, staying gritty with their learning and also being compassionate with themselves.

Dr. Beals: Absolutely. Yeah. You’ve got to have some grit nowadays, for sure. 

Hillary: Definitely. Well, is there anything else you'd like to share with our audience today? 

Dr. Beals: I can't think of anything. I think you've hit on a lot of key and very important points such as grit and innovation and the use of technology. So, the only thing I can say is just keep doing what you're doing. What you're doing is wonderful work and we greatly appreciate it in the nursing education world. 

Hillary: Well, thanks so much for saying that, Dr. Beals. It's a pleasure to partner with you and your team and we look forward to much more collaboration down the road. Thank you again for being with us today. I'm Hillary Acer. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.