Helping Nursing Students and Faculty Adjust to Growing Complexity: Brent Gordon, President of Nursing and Health Education at Elsevier

Shiv Gaglani: Hi, I'm Shiv Gaglani. We're all familiar with some of the challenges facing nursing, with the growing shortage of nurses and a significant increase in burnout topping the list. But there are other issues as well, including the increasing acuity of patients, the need for better communication skills as medical teams become more complex, and the need to master constantly changing technology. That's why I'm delighted today to welcome Brent Gordon, who is president of Nursing and Health Education at Elsevier. He'll help us understand how nursing education is evolving to meet these challenges. 

Brent has a long career as a business leader in publishing, education, and healthcare, during which he has launched and expanded numerous product lines and led organizational transformations. He leads 600 employees in accelerating the digital transition of Elsevier's content and enabling improved learning outcomes and practice readiness for future health professionals. 

I've had the opportunity to get to know Brent ever since Osmosis joined Elsevier, and I'm really impressed with not only him, but the team he surrounded himself with across content, product, sales, leadership, and the impact that they're having to train the next generation of nursing professionals. So, Brent, thanks for taking the time to be with us today.

Brent Gordon: My pleasure. Great to be here.

Shiv: So, obviously, I know a lot about you and your career, but for our audience that's just getting to know you -- many of whom are nursing students and faculty -- can you tell us what got you interested in a career in education and healthcare?

Brent: Well, I'd been in the education business for several years and I think, pretty much immediately, one of the things that inspired me was this great opportunity to play a role in helping students and faculty reach their full potential. That's something that was very inspiring to me. As I grew my career, I realized that I could also have that same impact on organizations and broader opportunities. The healthcare piece of this is such a great opportunity, and it's one that's really personal to me. So, I'm really honored to be in this position to serve our customers and improve health outcomes.

Shiv: That definitely is aligned with many of the people I've met at Elsevier. One reason Osmosis joined Elsevier was this authentic and genuine drive towards a bigger mission than ourselves. Pre-pandemic, I know we were all working towards this, but post-pandemic or during the pandemic, the problems became even more acute. I think the Clinician of the Future Report, which Elsevier released recently, said that one in four health professionals are planning to leave the profession in the next two years, which is very scary. Nursing has borne the brunt of that. Can you tell us about your own career transition to Elsevier? And then what are some of the major offerings that the NHE team provides to nursing schools and faculty and students?

Brent: Sure. So being in the business for a long time, I've always had great admiration for Elsevier but interestingly, I didn't have any relationships within the organization from a people perspective. I was recruited based on my experiences, largely in educational technology and helping companies like Elsevier harness technology for the benefit of education and all that it can be from a learning enabler standpoint. When I got the call, I was immediately interested for a variety of reasons. I mean, one, I've always had great respect for the company. The brand that the company has is very well respected. The company has scale, which I knew was critically important to have the kind of impact that I wanted to have. When I met the people that I was interviewing at the time I was really impressed, and that was inspiring. 

The healthcare part of this was one that I really started thinking about several years ago. My mom suffered from Multiple Systems Atrophy for several years, and that's a disease that has a great impact on the nervous system. I had to sort of watch my mom and my dad go through this long, multi-year process of trying to find answers. She finally got one, which was a great relief to our family, but watching her go through that process over the years just made me think a lot about healthcare and patient outcomes. I thought if I could play any small role -- and I consider the role that I play to be a small one in the grand scheme of things -- I would really jump at the opportunity to apply my experiences in helping make a difference in healthcare. So, when I got this phone call knowing what I knew about Elsevier, and then the connection with healthcare and having this great opportunity to play a role in improving healthcare outcomes, it was so exciting to me. So that's how I ended up at Elsevier, and I'm really grateful for the opportunity.

Shiv: That seems to be a theme and thank you for sharing that. We both work with Jan Herzhoff on the health market side. He's been pretty public about his wife's experience with cardiovascular disease and the process of being a patient. We always say this at Osmosis -- and I think Elsevier feels the same way -- that everyone has a body, everyone cares for someone, everyone loves someone. And if you have a body, and your friends and family have bodies, you care about your own health and healthcare. So, the work we do is not only to train more nurses and doctors and make the ones who are in practice healthier or more qualified to provide health, but also to directly impact patients themselves, which is something a lot of our products do. It's another reason we were excited about joining Elsevier, as well. 

So, getting very specific, I know you recently launched Elsevier 360 for Nursing, which was a big announcement. I would love for you to give our audience, who may not be as familiar with the diverse and comprehensive array of Elsevier nursing products, an overview of that and the impact it's having already.

Brent: Let me first just kind of frame what we offer higher education institutions. We serve faculty and students and we provide content tools and predictive analytics that help students improve learning outcomes, and also prepare them for practice. It's a very important role. There's a lot of challenges, as you well know, in becoming a nurse and being practice-ready. 

Elsevier 360 for Nursing is the result of a multi-year effort to connect our offerings.  We had the understanding that our customers used multiple products that we offer. But over time these products were developed really as single-point solutions, and they weren't stitched together. So, we recognized that we can improve the customer experience both for faculty and students by making the connections where they mattered. That's really what Elsevier 360 for Nursing is all about. 

Our offerings cover the entire learning journey for nursing students. We do that by helping build foundational knowledge, and that's at the course level, by helping them develop and apply clinical judgment skills and delivering clinical experiences through digital simulations. Then also assessing their readiness for the North America licensure exam, the NCLEX. We have connected these offerings across the learning workflow. One example of the benefits is now we can deliver predictive analytics across the program to help both faculty and students assess their readiness to pass the NCLEX exam.

Shiv:  I remember my own experience as a health professional student. You're always taking tests and trying to figure out, "Okay, if I do well in this practice exam, how well will I do on the actual exam? That matters for whether I can pay off my student debt. I have to be able to practice to be able to at least pay that off, if not actually earn a living moving forward." So that is very compelling. 

In the last few months, I've enjoyed your articles about the broader trends in nursing and nursing care and nursing education. I mentioned in the intro some of the challenges we're facing -- like the lack of nursing instructors, moral injury and burnout leading to a lot of practicing nurses leaving the workforce, the rise of remote online learning, which obviously we're all part of.  Let me actually focus on this one: the changing nature of clinical teams, where there's all these mid-level providers and so-called physician extenders. What are some ways that we can better prepare nurses and others to be effective team members in this complex care delivery landscape?

Brent: Yeah, great question. It's a big question. One of the things I like to think about is just sort of stepping back and asking why is the NCLEX exam changing? Next year, 12 months from now, the next generation NCLEX is being launched. The exam is changing because students are passing the exam, entering practice, and they're not practice-ready. The job, as you know, has become far more complex. Students and first-year nurses are being asked to make very complex decisions right away. Then if you think about the workforce shortage that we have, that's adding a whole other dimension to the challenges associated with being a first-year nurse. So, the exam is changing because nurses are not practice-ready, and in many cases, this is employer-driven. Students need to have stronger clinical judgment skills when they graduate. The exam is adding a new module to assess clinical judgment skills, which is a really hard thing to assess. 

This exam has been years in the making. We recognized a few years ago that we were not in a position to deliver these question types within our existing platforms. We made the decision to go out and acquire the company Authess, which is a competency-based assessment platform to develop workforce readiness and to develop and to assess workforce skills. It's a very different type of assessment. By doing so, we've integrated that platform into our courseware offering, which is Sherpath, and in our assessment solution, and we can provide these new question types across the program and at scale. 

I just want to make this point: because we're testing these question types broadly, right now thousands of students have taken the assessments on our platforms, and many students have never experienced these new question types before. These are not question types that you would see on the SAT, the ACT, or typical course-based exams. So, there's a great effort that needs to be made in preparing students to take this exam. 

The other part of this, related to clinical judgment skills, was one of the reasons we acquired Shadow Health, which is a best-in-class healthcare simulation business. The simulations are proven to develop clinical reasoning skills and clinical judgment skills. We're doing two things that we think are really important. One, of course, we do need to prepare students to be successful on the next-generation NCLEX. But at the end of the day, solving these kinds of problems is much larger than passing a standardized summative test. We have to help institutions and help students develop and apply their clinical reasoning skills throughout the program. In my view, that's where simulations can really help. 

We also recognize that there are significant capacity constraints within the U.S. higher education system, in particular. We need to do whatever we can to help institutions remove some of those obstacles so that they can enroll more nursing students so we can help address the nursing shortage. Simulations are just one example that can help institutions augment the hour requirements around physical clinical rotations, because there's space shortages with clinical space, and they can use these simulations to help augment those experiences. Those are just a couple of examples that I would highlight.

Shiv: One of the things that immediately struck us once we started getting to know you and the Nursing Health Education team is how comprehensive the different product portfolios are and how they've been integrated by a lot of people -- including leaders like Mikhail and Paul who came in through Authess.

On competency-based education, we're really excited because that was a core thesis of Osmosis...about trying to create an online med school or online nursing education programs, too.  Our view was some people may accelerate through the curriculum much faster, which lets us train more nurses or doctors faster, hopefully at a lower cost with less student debt. Then others may be working full-time somewhere and they're doing part-time programs, so if there's ways to make the program faster or slower based on their competencies -- as opposed to just time spent in classes like the current one-size-fits-all system -- that's a really compelling shift that we need to do to, as we say, raise the line and get more people trained up to be healthcare professionals. 

Are there other nursing challenges you've written about that you think Elsevier and NHE are well-positioned to help address that you want to get into on the podcast right now?

Brent: Well, one of the things that we're doing around practice readiness, in addition to the work in higher education, is that we're extending the Shadow Health simulations offering to the hospital space because we recognize we're never going to reach or touch 100% of the nursing students that are going through programs in North America, and much less the world. One of the things we know is that hospitals are facing challenges around the lack of practice readiness as well. Their onboarding and training costs are going up, and all of this is a contributor to the attrition challenges that the hospital system is facing with nursing. One of the great things about what we're doing at Elsevier is we can reach first-year nurses through our clinical solutions -- our professional business -- and we can extend these simulations to the hospital market so that we can tackle this problem both from a higher education perspective and also from a professional perspective across the learning journey.

Shiv: Definitely. We've had several CEOs and chief medical and chief nursing officers of hospitals come on to the podcast, and many of them echo the same thing, which is not only retention, but then getting entry-level or early-stage healthcare professionals trained up fast enough to be contributors to the system. All of this is overlaid across all industries...what we're seeing with the "great resignation" and people changing jobs and being job-ready on day one coming out of colleges or degree programs. I’m so glad we're addressing that together as Elsevier. 

There have been a lot of changes to the healthcare system because of COVID. We're still in COVID, though things are looking up as of the recording of this episode. What are some of the macro trends or changes to the healthcare system that you think are going to be lasting because of COVID, or any other commentary you want to make on how the pandemic has changed the healthcare system or education system?

Brent: Well, I think one of the things that has really surfaced because of the pandemic -- it's not new, but it's definitely in the spotlight -- is the impact of the nursing shortage and what that is doing to the hours that nurses are having to work and to the stress of the job. Mental wellness is a really important topic that hospitals have to take into consideration for their workforce, right? But really, from my perspective, the most important thing that we can do is to invest in nursing education. I mean, we have to solve this problem around the shortage of nurses. I would argue that it's a crisis, and we need governments and higher education institutions to really be innovative and think critically around how they can increase their enrollment because that's the only way that we're going to produce more nurses in the future. I would say that is one of the most pressing problems that we have in society today.

Shiv: Absolutely. Couldn't agree more with that...domestically and globally. My final question is, what's your advice to the students and early career health professionals who listen to this podcast about meeting the challenges of this moment and approaching their career in healthcare?

Brent: Develop your clinical reasoning skills. As we've talked about, of course, you're always focused as a student on what's on the test. You have to be because grades matter and you do have to prepare students in North America for this licensure exam. But I would also put as much effort, if not more, into those opportunities around developing and applying clinical judgment skills -- whether that's through your clinical rotations, internships, or utilization of simulations. 

Oftentimes, I'll use a sports analogy -- which works for some people, doesn't work for everyone -- but if you think about the game of golf, you could take lessons, you could understand how to hold the grip, you could understand the techniques of a backswing, but if you never practice, you'll never be great at the game of golf. I believe in deliberate practice. I believe that to be great at anything that requires high technical skill sets, you have to have the foundational knowledge, but you have to practice over and over again. It's a continuous learning process because if you don't keep practicing, you will get rusty, and you will fall behind. So, from that standpoint, you have to be a lifelong learner, and you have to really apply yourself throughout the career journey.

Shiv: Absolutely. I like that analogy a lot. In healthcare, the rules are changing as new treatments and discoveries and guidelines come out so the work that you and your team are doing is even more essential to get them practice-ready and then keep them practice- competent. So, Brent, I really appreciate you taking the time to join us on Raise the Line and share what Elsevier's Nursing and Health Education division does, and more importantly, the work that you guys are actually doing to raise the line and improve nursing education worldwide.

Brent: Thank you. Great to be here and appreciate the opportunity and look forward to more conversations.

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show, and remember to do your part to flatten the curve and raise the line. We're all in this together. Take care.