What Changes Are Needed in Nursing Education - Dr. Katie Kay, University Dean for West Coast University College of Nursing

Shiv Gaglani: Hi, I'm Shiv Gaglani, today we're turning our attention to nursing education and the critical role it plays in ensuring patients receive high quality care. With us to discuss current and future challenges and opportunities in nursing education is Dr. Katie Kay, a Doctor of Nursing Practice and University Dean for West Coast University College of Nursing, where she provides direct oversight of academic quality and delivery of pre-licensure through doctoral level nursing education. She brings many years of clinical experience in emergency medicine, trauma, and critical care to her leadership role. 

Dr. Kay is a member of the American Association for Critical Care Nurses, the National League of Nursing, and the American Organization for Nursing Leadership, and she serves as the executive director for the Association of Psychiatric Mental Health Nurse Practitioners.

I got to know Katie, when we were both on the ASU+GSV panel a couple of months ago -- along with our COO, Derek Apanovitch -- and we had a wonderful discussion on the future of medical and nursing and health education in general. So, Katie, thanks so much for taking the time to be with us today.

Dr. Katie Kay: Of course. Happy to be here.

Shiv Gaglani: So obviously, you have a really impressive track record. I've enjoyed seeing your career along the last few years of knowing you, but for our audience who may not know you yet, do you mind giving us a bit more of your background? What got you first interested in healthcare and nursing?

Dr. Katie Kay: Well, initially, I was really interested in becoming a physical therapist, so I started off down that path, but realized that it was going to be a several year journey and I wanted to get working in the healthcare environment sooner rather than later. I was fortunate to switch my degree path to nursing, and really have just been blessed with a great career where I've worked alongside some excellent clinicians and of course, educators as well. 

My father, when I was in nursing school, had a heart attack, unfortunately, which is where I got my interest in going into cardiac ICU for my first stop in my licensure career path and started off at the MetroHealth Medical Center, which is where my grandfather worked as a physician for several years. So, I had some family ties for why I started off where I started off, and then gradually progressed to leadership roles within that organization, and then I made the switch over to education.

Shiv Gaglani: That's actually a very common theme we hear from nursing leaders and leaders in general we've had on the podcast. For example, we had on Dr. Sheila Davis, who began her career as an infectious disease nurse at Mass General Hospital in the 80s during the HIV AIDS epidemic, who now runs Partners in Health, which as you know, is one of the largest global health organizations out there. So, going into your own career and the twists and turns it's made, can you talk about a bit about what attracted you to leadership opportunities and how you kind of develop those skills? There's obviously a lot of overlap between being a nurse and being a leader, and then finally moving into education leadership, as well.

Dr. Katie Kay: I can't really pinpoint one thing that really led me to the leadership path other than I just was organically finding myself in the charge nurse position frequently. I remember the advice of my dad was if you show up on time, and you work hard, and you support your team members, you're gonna go far, so I followed along with that type of mentality when I was working in the clinical setting and stepped into a unit manager role very early in my career. But it was a great move and I learned a lot. Of course, now looking back with different skills I've developed in leadership and management I would have done certain things differently, but I had the pleasure and experience to stay in that role for quite some time. Then I moved to a different role within this system, which was the management of our nursing staffing ops. That was a great role because I was able to be exposed to all of our different inpatient units that really had a lot to do with throughput and ensuring patients were moving through the system, appropriately, timely, and getting the level of care that they needed. 

I had an experience where I ran the Boston Marathon in 2013…

Shiv Gaglani: Cool.

Dr. Katie Kay: …well, it was the bad year.

Shiv Gaglani: Oh, that was the year! Oh my goodness.

Dr. Katie Kay: It was crazy. But, I was fortunate that in our family, everybody made it out okay and were able to finish the race. None of us were hurt, which is the most important part. But that is actually what triggered me to move into education. I wanted to be home more with my kids and have a little bit more flexibility. I found that education is not as flexible as one might think, but I started teaching and loved it. I absolutely loved it.

I started as an adjunct professor teaching pathophysiology, and then slowly transitioned into a full-time role. I didn't anticipate ever going back to leadership to be honest because I just loved what I was doing, loved working with students and making a difference in their lives on a day-to-day basis and getting to know them and what caused them to go down this nursing journey. But you know, things change and evolve and slowly I was taking on more and more leadership responsibilities at my organization and I found that this is really truly my niche. I'm able, in a leadership role, to make a difference at a broader level: impact more students, impact more faculty and colleagues and hopefully, make my small dent in the way we deliver nursing care and healthcare in general.

Shiv Gaglani: One thing I loved about getting to know you and the conversation we had at ASU+GSV was how wearing the lens as a practicing nurse -- which you've had plenty of years of practice, as a unit manager on the wards in nursing and now a dean and leader in education of nursing -- how maybe you can help individually and also with your teams break down certain silos between how we train nurses or other healthcare providers, and what they're expected to do in practice, especially in a hopefully, post-COVID world. So maybe we can go a bit into your current role, and then go back into nursing curriculum and the changes you'd recommend for that. But first can you tell us a bit about West Coast University and kind of the depth and breadth of the nursing programs you oversee?

Dr. Katie Kay: Oh, of course. So, West Coast University has five for-licensure nursing campuses. Three of those are in California, one is in Richardson, Texas -- which is the Dallas area -- and then the other one is in Miami, Florida. Our market is heavily pre-licensure nursing, but we also offer post-licensure nursing programs as well. So, we have FNP, we have acute care, we have adult primary, we have psych mental health and then we also have our MSM specialty tracks, which is our educator and leader track. Additionally, we offer the DNP, which is the Doctor of Nursing Practice. So, a degree for everyone depending on where you are in your career trajectory. One of our campuses also offers an ABN program as well, so really just the full suite of nursing degree programs.

Shiv Gaglani: Yes and it's a very large institution. Everyone's heard of Chamberlain and University of Phoenix and probably West Coast University as well, because there are other healthcare degrees it offers too, but maybe you can give us a sense of how many nurses West Coast University has trained to date and/or how many students you currently oversee, as well as faculty?

Dr. Katie Kay: Sure, so from a student perspective, I think I just heard the number this morning that we have over 90,000 nursing graduates. So that should put it into perspective. I know how large our institution is. Like I said, our primary market is California. We're working to grow our other campuses as well as our online programs as well.

Shiv Gaglani: Now, going into your role running these programs -- or overseeing the people who run these programs -- what are some of the biggest challenges that you have identified in nursing education and ways that we can maybe address those?

Dr. Katie Kay: Honestly, the past few years with the pandemic…it's no secret is probably the biggest challenge. Predominantly, most institutions had to flip-flop a curriculum that was intended to be delivered in person to online, and a combination of our faculty having to learn that and flip that information and content in a way that was meaningful in a virtual environment. Our students were also dealing with a lot of different variables. They have their kids that are home from school, perhaps they don't have childcare, or perhaps somebody in their family was experiencing a layoff. So, I think the way that students were consuming information during the pandemic was almost information and priority overload, where they had so many different at-home priorities while they were trying to have school in their home. 

Now that we're transitioning back to campus in a lot of places, I think that we have to be mindful that people's expectations or thoughts on learning have changed and integrate that into the way that we're teaching and delivering the curriculum as well. That, in combination with what is happening in the healthcare systems…we have to address some gaps in curriculums across the board that really prepare individuals, and nurses, for what they're going to encounter in the healthcare setting. There’s lots of work to be done there. 

From that, I mean, potentially are we doing grit assessments on our students when they're enrolling in the program to know if they're going to intrinsically seek out resources or need to be motivated by other forces to help them connect with what they need during a really difficult degree path? I also think that we need to do more resilience and wellness training within our curriculum so that students have coping measures and understand that they can take a break, can take a breath, and have healthcare systems really engaged with other experts in the space to ensure that they have the resources for their staff to be able to do that. So, there are gaps both on the academic side and on the healthcare side and how we work together to bridge those gaps, I think, is really going to be key.

Shiv Gaglani: Yes. I love how you're thinking about that as well. One of our previous guests on this podcast is BJ Fogg, who runs Stanford's Behavioral Design Lab and he wrote the book Tiny Habits. We had him on a couple of months ago, and one of the coolest studies he's done, along with his sister and others, is going into nursing units and helping these nurses implement the tiny habits of norming taking breaks and actually taking care of themselves first, before the patient, so that they hopefully don't burn out or have the moral injury as much. Obviously, there's a whole host of systemic issues that we can get into about shifts, how they're set up, and you already got into that at the ASU+GSV talk about travel nursing versus staff nursing, so we will definitely talk about that. 

Another guest we’ve had on the podcast is Ariana Huffington, and with her and Thrive Global and the Johnson and Johnson Foundation, we created a whole continuing education accredited course on nursing resilience. I think one fault of that is that it's very much re-putting the burden on the student or the healthcare professional to kind of take care of themselves when the system itself is fairly broken. So maybe we can go into the system, because you had some really insightful comments from your days running these nursing units related to burnout or moral injury, related to the shift work that we expect of nurses and the travel nursing. So maybe can you identify a couple of those and what your thoughts are and how we should change the practice of nursing to lead to fewer shortages or less burnout as well?

Dr. Katie Kay: Well, there are several different things. But I think if you look at the organizations that fared well during the pandemic from a retention standpoint, it was because they were doing the little things that mattered. Small acts of appreciation actually go a long way. It doesn't necessarily all tie to financials. That's what you would see with the travel nursing is they were hopping from place to place, burning out in some instances in those contracts. It was because they weren't aligning with a particular system, because they weren't necessarily feeling those small acts of appreciation. Then on the flip side, I've heard of nurses that have picked up travel contracts that loved where they started and ended up staying at that institution. So, it's looking at what are those systems doing that's working and kind of modeling out from there. 

I do think that there are some challenges with the current way we staff and schedule. The first thing I would say that we need to look at is vacation, time off. Are we actually giving our nurses the time off that they accumulate during the course of the year and how are we treating them on their time off? Because I know in a lot of instances, if units are short staffed, they're going through a list and calling every single person that was off that day and that's not a really a great way to have your staff really disengaged with work and recharged. So even rethinking some of those things that we're doing from an outreach perspective to meet our staffing needs. 

A big thing that I think is going to take a really long time to look at and figure out and solution for, I guess, I should say, is how we treat or view nursing as an operational expense versus a billable service. Nurses are providing care, but they're viewed as operational. It's seen a cost to the healthcare system instead of looking at it as how are these nurses really preventing infections in the hospital? How are they ensuring optimal outcomes? How are they discharging their patients to make sure they're not readmitted in thirty days, and then how our healthcare systems monetize for that and how is the nursing profession paid in that type of model that's not just that expense drain on the system? Because when you have that thought process or you're looking at it from that lens, you're always going to look to cut corners and staffing -- or what we would say as "optimize staffing" -- to ensure that we're meeting our budget needs. 

COVID was hard on a lot of healthcare systems. A lot of healthcare systems lost lots and lots of money and are trying to rally from that, particularly, too, with the expense from traveling nurses. So, looking at a longer-term plan of how insurance companies or third-party payers are viewing nursing hours and billable services, I think, is a potential area that we need to explore. 

The other thing too is how we integrate technology. If we're integrating technology in a healthcare system, it has to be helping the workflow of the nurse or the clinician that's using that technology. If it's more burdensome or adds another step, it's just not going to take off, it's not going to work, and it's not meeting the needs that we have implemented it for. There are some systems that are doing this in a great way. They're utilizing nurses that may be towards the end of their career -- or they don't want to necessarily be inpatient anymore -- but they're using iPads for discharge teaching. They can connect those patients with a nurse that is qualified to deliver that teaching experience for that individual. Maybe that person prefers that technology touch point for that type of instruction, and it frees up to the other nurses on that unit to do other care delivery needs that require more clinical time and effort.

Shiv Gaglani: Yes, and that gets into scope-of-practice, which is, are we helping people practice at the top of their scope-of-practice and the competence that they have? Which is why it's been really interesting to see the development of new professions, not just within nursing, but within even dentistry. Recently on the podcast, we had the head of the Dental Assisting National Boards and the American Dental Hygienists Association talking about all the stuff happening in dentistry in terms of scope of practice. 

We wanted to talk about that famous Wayne Gretzky quote, which is, “don't skate where the puck is going, skate where the puck is going to go." You know, Elsevier recently released this report called The Clinician of the Future, which is about what is healthcare gonna look like in ten, twenty, thirty years especially catalyzed by the pandemic, and how should we be training medical, nursing, PA and other health professional students now for that future? My colleague, who runs the nursing division at Elsevier, Brent Gordon, talks a lot about this and we've had some discussions around it. But given that you run a large nursing program, I'm curious what are some specific curricular changes you think should be implemented and/or you're interested in implementing that'll help our nurses in the future? Whether it's the telehealth, which is here to stay, digital health, patient engagement, diversity, equity inclusion…there all these trends that we know about that are probably here to stay -- value-based medicine, home healthcare, CVS just bought Signify as you saw. The list could go on.

Dr. Katie Kay: Well, you called out so many. I was looking to say diversity, equity and inclusion, I think, has to be in every course that we teach and has to be a part of everything that we do. If you look at what the pandemic has done in the past three years, it really disenfranchised those that were already in trouble. Tying that into telehealth and telemedicine, you know, looking at the socioeconomic statuses of those that can access telemedicine or telehealth might be very different from those that we're serving. So I think it's understanding those limitations that the pandemic has caused; understanding that we're probably going to see a greater surge in chronic health illnesses because of the pandemic; understanding that we're probably going to have more problems with the opioid epidemic or alcohol abuse and depression related to the past few years, and how people handle that. 

I also want to emphasize that there's been a lot of disruption with the way that telemedicine has become more and more available to consumers. If you think about it, we're one of the only countries where pharmaceutical companies can do direct targeting to the consumer and that's now pretty much the same thing we're seeing with some of our telemedicine companies. It's, "if you need birth control, just call here, click these surveys and we'll mail it to you.” Some of those trends are actually concerning to me too…that consumers are able to just reach out and get exactly what they think they need without really being connected to the right provider or clinician to deliver the care that they actually really need. 

Those are all trends that I think we need to be aware of and teach both at the pre-licensure nursing curriculum level as well as post for our nurse practitioners, in particular, that will be working in virtual environments, to be aware of what practice guidelines we still need to have in place including things like judicious antibiotic prescriptions and those types of things. 

The other really big thing I think that we need to look at as academic leaders and how we're teaching our nursing students is how to really be an effective team leader. I've talked about this before at the ASU+GSV summit as well. We teach a lot of delegation in our nursing curriculum. But really, when you look at the way healthcare systems and teams work, it's really all about the healthcare team, with the individual patient being at the center of that team. So, how to optimize those relationships, how to get things done collectively, how to get buy-in from the individual members of your group that you're either working with or leading, I think is a lot different than how we're teaching delegation and a gap that we really need to close, particularly with the staffing challenges that a lot of institutions are facing.

Shiv Gaglani: Those are really great points. And just to respond to two of those as far as team-based care and interprofessional education or patient-centric care as well…one thing that was mentioned yesterday was how some dental schools are asking their dentists to go through dental assistant training first. So, they're kind of putting a future dentist in the shoes of the dental assistant. It’s the same thing in medicine with having students do scribing and/or EMS services so they have a better understanding of that profession because they've kind of lived part of the curriculum, or live the actual practice of it. I think it's really, really an insightful point, as we have to go to more value-based and team-based care.

The second is, I think in general we're happy with the consumerization of healthcare where patients are getting more engaged. They're wearing Fitbits and Apple Watches, and they're looking at their ECG or making behavior change from that. However, you're right, there's definitely some cause for concern. We had Cerebral on the podcast a couple of months ago, and they're right now in hot water because, they were doing a lot of potential overprescribing of ADHD medications and things like that. So, there's always that sort of, ‘where do you draw the line’ because information in the hands of some patients leads to behavior change, leads to preventive medicine. Information in the hands of other patients leads to tremendous anxiety and overuse of medications and non-value medicine. So, how do you do the distribution? The net-net on that is it’s really more of an art than a science it seems.

Dr. Katie Kay: It is, and that all goes back to health literacy, too, and how our clinicians -- whether they be nurses, nurse practitioners, nurse educators, nurse-leaders -- are promoting that type of connection with their provider. I like what you're saying. Yeah, it's great that we have all this technology to optimize our health care, and now let's just parlay that into a great relationship with their primary care provider and use that technology to keep them connected to the care that they're receiving. 

There's a lot of great telemedicine organizations out there that are connecting those dots back to their individual primary care provider, which I think is important, because then that primary care provider can go back to the patient and say, like, “What happened? You got antibiotics twice this past six months for strep, and I haven't seen you” or something just similar to that effect.” I think it makes a big a big difference. And we can use technology at our healthcare systems to engage our patients in the same way that some of these disruptors, I would say, are doing. 

I will say healthcare needs to be disrupted. There's just so much work to be done. I say that all the time. I drive everybody crazy. But there's so much work to be done. So, I like that we're thinking about doing things differently. It's just let's not lose sight of quality, and let's make sure that we're preparing our providers and our nurses for what they're going to be encountering and what those expectations of those consumers are going to be.

Shiv Gaglani: Absolutely. So, speaking of preparation, as you know Osmosis is a teaching company. We develop all this content with and for partners like 23andMe, all the way to the CDC on infectious disease education. If you could snap your fingers and have Osmosis make one video or one course on any topic -- whether it's for nurses or the general public, or some other stakeholder -- what would it be and why?

Dr. Katie Kay: Well, I think that there's two ways I would look at this. The first way, if I could do something for my students, snap my fingers, it would be some sort of resilience and grit training that they could have bite-sized content for as they move through their curriculum. Like, maybe just continuing to build upon the skills that they have as they start in their nursing program, and then by the end of the program, they're really feeling empowered to also help others that are starting their journey as a nurse. 

But, I also would love to see content for our faculty and colleagues, too. I think that really is important for them to be feeling equipped, mindful, present, and centered with everything that's just flipped upside down during the past few years. I want to make sure that they feel that same level of resilience and minimize the burnout that they're experiencing as well. So, I think the way that they would be tailored would have to be a little bit different because faculty really need to ground themselves, center themselves, to give back to the students that they're serving, and then the student population is really gearing up to be engaged and embedded in that content as they progress through their curriculum.

Shiv Gaglani: I love that. That's definitely something we can invest more in, and we'd love to continue that conversation. One thing is a sneak peek for our learners, and for you, if you may not know. You mentioned appreciation for practicing nurses and some health systems have done this a lot better than others. I think some schools do this a lot better with their faculty than other institutions across the board. One of my favorite initiatives led by one of our teammates at Osmosis, Lindsey Smith, is called the Raise the Line Faculty Awards. This is the second year we're doing it after the pandemic, where we're going to be basically awarding money and other prizes to some of the best faculty of medicine, nursing, PA, librarians, diversity, equity, inclusion, offices, etc, around the world to express appreciation to the people who work for you, the people who serve the students at your institution, who day in day out are training the next generation of healthcare providers, and in many cases, they take pay cuts to do this, right?  You can earn more as a practicing nurse than a nurse educator, generally, and that's why we see a nursing education shortage. So, really excited about that, and to hear that's an area of interest of yours.

Dr. Katie Kay: Oh, that's awesome. Yes. The faculty make it all happen, right? The content is there. We know that content is built into our curriculum, but they're the ones that make it come to life and they're the ones that relate the experiences or the information to practice and what they've seen in their tenure in their profession. So, they're the ones that need all the credit, in my mind.

Shiv Gaglani: Totally. It's wonderful. So, I know we're coming up on time, so my last question for you is, you have so many students at West Coast and you've trained so many students directly as a nurse, educator, and unit manager. What advice would you give to them about meeting their careers in nursing or in healthcare in general?

Dr. Katie Kay: I would say just never forget how important the work is that you're doing. Always remember the individual patients and families that we're caring for. Never lose sight of that, and never lose your passion for caring for others. This is not an easy profession. It is actually one of the hardest professions, I feel, that's out there and you can't lose sight of how important it is, despite some of the chaos that happens in the day-to-day.

Shiv Gaglani: Those are some wise words to end on. Katie, we really appreciate the time you spent with us today on the Raise the Line podcast, but more importantly, the actual work that you do, wearing many different hats to raise line and improve our healthcare system.

Dr. Katie Kay: Thank you so much. It was a pleasure.

Shiv Gaglani: 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 Raise the Line and strengthen our healthcare system. We're all in this together. Take care.