Bill Klaproth (Host): This podcast is brought to you by Nuance, a Microsoft company, a technology pioneer and market leader in AI, bringing deep healthcare expertise and proven outcomes to address your biggest challenges. Visit nuance.com/nursing for more information.

As you know, nursing is one of the biggest challenges for organizations from staffing shortages, to burnout, to rising labor costs. In this episode of Today in Nursing Leadership, we'll explore how using AI can help organizations solve today's nursing challenges, as we talk with Mary Varghese Presti, Vice President of Microsoft Health and Life Sciences.

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Mary, welcome.

Mary Varghese Presti, BSN, MPH: Thank you so much, Bill. It's a pleasure to speak with you.

Host: Yeah, happy to have you on. So, Mary, what are some of the biggest challenges you're seeing in nursing today?

Mary Varghese Presti, BSN, MPH: You mentioned a number of them in your intro, but it's really a matter of what are we not seeing in the nursing industry today? I mean, we, there's workplace safety issues, there's a cognitive burden to the workforce. Many of the nurses now that are actually on the floor at the bedside average less than three years of experience. They're seeing higher acuity patients. They're not able to spend enough time with those patients. There's a recent McKinsey survey show that over 30 percent of nurses say they're going to leave direct patient care in the next year. So it really is a really critical, I would say we're at a crucible moment facing healthcare broadly and globally, in terms of a nursing shortage. And that shortage has massive implications, you know, to society at large, to patients, and you and me, we're current or future patients at some point. And it's also has massive implications to the top and bottom line of health systems as well.

Host: Wow, 30 percent of nurses say they're going to leave being a floor nurse. Is that right? In the next year?

Mary Varghese Presti, BSN, MPH: Yup, that's what the study showed.

Host: And you mentioned some other things going on. Workplace safety, cognitive burden, higher acuity patients. So there are a lot of challenges facing our nurses today. So maybe it is ripe for disruption. Maybe that disruption is AI. So what areas of nursing do you see as particularly ripe for the introduction of AI?

Mary Varghese Presti, BSN, MPH: Well, within the Microsoft healthcare portfolio, we have Dragon, and we've been in the business of clinician productivity and clinician workflow, specifically around documentation for decades. So we know that physicians and their burden of documenting after seeing patients has been well recognized, well studied, and there are solutions on the market.

I think it's less obvious to people that nurses have to document a significant amount as well, and they're documenting mostly in flow sheets. They are in and out of patients rooms, continually documenting all shift long. And at the end of the day, nurses need to be hands free. They need to be eyes free, they need to be focused on the patient, and we really have not evolved the technology to a point where they can operate that way.

A big part of the nurse's sort of frustration and the loss of that joy of nursing is, you know, many report that they feel like they're caring more for the electronic health record or for the technology and the amount committed sort of steps and processes they have to follow through from a paperwork perspectivethat's taking them away from patient care. And this is an area where we've, I don't want to say fully solved it, but we've made lots and lots of progress on this on the physician front, and I think it is far beyond time now to solve it for nurses.

Host: So it sounds like it's time for someone to develop a solution tailored to nurses, right? So how can AI play a role in this?

Mary Varghese Presti, BSN, MPH: Well, if you have engaged in seeing a new physician or new visit anytime recently, you know that even as a patient, we fill out the same paperwork repeatedly oftentimes when we've already filled it out, for one doctor and then again and again, and it's all the same healthcare system.

Nurses are also stuck in that loop, right? They're also collecting very redundant, repetitive information as well. So I think that there is the possibility for AI to A, identify, just using voice, what needs to be documented and sort of do that documentation for the nurses in a way where nurses can check it, edit it, and be done with it.

So that's an opportunity and something that AI has been shown has the potential to actually execute. Another thing is just the cognitive burden. I mean, just to be able to have that assistant, being able to just sort of assist you as you're going from room to room and you're telling yourself, well, I got to go back in and check that IV, in half an hour, gosh, I gotta, check and see if that swelling is going down. Those are not necessarily things you have to write in the chart, but there are little tips for yourself and you carry all these things around. Now you multiply that by the five patients you have in a 12 hour shift. But if you had that assistance, if you had that sort of bot, that's helping you, just for you as that individual nurse, to not have to carry that load, all shift long. There's also opportunities for all those reminders and everything that you might ask for for all of that to just be summarized and AI is really great at summarization. So summarize at the end of a shift and then now maybe that is really a wonderful support when you're doing shift change and you're doing report out to the next nurse that's coming on.

These are all just various examples of really kind of applying the ability to kind of look through lots and lots of different kinds of data and kind of serve up in very useful ways in, relatively real time that's actionable.

Host: I like how you frame it as having an assistant.

Mary Varghese Presti, BSN, MPH: Yeah, I mean at Microsoft, you know, we have what we call a copilot. There's a difference between autopilot and copilot, you know, we feel really strongly it is a copilot. It's an assistance because I don't think there's any kind of AI that in any way is really going to replace what nurses do, but I think there's a lot of things that nurses do that don't have to be so tedious and don't have to be so cognitively burdened where that assistance can really free them up to really, really focus on that patient care, which is honestly what drew them into the profession to begin with. But the day to day of being a floor nurse has kind of taken them away from that quite a bit.

Host: So AI can help them with that day to day. One of them is helping to reduce the burden of doing all of that paperwork, helping them to get back to focusing on patient care. And that's why they got into this profession in the first place. And speaking of that, I'm wondering, do you see AI helping to alleviate burnout, which is a big challenge among the nursing industry right now? Can AI help with that?

Mary Varghese Presti, BSN, MPH: I would like to think so. I mean, we're at the very, very beginning stages of this, right? So we do need to kind of follow through with actual application of these latest cutting edge technologies purpose built for the nursing workforce so that they can actually have the tools that they need. I do think that when you are looking at a stat as astounding as 30 percent saying that they're going to leave; you got to think about the fact that during the COVID pandemic, the nurses as the frontline workers really came to the forefront and actually, as we went through the pandemic, more and more people enrolled in nursing schools, they were really inspired by the pandemic. And so we're graduating more nurses than we ever have before, which is wonderful.

But then when you see that only 30%, that up to 30 percent are saying they're going to leave; something is happening from when they are mission driven into, in terms of going into that profession to the amount of time and the quality of that time spent on the units. And when you spend the time with the nurses, they are burnt out because they are spending their time in ways that they didn't envision when they chose nursing as a profession.

And a big part of that is task management. It's coordinating across a lot of different stakeholders in a given institution. It's the documentation. And these are all things that have been solved in other industries, solved with technology in many other industries. So it's high time to bring those to nurses, but it has to be developed the right way.

It has to be developed with those nursing needs at the core and have nurses at the table in the design of those solutions.

Host: Yes, having their input, absolutely, would be critical. So let me ask you about this. We hear a lot of different opinions about AI. Some people don't want to use it. Some people don't like it. Some people are like, nah, not for me. Do you see any pushback coming from this, trying to use AI to help with the nursing profession?

Mary Varghese Presti, BSN, MPH: We haven't heard pushback in that regard, but I think where we do see, and we're very aware and sensitive to this is there, it's a very frothy market, right? I mean, you can't, I live in Boston, you can't even trip over a company that's not funded in some way to find an AI powered use case in healthcare.

But at the same time, though, It's got to be developed responsibly. It's got to be developed in a way that is fair and inclusive without bias, with controls in place. And it is really something that you have to think about in terms of not, like I said, not replacing nurses. I think the pushback or the threat that I sort of feel in the industry is, you know, is it going to replace me? Or is it going to reduce the number of jobs that are out there? And I don't think it will, because if you think about the nursing workforce, there is zero substitute for that really physical encounter between a caregiver, a nurse and a patient. So when you really kind of take signal for the noise, it really is around returning joy, returning time, returning the nurse to be face to face with that patient again, I think that is the promise of it, but again, it has to be developed responsibly, as I mentioned.

Host: Mm hmm. That's a great point. And anytime you talk about new technology like this, ethics come into the discussion. So, Mary, what can organizations do to make sure that AI driven solutions for nursing are applied in a calculated, ethical way?

Mary Varghese Presti, BSN, MPH: Yes, that's a great question. Many organizations are creating governance groups inside their institutions. Microsoft in particular is a leader in establishing a responsible AI framework. You know, some of the things that I would advise is when you think about the development of AI, as an organization, you really have to think about accountability, inclusiveness, reliability, safety, fairness, transparency, privacy, security. Those are a lot of words, those are a lot of different dimensions that you have to be really thinking about, but if I had to, like, kind of put into two perspectives, you want to make sure that the AI is ethical and explainable.

Those are the two key aspects. So, you want to be interrogating whatever solution or whatever AI model that is being proposed to you from those dimensions. But it is really, really important because we are very much at the very beginning stages of this new era. And if you think back to the very early days of the internet or social media or mobile; we went through all of this, right? We had to get to a place where we were comfortable and that we had trust and where we have to do the same thing with the development of AI.

Host: So Mary, from your viewpoint, can you give us your overview? What do you think are the benefits, the positive aspects, the key takeaways for the nursing profession when it comes to AI?

Mary Varghese Presti, BSN, MPH: Well, I think, like I said there is a lot of promise in terms of wicking away the work that, you know, an individual nurse doesn't have to spend an inordinate amount of time doing. So that they can sort of replace that time with what I consider kind of high value face time where they're kind of working at the sort of top of their license, if you know what I mean.

But, the use cases have to be practical, they have to be value add, they have to materially improve the experience of a nurse. So, getting the use case right, iterating on that use case so that the experience of the user, so the experience of the nurse, is elevated, and that that experience actually aligns with that nurse's workflow.

All of those things are really important if we're going to get to a point where we identify these innovations that actually scale and make a difference to the nursing workforce.

Host: And making a difference is really what this is all about. Mary, I want to thank you so much for your time. Before we go, is there anything else you'd like to add?

Mary Varghese Presti, BSN, MPH: Yeah, I think about two things quite a lot when it comes to the opportunity to really elevate the nurse's experience. Number one is we've been in the business of voice and voice power documentation. I'm really, really excited to see nurses adopt voice as the new interface because if you're using voice,

that does enable that nurse to be hands free and eyes free. And I think we're going to see more and more of that with ambient listening, multimodal language models, and that's going to be really exciting. And then the second thing, it's a little bit more broad, but you know, nurses for a very long time have been considered a cost center in health systems, and I would really, really like us to start reframing that to really looking at the economic power of care, because what we're also seeing with what's happened with COVID, the pandemic, what's happening now with the nursing shortage is the sort of, nurses as a line item on a P& L. They're moving from a margin issue, I would say, to a revenue issue. So, it's really nice to now think about like the value of nurses and the economic power of delivering excellent care.

Um, I'd really like for us to kind of reframe it because I think this is an invaluable workforce. And we have to make sure that we future proof our health system. And nurses are key to that future proofing.

Host: Very well said. Mary, thank you so much for your time. I appreciate it.

Mary Varghese Presti, BSN, MPH: Thank you.

Host: And once again, that's Mary Varghese Presti. And this podcast has been brought to you by Nuance, a Microsoft company, a technology pioneer and market leader in AI, bringing deep healthcare expertise and proven outcomes to address your biggest challenges. Visit Nuance.com/nursing for more information.

And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.