Strengthening the Foundation of Nursing Science Through Research and Innovation with Nancy Albert, Associate Chief Nursing Officer, Office of Research and Innovation, Cleveland Clinic Health System: Audio automatically transcribed by Sonix
Strengthening the Foundation of Nursing Science Through Research and Innovation with Nancy Albert, Associate Chief Nursing Officer, Office of Research and Innovation, Cleveland Clinic Health System: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Rebecca Love:
Hi everyone, this is Rebecca Love with Outcomes Rocket Nursing Podcast, so excited to have Dr. Nancy Alberts, who is here with us from Cleveland Clinic. Let me introduce Nancy because as you get to know her Dr. Albert is one of the most leading and distinguished nurses in our field today in the United States. In fact, in all of the world. So Dr. Albert is the Associate Chief Nursing Officer, Nursing Research and Innovation at Cleveland Clinic Health System and an international health system that serves 17 hospitals and over two hundred ambulatory sites. Additionally, she is an Adjunct Associate Professor at Case Western Reserve University, Foltyn School of Nursing in Cleveland, and a full preceptor at Aalborg University in Denmark. Nancy works as a nurse leader, research scientist, innovation leader, and innovator. Her first innovation was developed and validation of a tool that tests nurses’ knowledge of heart failure self-care behaviors in 2002. It has been translated into multiple languages and used and published extensively. Her next innovation was a process that allowed heart failure, critical care nurses to work more autonomously to advance guidelines, directives, and medical therapies. Currently, Dr. Albert has information, technology, innovation, and development, and she is conducting research on communication, innovation aimed at patients with heart failure. Results are expected before the end of 2019. Dr. Albert has submitted multiple innovations to the Cleveland Clinic innovation offices and has been a mentor and colleague of other expert innovations. For example, multiple tools she developed are available at IDEOexpects.com, including risk analysis falls and hospitals to pressure also’s. And in 2015, she completed the American Organization of Nurse Executives at Arizona State Innovation Leadership Fellowship. She has three hundred and ten peer-reviewed publications in medical and nursing journals, including a 2018 paper on nursing innovation leadership and over 15 book chapters. She is the editor of the 2016 book Building and Sustaining a hospital-based nursing research program. Dr. Albert volunteers for many health care organizations. It is a journal editor and reviewer. She presents locally, nationally, and internationally on nursing research and innovation themes and clinically and heart failure management and biobehavioral themes. Dr. Albert, thank you so much for being here.
Dr. Nancy Albert:
Thanks so much for having me. Thrilled to be here.
Rebecca Love:
Dr. Albert, as we get started, I think one of the biggest topics that we want to know and why I think the world of health care wants to know is what inspires your work in health and health care.
Dr. Nancy Albert:
I think what inspires my work the most is that I’m a clinical person. I work in a hospital setting and we see patients in need. Their needs are diverse. Their needs are important. They’re real. And if I could help improve somebody’s quality of life, if I can help improve their length of life or other clinical outcomes like not needing to be in the hospital, there is a level of satisfaction. And also, you know, the knowledge that goes along with being able to carry out activities and behaviors and functions and knowing that you’re actually helping society helping an individual, helping a family. So for me, I think a lot of it comes down to being a resource, being somebody who can be knowledgeable and help others so that they can live a better life.
Rebecca Love:
You know, I love to hear you say this because it doesn’t matter what level of nurse that I speak with from those on the front lines all the way up to executive. What seems to move us is this belief of helping others as a fundamental being. And I think that to me, it’s just still so powerful because when I talk with all these other health care leaders across the world, I’m not sure that the trueness or the sincere point of our north is so evident in any other profession outside of nursing. And I know that our audience knows Cleveland Clinic, one of the leading foremost institutes in the United States and the world. And I think that what I would like to focus on is not so much just by what Cleveland Clinic means to the health care of the health care ecosystem, because I think we understand the power of the organization, but more about the work that you are doing, leading nurse research and innovation within Cleveland Clinic and what that means to the future of health care and what you’ve experienced. So can you talk a little bit about that?
Dr. Nancy Albert:
Yes, that’s a great question. So, you know, when we think of research, I know that sometimes a nurse, an individual nurse will conduct a research study and be all excited because it gets published and think, I did this. But I think beyond that all the time, I’m always telling people our job in conducting research and getting answers to important questions is to set the foundation of nursing science. So what we know today may not be strong science. And we have to constantly be on our toes, ask questions, why are we doing something the way we’re doing it? What can we do that’s better? What innovations are out there that may help us get to the endpoint faster, quicker, stronger, so that we can set their tone for future generations so that when I’m old and in the hospital in need, maybe the way that we deliver care or practice nursing as a whole will be different because of some research that was done previously that showed that something was quicker, better, faster. Or more important. So I think when I’m looking at that big picture, I’m looking at us not just doing something for the sake of doing it. I have an old bugaboo when joint commission used to come to hospitals, I used to hear especially leaders say, oh, we’re doing it because of a joint commission. And I used to always say, no, we’re doing it because it’s the right thing to do. The fact that the joint commission calls it high quality or better safety is excellent, but we’re doing it because it’s the right thing to do. So when it comes to research and even innovation, we’re doing it to set that foundation for nursing science and nursing practice down the road. I have seen a tremendous amount of very clever, simple, feasible, easy innovations. There are so many things that we could bring to life to make nursing more palatable, make it easier, make it safer. And we just need nurses to not be risk-averse and to be willing to jump in with both feet and be not afraid, to share an idea that may not be totally understood by everybody else. Something up here that may take time and effort and some massaging to get it to the end-point. And so I think there’s a lot of opportunity for us in nursing and at least from the research and innovation standpoint. I get to work with passionate people day in and day out who have cool ideas that don’t always work. But, you know, we will explore, investigate and see where we can go.
Rebecca Love:
You said something that I thought was so profound is that research becomes the basis of nursing science. And I think for a very long time, health care has not seen necessarily nursing as science on a larger scale. And what you have said then is through those innovations, you’re driving better practices, broader outcomes, new ways of driving the most important elements of what’s managing health care are really cool ideas to take care of how we deliver care to patients, how we affect their outcomes. But it all comes down to a new field, which really is defined as nursing science. And I love this because this the word science in and of itself brings such credibility to an understanding where I think for a very long time the nursing profession has been poorly defined to the general population. There is not a good understanding of what nurses do or their value add, because most of us in our profession at times have not necessarily been given what that looks like to be a nurse. And so this definition of nursing science, I know other leaders in the field, like Marian Leary out of UConn, constantly refers to this definition. But I love to hear that you also have this idea and translate what research becomes to the baseline of what our profession is building. So that being said, Cleveland Clinic has always been known for innovation. And you at Cleveland Clinic have become the forefront of nurse-led innovation in the United States, building one of the first programs at any hospital to exist. Can you explain to our audience what that looks like and how you do it differently than what is available in most other institutions today in the United States?
Dr. Nancy Albert:
These are great questions. I’ll tell you, a couple of years ago, I actually typed in innovation in Google in innovation in health care and when hospitals came up with their name and the word innovation tag to it, I went to their Internet site and I was actually very discouraged because I couldn’t find any link for the word innovation attached to nursing. And I finally recognized that when hospitals, administrators, leaders, or systems as a whole, when they tag the word hospital or health care center in innovation, it usually means that we purchase innovative products. We buy the latest MRI, we buy the new gadget that came out on the market. And so we’re innovators because we’re buying things. What we do here is really help nurses to understand that they have important ideas, whether they’re driving home and it’s the twenty-twenty moment when they look back at what happened during the day, should I have done this? What would have happened if I did that? How can I do this? So asking those questions. And so I think what we maybe do a little bit differently is we kind of push nurses to understand that innovation should be part of the foundation of what they do day in and day out. In fact, it’s so much a part of our foundation that in our professional ladder development program, it is not the top rung to start being innovative. It is at the bottom rung. So what we say to nurses is, if you’re part of the professional ladder, you need to submit at least one innovative idea a year through the innovation portal. And we actually have on the innovation portal, don’t just tell us that you want more staffing. That’s not an innovative idea. You know, we wanted to truly be an innovative idea. And so it makes these nurses who are trying to get the professional ladder status think a little bit about what they’re going to put in there and is it really innovative? And then give us something, it may be that they don’t really have the best solution, but they’re bringing up a really important problem. And if we see that problem repeatedly, we could get a creativity session together, bring that person and others together, and then talk about the problem and let’s come up with a solution. So a lot of times what we do is to help take the passion that people have for a problem or an issue or even the need and bring them together in one space and help them move it forward. And I’m very fortunate. I have a small team. It’s a half of an FTE, so a point five position. And she is responsible for helping me to review all of the ideas that come through. And then we discuss important things. I’m also very fortunate that we have an innovation team at Cleveland Clinic that goes beyond nursing. So we have a patent attorney. We have people whose jobs it is to review every idea that comes through to see if it’s marketable, is it commercializable? Is it novel? Is it truly novel? It’s because research and innovation are tag teams a little bit. It’s my team’s job. If it’s a nursing idea to make sure there’s value because we all know that innovation is novelty plus value. So people come up with novel ideas all the time, and I say, well, where’s the value? What’s the value? And then they stumble. So a lot of times I could help them go. But look, there is value. Think about this. Think about that, and then we’ll do the research or an assessment. It may be a quality improvement. It may just throw it out there, make some prototypes and do an evaluation. So it’s our job to kind of bring things to life and then see what sticks and what doesn’t stick, what lands up high and what falls down. I think the other thing that we do really well here is we help nurses to understand that failure is a part of innovation and that we want you to fail fast. You may fail often. I constantly tell people when I’m giving slides or giving talks that the average idea has failed 30 times before it becomes an idea that really makes it. Now, what do I mean by that? Well, it may be that the first prototype doesn’t work or that it’s not novel enough. Somebody finds there’s a patent out there already and you just keep working at it, working at it and tweaking it and working with it and figuring out how to get the bugs out of it and how to make it so that is novel and then there’s value. So I think those are things we could do really well here.
Rebecca Love:
You know, this idea that innovation begins at the bottom of the ladder of someone’s career and taking someone’s passion to drive it forward and that failing fast. These are not things that you learn about in nursing school. These are not things that are typical in a health care environment. And what really excites me about this is tell us about a time that, you know, I think there’s a fundamental understanding, what do people not know about nurses that they should know? Because you’re taking this you’re giving them their passion. You’re saying go and fail fast. This is not a typical environment. But, you know, I don’t think that people in the general community have that understanding. So tell me, what do you think that the greater world of health care, in retrospect of knowing what you’re doing, that they should know about nurses in this space of research and innovation in nursing science?
Dr. Nancy Albert:
It is such a simple concept. It’s not novel. And that is that nurses are generally in their environment of work 24/7. And a physician may come to the bedside for 10 minutes, 15 minutes, or see a patient in an outpatient setting for a 15-minute appointment. But the nurse is the one who has to deal with the telephone calls if it’s outpatient. On the inpatient side, they have to deal with the families and they learn a lot about the socioeconomics and all those other factors, the culture that makes up the whole. And because the nurse is there 24/7, they know what the problems are. They know what the issues are, and certainly, they know what the needs are, at least for the area of focus for them in their world. And we need to tap into them and utilize them to find out what could work and what’s never going to work because they see X all the time. And so we just need to remember that they’re an important team member and we need to bring them to the table and give them a voice, allow them to speak up.
Rebecca Love:
I love it. Everybody is going to want to know. Give us an example of a time that your nursing team came up with a really great solution came forward because I still remember the earliest days of COVID and that email that came out from Cleveland Clinic by one of your nurses who developed how you can do remote transfusions and infusions. And this is just an incredible innovation that was done. Tell us more. Tell us more about a time and a problem and a solution that your nurses who solved.
Dr. Nancy Albert:
We have so many of them. I can give you in a simple example, we have a nurse who has, because of her patient population, she has to crush a lot of medicines. Now, we all know there’s the pestle and a mortar and there are different devices out in the market. She actually went out and bought each of the devices on her own to see which one was best for their unit because the device that Cleveland Clinic used to crush medications was a stationary device that was big and bulky, but it worked really well as a stationary device. But she got tired of going up and down the hallway from the bedroom back to the station, do the thing, go back to the patient’s room. So she came up with her own solution that fits in her pocket, that looks different than all the other solutions out there. What happened was that she went and bought these other solutions and found problems with each of them. So her goal became to find out a pill crusher that can overcome all the problems of everybody else’s. So right now, we are prototyping it. It seems to work really well, and we’re going to hopefully commercialize it. So I can’t tell you more than that right now. But that’s one simple thing. So I think the heart of it is, are you willing as a nurse or any professional to come up with an idea and then stick with it? Because she went through many iterations and even got advice. We have a peer review innovation council. And so she brought it to this peer review council. And even the people on the phone and in the Microsoft team reading gave her a lot of feedback about, did you think about this? Did you think about that? So, again, hearing those voices around you and bringing other people in could be really important. We actually brought in an engineer because we wanted to make it in a certain way and we needed to look at polymers and different things. And so, again, bringing in the right people into the mix, but also being passionate enough, being persistent enough, having a willingness to endure setbacks, you know, putting that little iron plate over your chest so your heart’s not affected when somebody tells you this will never work. And instead of feeling dejected and rejected saying, I’m going to figure it out, I’ll come up with a new solution. And so I think one of the things that we can help with when I say we, I mean nurses at large is helping each other. I think I put this in the book. One of the earliest innovations that I brought forward at Cleveland Clinic, my boss came up to me at one of our standing meetings and told me to watch my back. And I was so shocked when she told me that. And it turns out my CNS colleagues were a little bit threatened about this idea I had come up with and was pushing forward in my world of heart failure. And so I started watching my back, knowing I loved all of my peers and didn’t know which peers I should be watching my back for anyway. But I just started keeping it more internal and working with the people that I knew really appreciated it. And it turned out there was never any threat and get better again. But I could understand how when people come up with innovations because it happened to me with the watch your back, that people can feel a little bit worried or threatened or somebody thinks that they’re doing something outside of the scope of their job when actually it is part of the scope of their job to be innovative. So we’ve kind of set the parameters for that. And then we’re allowing people to fail and to respond to those failures and move on. So I think people come up with really cool ideas all the time. I know I mentioned that already. And it’s just a matter of how do we set the tone to help them succeed.
Rebecca Love:
Nancy, I’m so glad that you actually mentioned this experience that you had, because I think that these are the things that we don’t talk enough about. We don’t talk about those setbacks or those terrible things that happened to us, that possibly those three words that could basically transform what you went on to do and what you might not have done and what that impact would have been to the world if you had not taken that idea forward. Would nurse innovation exist at Cleveland Clinic if you had not kept going with those ideas and believing in yourself? So many of us have experienced those kinds of emotions and how many listening today have stood on those moments to let somebody else define their dreams, their passions, or what they do with that? And one thing before we move right on that idea that your nurse came up with like I think there was a study out there that said nurses are in thirty-six different places an hour or so coming up with a solution that allows you to do these in stop all that running around. How many hours are nurses just in the midst of, instead of being able to provide patient care, a running back and forth between rooms? This idea is not only exceptional from the ability of what it does, it means for access to a device that we’re using every minute. But how many minutes and hours a day is that we give a nurse back to actually be able to provide more care? When you calculate that against the hundreds of thousands of nurses and hospital systems you’re doing in dealing with this issue. So I love that there is a practical means to this solution on crushing, but what does that actually mean when you’re actually looking at time efficiency studies on a large scale if we can just give nurses back their time? Because we see the solution as being, oh, it’s great, we have a new, but the truth is, what we’ve really just done is we’ve just allowed nurses time back to provide care. And that is real dollars, the health care system. So I love that some people might listen to this idea of this impact of what this device is, is like, oh, they came up with the pill crusher, just like those group of nurses who came up with a night light. But what that doesn’t mean is all of a sudden we’re devising efficiencies that are going to deliver better care because time goes to more important tasks. But I love this. And as we go back to it, you gave us one example of somebody who said something that could have derailed you, but you kept going. But could you extrapolate on one of the biggest setbacks you experienced? And what was the key to that learning that you took with it? And how did you keep going forward?
Dr. Nancy Albert:
You know, that’s a really interesting question. I think the biggest experience for me is that when you get that setback and you finally get to move forward, it turns out that it’s probably a good thing in an odd way because when you move forward, it’s a better product, a better solution, a better whatever. We had a nurse who developed right before COVID, she developed the product, as she calls it the High Line just recently has been commercialized. And the Highline’s purpose was to get I.V. tubing off the floor in pediatric patients who need to get up and walk or maybe be in the wagon in the tubing was getting caught in the wheels and the wrapping tubing around their arms because they’re little people, but long tubing so it’s dragging on the floor. COVID hits us and nd suddenly we need to get tubing off the floor because we’re trying to have I.V. pumps outside of the door and we’re adding in all this extension tubing and it’s all dragging on the floor. So she was right at the point of trying to make a successful impact with her product for pediatrics. When we got this nirvana, we could be helpful to the critical care nurses, but we needed to change our product because our product was meant for one I.V. to get it off the floor because most kids don’t have six pumps going with vasoactive drugs and neurohormonal stimulants and sedatives and all of those things. And so the setback we got actually helped us move forward. And now we’ve got this even better product that was marketable to our company and now is going to be commercialized permanently down the road, we hope. We’re waiting for the new prototypes to come through so that it can move forward. So I think when people get setbacks, we just need to help everybody understand that a healthy setback with a good mindset Of I can do this, I’ll figure it out, I’m going to still move forward, could actually be a blessing in disguise. Hard to hear, but really important.
Rebecca Love:
Oh, my gosh. That is the most brilliant statement I’ve heard in a very long time. And it’s so encouraging because I think when people recognize that the reason sometimes these setbacks happens is to push you to make it better. It’s not to stop you in your tracks. It’s just to sit there and say, OK, so there’s something here that is supposed to make this better. And I say it’s the nurses that I think this transcends both on products to careers, to everything, that life has its moments of hardness, not to discourage us or beat us down so that we stop going forward, but so that it makes us grow and learn and keep moving forward and become better. Not only that product but as a human being. And honestly, as we look backward for and I know you look backward in your career to those moments of where you started out to where things ended up, nobody has a roadmap. But could you provide actually for the audience who’s listening today, what key takeaways like where you started and did being one of the most forefronts leaders in nursing today? What advice would you give to all of those who are coming out of COVIDd who are looking at this profession and looking at their careers and thinking, I’m not sure I can do this. I’m not sure I can do this.
Dr. Nancy Albert:
All right. So I would say a few things. I would say, number one, and maybe this is a downfall of mine, but it’s also helped a lot to get me where I’m at today, and that is that I rarely say no to people. So whether it’s a committee to be involved in, like a national committee, whether it’s a work at Cleveland Clinic that involves people outside of my discipline that I’ve never met before. Every interaction I have, I grow and learn just because I pay attention to who’s talking and what they’re saying. And I may not agree with everything, but it brings a new perspective to life. And I’ve really come to value that multiple perspectives on a topic can be really important to give you that bigger picture, the other thing I would say, and this may sound a little bit odd, is to pay attention to serendipity, because things happen that I maybe can’t control at all. But I have to respond to those things. And so when I’m responding, I think about what’s put in my face that I have no control over. And what I can do to make something better, make it right, make it, you know, lead to more important outcomes, whatever comes along. So if we’re in the moment and we’re also looking outward to the future, we can take what comes at us and really bring something to life down the road. And I have to say, some of my innovations are serendipitous. I went into the project, the process that whatever I was doing with a whole different intent. But while I was there, I recognized there was a problem that I thought I could fix. And so I went into a research study, but I couldn’t find any tools out there for what I needed. So I had a create a tool. Yes, I had to do psychometric testing. It’s a long process. You know, it takes time and effort. But in the end, I have a valid, reliable tool now that not only I could use, but other people around the country could use. And so I think some of what we do in nursing, we don’t pay attention to the simple moments and pay attention to the details. And also, when something goes well, we need to pay attention to tell others, even though it’s just so easy to think, oh, no one cares about what I do or no one really wants to listen. Everybody’s busy. They’re working on their own world right now. They don’t want to hear about it. People just need to find the one person who does want to listen. And, you know, you could take a seed and get a tree. So you got to start somewhere. And so plant that seed and then see if it’s going to grow.
Rebecca Love:
Serendipity. Luck. Those moments and how you view that moment in time, that hardship, that problem. Every problem just means that there’s an opportunity for a new solution. Exactly. That is innovation. And I love that. So tell us, what are you most excited about today for the future of nursing, for the future of health care? Your learnings coming from this tragic COVID pandemic for the last 18 months. What gives you the most excitement and hope?
Dr. Nancy Albert:
When I think about the excitement in health care today, I think about the fact that we’re kind of turning a leaf in a sense. You know, a lot of people that were probably my age are retiring. And we are noticing that nursing is full of millennials now and Gen Xers are growing. But millennials are the height right now, and they bring a different skill set than the baby boomers did and people from before. Their minds work differently. They think differently. And so I’m excited to learn what millennials can bring to the table and bring forward. That’s going to help us down the road. And the same with the Gen Xers. So, you know, taking these bright people that hopefully are getting into nursing for the cause. For a while there, we used to say a lot of nurses went into nursing because it made good money. You know you did it because I’m going to have a steady income. I can have good financial status. I’m doing it because of that. But I think because of COVID, a lot of people realized they weren’t in it for the right thing left. We’re seeing a lot of change in status within hospitals. And I don’t mean just my hospital. I’m hearing about it throughout the country. So what I’m excited about coming up down the road is that people that choose nursing hopefully because of COVID, maybe choosing nursing for the right reason, whatever that is, but not just because it’s going to pay well, that they’re passionate about helping people, that they’re passionate about working with strangers that are humans, that have a need, and that they’re there to help them. And because of that, we actually may see a better or maybe a faster increase and change over time. That will help us get to the point where we have more evidence-based practices versus those practices that have been around forever because I said so, because that’s the way I was taught. And we have a lot of those standing practices that really don’t have evidence out there, but we don’t have something better. So what can we do that’s better? And I think there’s a lot of enthusiasm for raising voices. I’m part of a magnet facility and we want shared decision making. We want nurses to come forward. So as Magnet moves forward with the American Academy of Nursing and also our American Nursing Credentialing Center, I guess I should say, and as newer, younger nurses are moving forward and want to take ownership of their profession. I think it’s really good for us.
Rebecca Love:
I see a lot of that next generation and so many endless opportunities for the next profession to come in and rewrite things and do things differently to keep advancing the profession overall health care. Dr. Albert, where can people find you if they want to follow up with you? They want to hear from you. They want to see you speak. How can they find you? How can they get in contact with you or your office for future conversations?
Dr. Nancy Albert:
Well, thanks for asking that. So I have a simple name, so it makes it very easy. I’m at albertn@ Cleveland Clinic Foundation ccf.org. So albertn@ccf.org. And I’m very happy to hear from people. Please do not send me notes on LinkedIn or Research Gate or any of those sites. I get so many emails, I ignore all of that stuff. I know it’s terrible. II can’t be on ten email sites, so I use my work email site as my primary site. But I love talking with people and I would be very happy to do that.
Rebecca Love:
Well, Dr. Nancy Albert, the associate chief nursing officer of Nursing Research and Innovation at Cleveland Clinic. It has been such an honor to have you on today and your hope and inspiration and your insight into the world of nursing, but more importantly, the world of nursing science into the future of health care. It’s been remarkable. Thank you for spending this time with me and us and for everyone who is listening, please do reach out to Nancy. Thank you so much for being here.
Dr. Nancy Albert:
Thank you so much for inviting me. I really enjoyed your time talking.
Rebecca Love:
Everyone, please tune in for the next section of Outcomes, Rocket Nursing as we interview future nursing leaders and further nursing news. Thank you so much for being here.
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