Transforming healthcare relies on technology that augments and enhances the work of caregivers. And tech has become increasingly central to the role of nurses. As leaders on the frontlines of healthcare, nurses are in a unique position to innovate and use technology in ways that ensure it will improve lives. This year, out of hundreds of applications to the challenge, two nurse leaders stood out as visionaries in leveraging remote care, a burgeoning new technology. One radically reshapes nurse staffing models while the other brings the AI technology revolution to wound care.

Jean Putnam, DNP, MS, RN, CPHQ, NEA-BC executive vice president and chief nursing officer at Community Health Network and her team; and Paulo Alves, PhD, MSc, RN, and team from BestHealth4U were selected from a global pool of applicants to receive up to $100,000 in grant funding, access to the Johnson & Johnson Innovation – JLABS ecosystem, and mentoring from experts across the Johnson & Johnson Family of Companies to help bring their innovative ideas to life.

“Nurses are inherently innovative and have the skills and experience to reshape the healthcare system from the ground up,” said Lynda Benton, Senior Director, Global Community Impact, Johnson & Johnson. “Jean and Paulo represent an exciting future for the nursing profession, in which technology complements nursing care and improves patient outcomes and – critically – nurses’ well-being and satisfaction in their work.”

"Advancements in remote technology are poised to revolutionize healthcare delivery,” said Chief Executive Officer of the American Organization for Nursing Leadership (AONL) Robyn Begley DNP, RN, NEA-BC. "We are proud to support these inventive nurses and help bring their creative solutions to life."

“With hands-on experience and a wide skill set, nurses have the insight as to where technology can have the biggest impact,” said Kathleen Ulanday, MBA, MHA, BSN, RN-BC, CPHIMS, President at American Nursing Informatics Association. “Jean and Paulo demonstrate exactly how important nurses will be in leveraging technology to make healthcare better and more efficient.”

Bringing the future of virtual nursing to Indiana and the nation

“We are on the dawn of a new nursing model, a new nursing professional practice” said Jean Putnam, DNP, MS, RN, CPHQ, NEA-BC.

As chief nursing executive at the nonprofit health system Community Health Network (CHNw), Putnam leads a team of more than 5,000 nurses – and she’s pushing that team to think beyond decades-old staffing models.

Alongside teammates Anna Lorenzetto, MS-CIPCT, BSN, RN, Chief Nursing Informatics Officer, Janel Borkes, MSN, RNBC, Vice President Professional Nursing Practice, and Missy Simpson, MSN, RN, Director Acute Care Services, Putnam and the CHNw team is piloting a nurse-led care team reinvention.

“It really became apparent to me during the pandemic, and even pre-pandemic, that we are not going to be able to sustain the current nursing model in acute care hospitals,” Jean said. “We can’t afford it. We’re facing this incredible workforce shortage. We’ve got to innovate now.”

Titled VITAL (Virtual Innovative Transformational Nursing Care), the program places a virtual nurse for all patients on pilot units to work hand in hand with bedside nurses and the rest of the care team.

This introduction of telehealth nursing practice to the acute care setting fully onboards a virtual nurse to the care team and enables two-way interactions, unlike traditional, one-way remote monitoring. Virtual nurses will employ three computer screens that provide access to a video feed of the patient’s room, CHNw’s Epic EHR and other systems, and will use sound integration and permanent cameras to care for an in-patient – all from a virtual hospital in Omaha, Nebraska.

Through a partnership with Banyan Medical Systems, which operates the virtual hospital in Nebraska, the project introduces an innovative model of nursing care delivery to Indiana and the nation.

Most important, it’s an innovation created by nurses, for nurses. The CHNw nursing team has served as close advisors throughout development of the new care team structure and delivery model, determining the roles of bedside nurses and virtual nurses.

Virtual nurses will focus on admission and discharge, patient education, quality and safety surveillance and care planning. Documentation is a shared responsibility, but CHNw expects the VITAL program will relieve bedside nurses of as much as 30 percent of the time they currently spend on documenting charting activities, creating more time for hands-on patient care.

Yet virtual nurses are more than just scribes, Putnam says. “They’re going to enhance our critical thinking. The virtual and on-site nurse can have conversations: ‘Here’s what I’m seeing. Is that what you’re seeing in real life?’”

Multiple improvements to practice and patient outcomes are expected through the VITAL pilot, including a reduction of patient falls, fewer central line bloodstream infections and catheter-associated urinary tract infections, higher patient satisfaction, lower unit turnover rates, and lower length of stay and readmission rates.

“I think our nurses will really appreciate having another set of professional eyes that can do some of the work and get them back to the top of their scope of license,” Putnam said.

But there’s another critical part of the VITAL value proposition. Currently, more than half of CHNw’s nursing workforce is under 45 years of age. Thirty percent of the nursing workforce is between the ages of 26 and 35. And the majority of nurses have five or less years of experience with the organization.

“I have a lot of new nurses coming out of the pandemic that aren’t necessarily confident,” Putnam said. “But the reality is that our patients are sicker than they’ve ever been, and these virtual nurses come to us with an average of 15 years of experience.”

That extra support goes beyond extra hands and eyes on patients to nurses helping each other withstand the pressures of their field. It reduces some of the emotional turmoil many of these new nurses have experienced through the pandemic, and Putnam fully expects virtual nursing to be a market differentiator for CHNw to recruit.

“Some of these new grads working in ICUs have seen more death in three months than some of us did in our whole careers,” Putnam said. “That emotional side of this, the improvement to nurse well-being, is very significant.”

The program will start on pilot medical surgical floors, and Putnam plans to expand to med/surg areas throughout CHNw, and then to intensive and progressive care units. Beyond internal scaling, the team expects sharing of workflows and outcomes to the broader nursing community will allow for faster adoption and transform nursing on a larger scale.

Virtual nurses will go through the same competency checks and training as bedside staff and, to ensure connection and engagement with the unit, the virtual nurses will attend staff meetings and inpatient huddles to truly be full members of the team.

Even so, she acknowledges that change management will be critical in creating a successful project. Yet, she says, “This is the time, right now, to move forward. If we can get people to ask what nursing could look like, instead of going back to the way it was, nursing is going to be so much better. We’re going to promote our professional practice, it’s going to be better for the patient, and it’s going to be better for each other.”

A smart revolution for medical adhesives

He’s a nursing specialist and assistant nursing professor at Portuguese Catholic University, and he describes chronic wounds as a silent epidemic, one often masked and aggravated by comorbidities. Wounds can lead to repeated hospital admissions, extended hospital stays and even surgical intervention, and often consume a substantial percentage of nursing care hours and hospital resources.

So, it was only natural that he’d partner with Sónia Ferreira, who has experienced challenges associated with having a medical device attached to her skin since the age of seven. Ferreira’s experiences as a patient led her to found BestHealth4U and embark on revolutionizing medical adhesives.

With 20 years of nursing experience and a research career focused on wound epidemiology and costs, Alves brought the clinical insight as Chief Scientific Officer. Ferreira, now a biomedical engineer, brought her personal experience, engineering expertise, and entrepreneurship, and with a multidisciplinary team of tech and medical experts, the company is focused on reducing discomfort and improving the quality of life for those with chronic or acute wounds.

By harnessing technology advancements in remote monitoring and artificial intelligence, the BH4U team created adhesive.AI, a smart dressing with built-in biosensors that connects to an app and web portal that runs predictive wound healing algorithms.

It’s a strong and flexible adhesive, safe and comfortable for skin, that remotely monitors the various metrics that help or hurt the healing of wounds, such as pH, temperature, presence of fluids, bacteria, and more.

The adhesive directly connects patients and care teams, and signals to nurses if conditions within the wound have changed. Then nurses and patients can be alerted as early as possible to potential problems. Alves explains, “Usually, by the time you go to the nurse for wound treatment because you have pain or leakage, you already have a problem.”

With data flowing to health workers 24 hours a day, patients and caregivers can follow the status of the wound and the evolution of healing through the app, while nurses and other members of the care team can monitor the wound via the portal and adjust treatment as needed.

Alves believes strongly in the opportunity for nurses to leverage technology to improve their ability to care for patients. “This doesn’t substitute the nurse at any point,” Alves says. “But you are giving the opportunity to the nurse to do other things. Usually, we see nurses using their hands and their head. They think, they anticipate. But why can’t we use technology to help us? We need to interpret the information regardless, so nothing changes,” he said.

The solution reduces the resources needed for nurses to maintain a constant record of the wound, and the BH4U team anticipates the technology could reduce the costs of wound management by 30 percent while improving the patient experience.

By the end of 2022, Alves expects the technology to begin the pilot phase, including preclinical tests and a biocompatibility certification, and clinical trials are expected in 2023. The team is also currently building internationalization plans to bring the technology to North America and Asia.

For Alves, central to the success of product is the multidisciplinary and dynamic spirit of the team. He encourages nurses to expand their influence by partnering with those in research, academia, and engineering. His partnership, for example, with Nelson Oliveira, chief technology officer, was critical to their success. Oliveira’s work is focused on the development of new polymer-based materials, and his out-of-the-box thinking developed the company’s biocompatible adhesive, Bio2Skin.

“You can have the idea, but if you are only in research, or only in engineering, or only in clinics, it’s difficult. To get everything working, and then testing, changing, making it better – this achievement is only possible because we work as a team,” he said.

Initially, adhesiv.Ai will initially be for surgical wounds, then diabetic wounds, and finally, for other chronic and complex wounds. BH4U sees a growing need for smart wound care due to the rising incidence of road accidents, burns and trauma events, the growing use of regenerative medicine and the high prevalence of conditions that impair wound healing.

“If we can make a technology that is feasible, that is not expensive, we can help people all over the world,” Alves said. “That’s what nurses do – they help people.”

With remote monitoring, nursing care is everywhere

The innovations led by Jean Putnam and Paulo Alves represent two of the many different ways that remote monitoring may be used to revolutionize the delivery of healthcare. While hands-on assessment and treatment will always remain the cornerstone of care, remote monitoring has the potential to entirely reshape our understanding of when and where care happens.

Being awarded the Johnson & Johnson Innovate QuickFire Challenge means Putnam, Alves and their teams, will gain access to grant funding and support to help advance their innovations forward. This includes mentoring and training opportunities from the Johnson & Johnson Family of Companies and access to the Johnson & Johnson innovation – JLABS ecosystem, which helps innovators accelerate discovery and get operational support to bring their healthcare solutions to life.

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Applications for the New NurseHack4Health Pitch-A-Thon open May 12. Nurse-led teams from health systems are invited to pitch their ideas for improving workforce wellness for a chance to receive a grant up to $250,000 from ALL IN! Learn More.

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