Today in the chart

Q&A Feature: What Problems in Healthcare Can Nurses Play a Role in Addressing?

A board member of The Nursing Beat, Fred grew up in St. Louis and earned his BSN and MS at the University of Kansas. He shared with us his thoughts on his career trajectory, the state of nursing today

Fred Neis, MS, RN, CEN, FACHE, FAEN, is the Vice President of Revenue Operations at Lumeris, Inc., a privately held company based in St. Louis, started by a group of primary care physicians. Lumeris’ mission is focused on value-based care through partnerships with health systems and providers and a collaborative Medicare Advantage program. A board member of The Nursing Beat, Fred grew up in St. Louis and earned his BSN and MS at the University of Kansas. He shared with us his thoughts on his career trajectory, the state of nursing today, and the future of healthcare in the U.S.

When did you know you wanted to be a nurse? 

In some ways, I think it chose me. I was an EMT coming out of high school, and I entered the University of Kansas thinking I would be pre-med. By the end of my sophomore year, I decided that I didn’t want to become a physician, and I wasn’t really sure what I wanted to do. I went to the University of Iowa for paramedic training and then returned to the University of Kansas, having decided that I really wanted to become a nurse. In some ways, I’m following in my mother’s footsteps. My mother was a nurse and also graduated from the University of Kansas School of Nursing. I also always really enjoyed the business side of the world, so I went on to get a master’s degree in Nursing Administration shortly after graduating with my bachelor’s. I worked full-time clinically in intensive care units, Life Flight, and emergency departments for about a decade, and I still work clinically today as a firefighter/medic.

What attracts you to administrative leadership in nursing?

Number one, I think I can affect patient care, improve community health, and also support nurses in a much more macro way in positions of leadership than one patient or two patients at a time. I have also enjoyed looking at efficiencies to be gained within process improvement, delivery of care, and standardization of processes. Some of that has been driven by my work as a firefighter and paramedic. I think it’s actually a nice parallel to the work that we should be doing more broadly, clinically, in terms of using evidence-based medicine and some structures around utilization and performance. 

How do the various hats you wear inform how you think about improving efficiencies in nursing? 

I have both a clinical and business background, education, and experience, so I can toggle between the two, trying to figure out what kind of the best solution is and finding that intersection. It’s not just purely based on financial and business performance, and it’s not purely based on the clinical. I also benefit today from working not only in the business world and managing a business unit but still working clinically. That helps me understand at a business level how we need to still fix some of our fragmentation and brokenness within the delivery system.

For example, we talk about how important it is to have continuity of care. Yet, in an ambulance, the person I’m caring for gets to decide what hospital they go to, and typically they don’t know what in-network is and what’s not in-network. They don’t necessarily associate a hospital with their primary care physician if they’re not directly tied to that health system. So we may end up taking the individual to a hospital that isn’t in-network or even truly connected or related to their primary care physician as tightly as it needs to be to have a good continuity of care.

What big problems in the healthcare system can nurses play a role in addressing?

Standardization of care and improving professionalism. Nurses need an introduction and education into the business of healthcare early in their educational curriculum, and I say that from the vantage point right now of a lot of the nursing protests asking for more pay, better hours, health systems supporting us and giving us more education and more nurses. Not a single person should argue those things. However, nurses may not understand that you can’t just go to your company or boss and say, “I want to make more money, and you need to hire more of me.” Where does the money come from or the people? We, nurses, have to help make our company an attractive place to work. 

Nurses need to understand how we impact the revenue cycle of a health system and the care of delivery. It truly is a mathematical problem. Your chief nursing officer probably will agree with you that you need more nurses, but nurses need to understand the value equation of role, responsibilities, and impact on both the individual and the system. I would also argue this is self-inflicted among nurses. We are horrible at accepting delegations. “I don’t need to put in an IV anymore; that is not what a nurse should be doing.” “I should be working at the top of my license, and we can hire techs to put in IVs.” But for whatever reason, our lobbying organizations are saying, “No, you can’t do that. You’re taking it away from nurses.” But I have other things I need to do that are much more value-added than putting in an IV.

What has been the most fulfilling of the various jobs you’ve had? 

By far and away, if it’s just titles in general, Dad is probably the best one ever. I have a three-year-old who just loves the world. So that’s number one, but on more of a professional side, my top two favorite roles have been, clinically, a flight nurse for a helicopter service and, in the private sector, working for the Advisory Board Company, where I was Managing Director.

Flight nurse, I would argue, is the most autonomous staff nurse position available, and it was an all-high-acuity environment. It mirrors fairly well what I like about the fire service and EMS, which is teamwork and camaraderie. Then at the Advisory Board, what I loved about it was the people. It was the culture of the organization, and the people made that culture.

What made it a good culture?

The founder of the company, David Bradley, probably started it on day one. It was an ability to create a fabric in the company where the mission was not only understood but executed every day, and it was done within the framework of our value system. Those values were “The spirit of generosity, force of insight, power of language, and run to criticism.”

What do you enjoy doing for fun? 

Aside from being a father, which is number one, I really like good food, good wine, and good experiences with friends and family. For true fun, I enjoy a good cup of coffee and the New York Times on a Sunday morning. I have been blessed with being able to be an international traveler. My favorite countries are Italy and Costa Rica. I believe to this day in the spirit of generosity, so I try to donate my time generously. Up until eight months ago, I was volunteering my time for the fire department. I serve on boards for the University of Kansas School of Nursing Alumni, Kansas Chapter of the American College of Healthcare Executives, Emergency Nurses Association Foundation, Capella University School of Nursing and Health Sciences, and I’ve been on medical missions into Western Kenya. Education was our principal mission, but we also provided primary care. 

If you could wave a magic wand and change one thing that would make healthcare better for all Americans tomorrow, what would you do?

If we’re only centered on health care in the discussion, access to good health care is going to be key; however, we as Americans define that. Yet, I do think that most Americans are not prepared for the consequences of what that means, like having to make some tough choices about who can get what and who cannot. In order to keep costs down and keep the quality of health care for all, it’s a math equation (resources, expected quality, and dollars). It’s not going to work that everybody’s going to get everything.

Just look at the pandemic and think about the moral issues that were faced by many clinicians, who had to make some truly life-and-death decisions that they are not typically educated and equipped to make. As a paramedic, that’s what I have to do — resource allocation and make those determinations. But we've not trained physicians and nurses to morally be able to adjust to that type of scenario. I had a physician years ago say to me, “One of the greatest difficulties facing clinicians is the ability to understand the power of doing nothing,” and I thought that was really true. It’s okay to comfort someone and their loved ones. I am not committing more acts of medical care.

What would lead to progress and better working conditions for nurses?

Change starts from within, so I’m reflecting more on it from what nurses need to own to make those changes and adapt to the system that’s coming rather than what nurses could have. We should be expanding our training and understanding in business, how healthcare is a business, utilization and optimization of technology and emerging technologies, the healthcare payment system; career pathing; wellness, and leadership. 

What do you see as the biggest barriers to more fulfillment and satisfaction among nurses in an environment of such high burnout?

I think it’s about education and recruitment into the profession, particularly early on, in really setting the expectations of what it means to be a nurse. Health systems are certainly to blame, but I do think we as an industry are also to blame because we don’t always hold ourselves to the right standards of expectations. I think that we are probably one of the last industries that still tolerates poor customer service. We are also one of the last industries to have a product in which we tell the consumer effectively what they’re going to get, rather than listen to the consumer on what they think they need/want and are willing to pay for, and that makes healthcare sometimes untenable.

We are the most trusted profession in the United States year after year, yet we don’t leverage that kind of power for good. We should harness that at a local level, state level, and national level on a regular basis to change health care, and we just don’t. We don’t know how to mobilize and organize, and sometimes we can’t get out of our own way. We’ve got to do better as a profession and seize that opportunity.

What do you think nurses as a group should be doing right now or advocating for in terms of steps toward a better future?

There’s certainly more power in numbers, but I think each individual needs to hold themselves personally accountable for a commitment to do that within the profession. We are nurses 24 hours a day, seven days a week, and we represent ourselves and nursing as a brand, so individually, we all need to figure out how to contribute. As a group, we’ve got to leverage our professional organizations better. I think we need to collaborate more with other professional organizations, such as the American College of Healthcare Executives, the American Hospital Association, and the American College of Physicians.

We need to start advocating with our consumers. One of the things that I am trying to push out of our lexicon is the word “patient.” There are times that patient is an appropriate word, but generally, as healthcare has truly evolved, we are consumers of healthcare. We are people, and we should stop centering on “I’m taking care of a patient” and think, “I’m taking care of a person.”

What should be done to address growing levels of violence against nurses and other healthcare workers? 

If we’re talking about protecting nurses from external threats, health systems and employers of nurses need to do that. But putting that to the side for a moment, I go back to, let’s indict ourselves first. As nurses, we need to take responsibility for taking care of our own and protecting ourselves and our teammates. It is not acceptable that, to this very day, we allow nurses to have lateral violence toward each other. It is an enormous problem. Nurses still eat their young, and they still pick on one another in horrendously bad ways. It should never be acceptable, but we tolerate it, and we do a bad job of generally policing it, reporting it, and holding folks accountable. So it starts with us; let’s take care of ourselves and our teammates.

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