Kimberly Long 0:00

Hello, everyone. We are honored to have Rob Bosch. He is the Chief Nursing Officer for Emory University Hospital and Emory Orthopedic and Spine Hospital. Welcome, Rob. Thank you so much for having me, Kim. I appreciate it. Oh wonderful. I appreciate you taking the time and share some of your expertise with us. I'm going to start out with is it possible for you to walk us through your journey to executive leadership and any defining moments that shape that trajectory?

Robert Boesch 0:29

Yeah, absolutely. You know, I'm happy to. You know, I had the privilege of starting off my career at Penn State Children's Hospital in Hershey, Pennsylvania. Uh, the reason I went to Penn State in the first place was actually what I really consider to be one of my career-defining moments. They had a really neat opportunity called a children's hospital float nurse. And so even as a graduate nurse, just getting my BSN, I was able to float between all of the units within the children's hospital. So I spent time in the pediatric ICU, intermediate care unit, acute care, pediatric hematology, oncology unit. And I gained some incredible experience, really, with a diverse array of patients and criticality, which I thought was really, really exciting for my first year in. And then after that, I landed in pediatric oncology. I was a pediatric bone marrow transplant nurse in my clinical practice, and I absolutely loved it. It's where, you know, I really fell in love and found my passion for pediatrics and that population specifically. You know, and that still carries through today. It's amazing to see some of those patients that have gone on to college or, you know, have gone on, one of them has published a book. And it's just, it's great to see those connections with family and patients that we've cared for in the past. My journey into leadership was really, you know, pretty simplistic, as most leaders experience. You know, I was tapped on the shoulder at one point to take on a charge nurse position and then really jump into the position of a nurse manager. The hardest jump that I had to make, though, was going from a nurse manager in a children's hospital and then really going within the same hospital, Penn State Children's Hospital, over to the adult side to become the manager for the Penn State uh Cancer Institute. And that was really my first foray into the adult world. And so it was a big jump, you know, going from caring for pediatric patients to going into the adult world and some of the challenges that were expected and unexpected within that transition. From there, Penn State helped me to go back to school. So I got my master's and my doctorate through Penn State. And I'm always a big advocate. If you can get somebody to help pay for school, take advantage of it. And then from there, I transitioned into the VP of acute care nursing at Penn State. And eventually I made a lateral move over to the VP of Surgical Services at Penn State, you know, based on the organization's need. And I think that's one of my, you know, kind of key recommendations is even lateral positions. If you are meeting the needs of your organization, say yes to those opportunities when they're presented to you because you never know how they're going to open doors and really give you an opportunity to learn and grow in some, you know, unique aspects of patient care and unique aspects of leadership that you wouldn't get exposed to otherwise. So I did those roles for a couple of years. And then I took my first CNO position in Virginia at Centra Health. It was Lynchburg General Hospital and Virginia Baptist Hospital. One of them was a 380-bed uh teaching hospital. The other one was a 180-bed women's children's and behavioral health hospital. It was my first CNO role, and I absolutely loved it. We lived in Virginia for a few years and uh really fell in love with the community, fell in love with the health system. And then I got the call from uh Sharon Pappas and my former chief operating officer at Penn State to come down to Emory Healthcare. And so I've been here at Emory for about two and a half years at this point. Absolutely love it. Uh, it's been an incredible experience. And, you know, certainly didn't think my career was going to take me from Pennsylvania to Virginia down to Georgia. But at the end of the day, you know, I'm blessed to have a family that's uh flexible and supportive. And, you know, we're always down for an adventure. And it's incredible to see how your connections, both locally and nationally, and all those opportunities that you've said yes to over the years to help the organization that you're within really helps to shape your own perspective and give you some insights that make you a better leader.

Kimberly Long 4:07

Oh, that is absolutely outstanding. Now, you know, I want to flip over to academia for a second. Yeah. From your perspective, you know, taking into consideration the nursing pipeline that's needed and that there's a two-part question. The first part is what are the greatest opportunities that we have to strengthen alignment between the healthcare systems and the academic institutions? And the second part of the question is, how can we on the service industry work with our academic colleagues to help them prepare the nurses for the realities of today's healthcare system?

Robert Boesch 4:42

Yes. You know, I think if you talk to anybody in healthcare right now, the ability and the readiness to practice is always a hot topic, right? We learn one thing philosophically and through theory in our undergraduate programs and in our LPN programs. But really, that transition to practice is incredibly important. There's so many strong programs out there about helping nurses throughout that first year transition. But realistically, you know, I think a lot of those models have been around for a long time. And we need to continue to push the bounds for what that looks like. We're really fortunate here at Emory Healthcare and Emory University, where we just got a new dean in our school of nursing. And so Dean Sean and I were talking about how one of our goals is actually to start hiring nurses between their junior year and their senior year, and then make their senior year practicum on the unit in which they've accepted their job. So that way we can really give them a strong first year experience, get some of the competencies done out of the way while they're still in school, and really make sure that when they graduate, they're much more prepared for NCLEX, they're much more prepared for practice because they've had real world experience. And that will really help with that transition from uh college life and prepared undergraduate life over into the adult world, which we know is a challenge for many of our new graduates right now as they prepare to take roles, you know, some of them for the first time in really formal jobs across the country. And so I think that there's some unique ways that we can challenge some of the preconceived norms, build upon the strong transition of practice programs that exist through organizations like AONL and through many local programs at the organizational level or university level. And then the other piece that I would say is I also think we have to start looking to the future. How do we make sure that we integrate technology into the classroom further? So things that I think of in that example are ambient listening. You know, we're doing an ambient listening trial on one of my units right now, where the nurse can walk in, narrate care, and it automatically uploads it to Epic. And one of the challenges that we didn't anticipate, because for me, that sounds magical, right? I don't have to sit at the computer, I don't have to waste all my time documenting. I can simply narrate care and have it translate directly into Epic. But what we found is that our nurses really struggled with narrating care, how to verbalize what they were doing, how to verbalize in a patient-friendly way. And it really took a huge shift and a huge educational push for us to get to that standpoint where our frontline team felt comfortable with it. And so if that's the emerging technology, getting ready for virtual nursing care delivery, making sure that we're prepared for practice, we have to start thinking about that at the undergraduate, LPN, RN level so that they can come to the environment and be ready to use that technology instead of really using the environment when they should be working to really continue to do all of the educational push.

Kimberly Long 7:29

Oh my goodness, that is so exciting. As you were talking, I'm getting right.

Robert Boesch 7:35

It's exciting stuff. It really is.

Kimberly Long 7:37

Amped up and excited. Now, you know, as a chief nurse, there's always so many different priorities. How do you navigate competing priorities like cost containment, workforce investment, innovations, and the like?

Robert Boesch 7:50

Yeah, you know, I think it's impossible to do on your own, and I'll say that much. You know, so the number one thing is I am incredibly blessed to have such a strong team around me. You know, and it that doesn't happen by chance. I think strong leaders want to hire A players, right? I think, you know, we look around us, and I have people that work with me on a daily basis that are significantly stronger than I am. They know more clinical practice, they know their areas of expertise, they bring different perspectives from different generational views. Surrounding yourself with a really strong team is such a key for success because you cannot do it alone. And honestly, as nurses, we never practice alone. So trying to feel like we need to lead alone is a recipe for failure. So surround yourself with strong team members who will challenge you, who will help to build the culture that you're striving for, and then who will always be open and honest with you too, about where we're missing the mark, where we need to pivot, or where the gap exists between what we're seeing and viewing versus where the front line actually is. And so, you know, we spend a lot of time on the front lines. It's another recommendation that I really have. You know, I work really hard to embed it into my clinical practice every week, where I actually spend time on a unit every week shadowing and working clinically with an RN because one of my pet peeves is that nurses, when they get to a certain level of nursing leadership, stop practicing clinically. Our provider colleagues don't do that, right? Even our chief medical officers still practice in their areas of expertise or still operate every now and then. I think we need to really follow suit within nursing and make sure that we're not losing that connection to clinical care delivery. And so embedding that into my calendar, rotating between all the different units, working directly with the clinical RN to deliver care once a week has been one of the ways in which I've stayed connected and really helped to understand where the priorities truly live for our frontline teams and how I could best advocate.

Kimberly Long 9:37

I love it. Okay. Legislation.

Robert Boesch 9:39

Yes.

Kimberly Long 9:40

How can leaders more effectively influence legislative and regulatory decisions that impact nursing and health care delivery?

Robert Boesch 9:48

Oh, absolutely. I think, you know, we're seeing this right now more than any other time in history with, you know, some of the recent changes that were made to the Affordable Care Act. When I talk to my colleagues across the country, we're seeing health systems are starting to really feel that over the past few months with the changes in the ACA, the Affordable Care Act. And, you know, with those changes, we're seeing increases in self-pay patients or the uninsured patient population, which has dramatic impacts, not only to the for-profit side, which we're seeing publicly reported in some of their data points, but also for us on the nonprofit side, and how do we continue to grow and invest in our people, invest in our infrastructures that are aging really everywhere across the country? You know, I think being uh literate in the politics and being literate in the ways in which we really drive legislation is an important piece and a competency that really, as executives, we need to have. I think more than ever before, we need to utilize the fact that nursing is the most trusted profession in order to really help us to tell those stories to the legislators, help us to tell those stories to the key decision makers so they understand the impacts of what they're saying. I think that this is really a completely bipartisan issue because everybody wants healthcare, but I think very few understand how it actually comes to be and the complexities around it. And the reality is that we're gonna have to have some really hard conversations with some of our colleagues in the other industries, such as the insurance industry, the pharmaceutical industries, because the reality is that it's getting more and more difficult on a daily basis, whether as a patient or as a caregiver, our function and our structure needs to change dramatically. Otherwise, something really will break and then we will we will hit a dangerous point in healthcare.

Kimberly Long 11:28

I think that we have band-aided so much now that, you know, we're at the overhaul stage now.

Robert Boesch 11:33

Yeah.

Kimberly Long 11:33

Where, you know, the things are not matching up the way they're supposed to match up. I have one last question for you. Yeah. And this is if you had to give advice to your younger nurse self, what would you tell you?

Robert Boesch 11:47

It's a great question. And honestly, I think, you know, when we look back on our past and we look back on the work that we've done, the thing that I am the happiest, I guess I would say, and the and the most proud of within my career is the fact that I went into nursing. I have young kids right now. So my son is 12 years old, and he's starting to dabble in what do I want to be when I grow up. And the one non-negotiable that has carried me through most of my life and most of my professional career at this point has been finding a profession that has meaning and finding a profession that you can rest on, you know, those late at night hours when you can't fall asleep or when life hits you hard, because we all we are all rolling through the challenges that life presents every single day. But having something to fall back on, like a profession that truly makes the world around you a better place, adds to the community, makes a difference in people's lives. I can't tell you how important that decision is because you need to have that strength when things are really hard around you. And so I think the biggest thing that I'm proud of is our profession. I'm so grateful that I took a chance personally to go into nursing. And, you know, I think that when you have that as your backbone, it really helps throughout the trials and tribulations that we all experience. And I'm a big advocate of making sure that no matter what you do in this world, it has to be something that is going to make the community around you better. It's something I'm instilling into my kids. And it's something that as I talk to family members and friends in other industries, I understand now how fortunate I am that I have that to fall back on. Dr.

Kimberly Long 13:17

Bosch, thank you so much. This has been a phenomenal conversation. And it is a pleasure to have you on the podcast. And I appreciate you taking your time to spend with us this afternoon.

Robert Boesch 13:29

Thank you so much. It's an absolute honor, and I appreciate all the hard work you do to bring voices to the table and to showcase the excellence that is the nursing profession. Thank you so much for all you do, Dr. Wong.

Kimberly Long 13:38

Thank you.