A Rural CNO on Healthcare Innovation That Actually Helps Nurses

Phil Sobol:

Welcome to The CereCore Podcast, where we focus on the intersection of healthcare and IT. From practical conversations to strategic thought leadership, let's unpack the decisions, challenges, and journey of those whose purpose it is to deliver technology that improves healthcare in their communities.

Today, we are pleased to welcome Holly Davis to The CereCore Podcast. Holly is the Chief Nursing Officer at Bingham Memorial Hospital, a rural health system based in Blackfoot, Idaho. She began her nursing career in 1995, and brings nearly 30 years of nursing and leadership experience to her role. Holly has held multiple roles in nursing, quality, and leadership, including time as Bingham's Chief Quality Officer. Now as CNO, she leads nursing strategy across hospital and clinic settings and a strong focus on staff engagement, operational efficiency, and sustainable nurse careers. Holly's known for her practical people first approach to leadership and for driving innovation that eases burdens on clinical teams. Holly, welcome to The CereCore Podcast.

Holly Davis:

Thank you, it's a pleasure to be here today.

Phil Sobol:

Well, we're excited to have you. We always like to start these off, Holly, with just a little bit of background. I think people are always interested in the background story, how you got into nursing. What was your initial exposure to informatics? And maybe just tell us a little bit more about the role that you have at Bingham there.

Holly Davis:

Yes. I was the first college graduate in my family, so I was born and raised in Idaho in a rural ranching family. When I was a kid, when we were around the dinner table, my dad was always encouraging us to get good grades, to get good education, and to get to college. And if we ever complained about the hard work we were doing, whether it was moving water, fixing fence, he'd say, "Well, you go to school and get an education, you don't have to work like this."

So me being naive, I walked, enrolled in college, went through the emotions of getting my career and realized pretty quickly that nursing can be a lot like fixing fence and moving pipe. It's a very physically demanding, hard job. But that background really has served me well. And being rural raised, it gives you a certain amount of grit, stamina for long, hard days, and also just knowing there's a lot of things you can't control. Just like in ranching and farming, there's so much you can't control. And in healthcare, especially in today's landscape of healthcare, there's a lot I can't control. So I focus on the difference that I can make and the people that I do work with, the patients, and it gives me a sense of hope and optimism. And really, that stamina and the rural lessons that I learned in my upbringing has really served me well as a leader.

I went into nursing, of course. My first job was in the big city. I worked in Las Vegas, Nevada, and then came back to Idaho and worked also up in Montana. Came to Bingham about nine years ago to develop a same-day total joint program here, which Bingham has a phenomenal program for hips and knees and same-day total joint, and then moved through Bingham in quality and then now as a CNO.

Phil Sobol:

Oh, that's fantastic. That's quite a journey. I think to the best of my knowledge, you're the first guest to draw the correlation between rural health and mending fences and nursing. That's excellent.

Holly Davis:

Yes.

Phil Sobol:

Well, maybe give us a little bit of an understanding of just what a day in the life looks like as a CNO of a rural health system.

Holly Davis:

Yes. We are an interesting critical access hospital. That's what is our anchor, but we have over 100 employee providers here at Bingham.

Phil Sobol:

Wow.

Holly Davis:

1,300 employees, and a lot of clinic locations. And mostly in my career, early in my career, I've only worked in the hospital and the patients just appear there in the hospital.

Phil Sobol:

Right.

Holly Davis:

Didn't really understand as much about the clinic system. I was taught in nursing school 30 years ago that someday in healthcare we would be preventing health conditions and really focus on community health. And here at Bingham, we have the opportunity to do that, to really be the difference in our community, as well as to work with our clinicians and our patients to help them improve their health, because hopefully in your life you haven't been hospitalized. Most of us have not spent much time in the hospital, yet we focus so much of our healthcare on the hospital setting, that here at Bingham, we really do strive to get out into the community and work on preventative measures as well.

And so in my days, as you know, I am focused heavily in population health and value-based care nursing, as well as just the whole circle of care around the patient. We really care about the patient that comes to us, whether they're in crisis or a planned surgery, and then how we take care of them in the hospital, and then how we carefully hand them back into the community and follow them through that home care as well. We don't have a home health agency here, but we have chronic care managers and transition care RNs who follow those patients through their cycle of care. So in my day, we're an older hospital, I deal with staffing, materials, equipment, and then just the continuity of care every single day.

Phil Sobol:

Oh, that's excellent. Well, and you touched on a couple of things, right? Staffing, one. That leads me to typical conversations around burnout. I think the latest term that I've been hearing from a lot of physicians talk about is cognitive load or cognitive burden and then really retention, right? Those seem to be top of mind for a lot of healthcare leaders. I'd be curious to see what you all are doing there at Bingham to make nursing a sustainable and rewarding career there.

Holly Davis:

Yes. I focus on this a lot personally. Being a bedside nurse is very physically demanding, but it's also emotionally and mentally demanding as well. I think those three things can really torpedo a nurse and their career is they can get physically hurt, they get emotionally hurt, mentally, spiritually hurt because we are very empathetic and we take people's pain, we almost absorb it. We work really hard to support our nurses in physical ways. We have special air moving mattresses that we've instituted here so that they look like an air hockey table. There's a sheet that goes out of the patient, you connect it to a thing and it blows up and it makes the patient suspend almost. You have to be careful you don't push the patient off the bed with it. We do things like that to reduce the physical labor of the nurse.

And then also I always, my mantra here when I do new nurse orientation and all of our staff meetings is we want to help you sustain your career. We offer real world resiliency training, and a lot of mental health opportunity to debrief. We debrief after every serious situation, talk things out. Those small things make a big difference for nurses. And then also just that resiliency training isn't taught in nursing school and isn't really taught anywhere. And so how do we not take work home? How do we not get toxic perfectionism in nursing, which happens where nurses feel like they cannot meet this high bar that's been set for them, and so therefore they're a failure and they take themselves out. That's some of the cognitive burden that physicians feel as well.

And then here we just have a lot of, we have positions available for our older nurses. We want nurses to return to the field if they've been out of the field. We want a returnment of nurses as well, and so it's not just about the physicality, it's about utilizing your mind and the experience that you have to manage chronic care or to help with discharge or discharge teaching or condition level teaching. We actually pair our population health nurses with a panel of patients who they reach out to on a cadence and help them with their chronic conditions.

If you have a diabetes patient and they really struggle with blood sugar control, that nurse will help you, they're coach in a simple way. Not a really advanced diabetic teaching, but more, so what did you have to eat today and what did your blood sugar do and how can we make a goal around that? And so to really have the nurse not just be seen as we see hospital nursing as just a cog in a wheel, but really to utilize the nurse for their brain and their ability to coordinate care at a high level.

Phil Sobol:

Yes. No, it is a very difficult job. You may mention that if you have or haven't spent time in hospitals this year, I got to see it, not personally, but with family members and it's a challenge. It's doing the job, it's interfacing with a patient that may or may not be able to effectively communicate, dealing with family members that are stressed, confused, uncertain, doctors that sometimes are unclear in that standpoint, but then also the technology aspect of it all. And juggling all of that does, it takes a lot of training, it takes a lot of support. Having that human element, but at the same point, hopefully the support of technology to help maybe ease some of that burden. And I'd love to dive in, if you wouldn't mind, just some of the things that maybe you're doing on the technology side that helps support the nurses there.

Holly Davis:

Yes. About a year ago, we started on our iPhone point of care scanning project. And so we have nurse iPhones that the nurses can utilize with MEDITECH and it opens the MAR on their phone. Most patients have 10, 20 meds, you're giving them in a shift, and if the patients have 20 meds and the nurse has five patients, that's 100 medications. I don't think people realize how long that takes and how much, it's very important work, but it can become busy work. We utilize the point of care scanning so that the nurse can open the iPhone, scan the med, document it right at the bedside. It's all safely done following all the medication rights and safeties, but it's fast and efficient and correct. And so we've worked on utilizing that. For our younger nurses, they love that tech. It's very easy for them to have that. They write their term papers on their iPhone.

Phil Sobol:

Right.

Holly Davis:

Scanning with their iPhone is no big deal. And in fact, they do their ADL notes on the iPhone, a lot of things on the iPhone. Our older nurses are still enjoying it because they're not having to log onto the computer, grab the scanner, scan the med, document the med, and then go to the next room and do the same thing. They have that computer in their hand. And so that's been a really great thing for nursing. We also right now are working on a virtual nurse pilot project, and we're not flush with money here so we don't have the fanciest AV technology in every room, but we are utilizing virtual nursing just with an iPad on a stand.

Phil Sobol:

Right.

Holly Davis:

We have the virtual nurse doing discharge teaching, admission screening, and discharge needs assessments for case management. The patients are actually really liking it, and being able to just have this nurse focused on them that is like their teacher and that's going really well. I mean, there's still technical glitches we're working through. And if we had a fancy hospital with all the cameras, technology, it'd be easier, but we're trying it out, and seeing some opportunity there as well.

Phil Sobol:

Oh, that's great. But you mentioned that being integrated in with your MEDITECH system and certainly with any EHR, right? They're always evolving, always changing. Maybe what are some of the things that you guys are looking at from a Bingham perspective as the next step in the adoption, optimization, et cetera, of your EHR platform?

Holly Davis:

Yes, we're constantly... We're new on MEDITECH. We're going to be entering our third year on MEDITECH Expanse and we migrated from an old system that had been bought and sold a million times. I don't even know what the final name of it was. We're really excited about MEDITECH because we have it now in all those clinics I discussed.

Phil Sobol:

Yes.

Holly Davis:

We have ambulatory MEDITECH, and then we have our hospital expanse MEDITECH. Really excited about all of that. We're quite thrilled, honestly. But going forward with MEDITECH, just continuing that optimization, we've worked with your company, with CereCore on an optimization assessment to see where we're at and where we have opportunity for improvement as well.

And then really for cognitive burden and burnout, we've really been focusing on a new AI tool that we have with a pilot group of physicians and it's going very well. I think when our CIO reported on it the other day, they've done 3,000 notes on it in the last month across 10 different providers. And those are all ambulatory side, not in the hospital yet, they're still building the hospital side, but our hospitals are really excited to get ahold of that as well as our ER doctors. And then hopefully nursing and then I'm hoping a PT and OT can also utilize it because a PT/OT person, when they document, they have all these functional scores and things they have to keep track of. Then they've got to go to a computer, open up the computer and document it all, so I'm really hoping it can be helpful for them as well.

Phil Sobol:

Yeah. It's been fascinating to see just that adoption of that particular use case just blow through the physician community. It's one of those things where it's so hard. I remember just EHR adoption initially and all the pushback physicians and then all of a sudden now it's like, something's changed. You put this in front of them and they all want it and they're all excited about it and using it and seeing great results. So it's fun to see when technology, there's a desire to adopt and that it really does make a difference in what we're doing.

Holly Davis:

Yes. I think there's some trust established there already, and just this excitement for being able to see and talk to the patient without worrying about remembering what they have to document. That's been a really great thing. Their documentation's more thorough because they usually capture the high lights, the things that they are treating, they capture those, the things they prescribe for, but they're not always capturing the whole story or maybe there was one small symptom that they needed to follow up on and it could be forgotten in the CliffsNotes. So that's been really a great thing for them.

Phil Sobol:

Yeah, indeed.

Holly Davis:

I would say for anyone that's looking at doing that, it's important to study where you're at first, so you have a pre-assessment and then a post-assessment to see the improvement so you have that hard data to sell to your board or your leaders as well, and I think that's really important. Sometimes we add new things and we didn't really assess where we're at. And yeah, it's going great, but we don't have a good measure of what the improvement actually was.

Phil Sobol:

I really appreciate you bringing that up because I think that's one of the things that we see so often is that there's an identified need, the project happens, there's great success, but then everyone scratches their head and go, "How do you measure it? We forgot to take the baseline."

It's very important because you're right, those boards and leadership and everyone else, they want to know. They want to see that, and it's important internally too, right?

Holly Davis:

Yeah. It's important internally if you have a provider who's like, "No, I don't think that'll help me."

You can say, "Well, your colleague across the hall or down the road is using it this way and look how much it's helped them." You have that pre and post measure.

Phil Sobol:

Right.

Holly Davis:

That's an exciting thing. I see that probably evolving and going faster almost than we can foresee.

Phil Sobol:

Yes. No, you're spot on. I think you make mention of it, right? Technology's evolving so rapidly, as is healthcare, as is quite frankly, the needs of the individual communities. As one of the leaders there, how do you keep your teams grounded, focused, and motivated to be constantly not only thinking about the job and the tasks that have to be done today, but looking into the future so that you can set yourselves up for success in that manner?

Holly Davis:

It takes a lot of curiosity, and I know that that's probably a term thrown around a lot. Innovation's thrown around a lot.

Phil Sobol:

Yes.

Holly Davis:

But it takes a curiosity and an ability to try at times. You can kill momentum with too many good ideas.

Phil Sobol:

Yes.

Holly Davis:

And you can't follow all those, fund all of those, do them well. I often draw a graph on my board when I'm trying to explain this to someone, but nothing is a good idea if it doesn't decrease effort.

Phil Sobol:

Right.

Holly Davis:

If it only makes it more complex and hard, it could be the best idea in the world, but it will not be sustainable because once you add all of those together, pretty soon your line is just this arc that climbs and it will almost turn around on you because the effort is so extreme. And so we're just really careful to know that most we can, like this year, my goal in nursing was to get my nurse iPhone project rolled out, like to make that my priority. That was the number one goal. And then I also worked on the nurse handoff tool, which sits within MEDITECH and I worked on that with a separate team of floor nurses who headed that project, trialed that project and got that project going as well because it's a decreased burden project, but those were only good projects if they helped.

And the same thing in documentation, people want to throw quality measures at nurses or other things that are important to them as a leader or important to pharmacy or important to somebody, but in the big scheme of things doesn't matter in patient care. Sometimes it doesn't matter. You have to be very careful that you're not just burdening your care teams because they're the ones documenting 24/7 and you want the data. I'm all about innovation.

Phil Sobol:

Yes.

Holly Davis:

But only if it decreases burden and otherwise we hold back on it, and the good idea fairy can really tank your division.

Phil Sobol:

Yes.

Holly Davis:

And it can overwhelm your leaders that report to you because they're just trying to train and onboard staff and handle those day to day issues. And when you're like, "Well, I have this great idea and then I've got another great idea next month and another one, another one." It really can be too much.

But I'm always very curious. I like to try things. Right now, I'm working on agentic AI, what would an agent for my leadership team look like that could help them be more efficient, that could help them with their cognitive burden on different things, staffing models or even doing these year-end evaluations, what would an agent look like for that? And so that's what I'm currently learning all about.

Phil Sobol:

That's excellent, and love to hear that. I think that the term and the word curious, I think is spot on and perfect and I think that kicks it all off and then you have to follow some sort of a defined process to evaluate all of those ideas and get to the ones, as you said, that make sense, that add the value, that don't increase the burden because then it's easily communicated and sold inside of the organization. And if you can't clearly articulate that value where it clearly makes sense, then maybe you scratch your head and go back to the drawing board a little bit on some of these things.

Holly Davis:

Yes.

Phil Sobol:

That's great. Well, as a CNO, I'll ask you a question that go two different directions. What would you like senior leadership, including the board, to keep top of mind and know about from a discipline standpoint? And then the same question, but pointed towards the CIO of an organization.

Holly Davis:

I think for executive leadership and the board, it's important to understand how professional and smart nurses are and how patient care really comes down to how great your nursing team is, how well they're supported in education, onboarding, hiring processes really is the backbone of healthcare. And that's very apparent now post COVID, but maybe wasn't as a parent before, but I do see sometimes a backside on that a little bit. I wish that when providers came out, I wish more time in school was spent with providers helping them understand really what a nurse does and how like a nurse has to have a holistic care mind because they have to understand what the doctor does, how it's ordered. How the insurance pays for it, what the insurance does. They have to understand every ancillary department, lab, x-ray, PT, OT, this holistic knowledge of the patient, they're the ones that manage all of that together and it's like a control tower for the patient, and there's a great deal of professionalism and work that goes into that.

And so anytime administration would make a hard line on something, "You can only have this many nurses and they can only do this." That's dangerous ground. It's like you have to think about what would the control tower actually have you do to land the jet.

My board is very supportive, my CEO is very supportive, and I have that relationship of trust with them for sure. But I think sometimes they hear nurses sometimes go to the battle cry of, "It's unsafe, it's unsafe, it's unsafe."

Well, what does that mean? And pretty soon nobody listens to you when you say it's unsafe. You have to have more communication around what that is from the CNO and nursing perspective.

Phil Sobol:

That makes sense.

Holly Davis:

Yes.

Phil Sobol:

I mean, I've seen firsthand where doctor's order says one thing, the EHR is saying protocol the other, and the nurse is in the room going, "That doesn't make sense for what I'm seeing with my own eyes." So you have to be that visual coordinator.

Holly Davis:

Yes.

Phil Sobol:

"Okay, wait a minute here."

Holly Davis:

Nurses might tell a doctor, "No, I can't do that."

And then the doctor will have to understand, "Okay, so what does that mean?" Is she defying me? Is she thinking or he that she's smarter than me? And that's not usually the case. There's usually a safety reason or a problem that you're not listening to.

Phil Sobol:

Yeah, or that just wasn't observed and now it is. It wasn't presenting and now it is. And so I think it is, it's that care team approach.

Holly Davis:

Team, it is very team-like. The physicians who I've worked with who get that, their patients are well cared for and they really, really understand that at a height level. And we love those kind of physicians to work with, they're amazing.

Phil Sobol:

Agreed.

Holly Davis:

We love them. And we have a lot of those at Bingham as well, some great physician leaders.

Phil Sobol:

That's excellent.

Holly Davis:

And then from a CIO perspective, having a really good immediate plan, one year plan, I don't know how far out you can plan in informatics any longer because it's changing so fast.

Phil Sobol:

Right.

Holly Davis:

And it's expensive, but having that roadmap or strategy is really important and having an evaluation team because we've all worked in hospitals where the super thing was bought and it's sitting in a closet collecting dust and never worked.

Phil Sobol:

Right.

Holly Davis:

I think having a really tight strategy, budget, and analysis and evaluation of things you buy and working with trusted vendors on that is really, really important as well.

Phil Sobol:

Yeah, that new shiny thing is sometimes irresistible, but again, I think it's similar to what you talked about earlier, right? Where you're curious, you've got ideas, but then you've got to run it through the proper business case.

Holly Davis:

You really do.

Phil Sobol:

Have that discipline.

Holly Davis:

And pay attention to the add-on fees.

Phil Sobol:

Exactly.

Holly Davis:

Those relicensing fees, all of the things.

Phil Sobol:

Build a full picture indeed.

Holly Davis:

Yes.

Phil Sobol:

No, that's excellent. Well, Holly, I really appreciate the time and the insight today. We always wrap up these with just a call for any last words of insight or wisdom that we might not have touched on that you definitely want to get off your chest.

Holly Davis:

Yeah. I would say that I would challenge any CNOs or nursing leadership that's listening to really get a lot more involved in informatics because it is the tool that every nurse you manage uses. It's expensive and you really do need to get into the details of it. A lot of times CNOs or administrators think, "Oh, I'm at this high level and I have people for that." And yes, you do, but it's a very important part of what your nurses use and do every single day.

And even doing surveys with your nursing teams, what do you hate to chart? What is not working for you? What are you moving or what are you bypassing? Follow a nurse around and see what they chart and how they do it. It's just really important to become more technically competent and not leave that up to someone else, because otherwise your informatics team, they're going to feel disconnected from nursing and nursing leaders, and also your floor nurses who are battling through utilizing the medical record every day are going to be disconnected from leadership as well. It's something that I don't think can be ignored any longer in the current model of being a CNO or an administrator in nursing, it's really, really important.

Phil Sobol:

No, that's excellent advice. Excellent advice. Well, Holly, thank you so much for your time today. Appreciate all the work that you're doing there at Bingham out in Idaho, and again, just thank you.

Holly Davis:

Okay. Thanks, great.

Phil Sobol:

Thanks for listening to The CereCore Podcast. We hope you enjoyed this conversation. Follow us on your favorite podcast platform for more episodes. Connect with us on LinkedIn. Visit our US website at cerecorp.net. And for those abroad, visit cerecoreinternational.net. Learn more about our services and find resources. At CereCore, we are healthcare operators at heart, and know the difference that the right IT partner can make in delivering quality patient care 24/7. Let's help make IT better. Here's to the journey.