Remote Nursing with Maggie Lejeune and Blaire McElroy

[00:01] Michelle: This week, I had a great conversation about all things remote nursing. My guests are Maggie Lejeune, Head of Clinical Services, and Blaire McElroy, Clinical Services Manager for the remote care company, Veda Health.
I came into the conversation with zero knowledge about what remote nursing entailed, and I left with a new appreciation of it.
Like the Grinch,  my heart grew three sizes that day because once again, I was blown away by these two dynamic nurse leaders.
They elevate the patient experience by first enhancing the nurse experience and providing nurses with the necessary tools and training to be successful and happy in their remote work. I have always admired nurses who help other nurses, and Maggie and Blair have my utmost respect.
In the five-minute snippet, we switched it up to a version of the Newlywed Game, and it's evident Maggie and Blair's partnership is truly inspiring.  Well, good morning, ladies. Welcome to the podcast.
[01:26] Maggie: Good morning, thank you for having us.
[01:27] Blaire: Good morning. We're glad to be here.
[01:29] Michelle: I'm really happy you're here, too. I met you both on LinkedIn. It's connected me with so many great nurses, and I am certain that you, Maggie, and Blaire will be added to that group of great nurses. So thank you both for being here. I'd like to start out by saying that all great nurses got their start somewhere, and so I'm sure you both are no different. So let's start out with Maggie. Just give me some of your backstory.
[02:06] Maggie: Sure, I'm happy to do that. I have been a nurse for a little more than 20 years now, and I actually became a nurse because whenever I was in high school, my mom, who was a single mother, didn't have a college degree. She really imparted on me that having an education, having a degree, being able to be independent and take care of yourself always is just very important. And we didn't have the money to pay for college, so I worked really hard. She's a wonderful, strong, independent woman, and she taught me a lot through that, just being a great mom. But I was able to get a four-year scholarship, which essentially meant I had four years to get a degree where I could get a job and take care of myself. And so with her, and I kind of thinking through what I enjoyed, which was math and science and biology in particular, landed on nursing. So I think at the time I thought I didn't have a really good story why I became a nurse. To take care of myself and my future family, to have independence. However, I think that there's actually a lot of us who have gone into it for that reason, some for first career, some for second or third career. And it really does give nurses all of those things in addition to feeding what a lot of our personalities want and taking care of other people. So for me, that's why I became a nurse, to take care of myself in the future, and it has provided that for me.
[03:48] Michelle: Well, I absolutely love that. And I feel like there's a big wave that's changing in nursing because I'll say being a 59-year-old who's been a nurse for 36 years, a lot of us say we got into it to take care of others. And I love how you started that, first of all, with being the daughter of a strong woman and seeing early on that you are going to need to take care of yourself. And I just think that's so cool. And hopefully that's kind of a premonition of things to come in nursing because I think we need to start with us, and then the rest will kind of fall in line. So thank you for that story. Blaire, give me some of your backstory.
[04:40] Blaire: Well, growing up, there was a lot of people in my family that were in healthcare in one shape or form, and I was always very comfortable in healthcare settings. So very early on, probably in middle school, I decided that I was going to be a nurse. I had a pediatrician that really wanted me to be a pediatrician, but I felt like her nurses were the ones who were really compassionate, that knew what they were doing and really made a difference for the patient. So for me, that was what was important for me. So when I graduated high school, I started as a nurse volunteer at our local nursery and worked with the babies and got to kind of see what nurses actually did. And then from there, I kind of did some medical interpreting in different places and made my way to nursing school. So it was really about picking something that met my needs, but that also, I felt like I could really contribute.
[05:33] Michelle: We have that in common, that we both came from a healthcare family. My mom was actually in nursing school for a while, and then she met my dad, and then she married him and had eight kids, so she kind of got off that track. But there's eight children in my family, and six of them are nurses, and another one is also in healthcare. So, yeah, I can totally identify with that. It seems a natural progression. It's kind of something that, you know, and I'm sure growing up in a family of healthcare professionals, you heard a lot of stories and saw them in action and said, I like this. I think this is what I want to do.
[06:20] Blaire: Yeah, definitely.
[06:22] Michelle: Very cool. So, Maggie, I want to go back to you because I saw that you have your master's in business administration, and so talk about why you did that.
[06:33] Maggie: So my first job out of school was in a small rural hospital in Southwest Virginia. And it was kind of a shock for me after being in nursing school and doing your clinicals in these big hospitals, how much we were asked to do without training working. I was in labor and delivery and was kind of a feast or famine. We would have a lot of patients, or we would have no patients. So we would often be pulled to ICU and ER and med/surg with eight patients and without any training. And honestly, it was pretty scary at the time, but that's really the norm in a lot of hospitals, and I just don't think I was quite prepared for that shock of it. So I took my second job after doing that for a couple of years at a big city hospital where we would ship our patients to, and I had to drive an hour each way to get there and work 16-hour shifts. And I did really love the work that I do. But whenever I started having a family, I had my first child a few years after. I couldn't manage that schedule and still easily take care of myself and my family. It was just really hard. So I knew at that time I probably wasn't going to want to work at the bedside forever, but I didn't know what I wanted to do, and I just always really loved school, so I decided to go back to school. I worked night shift. I went to night school on the days that I didn't work night shift, went school full time. I slept and studied during the day, and I just really loved it. And, Michelle, I was actually listening this weekend to your podcast that you just did. I think it was with Kwamane, who went back and got his JD and you asked him to compare and contrast law school to nursing school. And the first thing he said was, well, I will tell you, it was much easier than nursing school.
[08:39] Michelle: That blew me away.
[08:42] Maggie: I actually have always said that as well. Business school was so much easier than nursing school, and I was so surprised by that because these are classes that I'd never really taken, finance classes and accounting classes and management classes in this sort of way. And I just thought there was so much application to the work that we do, and it was exciting new ways to think about things. And I was different than everybody in class, but the school I went to really appreciated that and celebrated that and made it feel like those of us that didn't come from a traditional bachelor's degree brought something just as important to the classroom conversations, and I just thought it was a lot of fun. So I went back to school and got a business degree because I knew I wanted to do something that wasn't always going to be at the bedside. I didn't know what that would be, and this was something that I didn't have to choose that path right away. It could help me in whatever that looked like in the future, and I'm grateful that I did. It worked for me.
[09:49] Michelle: I agree. Kwamane was amazing, and it just blew me away when he said it was way easier. It looks like also that you are sort of a visionary in mapping out what you want to do in the future, like where you are now, where you want to go. I also interviewed Alicia Sandidge Renteria. She was a nurse practitioner. She is a nurse practitioner, and she at a very young age, said, I want to kind of map out my life into kind of what kind of life I want in terms of family and free time. And she chose the nurse practitioner route to do that. So I can appreciate nurses like you that really look into their future and say, what do I want for myself? So that's a cool story. And then, Blaire, I was reading about you, that you started as a medical interpreter.
[10:52] Blaire: Yes. So I worked in a variety of community settings as a medical interpreter for patients who spoke Spanish primarily. And so I kind of got to see every aspect, from dealing with insurance providers to dealing with physical therapy, occupational therapy, inpatient, outpatient, really a little bit of everything.
[11:14] Michelle: How do you think that served you in your nursing career?
[11:18] Blaire: I had much more appreciation for the patient experience and for realizing that even though, as the nurse or provider coming into the room, we are used to dealing with these things every single day. But for the patient, this could be their worst day ever, and they didn't have anyone there with them to kind of advocate for them. So I became very passionate about advocating for my patients and making sure they had the education that they needed to make healthcare decisions, because I saw how often that didn't happen.
[11:47] Michelle: I love your perspective that you were able to get that perspective from being an interpreter and working with patients. You saw it definitely from their standpoint, I think that just makes us better nurses. So now you both are with Veta Health. And, Maggie, you say you're working your dream job as a lead clinical services for remote care, and we're going to talk about that because I know zero about remote care. And then, Blaire, you are currently the clinical services manager there at Veta Health. So tell me how you guys met. Did you meet before you became partners, coworkers? Tell me how that came to be.
[12:38] Maggie: I joined the team, it's been about a year now, and I was brought on whenever one of my friends who worked at Veta at the time posted about the job, and I was looking for a new role and reached out to him and said, tell me what this is. Do you like the company that you work for? I'm really looking for something new that is going to be a good fit culturally and just from a work ethic kind of standpoint. So he was kind of my connection there. I will say what I found out is that everyone on the team was brought on by somebody else that they had worked with in a previous job. Which is really kind of cool because we're all sort of handpicked in a way. And I met Blaire for the first time whenever I interviewed with her for this role. She's been with the team longer than me. But I will say that Blaire and I also often talk about how we have very different nursing experience backgrounds and how we got here, which is really cool because we complement each other really well. Our personalities and the way that we work complement each other really well. And because we have different nursing experiences, we get to pull from lots of different places kind of in our past and our backgrounds, which really serves us well to be able to lead the teams. And I'll also say that we also laugh a lot about that. We were nurses in different areas in different parts of the country, but we have such similar experiences also. Like, we've talked about stroke education when that was rolled out, or restraint education and our experience in the way that that is. And it is just so similar wherever we were. So it's been such a joy to work with Blair, and she's a big reason why I love working here as well.
[14:34] Michelle: Very cool. Blaire, do you want to add to your relationship with Maggie?
[14:39] Blaire: Yeah, I think it's been really wonderful. Something that, as she was mentioning a lot of times in nursing, we all have very similar experiences, and so maybe it's with a leader that we're working with or seeing know education is presented, and a lot of those experiences kind of help us want to make sure that we do better when we're in a similar role and that we really help to move our current team forward. And so I think we really had that in common is maybe being that leader that we didn't have before and to make sure that we are creating that success and creating that pattern of excellence that we would have liked to see in other roles.
[15:16] Michelle: That's fantastic. It sounds like you guys are a great team. So I want to talk about what you both do there at Veta Health with the remote services that they provide. And I got on the website, and that's amazing and learned a lot that I didn't know about. But maybe let's launch into what you guys do there.
[15:41] Maggie: So I am in the role of head of clinical services, and Blaire and I work directly with our chief medical officer, Nora. Nora is actually one of the founders as well, and a physician, and she's fantastic. Absolutely love working for her as a very passionate and compassionate physician as well as a female leader. And so part of my role is to work with her as well as her co-founder, Tan Vi Abi, on clinical strategy, working with our operations team and our implementations team for rolling out programs with new clients, working with our product team to continue enhancements on our platform and that sort of thing. Blaire really has the kind of more familiar role, I think, in what we think of as nurse leaders. So she leads our clinical team, and I'll let her. Blaire, maybe whenever you describe your role and what you do, you can also share some descriptions about remote monitoring and what all that entails for those who don't know.
[16:53] Blaire: Yeah, definitely. So, like Maggie said, I work as our clinical services manager, so I work very closely with Maggie as well as with other members of our team, including our product team and client success team, to kind of meet our partner's needs. So that includes overseeing kind of the day to day operations of our clinical team. So that might be troubleshooting a patient care issue or looking for ways to improve the quality of care that we provide for our patients, or maybe doing quality audits on phone calls that we're making to patients, as well as reviewing products to see if this is a really good product that would work well for our patients and for certain populations. And of course, working with Maggie as we do implementations with our various clients. And in regards to kind of like remote care, what we do at Veta is really the whole idea is kind of creating a more personalized healthcare experience for our patients and for our clients. And so that might be a physician's office who needs someone to fill in the gaps there for care when the patient leaves the office. They need someone to make sure the patient understands the instructions that they received. They need someone to monitor the patient's vitals via devices that they're using at home, or maybe that they need help creating a care plan with a hospital system. It might be more of a hospital at home or enhanced home health type program, and we're doing more close monitoring of those patients and making changes for medications and for their care. We also do more chronic care management. So really finding resources in the community for the patient, making sure they have transportation to the doctor's office, and very similar to what you would do in a brick and mortar care management team, but just doing that in a more remote setting.
[18:33] Michelle: Well, it sounds really comprehensive, because I wanted to know more about Veta Health and who do you guys serve? And I saw that you serve healthcare systems, providers and then patients. And so what has been the response from different healthcare systems about the services provided?
[18:58] Blaire: I would say that we have a lot of success with our healthcare systems because we personalize the care both for the patient and for the system. So there isn't a one-size-fits-all all. We look to see what type of program do you need. Do you need this type of education for your patients? Do you need this type of device? Can we help you with analytics? Do you need help training your staff? And so really creating a customized approach for each client that we work with, and that seems to be the most successful for them, and therefore, they're able to be more successful with the patients they're providing care for.
[19:31] Michelle: And then how do providers access the services? So they have a patient that needs remote monitoring of some sort. So how do they access that?
[19:46] Blaire: Well, we have a platform called Prosper, and with that platform, providers can log on. They can see their patients vitals. They can see if the patients have answered symptom assessments, they can see if the patients have called and interacted with the healthcare team and any notes that have been made along with that call. Also, we are integrated with some EHRs, like Epic, so they're able to log into their Epic instance, and they can just click on the Prosper tab and see in real-time what their patient's vitals were and any other notes that may have been made in that patient's chart.
[20:19] Michelle: Okay, so what kind of monitoring takes place? What can the patient be monitored for remotely?
[20:27] Blaire: Well, again, that can be customized based on the needs of the patient and of our partner. So, for example, we can monitor hypertension patients, CHF patients, and diabetes. There's a variety of devices that can be used. Glucometers, blood pressure cuffs, thermometers. There are even different devices that you could wear continuously to monitor your temperature, to monitor your heart rate, your gait, your sleep. So there's a whole variety of devices that can be used in conjunction with the care team to monitor the patient's vitals.
[21:00] Michelle: So are these what you would call wearables? I'm asking because I interviewed Taofiki Gafar-Schaner, an informatics nurse, and he talked a lot about wearables for the patient and different ways of monitoring. So is that kind of what he would be referring to in something in a remote setting like this?
[21:28] Blaire: So that can be one scenario. Is the wearable something that you would have on continuously for a week or for 72 hours? But we also have devices that you would put on, like a regular blood pressure cuff that you would do that's cellular-enabled, or perhaps it's Bluetooth enabled. So they would put their blood pressure cuff on, check their blood pressure, and that measurement would be sent directly to our platform. Same thing with using a scale, glucometer, pulse oximeter. Those would all be one-time measurements. You do that, for example, once a day or twice a day, and that's a little bit different than the variables that you would have on for a longer period of time. But we can do both of them.
[22:05] Michelle: Well, is this the wave of the future? I mean, it sounds like a home health nurse just in your house, basically. Am I being too simplistic in that description?
[22:20] Blaire: No, actually, I wouldn't say so at all, because there are some programs that are kind of like enhanced home health or very similar to the hospital at home type programs, where you do have more frequent monitoring. So maybe the patient uses their device four times a day. They complete symptom assessments. They can do a video call with the nurse or with the caregiver if they have questions. Medication changes can be made based on the patient's symptoms and their vital signs. So in a way, it could be used similar to a home health program.
[22:52] Michelle: That's fantastic. What have you seen in terms of success? I guess, is the remote monitoring, is it keeping patients out of the hospital? Is it a way for us to intervene earlier? Talk about some of the wins that you guys have had.
[23:12] Maggie: Yeah, so I think that's a really good question. And one thing that brings to mind for me is that the wins that we've been able to have in the programs that are really successful are more than just the technology, the technology that you put into the patient's hand. There's a technology that we have that Blaire mentioned called Prosper. But without the human component that runs that technology and the patient's engagement in that technology, you don't have any of those really positive outcomes. And I think that's where some of the tech companies maybe aren't as successful or aren't seeing their clients as happy is because of that, we're extremely fortunate that we have a lot of people in leadership roles on our teams that have a clinical background, either physicians or nurses or some sort of clinical experience, even though they're not in a specific clinical role. One of our engineers is a physician by background. For example, our head of operations has a nursing background. So we take an approach to this as it's more than just the technology, and that if we can't figure out how to lower the barriers for the clinical teams using the technology and the patients using the technology to make it really meaningful, then they're not going to have those positive outcomes. So it's very important to us, whenever we're building things with the product team, the engineering team and such, that it makes sense, that it's intuitive, that it's easy for patients and it makes a difference in their health care, because ultimately, that's why our founders started this program or this company. So, all of that to say, to get back to your question, yes, we have seen some great outcomes. For instance, our patient engagement is well above 80% sustained over twelve twelve-month period on some of our programs, whenever our clinical team is supporting the program. And all that means is that for those patient engagement metrics, how often that they're using the devices, how often they're responding to those surveys and the education tasks that they're sent, that they're engaging on a regular basis, and that shows that the more times that they're engaging, that they're learning about their health, they're more empowered and educated to make healthy lifestyle changes, and that that really drives those outcomes. So we see decreased visits to the ER for acute episodes, decreased readmissions, say, for like, heart failure patients related to heart failure instances and related to all instances. We have some data, and Blaire, maybe we'll be able to share those with Michelle for some of our case studies, but we have some data about stabilizing weight for heart failure patients, for instance, because of these programs. So, yeah, we've seen some wonderful clinical outcomes. And really, what we're always looking to do is to have those patients understand more about their healthcare conditions so that they can be educated and make those choices for themselves, because, of course, that's what they all want. And a lot of, Michelle, you mentioned having a lot of nurses in your family. I know for me, my family calls me for everything. Even though my background was in labor and delivery and NICU, they will call me for anything. And if I don't know, I will go find one of my nursing friends who has experience in that space to help educate my family. Not everyone is that lucky to have a nurse or a physician in their family. And it's almost like this allows patients to have access to those nurses in their family. We become the nurses in their family that they otherwise wouldn't have access to to help them manage the healthcare environment, to manage their health condition, whether it be heart failure, hypertension, oncology, whatever the case may be. So, like Blair said, we can support patients in any space if it needs giving them that education and that care. Between the hospitals and physician walls of the clinic, that's what we're there for. Blaire, did I answer that? Do you have any additional outcomes? I didn't think of?
[27:45] Blaire: No, I think that sounds great. That definitely addresses how we've helped improve those outcomes.
[27:50] Michelle: Well, that's phenomenal. I mean, it's the perfect marriage of technology and humanity, right? What hospital can say that they have engagement scores greater than 80%, probably very few. So those are some huge wins. And I want to talk about technology for a second, and specifically AI technology. In my last episode with, you know, he was talking about AI technology that's being utilized with his company that he founded, Nutrible, and they use AI social workers to connect patients to nutrition services because there are just not enough social workers. Right. But talk about the AI technology that Veta Health uses and how that improves the patient experience.
[28:44] Maggie: Yeah, actually, I loved something that Kwamane said about that, and you and him kind of spoke about how nurses might be a little bit nervous or scared about the future of AI coming into healthcare and what that means for us. And he really spoke to AI being a space that kind of takes that administrative burden off of us so we can do the actual nursing component of the care that we give. And I don't think he said it just like that, but I think that is very true for the way that we think about AI as well. It makes our nurses smarter and faster and able to really spend their time doing the things that Blaire described and taking care of patients. We have regular education calls with patients, make sure they understand their condition that we are support for them. You're helping them connect with those resources in their community, all of those things. The AI that is in our platform really learns through the interaction with the patient. So what we call it like a digital phenotype or digital thumbprint. The AI, we can communicate through patients to patients with phone calls, with SMS text. With the app, we can send them long form education, videos, surveys, tasks to complete all these different ways, but patients will have a preference for the way that they like to receive education. And so the AI learns from the patient and the way that they are more likely to engage with education content, and then it sends in more of that. So if, Michelle, we send you this article that has written education and you're, oh, no, that's too long. I'm not reading to. Then the platform knows and learns and doesn't continue to send you that, so it sends you what you're going to be most engaged about. In addition, we have, from the clinical perspective, some AI and machine learning built into our platform that really helps. The nurse may be taking care of patients in several different kinds of conditions on her team. So maybe she's doing heart failure, maybe she's also doing hypertension. And she has these weight management patients. And so they all have different care pathways that are personalized for that program and that health system, as well as to that patient. And it would be really hard for her to know all of the escalation pathways, all of the preferences of the physicians, all of those things. All of that, for us, is built into the platform. So it's at their fingertips very easy to take care of patients, to see who is alerting more, so I can take care of them first, and then I know exactly where they are in the pipeline in the process of their care pathway. So I know what to do next. If it's onboarding or if it's scripting for an education call or whatever that is. So we really take that administrative burden off of the care team so they can spend most of their time actually with the patient. And then lastly, I think the other place that I would say that we use AI not only in the way that content is delivered to the patient, but in that care pathway, because no two patients are exactly the same. And while they might come into the program because their physician is seeing them for hypertension or heart failure, and they get in, that, we might find out that they also are a smoker. And so their care pathway will change as the platform learns more about the patient and what content will be specific to that patient and we'll deliver that content that way. So your pathway and my pathway would look very different and that's all done automatically. So again, takes that administrative burden of educating specific for that patient off of anybody's care team. So it's just intuitive within Prosper.
[33:00] Michelle: Well, this is just AI being used for good, right? We've had so much press on all the negative things that AI has done or can do and like Kwamane, you guys are using AI for good. And I love how you made the distinction about it's really helping your nurses, your providers, it's enhancing or making them into super people. I really like that. So let's talk about nurses for a second. I want to know where do nurses enter the picture and in what capacity are they being utilized by the company.
[33:48] Blaire: I would say nurses are at the forefront of providing patient care. We have a RN-led care team that directly works with the patients. We have quite a few, as Maggie  mentioned, nurses or people who have nurse background in our company in various roles. So it's really important for us to make sure that nurses are contributing to the process into how we are setting up our policies and our protocols, our SLPs. All of these things are very influenced by those that have a nursing background and the nurse care managers really work directly with the patients and their feedback is essential for us to know ways that we need to make adjustments to better provide care for the patients or even to better serve the nurses and the role that they're doing.
[34:34] Michelle: Let's say I'm a nurse and I see there's an opening at Veta Health. So take me through a day in the life, like what am I going to be doing?
[34:46] Blaire: Yeah, so I mean, once you apply for that role and you get this role, we have different areas that you could be working in. So you might be working in remote patient monitoring, you might be working in chronic care management and you might be supporting a team of nurses who have patients from both categories that are RPM and CCM. So you would log on to the platform in the morning, you would check which patients based on our platform, the alerts that are built into it will tell you which patients are rising risk. So patients who maybe need your attention first and you can kind of prioritize those patients. You can go through your patient list and see who needs a phone call this month, who needs to be reached out to because they answered something concerning on a symptom assessment. And so you'll go through your day and kind of prioritize which patients need your attention first and go through and address all the patients needs.
[35:39] Michelle: Okay. And then are any of the nurses actually going into the patients homes, or is this all done remotely?
[35:47] Blaire: This is all done remotely. So with the virtual care platform, it can be done from anywhere. So we might have nurses from anywhere, really across the country, because based on the legal needs of that patient, if that patient is in a certain place, then nurse needs to also be in that same place. And so then it's very important for us to make sure that nurses have licensure in the states where their patients are in order to serve them in a virtual capacity. So they would be looking at the device readings for that patient. If they have a question and the patient has concerns, they can do a video call with that patient and the patient can say, hey, look, my left leg looks more red today than it did yesterday. And they're able to do that through the platform and communicate with their patients virtually.
[36:29] Michelle: Wow. Okay, so these nurses are working from home?
[36:34] Blaire: Yes.
[36:35] Michelle: Wow. There's a big interest in remote nursing. So what are you hearing from nurses that,  let me back up. So what experience are nurses coming to you with? Like, if I'm a labor and delivery nurse and I've never taken care of a heart patient, is there a spot for me?
[37:00] Blaire: That's an excellent question, and that's something that at data, we are very careful with and we really pay attention to. As we all know, a nurse is not a nurse. And depending on your background or your strengths, there are certain roles that are better suited for you. So if, for example, we are doing a postpartum hypertension program, then, yes, a nurse coming from labor and delivery is perfect, and that's who we're looking for. If we're doing a program for a patient that has a left ventricular assist device and it's very cardiovascular heavy, then maybe we're looking for someone that has more of a cardiovascular background to meet those patients needs. So the type of nurse will also influence what type of patient population they're caring for.
[37:40] Michelle: I saw on the website that you have an education series there at Veta Health. Who is that tailored to and who can benefit from it?
[37:49] Blaire: Well, really, the education series really came out of the fact that we saw that there are many healthcare professionals in virtual care that were not equipped to deal with the changes and the needs of virtual care. For example, during the pandemic, we know a lot of people were kind of just thrown into virtual care, into remote care without any specific training. And some of them now are finding that to be a challenge, or there are some people who are building new teams who want to make sure that their team is equipped with the knowledge and skills that they need to kind of keep up with what's going on in virtual care. So we kind of built this education series to help providers, whether that's a healthcare provider, who's a physician, whether that's a nurse, whether that's a care manager, whoever it is who's dealing with the patient to be able to have the skills they need to provide care in a virtual setting, whether that's remote patient monitoring, if it's an EICU, if it's virtual nursing, it really can work for any setting.
[38:45] Michelle: All right, what about patient load? So I'm a nurse and I'm working for Veta Health, and I log on in the morning and I'm seeing my patients. What kind of patient load could I expect?
[39:01] Blaire: So that really depends based on the type of patient that you're caring for. So if you have strictly remote patient monitoring patients, that load might be a little bit larger than if you have chronic care monitoring patients, if you have a combination of both. Also the acuity of the patients. So in some places, patients are not receiving great care at their primary care office. And so the primary care doctor says, hey, my patients, their A1C's are through the roof. All my diabetes patients are struggling. And we say, okay, so we take on that population that's maybe more needy, that will affect the ratio, versus we take on a population of patients who are very well managed, very well controlled. They just need very little input into helping them in their healthcare journey. So then that ratio might be a little bit higher because those patients don't require as much care. But that number is not set based on just RPM or CCM. It really is impacted by the type of patients.
[39:57] Maggie: And Michelle, if I could also add, I think that is an excellent question, and any nurses that are interviewing with a company similar to Veta or with Veta should definitely ask that. We've heard varying numbers with other companies in this space, and I think for us, if a nurse was interviewing with us, we would know specifically, like Blaire said, what program we were looking for nurses to support, and we would be able to tell you with much more detail. This program is about these X kinds of patients, and we're expecting this, and we know down to, we anticipate you would spend this amount of time per patient per month. We don't expect that you would be working 100% of the minutes that you're on the clock. And so we account for all of that. And Blaire and I also, like she mentioned at the beginning, have both had experiences where we worked in the hospital with teams that did not have good ratios, that we didn't feel like we could take good care of patients. We are committed that we build a team, that our nurses feel good at the end of their shift in the care that they were able to provide. And you cannot do that without good nursing ratios that make sense and that make a difference for patients. And so that's an excellent question. I think anyone considering a role like this should ask and should feel good about the answer that they receive.
[41:30] Michelle: Yeah, absolutely. I mean, patient load, that makes a big difference in care. What length of shifts are the nurses working?
[41:41] Blaire: Our nurses are generally working eight-hour shifts. However, depending on our clients needs, that might be during remote nine to five business hours, that might be after hours, that could be some overnight shift, depending on what type of need we're filling at that time. If we're filling in for staffing needs for a client, then maybe they just need after hours on call care versus the traditional nine to five type schedule. But the majority of our nurses are working Monday through Friday, nine to five.
[42:11] Michelle: If I'm a nurse and I have case management experience, is that something that would be really valuable in this job?
[42:18] Blaire: Most definitely, because a lot of those skills are transferable, not just for chronic care management, which is pretty much case management, but also for outpatient monitoring, because a lot of what you're doing is customizing care. You're looking at care plans, you're seeing what's best for that patient. So that definitely would be useful.
[42:36] Michelle: Okay. And then let's talk for a second about just kind of what you're hearing from your nurses in terms of what has been something challenging that maybe they didn't expect working in remote care. And then the other side of that, what has been really surprising and good working in remote care.
[42:59] Blaire: I'll start off with the challenge. I would say one of the largest challenges is that you are not sitting with your patient face to face, so that assessment is not done in the same way that it would be. I could walk physically into a patient's room. I can see. Are they sweating? Are they breathing quickly? Do they look flushed? Is there family around them? You can pick up on so many things without saying a word to the patient, and you can't always do that when you're in a remote setting. So learning how to transfer those assessment skills that you provided for the patient in person to a more virtual setting sometimes is a challenge. Which is kind of why we created the first module in our education series was on telehealth assessment and kind of enhancing that nursing practice for remote care, because that is a challenge that a lot of nurses face.
[43:45] Michelle: Yeah, I could definitely see that being a challenge for many, myself included. You're absolutely right about, you don't even have to touch the patient or say anything, and you can make probably 100 quick observations about what's going on. And so what have been some of the things that nurses have said that they really love about it?
[44:10] Maggie: Blaire, I had an idea for this one. I thought maybe you could share one of the stories that you've shared with me about the impact that you've seen that you've been able to make just even past the patient. But the way that educating these patients more deeply about their condition, they get excited and then educate their family members. And so you really begin to make an impact in a much bigger way than I think most of us experience just in the acute care setting within the hospital.
[44:42] Blaire: Yeah, definitely. We've had patients who, for example, would go to their provider, and the provider recommends a certain procedure to be done, and maybe the patient says no. So then they come home. I'm calling to check in with them about their device use or about something for their remote patient monitoring, and they tell me, oh, the doctor said I should do X, Y, and Z. So I ask them, do you know what that is? Do you know how this could help you and your personal life? And then we can kind of delve into their reasons as to why they said no and how this procedure would help them. And so there's been cases where I've had those kind of conversations with patients who then went back to their doctor and said, oh, you know what? I think I'll go ahead and do this procedure. I talked to Blair about it. I think it'll be okay. And then their family has more confidence in the care that we're providing. And when someone says, oh, hey, I have another program that Veta health is also doing, they are more likely to sign up for it as well and more interested in advocating for their own care because they realize they have someone who's kind of there to answer their questions.
[45:43] Michelle: Those are so many benefits. Right? And we do that all the time. I'm coming from my experience of working in a hospital. We're making rounds and the doctor comes in or the provider comes in and they rattle off all this stuff, and the patient is sitting there looking at you like, and you're kind of the go between do you understand what the provider is telling you? And we're kind of the translator. Right. And we can be really instrumental in helping patients see the benefits and the detriments of a certain care and really helping them decide because the provider is now long gone and that kind of becomes our job. So I could see that would be really beneficial. There's so much that I've learned about remote nursing. Okay, so one of my last questions, I guess we talked about licensing, and so I'm a nurse in California. Can I only see patients in California?
[46:51] Blaire: The answer to that is no. So you can see patients in California with your California nursing license. However, if you are working with patients in another state, you need to have a license for the state where the patient resides or the patient is receiving care.
[47:07] Michelle: A lot, a lot to talk about, a lot to cover. And I think we made a big dent in talking about remote nursing. I think for a lot of nurses I know because I've seen a lot of nurses in nursing circles really gravitating towards, especially after the pandemic. If they had a remote job during the pandemic, they tend to really be protective of that and they don't want to change it and go back to working in a hospital or in a clinic. And so they really get accustomed to that type of setting. And I imagine there's a big learning curve. But then I imagine once you learn it, he really would love it. Tell us how we can find you, Maggie and Blaire, and also Veta Health, and then just anything else that you want to add to the conversation.
[48:10] Maggie: So Veta Health has our homepage just on the website@myvetahealth.com. There is a page within our website called the Education Series that you can get more information for an overview about the education. That player mentioned that we just launched in October. We also have a Veta ahealth page on LinkedIn that often have blog posts from our website as well. You can find our case studies on the website as well. So a lot of good information just to go learn about remote patient monitoring in general and about the company. And then Blaire and I are also both on LinkedIn, have our own pages on there as well. And you're welcome. We love to connect with people. I've had people reach out to me for years, other nursing leaders, and I've met lots of people that way. I'm always happy to kind of make new friends through there as well. So we're happy to kind of be another resource for your listeners who are thinking about getting into this space or have any questions.
[49:18] Michelle: Perfect. Yes. And I will add all of those links in the show notes so that my listeners can find you. Blaire, did you want to add anything?
[49:28] Blaire: No. I think that those are the places where you can find us. And as Maggie said, we're always open to answering questions or whether you're a new nurse or experienced nurse. And if you have questions about kind of transitioning from the bedside to telehealth or working at Veta Health in particular, you're more than welcome to send us a message and we'll chat with you.
[49:46] Michelle: Very good. Well, I thank you both for being here today and just bringing so much of your knowledge and expertise to the platform and talking about remote nursing and how it can help patients and systems and nurses. So thank you both for being here.
[50:04] Maggie: Yeah, thank you for having us, Michelle. This is the fastest hour I think I've had in a long time talking, and it was a lot of fun.
[50:12] Michelle: Yeah, it goes by very fast. And one of the things in the back of my mind, you guys know I've been retired now about a year and a half, and I have thought about remote nursing, but I haven't really known what it entails or what it's about or if it would fit for me. And so this whole interview, I'm like, maybe?  So, thank you guys for that. But at the end, we usually play this thing called the five-minute snippet, and it's just five minutes of fun. Today because there are two of you, we're going to play a version of the newlywed game.
[50:51] Maggie: Okay. That sounds fun.
[50:53] Blaire: Yeah, it sounds good.
[50:54] Michelle: It's super fun. We're going to find out how much you guys know about each other, so I'm going to put my timer on, and then we'll just get going. So, Maggie, the first question is for you. What is Blaire most proud of?
[51:13] Maggie: Oh, I'd say she's most proud of her son, Ryan, who is adorable and smart as, like, I'll get.
[51:22] Michelle: Oh, I love it. Okay, Blaire, the DJ is playing Maggie's favorite song or favorite group. Who is it or what?
[51:32] Blaire: Ooh. I'm going to say that it is a Taylor Swift song that's playing.
[51:37] Michelle: Oh, you're a Swiftie!
[51:39] Blaire: Mm hmm.
[51:40] Maggie: She got that right.
[51:42] Michelle: Okay, Maggie, what is Blaire's guilty pleasure?
[51:49] Maggie: I would say probably some sort of fruit, like grapes or something. I feel like she's always like, her go-to snack are little fruits, and I love that.
[52:03] Blaire: That is so true.
[52:06] Michelle: Okay, Blaire, Maggie's biggest fear.
[52:12] Maggie: I feel like Blaire got all the hard questions.
[52:15] Blaire: Right?
[52:15] Maggie: I would say so.
[52:16] Blaire: I would say maybe being in a group with a whole lot of people nonstop for seven days.
[52:25] Michelle: Oh, God. Yeah. Okay, Maggie, Blaire asks you to pick up a snack from the store. What is it?
[52:35] Maggie: Well, I feel like I kind of already said this one. Definitely some fruit. Yeah.
[52:43] Michelle: Okay. Blaire, whose desk is more organized?
[52:48] Blaire: 100%. Maggie's.
[52:51] Michelle: Okay. All right. I love it. Maggie, if an actress had to play Blaire in a movie, who would it be?
[53:01] Maggie: I would take Karey Washington.
[53:04] Michelle: Oh, wow. Okay. Yeah. And I would say there's some similarity. I saw Blaire on our call, and, yeah, she's beautiful. So I agree. Okay, let's see. Blaire, who spends the most money on personal items?
[53:20] Blaire: Oh, that's a tough one
[53:22] Michelle: That is.
[53:24] Blaire: I would say it's probably about equal because we both have kids, and we probably would spend it on our kids first. But I would say if we were going to buy something personal, it probably would be an equal amount between the two of us.
[53:35] Michelle: Okay, Maggie, what would Blaire say are some of your best character traits?
[53:45] Maggie: I would say she likes that I'm not a micromanager and that I trust her implicitly. And I think she would say, I like to make people feel like they belong and they're important.
[54:01] Michelle: Wow. That's some high honors.
[54:04] Blaire: I agree with that. I think that's exactly what I would say.
[54:08] Michelle: Especially the micromanaging. Like, can we just get rid of that? Okay, Blaire, Maggie's most annoying habit.
[54:19] Blaire: She is fantastic at designing everything. So if she's on Canva, she's on Google Slides. She makes everything look perfect and beautiful super fast.
[54:33] Michelle: You and me, Maggie, we're sisters. Yeah, I love any kind of design program. So fun. Okay, last question is for Maggie, who is more disciplined?
[54:48] Maggie: I would say Blair. Blair is really good about taking care of things. She always does everything that she means to do. She's very intentional. So I would say, in the best possible way, she is more disciplined. She never drops the ball on anything. I absolutely love it.
[55:09] Michelle: Wow. I love the relationship that you guys have. You speak so highly of each other, and you work so well together, and it's a perfect marriage. And you've brought so much value to me today. And I thank you for that because I really was starting from zero in knowing about remote health, remote nursing, remote monitoring. So thank you for that, both of you. And just thank you so much for joining me and doing what you do for nurses, for patients, for providers. It's really vital. It's really important, and I appreciate what you do. And I thank you.
[55:54] Blaire: Thank you so much. We appreciate it.
[55:56] Maggie: Yeah, and thank you for doing what you do, Michelle, because it's been a joy to meet other nurses through your podcast and being able to kind of highlight the work that nurses do outside of kind of traditional settings.
[56:10] Michelle: I appreciate that. I'm really having the time of my life. I have met so many amazing nurses and some other great allied health professionals, and the conversations have been so fun and so informative. And, yeah, I am blessed. I am very blessed. So thank you for that. And you guys have a great rest of your day.
[56:39] Maggie: You.
[56:40] Blaire: You so much. You, too.