Starting a nursing career is both exciting and challenging, especially in the fast-paced world of healthcare. New nurses often struggle as they transition from school to real-world practice, navigating complex systems and high demands. How can we improve nursing education to better support them?
In this episode, I speak with Morgan Taylor, Chief Nursing Officer at Archer Review. Morgan shares insights into the challenges new nurses face, the structural issues within nursing education, opportunities for innovation in healthcare, and ways to better align incentives in the field. Don’t miss out, listen now!
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Carving Your Own Path in Nursing with Morgan Taylor
Welcome to Action’s Antidotes, your antidote to the mindset that keeps you settling for less. Today, I want to talk to you about the many different ways in which we can go about carving your own path because I think sometimes people think about any pursuit and they think about the most common manifestation of it and they think the most common manifestation of carving their own path as being something along the lines of either starting your own business or doing something really, really wild, like going and living off the grid somewhere in, I don’t know, Uganda, for the lack of a better place to think of, but there are plenty of different ways in which you can kind of discover where your path is going and discover how you can get to a place where you once again feel excited about the things that you once felt excited about.
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Today, my guest is Morgan Taylor and she is the chief nursing officer at Archer Review and chief nursing officer, I feel like a different C-blank-O title emerges every other week, so, yeah, Morgan, tell us a little bit about that.
Yeah, absolutely. Thanks for having me on today. I’m excited to talk. Yeah, chief nursing officer, to me, sounds totally normal, because I grew up as a nurse at big hospitals that always had a chief nursing officer. But, of course, if you don’t work somewhere that has nurses, that’s going to sound a little funky to you, right?
Yeah.
And really how I got to where I am is kind of funky. It was not a straightforward path at all, not something I had planned out or set my sights on a decade ago. I started out as a bedside nurse at Duke University in the Raleigh-Durham area here in North Carolina. I started working in a – we called it the children’s resource unit. I went to all different pediatric areas of the hospital, spent a lot of time in the ICU, in the emergency department, and I loved it. I learned so much. It was a wonderful experience. And then COVID happened and things got a little dicey there. It was a big challenge, one that I’m proud to have played a part in, but what was most impactful for me and kind of what started me on this path where I ended up today now was I started seeing that the new nurses coming in to join us in this profession were very underprepared, and not to any fault of their own. They just didn’t have the experience that they needed to get prior to coming and working in a level one trauma center taking care of very, very ill patients. So that got my wheels turning. I started to think maybe there’s something I can do in kind of the education bubble, that’s something people talk about. I started kind of looking for ways to dip my toes in the water, so to speak, see what’s out there, and that was when I connected with the CEO, Karthik Koduru, of Archer Review. He was working on trying to put together a platform to really enable nursing education that was accessible and affordable and specifically targeted nurses getting ready to take their board exams. We call those exams the NCLEX and it’s that last test you have to take before you’re fully licensed, you’re out there on your own actually caring for patients. And we had really poor pass rates. They were anywhere from about 80 to 87 percent, depending on the year and which group of students you were looking at, but what Karthik said is that leaves 20 to 13 percent of students here that are educated to be nurses and that we now don’t have at the bedside actually addressing clients. And there’s this huge nursing shortage and we’ve got this pandemic, we need nurses, so this is a problem that needs solving. That’s where he and I intersected and started really trying to build this platform that could connect with nursing students. I’ll say the rest is history. I’m sure we’ll get into more of the nitty gritty as we talk, but that was the impetus for me seeing that there was the problem, starting to brainstorm how I could be a part of the solution, and it really started carving this different path from there.
So what was the nature of the problem that happened with nursing and COVID? Was it the fact that we had people who were expected to do one kind of nursing and then, all of a sudden, a pandemic hit? Or is it more structural around a lot of people graduating from nursing programs and just not having the sufficient education for generally what that job entails, even during non-pandemic times?
Yeah. I tend to say more the latter. We have a structural problem. And don’t get me wrong, I’m sure it’s multifactorial and we could probably pick apart ten different things that are contributing, but some of the top ones that I am trying to address are a lack of hands-on clinical experience in those formative nursing school years, that was really augmented by COVID when we weren’t allowing students to come into the clinical environment during the pandemic for very good reasons. They graduated nursing school and didn’t really have experience touching a patient, and that was a big, big driver of what I was seeing working in the emergency department. Beyond that, there are several structural components that have to be addressed if we are not going to face a crisis-level nursing shortage, and the biggest one is that we do not have enough nursing faculty to teach all of the upcoming nursing students and do it well. Nursing students need a lot of mentoring. They’re coming on, taking these complex courses, learning about things for the first time that are very challenging, and that requires faculty who are invested in them, ready to really be a partner in their success, and you can only do that for so many students. We’re all human. So when we’ve got these faculty that are responsible for 200 nursing students, we end up with high failure rates, high dropout rates, nurses that aren’t supported and get burned out really quickly. I’m not trying to say anything bad about the faculty. They’re being asked to do a big job with little resources.
And I think where Archer Review comes in is bridging that gap so that faculty can more effectively mentor that next generation of nurses. Share on X
So, we’re having problems pumping out nurses to meet the needs and I know there’s also a generational component of it too, with the aging population and just knowing that as our largest baby boomer generation group retires, gets older, needs more nursing care, we need more people graduating from these programs from generations that are smaller.
Yeah, absolutely. There’s a mismatch here in the number of nurses that we have coming up and the number of patients that we are seeing. We’re already seeing that and it’s just going to continue to widen. So, unless we get very smart about the way we educate this next generation of nurses, we’re not going to fix the problem. We’re not going to magically have 10 percent more faculty that can adequately mentor a larger group of nurses. We’ve got to innovate how we can effectively teach them, give them the support and guidance that they need and deserve, and do it without burning out our faculty as well. So it really requires rethinking our teaching models, using technology to the full extent of what we can, using it appropriately, a dozen other things that I probably haven’t thought of yet.
That makes sense. And so you talked initially about nurses unprepared for the challenge of both COVID as well as general challenges of the profession that originate from the fact that the faculty that was training them were just too stretched thin.
They were stretched too thin. And that is one component of what has many components, but it’s an area that I am actively seeking to address in my work with Archer Review. We can all just only do so much. We can only serve as a mentor to so many students. A big thing I talk about is we should be actively looking at the students we’re teaching. Let’s say I’m responsible for a hundred students and identifying who is struggling early. So if we’ve got, after test one in nursing school pharmacology course, these three students failed, we need to actively work with, problem solve, and remediate then and not waiting until they failed the entire class and now they can’t progress with their curricula. And when we have a hundred, two hundred students, how challenging is it to actively monitor every single one of those individuals and get them the mentorship and guidance they need? It’s near impossible. We just only have so many hours in the day. So Archer Review comes in to play there providing an educator dashboard that helps automate that, polling and aggregating data and presenting it visually to the faculty so that they can quickly see 10 percent of my class is below where I need them to be, they are struggling with concepts A, B, and C, so now I can be smarter in my effects to how I remediate, what I remediate, I say, work smarter, not harder. If you don’t know what areas they’re struggling in, it’s very hard to adequately remediate, and it just takes the manual pressure off of that faculty so they can actually do their jobs and what they’re great at, which is mentoring these nurses.
And is the challenge specific to taking the people who’ve already enrolled in nursing programs and getting a higher percentage of them to pass and getting them better prepared? Or is that not even sufficient? Does meeting the needs that we have for hospital and all sorts of other care require actually making the profession more attractive to more people going into school to begin with, increasing the number of people enrolling?
It’s a great question and I do think we have to do both.
and that is not what I want to see happen. I’m a big advocate of the next generation of nurses being the generation that cheerleads and supports each other so that we really have a workplace environment that we want to show up in. That is not how nursing has traditionally been and I think that’s a part of why we have a lot of burnout. Absolutely not. The thing I was told in nursing school was nurses eat their young. You’re going to get a preceptor, they’ve been there for 10 years, they’re going to tear you to shreds. And not every nurse is like that but it has been the mentality for a long time. I don’t have a good answer to why. It’s something that’s been baked into the culture long before I or you or anyone was – anyone that I know was there, and I think it’s such a shame. It’s such a shame that we don’t initially have a supportive environment for these new nurses because it sets them up for this burnout, it sets them up to leave after two years is really common. A nurse will be around for two years and then they wipe their hands of it because it’s just not conducive to a work-life balance, having a family to wanting to show up at work.
I understand sort of, even though I wish it wasn’t that way, in the business environment, people still being of the mindset of, okay, we’re going after the same market, the same target market, the same opportunities as our competitors. These are our competitors, we need to out compete them. But nursing, it does feel like it’s like everyone’s on the same mission, we have people that need care and we have all of our systems, our doctors, our hospitals, even our therapists, nutritionists, all these people that kind of all come together to do the same things to help bring people to health.
And that is absolutely what the ideal model is, how it should look, and I think if we all have that mindset of this person has the same goal that I do, how do we work together to get to our desired end result, I think we will see a lot less nurses just leaving quickly. But the fact of the matter is, it is a challenging, emotionally taxing, physically taxing role, and it does get the better of us sometimes.
No, because it seems challenging enough in that anyone that works at a hospital, you’re dealing with death, you’re dealing –
Yeah.
– watching people lose loved ones on the reg, on the daily, possibly, depending on where you work, right?
Yeah, depending on where you work, 100 percent.
So there’s already an emotionally taxing aspect of it, and then if you add some sort of other pressure from above, and somewhere along the lines in our work culture, I don’t know where it was, we got this idea that everyone that was a manager needed to pressure people. Pressure people –
Yeah, you’re so right. Why did we decide that?
Yeah, where did that come about, because maybe 10 percent, 15 percent of our companies are now starting to realize that if you want to motivate someone, you build them up and remind them of the mission. So, obviously, the thing about nursing, whenever I think about that profession, I think of it as having a closer, clearer proximity to the mission that you’re specifically seeing the people you’re helping as opposed to other organizations that offer other services or products where you have to kind of be reminded like, “Okay, this is why, what we do next –”
“This is why we do what we do,” yeah.
Yeah. So what is happening in these nurses that experience this burnout, on top of the job? What are they specifically experiencing and what is specifically making them just have enough, I guess?
Yeah. Well, first of all, I’m going to speak specifically to my own personal experience, knowing that many other nurses have very similar ones, but it is, of course, unique to where you work and the environment that you work in. For me, the moment where I said, “You know what? Something is definitely wrong here, I can’t do this forever,” was I had a very long, I think it was a day shift where an infant had come in overnight and had unfortunately experienced SIDS and was coded in our emergency department to the point where we got his heartbeat back but there wasn’t any brain activity going on, and that was a brutal shift. There were so many things going on, very, very emotional talking with the family, and I went home, I was just spent. And when I woke up the next morning, I had an email from my manager that told me I had a warning because I didn’t document that one tube got placed on that patient, probably the 15 that got placed, I missed one. I missed one of the tubes, their Foley catheter tube, and I was like called in and beaten down about it. I was not asked what went on that day that was hard, how can we make it better next time, and even though it wasn’t something that impacted the outcome, what was going to happen was going to happen, no matter if I didn’t document at all, I missed one thing, I was torn down about it. There was no effort to support me, to see if I was okay after an emotionally taxing day. And that was when I decided that it wasn’t an environment I could put myself in for the next 20 years.
But it’s sad to think that the world needs nurses, and nurses is one of the few things we’re definitely going to need more of, everyone’s speculating about AI or whatever technological innovation that you’re talking about on whatever day you’re listening to, it’s always something like, “This technological innovation is gonna take away all this job and that job and that job,” but nursing care definitely needs going to be going up and so we need this and now we’re tearing people down over one line of documentation in an otherwise really emotional day and it just confuses me as to how that mindset, how whoever it was that gave you that tearing down, what they were thinking, like what possibly can make them think that that’s a good way to support even the organization that you work for, “Oh, we’re gonna tear down this nurse and that’s gonna make my hospital work better.”
That came from just a unit manager, just one level overlooking that department. And I really do believe, though I’ve never been in their shoes, that it’s them getting pressure from above and that person getting pressure from above about accreditation standards, about meeting what we need to meet for the joint commission to sign off on the dotted line to get funding, X, Y, Z. There are so many nitpicky requirements and that is what is emphasized at the highest level is the dollar sign, making sure we’re billing and getting the maximum revenue impact out of the care that we provide, making sure that we are covering ourselves with adequate documentation, the documentation requirements are out of control, and that’s what’s emphasized from C level down all the way to managers that then feed into their bedside nurses. And when all that is emphasized from the top are these accreditation standards and money and X, Y, Z, there’s no room left for building up a generation of nurses that cares, that takes care of your mom and dad with compassion and that wants to be doing this for the next 30 years because they can. Right now, the culture that we’re in, it’s not one that most people want to be in for their entire career.
And I’m assuming that most people that go into nursing go into it for the right reasons of wanting to care, wanting to care for people –
I think so.
– be there for people through these difficult situations when their health is in jeopardy and so I’m just envisioning a story of someone who goes to a program and maybe they, I don’t know, struggle because their professor, as you were saying before, the instructor is so spread thin amongst hundreds of people, but make it through and pass their classes, pass their accreditation, come into this hospital and they’re all ready to like, “Okay, I’m ready to come here, I’m ready to do working at this hospital, I’m ready to care for patients,” and then all of a sudden, the feedback they’re getting from the supervision is not how do we care better for our patients, how do we make experience would be one thing if they were given feedback such as, “Okay, what you said to that one statement, you could have been a little bit more this way, you could have been more direct –
Yeah.
– versus those lines of code. Is that consistent? Did you get any feedback around the things that really matter for nursing? Like, “Oh, you could have been more comforting in your tone of voice,” or something along those lines.
I probably did to some degree and it was probably from my peer preceptors, so the nurse who had been on the unit for a year, three years, five years, who was directly overseeing my development as a new nurse. And I do think that those people are in the most impactful position to really influence how a new nurse puts their roots down and feels about the culture around them. It’s also the most exciting group of people to work with because, like you touched on, you come into work and you’re ready, you’re like, “This is what I’ve been studying for. I’m finally here. I can do what I set out to do.” So that’s why it’s my favorite group of students to work with because they still have that fire in their eyes and I have the chance, through my work with Archer Review, to really say, “Hey, this is what support looks like. Where are you needing help? How do I provide that mentorship to you?” and I’m learning from them every day different ways to do that, different people do need different things, depending on their background, where they’re coming from, where they’re working now, but they do go in so excited generally that it makes my job so exciting. We have this energy exchange that’s just phenomenal and speaks to the core reason why we all became nurses.
Yeah. So you work not only with students who are trying to pass the exams but you also work with new nurses who are just learning how to come up on the job. Is part of your support with them also helping them endure some of that type of, for lack of a better way to put it, bullshit that you went through?
Absolutely. Yeah, I call it like learning how to nurse, learning how to be a nurse 101. We do a lot of mentorship. That’s one of our core tenets at Archer Review, and we try to span the lifespan of the nurse, so from getting into nursing school, how do you navigate, how do you traverse those applications, those exams, supporting you through every class that you take, with your boards, and then going on into certifications, professional, going back to get your doctorate degree. There is something for everyone. And at every single one of those stages, you need different guidance and mentorship. I want to talk to someone who’s been through what I’ve gone through before, and even if that’s just to bounce ideas off, to say, “Hey, was this normal?” For me, that was a big thing. I didn’t know if that was normal or not. Are other people getting bullied like this? Are other people getting demerits for something completely silly? Am I overreacting? I can be a big overthinker so if I don’t have somebody to talk to who’s like, “I’ve been in your shoes, I know you’re talking about,” how am I supposed to know if it’s normal or not? So that mentoring is absolutely key at Archer Review. We want to be that support, that if you don’t already have it in your place of work, we’ve got your back.
And then I do need to ask you about your funding for your organization. Does it largely come from individuals paying you for that support or do the education institutions and the hospital institutions pay for unified support for the students who then become the nurses?
Yeah, it’s both. We have a large B2C audience, our students who come and purchase a program, they get a video review package or they buy a session of mentoring. And more and more, we are working to form long-term relationships with health systems and institutions, universities, staffing agencies to assist them in mentoring and educating the next generation of nurses to scale and sustainably for decades to come. I think it’s been a beautiful, organic growth trajectory for us in the past five years, mainly just by really getting in the weeds with the students. We’ve been very fortunate that they have gone and told their universities that, “Hey, this resource exists. This is what helped me,” and now we’re able to kind of form those relationships at a bigger level.
And then, do you ever work with people before they become a nursing student? Like someone who’s just, I don’t know, about to enroll or even that junior in high school that’s thinking, “Okay, what do I wanna do? I kind of have two or three paths. I’m gonna try to pick one as I pick a school.”
Yeah, and this circles back to your question earlier about do we just try to fix what’s there now or do we also need a larger funnel of students coming into our programs, and I do believe that we need to encourage, support, and get more students into the nursing profession to meet that growing demand. So we absolutely mentor and educate students in our pre-nursing division, where the primary service we offer is helping them study for their entrance exams. Navigating how to apply and get into nursing school can be very tricky so that’s a big mentorship opportunity for us there as well as there’s a few different tests they might have to take and we can help them study for those so that hopefully we get more students going into the nursing profession.
And what are the trends in student interest in nursing? Because we all see certain professions and how the trends kind of wax and wane and, recently, there’s been some professions that have seen a resurgence in interest and others have seen interest kind of fall off a little bit because of the conditions on the ground and what people are experiencing in that profession, what they’re seeing their older cousins and even parents experience.
Yeah, true. In 2023, the total number of applications went down a little bit. It wasn’t incredibly significant, it was like a 500-ish application decrease so we’re waiting to kind of see where those numbers come out in 2024. We remained pretty stable throughout the pandemic, which, honestly, I’m so proud of. I’m a little bit astounded that people were still wanting to go into it. I think we had a lot of people who were really like, “This matters. I can do this. I know it’s hard but it matters.” Tapered off a little bit so we’ll see what the numbers look like in 2024. But, overall, whether the numbers are going up or going down, something important I do want to know is that, traditionally, we have more students applying for nursing school than are accepted, and a lot of students are turned down who have phenomenal grades, who have really good test scores, who would make it through nursing school, could be great nurses. And, again, back to the faculty, we just don’t have enough teachers to teach them. So to address that, again, we have got to get more faculty. We’ve got to incentivize students to go be nursing educators and we have to give educators the tools to effectively mentor all those students, and then we can accept more of them.
And then do you have curriculum and videos around learning how to become a nursing professor?
We do not yet. That is in the pipeline of bucket list things that we want to get to. We just launched our nursing school companion product, which was a huge passion project for us. Took about year and a half to develop a full comprehensive kind of companion to really go with the nursing student from day one of school. And then we’ve got a few things in the pipeline for post grads, which will hopefully soon include faculty education, because there’s not enough people doing it. It’s not presented as an attractive option. I was never talked to about it, and we won’t get more faculty unless we put some effort into it.
And do you think there’s any chance that amongst some of these other nurses that have similar experiences to you, where they just got fed up with being, I don’t know, chided or whether it’s over some dumb, mundane detail or documentation that say, “Okay, I can’t do this anymore,” that maybe some of them would be interested in going back and learning how to become a nurse educator to educate the next generation of nurses?
You know, I don’t have any data to support it, but I really, truly do, just anecdotally in all my conversations with students, with my peers, with people who I’ve kind of elbowed during grad school and said, “The way you explain things is so great, you should go into education,” my feeling is, yes, there are a lot of excellent nurses out there who would consider going into education and maybe just haven’t had that opportunity or idea planted in their head. It’s not something we talk about very much in nursing school, and I think there should be a shift. Kind of dream of mine would be in your last semester of nursing school, many of the bachelor of science of nursing programs have some sort of professional licensure class where you learn a little bit about some of those aspects and I think we should talk more about the different pathways that nursing can take. We really focus bedside nursing, go to grad school and be an NP. We don’t talk about entrepreneurial paths. We don’t talk about educator paths. We don’t talk about healthcare administration. We don’t talk about public health and how we can go impact entire communities at scale.
Long-term idea that I’m planting the seed for is really emphasizing for those new nurses, “Hey, your education doesn’t have to stop here. Here are some paths you can carve for yourself.” Share on XSo you talked about a couple other paths, talked about entrepreneurial paths and also preventative and these are two things that are very important to me, because, first of all, entrepreneurial path, I interview a lot of entrepreneurs on the show, I think it’s a great way for someone to pursue something they’re really passionate about and also do it in a way that suits them. And then also, our healthcare system is a bit too reactive and preventative care, something I think a lot of people are more and more interested in, even if it is just a nutritionist and an exercise coach to help them stay generally healthier. So what are some examples that you’re seeing right now or are there enough of people who are kind of coming out of these nursing programs and taking one of those paths?
Yeah, absolutely. I always say we have disease care, we don’t have healthcare. No, I go to the chiropractor once a month for a maintenance visit, and I’m not reimbursed for it, but if I have an actual spinal cord injury and I need adjustments, they’ll pay for that if it’s an active issue. We’re not trying to keep people healthy, we’re just trying to fix active problems. And, again, that will not work long term as we see more and more patients, aging population, less nurses, all the stuff we’ve been talking about. So if we have a bigger focus on either catching disease before it starts, that’s what we call primary prevention, or treating it really early, our secondary and our tertiary prevention, we will need less nurses. More nurses will not be as crucial. It’s very important that we support the nurses, that we funnel more nurses into the profession, but that we also maximize their impact. And if we really look at preventative care at a system level, at a community level, if we support programs that are nutrition focused, exercise focused, disease surveillance programs, then we will not need as many nurses. The best example I have from this is some of the service learning I’ve done with my doctoral research. I worked in Belize on implementing a community-based screening program to screen for diabetes. Very, very high rates of diabetes in that country. Lot of people don’t know they have it until their foot needs amputated. It’s like the five out of six amputations are for untreated diabetes, and that didn’t need to happen. There’s a very straightforward way to address that before we need an amputation. So in working with their ministry of health, I think this is, at least, personally, the best experience with preventative medicine I’ve had where we surveilled the community, we went door to door, and instead of asking, “Hey, is anyone here sick? Does anyone need a doctor?” we started just saying, “Hey, we’ve got a health screening. You wanna come down? You wanna get your blood sugar checked? Let’s check your blood pressure. Go over to this clinic,” we brought it into their community so we negated the need for people to travel, for people to take off work or find childcare. We brought that to them and then we did the basic disease surveillance that we have access to. And just by doing that, there was an uptick of about 30 percent of cases of diabetes identified. They didn’t know, but their blood sugar was 500 and, from there, we could go ahead and refer out to the necessary support. So there are tons of programs, if not exactly like that, similar to that, both stateside and abroad, that you can get involved with. And what I tell students is go volunteer. There is always a health clinic at your Walmart, at your CVS, you can go give flu shots and just talk to people, find out what’s going on in your community, the areas that you’re passionate about, and you can just take it to the moon from there.
What role can technology potentially play in it? Because we have a lot of technology, and mostly we’ve used that technology to distract people and get people to buy random stuff –
Yeah, absolutely.
– stuff that monitors your heart rate on a regular basis, or monitor something where it’s kind of built into your daily, your weekly, and so if something kind of trends one way off, you’re just going to be aware of it and maybe even be able to take the necessary actions at a point where it’s just mostly about, “Okay, maybe you just need to take two days off of work and get some sleep,” as opposed to –
Yeah, absolutely. Absolutely. You’re so right, and it’s called like wearables, our Apple Watch, our Oura Ring. There’s so many you can get so much robust data from, and what I think is a really promising step forward is linking that information to our primary care providers. Our primary care providers should be our first point of contact for monitoring, identifying those trends, the trends are very important. I tell – I work with kids so I tell parents, “I don’t care how tall Johnny is today, I care how much he grew from last time and what does that line look like.” So same for adults. I don’t necessarily care what your heart rate is today but is that heart rate variability going up or down? What is it moving towards? And if we can sync that information from our wearables, AI, that stuff, over to our primary care providers, we decrease the burden on them of collecting all that information that they wouldn’t be able to get and being able to take action before it is an emergency situation or something you can’t come back from.
Yeah. And I just imagine with primary care providers, that annual, every couple of years, that blood test you take, where they draw a little bit of blood then you wait three days and you get those numbers and you look at your cholesterol and you’re like, “Oh, is it below or above 200?” and every other number but cholesterol is by far the one people talk about the most.
I had this done, actually, very recently for my annual and I thought it was so interesting and possibly not effective that after my visit with my PCP, I went to get my blood draw, and then I got my results three days later and I missed the opportunity to talk to my primary care provider about them. They’re just flagged high or low. But as a provider, I know there’s a lot more nuance to that. And cholesterol, for example, if it was 150 last year and 180 this year, I need to make some dietary changes, but it wasn’t red because it wasn’t over 200 and by getting my lab results after my visit, I’m really missing the opportunity to be educated, to have a productive, forward thinking discussion about my health. It goes back to what you said, it’s reactive instead of proactive.
And in this vision of the world, I would say vision of the future that you’re presenting, how do you envision the role of a primary care physician being? What’s that relationship like between me and my primary care physician?
Yeah, I think we need much closer relationships with our primary care provider. I’d be a big advocate of moving from annual visits to biannual visits. I think 12 months is far too long. If I have a caseload of, gosh, they see hundreds and hundreds of patients, they are not remembering me from last December. We’re human. We can just only keep so much information in our head. For us to get the most benefit out of those primary care relationships, we need a relationship. We need to know their first name. They need to know if we have kids and what our family life is like. All of that plays into the health decisions we’re making at scale. So that’s the first thing I would say is more frequent, but we can’t do that without enough primary care providers. We’re stretched thin with them as is. So it’s a little sticky there. But from a patient perspective, I say step number one is increased visit frequency.
So increased visit frequency, and we’re talking about a theoretical world where some of these resources become available and maybe primary care physicians, maybe they have a similar education issue as nursing does where they just need enough educators to teach them how to do the practice. But one of the things that would happen, though, is if there was more preventative stuff that I’m calling in and I need to come in because I’m sick would probably happen less often.
That’s my train of thought as well and I think many people’s train of thought is, “Hey, you’re coming in every six months, we’re keeping an eye on these numbers, we’re having proactive conversations. Hopefully, we don’t become hyperlipidemic and need to go on a statin that then comes with side effects. Hopefully we manage that blood pressure with diet and exercise and it doesn’t get to the point where we’re in a crisis event and coming in for being very ill with headaches and blurry vision.” So I think in some ways, maybe it starts to balance out, even though we’ve got more of those well checks, those annual or biannual visits, hopefully, our sick visits go down and it’s a better, more efficient use of resources, both at the medical, the nursing level and society and a financial level as well.
So is it an issue of thinking this through the lens of the entire journey and I’m thinking about from the standpoint of customer journey mapping that a lot of businesses do, where you’re thinking about the journey of a person taking care of their health and maybe you go to a pediatrician, you graduate high school, now you’re on your own, you’re no longer with your parents’ pediatrician so you get your own doctor and at that point, you have an entire holistic health journey that can go from a nutritionist, a personal trainer at a gym, all these people, and even combined with like, say, mental health, with whether you have a therapist or whether you have some other type of coaching as well as your primary care physician and they’re all there to kind of give you some amount of coordinated advice as you go through, whereas now I think there’s actually plenty of people who graduate high school, end up out on their own, and don’t even bother to think about getting a primary care physician until they’re 35 and realize, “Now I’m at the age where things can happen to me.”
I’m not immortal anymore. Absolutely, and I’ll speak first to the transition of care for someone who is 18 and has become an adult, they’ve aged out of their pediatrician. That is an incredibly pivotal moment in primary care, and as pediatricians, we should be talking to our teen clients, really, the AAP says from age 13, we should be introducing to them, “You’re going to need an adult provider.” We should have a list of referrals. We should have relationships with adult providers in our communities, and we need to start that transition well before they are 18. There needs to be some overlap there, especially if there are any chronic conditions. If you’re a type one diabetic, if you have a congenital heart disease, if there’s any sort of genetic component, we’ve got to start that transition early because a lapse in care is not appropriate. So that’s the first thing I’ll say there, and that really does have to be on the pediatrician, the pediatric nurse practitioner, but it ends up falling on the family some too, and it shouldn’t. We should be taking all of that burden to the degree that we can. They do have to follow through, but more and more, it does fall to the families to go find that provider, and like you said, what 18-year-old’s going to do that? They’re going to wait till they’re 35 or something terrible happens or something’s wrong, right?
Yeah, yeah, they could get sick before they turn 35 and be like, “I’ve got terrible cholesterol,” I’m just taking a typical experience of someone –
You are so right, yeah.
– thinks they’re immortal and they’re like –
Yeah, they think nothing’s ever going to happen. Absolutely, absolutely. So, yeah, that transition of care, just as a pediatric provider, is something that jumps out to me and is very, very important for this. But the other component you were talking about I want to touch on is that ideal world where we have our entire interdisciplinary team under one roof. I’m starting to see this happen more with mental health and behavioral health, which is a huge step in the right direction, us recognizing that this is actually part of our whole wellbeing and it is very beneficial to everyone that we have that under one roof. I see it less with nutrition, I see it less with exercise, counseling, those types of things. So, I really do think that getting that interdisciplinary team for collaboration. I see it in the hospital a lot. When we’re doing rounds, we have the whole team on rounds. Why are we not doing that in primary care?
Because one of the things that I’ve observed a lot, and this is something I’ve been observing a lot over the past five years, I’ll admit ten years ago, I was not on this mental wavelength at all, is what people call the mind, body, and spirit connection, right? And so the connection that you have this idea, let’s say your doctor tells you, “Okay, don’t eat Doritos at three in the afternoon anymore,” as some people, I live in Colorado, maybe you’re eating Doritos more at like midnight for different reasons.
For different reasons.
If you catch my drift, but people say, “Don’t do it,” but the person would be like, “Well, why do I feel the need to eat Doritos at three in the afternoon? Or why do I feel the need to take on the activities that preceded eating or drinking at midnight?” and that could be a mental-spiritual thing that’s connected to it.
I think almost always it goes deeper than what we see at that surface level. And if we don’t ask why and then ask why again and ask why again, we’ll never really get to the root of it and it will still be a problem. I also think, you said don’t eat Doritos, a primary care provider is really good at saying, “Don’t do this, don’t do this, don’t do this,” and not offering actionable replacements for those habits. If you have the habit of eating Doritos every night and they say don’t do it, maybe that’s going to go okay for a couple days, a week, maybe, if you’re really got the willpower, but long term, we are not setting you up for success and we don’t acknowledge that in a primary care visit. We’re just like, “Don’t do that. Your cholesterol is high, no Doritos,” instead of what alternatives do you have? What are some other behaviors? Maybe we go on a walk after dinner instead of eating a pound of cookie dough.
We just say, “Don’t do it,” we don’t actually give actionable advice elsewise. It’s crazy. Share on XI mean, and that actually lends right into what I do with my screen time reduction program, with Reclaim Your Time, in that a lot of people will look at their screen times, like, “Oh, I shouldn’t go on Instagram and scroll for three hours. I shouldn’t go on TikTok,” and then do what is a big question.
And then what?
Willpower only take you so far and there’s going to be that night –
It will only take you so far and then you’re doom scrolling, procrastinating into bedtime.
You probably saw an advertisement for cookie dough and went to the store and just like…
Downhill from there.
A couple of times when I was in college, college is the time when you think you’re invincible, I literally I walked up to the Walmart and bought a roll of cookie dough and I just walked around the dorms the entire night just eating the cookie dough, just eating the raw cookie dough, as if I was –
Raw cookie dough.
– on a stick or something like that.
Oh, man. There’s something really irresistible about it. It is good. Like you said, the deeper we dig into – if that is a habit, if that is, “I do this every weekend.” We all have a one off where we just have to eat that stick of cookie dough. Again, I don’t get too worried about that, but when it’s every weekend or every night or so, asking ourselves why and then thinking about what actionable habit can be a more suitable alternative to that sets us up for a lot better success.
Yeah, and that’s where all that stuff comes in and combines. So I guess I’ll finish up by asking what do you think is the main obstacle in us trying to get from the world where it is now, where everything is just reactive and everything’s checkbox, to what you and I and a lot of other people are thinking the same thing, so it’s not like it’s only a few people in a vacuum saying we need to have a more preventative healthcare system and we need to kind of think about things more holistically as opposed to just disease cure.
And that really ties into everything we’ve been talking about, right? Instead of just checking the boxes at the health system level, which creates a horrible workplace culture and doesn’t support nurses, instead of just checking the boxes at the institutional level so that we can adequately mentor nursing students, I really think I have the same answer from preventative health to nursing schools to hospitals and it’s that our financial incentives are not in line with the outcomes we really desire. It’s easy for us to sit here and say, “I want an interdisciplinary team at my primary care office.” They are not financially incentivized to make that happen, and they need to put food on the table, they need to send their kids to college, they’re being incentivized to see as many patients as they can, to do the tests, to do the procedures so that’s what they’re going to do. Same at a school level. How do I push as many students through? I don’t really care if they churn and burn, they’re paying tuition. Same at a hospital level. So if we are more intentional, and this has to come from the top, about aligning our financial incentives with these end outcomes that we’ve been talking about, I don’t think we’ll see system wide change until we make that happen.
Yeah, and those financial incentives are messed up pretty much everywhere in the world. I mean –
Pretty much everywhere.
Most of world, it’s also a lot of that short termism. I just recently found out that this is – so today is September 17th, the day we’re recording, this is a time of year when a lot of people lose their jobs because people who have certain payroll numbers at the end of the year for annual reports and so it’s like disincentivizing the annual report as opposed to incentivizing what’s the mission of the organization and even what’s the –
Absolutely. Yep.
– you lay a bunch of people off, everyone else is going to get really stressed, people are not going to perform as well and you sacrifice 2027 for Q4.
And then you left the people who you didn’t lay off in fear of their jobs, not feeling valued or respected, thinking they could be laid off at any point in time because their friend was and their friend worked just as hard as they did. And how does that impact your entire organization and make them work harder towards your mission? It doesn’t. It doesn’t work in the long term. It worked for this quarter, it worked for your revenue report at H2, but you failed to look at the 10-year mark.
It’s the same way the hospitals are losing nurses like you who just want to do a good job, even at bedside table nursing, everyone’s focused on just because they’re focused on that one line in a report that which is like, as you said, didn’t affect the outcome, it’s not really what matters when it comes to what the hospital is there to do.
Absolutely. I agree.
Awesome. Well, Morgan, thank you so much for joining us today on Action’s Antidotes, talking about your experience and how you made the pivot kind of intentionally to think, “I still wanna be involved in this healthcare field, I still wanna be involved in nursing. What can I do about what I observed? I just had this terrible experience but what can I do about it? And who can I connect with and how can I still make a meaningful contribution to this overall mission of nurturing people health?”
Absolutely. I couldn’t say it better myself. That’s what we’re all about at Archer Review is how do we nurture, how do we mentor that next graduation, that next group of nurses, because they’re going to be the ones taking care of us so we have to pour into them.
Oh, yeah, definitely have to. And I would also like to thank everybody out there listening to Action’s Antidotes, hopefully you got some inspiration, especially if you’re thinking about pivoting a little bit but maybe not thinking starting a business or maybe not thinking any of the standard routes that people often take, apply to a next level position, blah, blah, blah, is what you need at this time. And tune back in for more episodes with people pursuing their passions here at Action’s Antidotes.
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About Morgan Taylor
Morgan is the Chief Nursing Officer at Archer Review, and Healthcare Education Visionary.
Morgan Taylor resided in Guatemala, where she actively participated in nursing care. During her time there, she developed a deep appreciation for the accessibility and support readily available in affluent nations such as the United States. This experience left her inspired and profoundly transformed upon her return.
During the pandemic, Morgan identified crucial gaps in nursing education affecting new graduates. With a strong dedication to nursing education and community development, Morgan has made significant progress in improving the readiness and assistance provided to nursing students and professionals. In 2019, driven by a desire to effect change, Morgan joined Archer Review.
Leading the way at Archer Review, Morgan introduced a robust curriculum and innovative teaching methods emphasizing empathy and community. Her approach has deeply resonated within the nursing community, fostering confidence and competence among new nurses. Morgan is dedicated to creating a nurturing environment for nursing students, emphasizing values of compassion and kindness. She advocates for a holistic nursing education that instills a genuine passion for the profession beyond exam success.