Why 50% of New Nurses Quit Within 2 Years (And How AI Can Fix It) | Angela Millan

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I think the problem is actually a lot of these new grads are not becoming these experienced nurses past 2 years and the statistics show about 50% of them leave the bedside within 2 years. The patient went into hypoglycemic shock and had to be transported to the hospital. This could have been avoided. It looks like nurses saving the next 100 million lives for the future. What we need is AI to help with capability for nurses because >> welcome back to the signal room. Today we're going to talk about the gap between what clinicians know and what they can actually do when it matters most.

My guest today is Angela Milan. She's a nurse practitioner, a nurse educator, and the co-founder of Prism Health Technologies. She brings more than 15 years of clinical experience. But what stands out is the problem she refused to ignore. As a nursing student, Angela had a moment where her clinical instincts were right, but her execution was not. That gap between knowing and doing has followed her through her whole career. 15 years into practice, she's still watching nursing students fall into that same gap, especially when they're alone with the five patients at 3:00 a.m.

Instead of accepting that is normal, she decided to build around it. Through Prism, Angela and her team are building Hazel, a conversational AI clinical reasoning tutor designed to close that gap before the nurse is on her own in those high stakes moments. This conversation is about clinical judgment, the training gaps we have normalized, what it looks like to design AI that actually strengthens nursing practice instead of replacing it. Angela, welcome to the show. >> Hi, Chris. Thank you so much for having me. I'm so happy to be here today with you.

Well, I' I've been looking forward to this since we first had our conversations. I think we went back and forth on some LinkedIn posts for a little while. Um, but after chatting with you, like we just have to have a conversation that everyone else can get it done. Really excited to to talk to you. There's so many >> places we could start, but I mean, I want to start kind of at the beginning a little bit and just tell people a little bit about your background. And I think there's always a a passion that I find in anyone who's really doing healthcare for any length of time and certainly that you're you're not an exception.

There's just a ton of passion I see in you. >> Yeah, thank you. Um yeah, I've been a nurse for about 15 years now and my journey actually stems as a new grad kind of transitioning into my practice on at the bedside. I vividly remember me, you know, becoming this new nurse after being a student. And in nursing school, I was told I was going to be a great nurse. I got good grades. When I got on that bedside floor, it was a really hard transition. And so from moving from the bedside, I went to get my masters. I became a nurse practitioner. Again, I saw that gap.

And it was at that point I think it was like um a higher learning curve I could say from being a nurse to becoming an actual provider. Um and so after a couple of years um after the pandemic I was hearing about all the nursing students not really getting enough clinical exposure. That worried me because I had some friends and family who were also nursing students and not able to get that type of training. And so I went back to become an educator as a clinical instructor and I was seeing the same gaps, you know, that I experienced myself. And so I thought to myself, how can we fix this problem?

Because in its entirety, we are training these nurses basically to be in a system where it doesn't necessarily support them >> and that can in turn, you know, affect health care and how we we actually provide care to patients. So, I decided to build a platform to help really strengthen clinical reasoning, that development of clinical reasoning, and really help students understand what they're getting into becoming a bedside nurse and building that clinical identity, which I always think has to start at school and not after. Yeah, I think that's an important distinction too that I I know what I'm sure we'll get into this a little bit, but the the last several years.

Uh we've we've seen some pretty intense transformation going on first with the pandemic, but now with AI being part of uh almost everyday life for people. I'm sure there's some impacts there that concern you as well. under I've heard some sure heard this from some physicians recently in terms of the training and what they what the impact is going to be like >> but right let's start between in a spaceport where you've talked about the difference between what being licensed and ready you could pass boards >> and still feel unprepared at 3:00 in the morning from your vantage point why can nursing school produce compliant test takers without always producing a competent clinician I mean this is a real significant challenge I assume that you're you're trying to address, >> right?

Yeah. So, I mean, here's a truth that nobody actually wants to say out loud is that passing the enlex means you're safe enough to start, but it doesn't necessarily mean that you're ready to take care of actual people. In nursing school, they teach you how to recognize and interpret. It's this is what the patient's showing me. But sometimes there's a gap between actually recognition and then doing. So with every symptom that you recognize a patient has, there has to be an intervention attached. And so what I've seen with my students is that they freeze at the bedside and then >> right >> they understand what they're seeing but they don't actually know what to do next.

Um and I think you know there is this I don't want to say stigma but there's this perception in nursing that once you graduate with once you graduate and pass the enclelex then all of a sudden you have this built-in clinical recognition system inside somehow but it's really hard to determine you know memorizing for a test and then applying that to the human in front of you. That's where the gap lives. So yeah, I mean I I I I can share a few examples if you'd like of of what I've seen, how I've experienced it. >> I mean, it sounds like one of the main focuses you've had is kind of building this essentially a map to readiness based on what the qualifications say that they should be doing and able to do versus what they're prepared for.

Is that right? >> Right. Yes. Absolutely correct. Yeah. I think in nursing school there's this like misconception about what makes a good nurse and in school it's your grades right if you pass pass school pass your tests then you should be an excellent nurse and I think we or nursing school gives you more lectures more content to make sure that you are competent in understanding concepts but what's missing are two things it's practice and feedback back. And so practice is the actual, you know, action of of doing. And feedback is someone telling you like, here's what you actually missed.

And those two things are really like what's the heart of nursing, right? Action, doing something on the floor. And then it would be nice to have someone to tell you, you know, this could have been done a different way or what if you had anticipated this to be able to prevent, you know, a consequence of of an action. >> I mean, I've heard this from from other other nurses, too. the the expectations are are high, but it seems like there's not enough emphasis on providing the opportunity for you to be, you know, side by side with someone, you know, to really get to get to a place where you really feel confident.

I'm guessing that's probably has a lot to do with why you formed your company, >> right? Yeah. And I think there are some good programs that do that, but the problem is consistency. So, not every hospital-based newrad program offers that one-on-one mentorship. And so, there's a gap between some nurses who graduate with with a preceptor that they've had for, you know, I don't know, 6 months, even sometimes a year, to somebody who just kind of gets thrown out there. And I could speak for myself. I was unfortunately one of those nurses, you know, I graduated when I was 22, 22 years old, and I was just thrown out there.

I think I had maybe 18 days of preceptorship, like a a one-on-one mentor, and after that, they're like, "You're ready. You can take this whole new patient load." And at 22, was I really ready to take care of somebody else? I felt like I was not even a full-fledged adult yet. So, >> I can imagine >> it was a tremendous responsibility and I had to navigate those waters myself and yeah, it was it was frustrating. It was hard. I I cried a lot. I can say to say the least. I cried probably every single shift after for like three months driving home. I'm crying.

>> Oh my gosh. I mean, I I I've always had a a heart for for people that do this work. You know, I've always respected nurses. I know it's a it's a workload and mental toll that it takes on someone that I don't think anyone could really understand unless they are seeing it up close and personal. I'm sure your family recognizes when you come home and you've had a a difficult shift, but this is just not a reality that people deal with. And honestly, I'm a little taken back by the short time you have, you know, having that preceptor uh support. I had I mean, I know that there's a nursing shortage and all, but I guess that's something I hadn't really had really heard that before.

That's a very short time to get yourself ready, >> right? And and I think it's, you know, I think the problem is actually a lot of these new grads are not becoming these experienced nurses past two years. And the statistics show about 50% of them leave the bedside within 2 years. And so the thought is or the way I see it is that if they don't mature enough after 2 years, then we don't have enough mentors or we don't have enough of these like senior nurses to become mentors to mentor the next generation. And so what's happening in some of these hospitals that I've seen and I've talked to a bunch of new grads is that once they they have like a year and a half, they become these new mentors to the new nursing students.

And it's kind of strange and silly. It's like you're only a nurse for a year and a half. You are trying to figure out who you are as an who who your identity is. You're trying to figure out how to navigate a hospital system that's complic complex on its own and then now you're expected to train these very brand new nurses and you know it's it's a nursing shortage in that our nurses are not becoming you know full-fledged senior nurses and then the senior nurses are now retiring and or leaving the bedside and it's it's this bottleneck that we have.

>> Yeah. that this compression piece of I'm like I don't know. I guess I I never realized it. I mean this is I'm glad you're talking about it because it's really really important. I think we know that there's pressures there and and taking care of the the people who take care of us is is an important thing, but I don't think people realize what we're throwing at people at young people. I 22 years old, you you just getting into it. There's so many other things. I mean, be becoming a nurse is not the only thing that's going on in your life at 22, I'm sure.

>> True. That's >> crazy. >> Yeah. Yeah. And and a lot of the nurses are are that age when they graduate >> and they're they're given this like immense responsibility >> and to kind of like sink or swim basically. It's like, can you survive this? If you can survive, you survive. Great. now, you know, teach the next generation how to just survive, which I feel like nursing school or nursing in general should not be taught that way. I think it should be taught in what something that I call thrival instead of survival because if you're if if you're learning in survival mode, most likely you're going to teach in survival mode.

And then this just becomes a whole vicious cycle that you know it just causes more burnout, more um nurse fatigue and more people leaving the bedside unfortunately. >> Just I want to kind of dig in a little bit. So we've talked before you you you kind of distinguish between clinical judgment which obviously hope you know is coming from a place where you've got some a pretty decent handle on what the care pathways might be that you got to be dealing with in a in a situation but talk about the difference between the clinical judgment and kind of the checkbox education because it seems like everything's so compressed I don't know how it could be anything else but checking off boxes and make sure you're just covering everything that has to be talked about, >> right?

So, yes, it is the INLEX measures minimal competency. It measures your understanding of disease processes. It measures your understanding of minimally putting the pieces together. But I think what's really missing is that is is the repetition, the reps, the practice of understanding different clinical scenarios in a space that's safe and not on the floor where stakes are very high. And so I think the way that I can um put this into perspective is that the way we teach clinical judgment is like how you teach someone to to drive. You hand them a nursing manual or excuse me, not nursing.

you hand them a manual and then you have them take a multiple choice test and then you're like okay now drive on the freeway but it's like that gap between you know memorizing the answers this is what you should do in this specific scenario versus you actually going and doing it and so I think clinical judgment is built in the way identity is built and what I mean by that it's by daily small decisionm with someone who's watching you or someone who's guiding giving you like I said the practice and the feedback someone who's there saying here's what you missed or maybe think about it a different way and then this this way these nurses can not only build I I guess what I'm trying to say is they're going to build be able to see the cause and effect of things if they administer this medication this is what can potentially happen and so they're building this foresight this anticipation and that can really help to prevent prevent bad outcomes.

>> It sounds like there's a there's a part of this where, you know, as an educator, you've got to kind of figure out, you know, when you when you've got someone you can lean on a little bit more because you feel like they they've really shown you that you can trust their judgment versus, you know, where you Well, let me put it another way. How do you get comfortable and and what are the things that that have to happen for you to be able to feel good that someone actually is prepared and can you exercise that judgment? >> That's a really good question and I think so what you're asking is like how can we know someone is actually clinically competent at this point.

>> Right. >> Right. And I think exposure, experience, right? Being able to do these scenarios, being able to have a certain amount of scenarios that they've encountered, even just normal scenarios that might happen on on on the floor. So, for example, I'll give you a story about a student from from my colleague who understood diabetes. She was taking care of a patient at a nursing home who had a history of diabetes and dementia. And so this patient was unable to care for himself, unable to give his own medications to himself. And it was time for her to administer his insulin prior to eating.

And so she knew what the insulin was for. She knew how much to give. She even checked his blood sugar prior to giving the insulin. She did everything that she could. she she should do prior to giving the insulin. But she did miss one important thing is that while she knew that she was giving rapid insulin which works within 15 minutes, she forgot to set up the patient's tray before giving the insulin. And so she gave the insulin, left the room and didn't even think to feed the patient. So it is a rapid acting insulin. And you know about 30 minutes later the CNA comes to her and they're like you know Mr.

Bob in you know room 103 is not responsive and so she didn't connect why what had happened and it was because she checked the insulin but she didn't necessarily think to like this patient actually needs to eat because rapid insulin corrects their postprandial sugar levels. So it means that it helps to prevent their spikes after eating. But unfortunately the patient went into hypoglycemic shock and had to be transported to the hospital. This could have been avoided, you know, if she had connected the dots. >> Wow. That I I'm just I keep coming back to this.

I'm like just kind of it's eye opening. I I guess there's no way to put it. I mean, we think of you you you know, we if I go to the hospital, I see nurses that that are just flying all over the place doing amazing things coming in and taking care of my family members, you know, showing great, you know, compassion and concern. But what you know, it's not it's absolutely not obvious all these other things that that you're dealing with in your mind, what you're trying to juggle and remember at the same time actually have compassion and be personable, >> right?

Right. This is remarkable to me. >> Yeah. It's it's it's a lot of what can I say? Multitasking. >> Multitasking. >> Like emotional and physical multitasking is is really the heart of nursing. Yeah. And it's just taking all of that into consideration >> and thinking through like if I if I administer this medication, what is a potential side effect of this? and then thinking of interventions to mitigate that. How can I decrease that from happening? What should I do to anticipate if this patient will have a certain outcome of giving this medication?

So, it's not just giving the medicine, but it's also thinking through scenarios and understanding and have a plan A, B, C, and D if it were to happen. Well, it's if you could change something, it seems like you probably could name a few different things, but if you could just redesign one piece of the the pre-licenture education around judgment, where would you start? Like I said, I think more more repetition and more clinical scenarios, really honing down on students understanding the patient and having them connect the dots between what they're learning in theory and then how this pertains to this specific patient.

I think nursing education I I believe in the last few years have changed that they're not really able to have that much clinical exposure. I'm not quite sure what the underlying reason for the change is. It could be, you know, a lack of sites. It could be a lack of educators. But yeah, I wish that students would have more opportunity to be able to have more hands-on practice, more exposure to patients, more guidance and mentorship and consistency within that. >> Yeah. I just I don't know. I'm just trying to imagine how you how quickly you're having to ramp up.

I mean, we've already mentioned it, but like you go from zero to all of a sudden you're on a shift at 3:00 am and and you're taking care of five patients all of a sudden. What's that look like for on a typical night for a new nurse that's got multiple patients and limited backup? I mean, that's got to be stressful. >> Very stressful. And I was I've been there. I think on my first shift as a new nurse off of orientation, off of my 18-day orientation, I had a patient who had constant G tube feedings. So, I had two of them and that's very task oriented.

So, they were very reliant on other people for for just eating, right, and oral intake. I had one who was in constant pain. So, I had to administer pain medications every 2 hours. And so what that meant was I had to monitor this patient's respiratory rate more frequently because they were on on high doses of opioid medication. And then to top that off, I was also the first one to be to have to admit a new patient on the floor. So, it's it's like juggling all of these things and I had so many questions because I'm like, what's going to hap what what happens if this one patient is not digesting, you know, the G2 feeding that they're having?

What do I do? And I was a brand new nurse, so it I had it was scary. It was scary for me and nerve-wracking. And luckily my team on the floor, my one of my my preceptor was actually on the floor with me. So she was able to help me help guide me and my questions. >> But it was just, you know, I think that's just even scratching the surface too because in between those in between then you have the doctors coming in asking for a status update. You have radiology coming in having to do some procedures like X-rays on the bedside. You have physical therapy who want to, you know, help the patient up.

Are they able to get up? And then you also have the patient's family who's asking all these questions that and they're looking to you for the answers, right? >> And some of them are upset because, you know, they want to go home. They really have no idea what's going on and they have it's the fear of the unknown. And so trying to satisfy all the ancillary staff that needs to complete their jobs and you being you know kind of like the project manager manager managing everyone while also taking care of the patient and making sure they're okay and then at the end of it somehow documenting this all succinctly.

>> It's a lot of tasks all wrapped in into a 12-hour shift. You mentioned that, you know, working with your preceptor. That's got to be an interesting balancing act, too, if you're if you're the one who's, you know, acting in that capacity. How much do you allow someone to kind of figure things out on their own versus what you really need to step in and really help them to to navigate? >> It's understanding the students limitations too and their strengths and their weaknesses, right? So understanding what they they understand and understanding what they don't understand.

So in these new grad programs, they do have a preceptor that you work with on one-on-one. And I do believe some programs allow them to share a patient load, >> right? >> Which I think is fantastic. I think that's a really good way to do things side by side and then as time goes on then, you know, they have them in charge of like one patient and then as they build more skills have them in charge of two and three and four and five and so on. So I think that's a really good structure for a preceptorship program. Although I I'm not quite sure what what other hospitals or how they exactly do things.

So I think, like I said, the consistency is is the issue too because some hospitals do it, some hospitals don't. And so there's just this big question mark on how do we how do we quantify clinical judgment? How do we make sure these nurses are ready? And the only thing from nursing school when you graduate and to become a full-fledged nurse is the ENLEX test, which we can see has gaps. That kind of gets us up to the the part that I'm most curious about now. U we've had some good conversations. I I I understand a bit about your personal why, but you have pivoted now from trying to figure out that the questions you were just talking about to creating a company and you're moving from this is a problem to I've got to build something here to fill that that gap.

tell us about Prism and the name and there just there's a whole bunch of questions I got but let's start from there. tell us you what what inspired you. >> Yeah. So what inspired me was basically like I said my own experiences to build Prism. I see this this problem this gap and so we're building this platform that helps nursing students devel develop their clinical fluency and reasoning which is exactly what the heart of what a nurse does every single day. And I think the most important thing that is is the impact right? So when we build these nurses or when we have nurses who understand >> clinical reasoning, they're able to anticipate the needs, they're able to intervene at the time that they need to, they can save really save lives.

And I'm not saying they're they're not saving lives already. But I think because they are and that's what they do every single day. But I think this this needs to start in school and this needs to be we need to mitigate that burnout for the nurses that we have right now by really supporting the new nurses that are coming in. And we're handing them a system, right? We're handing them a system that's already broken. So I feel like we need to start from that beginning and hand them something, hand them that confidence and the competency to be able to to change healthcare and shape that healthcare landscape for not only for for them but for our own well-being, right?

We're all going to be patients at one point in time. We already have been, >> right? You know what I like to think about when I've created this this company is that like nurses are the first person you meet in your life is probably a nurse, right? A doctor, a nurse, your mom, >> your dad. We were born in a hospital, right? >> And then the last person you may meet is also a nurse. >> And so we're there through every stage of your life. And so we need to build tools that help support us better so we could do our jobs and not feel burnt out doing it.

Us feeling more confident and competent in accomplishing what we need to do is take care of of humans. And one thing um I just want to add quickly is like I don't feel I don't think at all that that that part of it has to be should be delegated to AI that clinical reasoning should not be delegated to AI. So what we're doing with Prism is actually helping the nurses build this their clinical muscle. So the this cognitive the co cognitive thinking is not delegated to someone and nurses just become like button pushers like approve or actually doing the work.

>> What a powerful perspective. I I hadn't really heard it put that way but you're right. The nurse is one of the first people you're ever going to meet when you're born and one of the last ones you see on the other end. It's it's remarkable. I hadn't really considered it that way, but it just makes it even more clear and how important the work that you're doing really is. People who haven't heard about Hanzel, this is the first time. This is the part I'm excited about because it's it really gets to some some really good things that you're doing to provide a whole another level of support.

But tell us about Hazel and how that is how you're using that uh in your work now at prison. Yeah. So her nurse Hazel is a conversational AI tutor. And so she is exactly how a nurse educator teaches. What she does is how a nurse educator teaches. She doesn't give you the answers. She's not just giving you so much content. She's actually making sure that you understand the concepts that you're learning and she takes time to break it down in ways that you understand yourself. So, one of the problems in the classroom is that if you are one educator with 30 students, everybody learns differently.

Some people might might be more visual, some people might be more auditory, some people like to do hands-on things. And so Hazel is that one-on-one tutor, that one-on-one support that and she can adapt to the way that you learn. She can deliver the information in a way that you learn best. And the great thing about her is that she really can break it down into real world concepts that might not be related to nursing, but break down these con complex concepts in ways that you would totally understand. So, example, if we're talking about, let's say, you know, a hemorrhagic stroke, the nursing textbook will give you all of these like medical terminology that you don't even understand at all as a student, right?

But Hazel would maybe say something like, think about having um a fixed container and you have a a small water balloon that's stuck inside that container. what happens to the pressure inside of that fixed container? So, obviously the water will get displaced, but since it's a fixed container, >> the pressure might not be able to go anywhere, right? And so, she she kind of delivers all of that into like real world real world um I guess a real world perspective on understanding complex concepts. No, I I love that because I think that's the piece that people are most lerary of with AI is, you know, you don't want it giving you a confident answer.

It's, you know, I'm not sure we should trust a confident answer from AI to be honest, >> right? Yeah. >> But you're talking about using it in a way that it helps you to reason and and process information. I I think that's brilliant. How is that how has it been for you in terms of, you know, how how it's received? I'm sure people must be really happy to have some kind of support like this. >> Yeah. So, I I actually had a student who was on his last year of nursing school. He graduated um well, he was using nurse nurse Hazel on his last um semester of nursing school, graduated, started using her for practicing ENLEX.

And he passed his enclelex. And one of the greatest things is he told he emailed me and said, "Hey, you know, I want to thank you so much for allowing me to use use your platform, use your product." And nurse Hazel actually really helped me understand the concepts to pass the ENCLEX. So that's, you know, one phase. I'm I'm I'm curious to follow up with the student as he transitioned to a new grad because he also asked me how can I continue to use nurse Hazel to developing my clinical judgment. So, I'm really interested in in following up with him once he transitions into a position as a as a new grad and see how Hazel can further help him.

So, he's still on our platform. He's doing our our scenarios. He's building his reps and yeah, that was something that was super exciting for us. So, >> yeah, I can't even imagine. How does it kind of grow with with someone? I mean, so once they're on it, it starts to understand a little bit about h how they how they're processing information and it kind of dials things in as it goes a bit. >> Right. Yeah. So, a function that we have on nurse Hazel is also the a clinical reasoning lab where she takes a patient with full information. The the student then or the new grad will then have to have this conversation about Hazel about this is a 67year-old female.

You're going to be taking care of them. you see these types of vitals, you see this diagnosis, what is your first course of action. So, it really helps them with identifying the signs and symptoms and then also connecting that, like I said, to an intervention. It's great because I think they're that's how they're able to really build their reps, right? You know, they're able to to kind of see how that case study will unfold in real time based on the actions that they do that they do. And so then they can go ahead and debrief and like if if they accidentally gave the wrong medication, this is the consequence that happened and Hazel will debrief like what do you think went wrong?

So >> yeah, >> that's phenomenal. I I know that you've got some deeply held values. Um the concern often we're we're hearing about with uh with AI is where's the light? Where do you where do you say okay we're not going to cross over here? This is a human judgment thing. we're not going to touch it. What are the kinds of things that help you to decide what Hazel should do and and what she shouldn't do? >> Yeah. So, there's strict guidelines for Hazel. Um, she's not able to to ever give like real time advice. >> If you prompt her, I'm at the bedside, my patient's doing XYZ, she's not able to really tell you you should give oxygen or do this specific intervention.

She is purely educational. So what she's supposed to do is to build capability for students. Build capability in a way that means she's helping she's helping the nurse be that resource, be that person, that go-to person, but she's not able to give you actual advice at the bedside or any medical advice or anything like that. It's purely she's purely educational. >> Excellent. that that's the I think that was the thing like I I knew I was going to hear that but I'm sure everyone else was curious too that you know there's to me there's a lot to be said when the people who are developing these solutions have lived in the shoes of the people that they're making creating it for and that's one of the things I really love about what you're doing um it's informed by your own personal experiences both positive and negative and that that's how you've been building it that's remarkable >> but yeah >> the personal side of it and talk a little bit about I know you've touched on it some but what is the emotional cost of become a clinician becoming a clinician when you're dealing with a system that essentially you've been taught to care but then you're being measured for compliance I that kind of unfortunate uh reality but but talk about what that's like and you know what are the things that we should be doing to really help provide a better understanding and better support to to clinical staff, nurses in particular, have these short opportunities to get their feet under them and be a rock star overnight.

>> Yeah. I mean, I think that's the the real heartbreak of the profession, right? All of us nurses, we come into this profession because we want to take care of people. And actually, you leave nursing school still believing that, that you're going to be taking care of people to the best of your ability. But then the system meets you with a clipboard and you learn very quickly that nobody on the unit is going to ask like did you actually sit with this patient? You know, did you did you make sure this patient understood their education? Do are you they're not going to ask you like how do you feel after losing this patient who you cared for?

>> And the only thing they'll probably ask you is did you chart it? Did you chart it? Is it charted? Did you chart it in a timely manner? You know, did you >> hope you didn't get any tears on that paper? >> There's not going to be any tears on that paper. No. And so I think that's the emotional cost. It's >> it's the part of you that's that natural caregiver and you you want to give more time to the patients, but it's like >> the system is asking you to just give it in a doc in a document. >> They it's it's the metrics that they're measuring, right?

They're measuring how fast, how efficient you can be on the floor, but they never un they never see that maybe this patient that you're currently taking care of is very health illiterate or what if this patient can't even read their discharge instructions and you're handing them a paper that says do x y and z and they're like first of all I can't read it. I don't know what this means. And so, you know, unfortunately, that's the cost because you want to do better for your patients, but the system is expecting you to do something else. >> Well, we're coming down to the end.

>> Time is a limitation. Yeah. Sorry. >> Sorry. We're coming down to the end. I I want to have you kind of apply it on. What would you say to hospital executives? They're they're just listening to to our conversation. What would you tell them those is most important thing that they could be doing right now? You know, we've talked about the fact that there's a shortage of nursing. The weight that they're carrying is incredible. What What do they need to know? And maybe they're not hearing. >> I mean, I think they should know that nurses are humans, too, and that we have our limitations.

We have emotions. We're not robots that can keep giving. You know, if if you add more things to our tasks that rem, you know, that and and not remove anything or replace it, then that makes it impossible for us to complete our job and and why we went into this profession, the reason for why we went into this profession. You know, sometimes the math doesn't necessarily math. And I think a lot of the executives, they do a great job, too. I'm not saying that it's all totally bad, but I think there has to be a way that we can all work together so we can emotionally support nurses, give nurses things that they need to help do the job better, but also be considerate that if you add a task that we need to fulfill or another metric that we need to fulfill, then you know something has to give somewhere in that equation.

So if you add two to one side and don't take out zero on the other side, >> right, >> you're you're adding more more on the plate and it makes it impossible. >> And one last one and then now then we're going into a speed round and end on some some fun. But but looking ahead for you, you know, 10 10 years from now, what does success look like for you in and what Prism will have accomplished and what kind of impact will it have on a first year nurse and how they feel on shift and and does it stretch that time out so we're not losing people after a year or two?

Uh what does it look like if you if you can have it at the way you want it? Yeah. I mean, I I I feel like it looks like better healthcare, right? Yeah. >> So, better patient outcomes. It looks like us having a strong nursing workforce that's supported. We're all consistent on the same page. I feel like it looks like nurses saving the next 100 million lives for the future. For our future. Yeah. and re and and you know all of these tools that are coming out, all this great technology that's coming out, it looks like healthc care and nurses know how to utilize them to extend life expense expectancy for our patients, >> right?

>> And get these better outcomes. I think that's the ultimate impact and the ultimate goal that I want to have because nurses are the delivery of care. They're the deliverers, excuse me, deliverers of care. So it looks like them being supported to be able to translate what's going on in technology, what's going on in the latest developments in healthcare and applying that to us to the humans. >> Yeah. To everybody. >> No. And I I love it and I love what you're doing with the with the company. I think it's a it's definitely a time for people to be paying attention to to things that you're talking about in the way that you're adapting technology to actually address some of the deficits that are there that rather than keeping layering more stuff on.

You're you're creating technology that's addressing a real need and really bridging a gap that has no one's really doing a great job with it to be honest with you. the the platforms continue to be able to adapt to quality metrics and all these other things, but it's not really meeting uh the clinical teams in the workflows that they're living with. They're in the middle of it and having to deal with every day and are always changing and technology people are, you know, tossing something else over the fence and saying you got to use this and it's just not it's not realistic most of the time.

It just breaks right the processes you guys are already struggling to keep up with. >> Right. Well, >> yeah. I mean, I think, sorry, just just to add to what you said. I think, you know, AI, like the documentation, the scribes, the all this AI scribes, all the AI documentation, I think they're great. They they really help nurses do our jobs, right, more efficiently. But I think what we need is AI to to help with capability for nurses because we're ultimately going to be the ones that are using these tools. So we need to build something to help them understand how these tools are built and help them how to integrate that into workflows.

And if a new grad nurse is just struggling to understand what's presenting in their patient, of course that's that's going to be the priority is the patient. But now they're in conflict because now I have to learn how to document this. But what did I just do? what am I just documenting? You know what I mean? So, I think it's great that we're we're we're getting we're getting new things for workflows and AI scribes and all of that, but we also have to support the new generation who who will be using these tools eventually. >> And I love that it's a nurse who's driving the direction of this this capability.

And I think that's it's it's quite inspirational, Angel. really have a ton of respect for what you're doing and I and I hope people in you know are listen to this and they're inspired and I know having been on the technology data side for a long time it's really kind of embarrassing how we've kind of done things in a vacuum for so long and haven't really dialed in on what really is going to support the workflows instead of inhibiting it or making them worse. Let's uh have a little fun. >> Okay, >> a little little quick round of questions for you.

These are really, really complicated ones. So, you know, just just give me the first answer that comes to mind if you wouldn't mind. >> Okay. >> What is your go-to comfort show or movie after lunch? >> Have you seen the one with Adam Brody and um Kristen Bell? I think it's called uh Nobody Wants This >> Yes. >> That it's like a romantic comedy that's I love it. It's so funny. But I I I just binge watch it. Like I binge watched the last two seasons and I just I wish they like make more. So >> I love it. >> That's my guilty pleasure. It makes me laugh.

I like romantic comedies that make me laugh. >> I I have a favorite too, but it's a I don't know if you watch Shitz Creek, but that's one of my favorites. >> Yes, >> it is. It's so It's hilarious. >> A little a little different. If you're not in healthcare, what job would you love to try for a year just for fun? not in healthcare for a year and like I could do anything I wanted to. >> Anything you want. >> Maybe I'd go work at Disneyland. I think it's fun over there. It's not very ambitious, but I love the the the environment and my kids love Disneyland, too.

So, we're big Disney fans. Maybe be an Imagineer. That would be cool. >> Yeah, that would be fun. >> Yeah, building rides. Yeah, that would be really cool. What's one clinical skill you think every human should learn? >> Patience. >> Oh man. >> I don't know if it's a skill that you can learn, but I think everyone should have a little bit more of it. >> I I I learned the lessons like there there are things you want to pray for, but this one's a when you be careful because you know the way you learn patience is you have to you're in a situation where you really need it.

>> I know. Exactly. Exactly right. Oh my gosh. I think my mom told me one day, she's like, "You want to learn patience? Go stand in the in the line of of the post office. That's how you can best learn patience." >> I love it. Yeah. There's some sort of coffee, tea, or something stronger of a rough day. >> All of it. >> Little Bailey's in your coffee. >> There you go. Mix it up a little bit. >> All right, last one. This one's maybe a little more challenging, but it's fun. If you can design a totally ridiculous AI sidekick for your shifts, what would you have it do for you?

>> An AI sidekick, like a robotic one or anything? >> Never really thought about that. But what about like like a coffee bringer that just knows when you need your next shot of coffee or your next shot of espresso? That would work. I I would >> I think that's too silly. I have to think about that one a little bit more. But that's that's what I came up with. >> No, this that this has been fun. No, Angela, >> what about you? I'm curious about your your AI sidekick. >> Oh my gosh. Well, lately I would want it to take over some of the things that I've learned in terms of building uh some automation stuff for myself because the more I do it myself, the more I keep discovering it's possible and I just burn too many hours and it's just probably not good for me.

So, you know, if someone could just take on that stuff and just chase all the rabbit chasing all the down down all the rabbit holes for, you know, not have me do it and stay up so late because that that's one of my vices these days. I'm up way too late doing that kind of stuff. But >> way too late going down the rabbit hole for things. >> Yeah. I mean, you pull one thread and you realize, oh wow, we can do this. Then you start this, oh my gosh, but we could also do that. And you know, it just like it never ends. Just never ends. >> Yeah. But I think that's what makes the experience of life great because then you're you're a lifetime learner.

So don't delegate your learning to AI, Chris. >> Well, I don't want to do that, but I do need to sleep a little. I'm told that that's necessary. So >> very necessary. Very necessary. Well, Angela, where can people get a hold of you if they want to reach out and hear more about Prism or Nurse Hazel? >> Yeah. So, um, they can visit us on our website. It's www.joinprism p r i smn.com. I can give you my email. We can put it in the links below. Reach out by LinkedIn. I have a LinkedIn also, Angela Milan. Um, and please feel free to to connect with me.

I'd love I'd love to get to know you and meet meet you and we'll have a chat, a cool chat. >> Awesome. Thank Thank you so much, Angel. I really appreciate you being with me today and, you know, great conversation. I learned a lot. I just want to say thank you for what you're doing because it's it's truly an very important role that you're playing as a nurse educator. really making sure that things are being designed to support nurses at probably the most critical time when they're actually first getting started. It's remarkable and I really appreciate you're doing it and I happy to have you on the show.

I want to make sure I can get get the word out to as many people as possible. There's going to be a whole bunch of information in the show notes. U I'll take we'll take good care of you also. Whatever you need, we'll make sure it's available. Thanks again, Angela. >> Yes. Thank you. Thank you so much, Chris. Thank you. That's it for this episode of the Signal Room. If today's conversation sparked something in you, an idea, a challenge, or a perspective worth amplifying, I'd love to hear from you. Message me on LinkedIn or visit cigarroompodcast.com to explore being a guest on an upcoming