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Marilyn Dubree

Posted by on Monday, June 25, 2012 in June/July 2012.

Marilyn Dubree, MSN, RN

Executive chief nursing officer

What are the major changes you think will come to Vanderbilt and the Medical Center over the next 10 years?

I think the major changes will be reflected in our innovations for populations of patients, the way that we educate students and the way we work together as teams to provide clinical care.

Between the challenges of health care reform and the changes in the workforce for health care, there will be different ways of taking care of patients. We have different databases and information that can help us learn about patterns of care that we have not had in the past 10 or 20 years. I think that we use technology differently now and will continue to use technology differently, whether it is monitoring people from home or in their own community, so they don’t have to be here at Vanderbilt. I think we will see those changes impact us not only in the hospitals and clinics at Vanderbilt but also where patients live. The difference of how we use data and technology will make a big impact.

Broadly, I think that we will continue to push the envelope about how we learn together in inter-professional teams and in how we onboard new practitioners, whether they’re new staff nurses, advanced practice nurses, physicians, etc. We are learning that you have to be onboarded well, and our Nurse Residency has been one example of success in that. We will continue to expand those efforts so people step into their professional roles in ways that are supported so they can be not only a better individual practitioner but also a better team member.

What will health care teams of the future look like, and how will nurses fit in?

I think the health care team of the future will be made up of individuals that bring content knowledge to the care of patients in hospitals, clinics, communities and homes. It will vary depending on what the patient needs. The team will be available and present both physically and virtually at just the time the patient needs them, so that we preempt things that should not happen and support the things that do need to occur. There will be a partnership with the patient and their family in ways that will be beyond what we’re doing now. There will also be incredible partnerships with technology, and we will not be able to do the work without it.

Nursing will be a major role in those teams. Nurses will be a large part of the glue that holds those teams together and is in the midst of that care.

Where do you see the seeds of those changes now?

Fortunately, I think that in each of those areas we already have great minds, great spirits and great hearts not only helping to define and craft and impact those things now, but we are trying to create an environment where we can be courageous and bold and do great things for patients, students, staff and leaders. I’m encouraged about that because I think we’re trying to be ready for those changes and create an environment where those things can happen, even beyond what we can predict. My crystal ball is a little cloudy, but I think it’s important to have an environment where big things and bold things can happen, and I believe Vanderbilt is that place.

What is happening now at Vanderbilt that has a chance to have impact all over the world?

I think the contribution that nursing at Vanderbilt makes that will impact a broader span is our participation in using evidence and learning how to be better implementers of change. We are willing to try things, make mistakes, learn from that and share it in ways that other institutions are not. I really value that about Vanderbilt. We really are willing to be transparent about the things that we’re doing and share that with others. Out of that, there will be many things we will contribute that impact clinical practice, education, leadership and research.

What are the biggest obstacles or challenges Vanderbilt and the Medical Center will face in the next 10 years?

Most of the obstacles are around the pace of technology change. We cannot imagine the impact that technology and informatics will have on us in the next years. It’s so pervasive and so impacting in how we do our work, how we share information, how we communicate with each other. I don’t think any of us can stop and plan for what it will look like because it’s happening around us so fast.

There is also an ever-growing need for more education. The reality is that health care is more complex than it was five, 10 or 15 years ago. Practitioners need to be more skillful, and as a result we need to bring people in at the highest possible level of education and also use them at the top of their license. We also need to have a commitment to lifelong learning. I find that really exciting, but it can be frightening for people—are they ever going to be able to rest? But we look for people who have a good work/life balance but also embrace lifelong learning.

What are your hopes for Vanderbilt and the Medical Center in the next 10 years?

I hope that we write the new rules, that we are not just doing the traditional but we help to craft the new standards of health care. I hope that we hold onto the things that have made us strong and value the legacy that we’ve been given, and that we continue to be really committed in a genuine way to patients and their families. I hope we don’t lose that and continue to keep that at the forefront and learn new and different ways to partner with patients and families and their communities. I hope we’re on the leading edge of this work and do it in a way that people feel challenged and inspired. We want a future that is energized and vibrant, and we want Vanderbilt fingerprints all over that future.

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