Donna Meyer: Okay. Good afternoon, everyone. We're happy to see you joining us today for the June Elevate series from Level Up RN. And we're going to get started here very shortly. I know people will still be joining, but we're really excited to be talking today about moving students beyond memorization and developing clinical judgment. Welcome back to our Elevate series. Many of you have joined us since January, so we're pleased to see you here again. I am Donna Meyer, Level Up RN education advisor. And along with me today from the Level Up RN staff is Kelley Larson, who's the vice president of learning solutions, and Angelina Guzman, our senior manager of learning success. Together, we support the nursing programs across this country through educational partnerships, implementation, and learning solutions. We're excited to spend this next hour with you as we discuss one of the issues that is always on our minds, developing clinical judgment. We have some wonderful speakers that are educators with us today, and they're going to talk to us about their experiences with developing clinical judgment. The purpose of the Elevate series is to bring a collaborative space for all of our educators who can share their experience and talk about the many issues that we know you are confronted with every day in the wonderful world of nursing education. So we're very excited to have you here today. A couple of things that we want to remind you about Zoom for Zoom housekeeping: use the chat if you have any questions, and if you want to share any ideas, we have multiple staff from Level Up RN that will be monitoring the chat today. You can also use the Q&A feature, and we want to have this be active. So please, we encourage you to participate and ask questions. I also want to mention to you that there is the resource section at the bottom of your screen, Zoom, and there are some resources in there. One of them that we will address later is how to get access, complimentary for all nurse educators that join, if you do not have access yet. So we're going to go ahead and kick it off and get started, and I'm going to turn it over to Kelley. Kelley?
Kelley Larson: Perfect. Thank you, Ms. Donna. Patrick, would you be able to go ahead and advance the slides for me? Perfect. So Donna touched just a little bit about our Elevate series. This is something that we're doing on a monthly basis. And at the end of the presentation today, we'll share next month's topic. So we appreciate everybody being here today. Now, for our agenda, as Donna had mentioned, we're going to talk just briefly about some of the barriers for clinical judgment development. After we talk a little bit about that, then we're going to jump into our panel discussion. So we've got two panelists to help us kind of navigate what are some of those challenges. And then we're going to jump into a group activity where we're going to show you some of the things that we've been working on to help students really understand how to identify key prioritization activities for patients. And then we'll wrap up our time together today with a question and answer and key takeaways. Next slide, please. Perfect. So what is clinical judgment? I think this is a term that we've all heard. It's commonly used when we start to think about NCLEX preparation and the skills that nurses need. And when we really try to break it down, we can kind of break it down into three categories. So when I start to think about what clinical judgment is, it's to really start at that basis of what critical thinking is. And critical thinking is really a broad cognitive skill where we're asking our students to analyze and evaluate, gather evidence, identify assumptions, recognize bias, and make logical decisions. So we use critical thinking every day. It's not necessarily unique to nursing.
Kelley Larson: But then, when we start to break it down a little bit more into clinical reasoning, it's that process of applying thinking to a patient care situation. So it's using critical thinking skills and clinical reasoning skills to make clinical judgments. And the judgment piece is really the, "What are you going to do or what action are you going to take?" Next slide, please. So when we think about clinical judgment, it's really broken down into six diffuse steps that help that thinking process. And this is where Christina Tanner really gave us a really solid guide to follow in terms of what are those steps for developing clinical reasoning and clinical judgment. So that first piece is really recognizing cues, that it's that ability to identify what is important, and then analyze those cues to determine what does that information really mean. Once that process has happened, the next piece is to figure out what is happening, determining what is most important. And then from there, generating solutions. So what are you going to do with that information? The next step is to take action and then evaluate did that action actually work. So next slide, please. So if we break it down, trying to kind of separate out, what is that real difference between knowledge and clinical judgment?
Kelley Larson: I know for me, I've worked with a lot of students, and I've always struggled with the piece where they know information, but they're not necessarily always applying it in the context correctly. So when I think about knowledge, my students may know the signs and symptoms of sepsis, and they may be successful on answering that in a multiple-choice question. But could they recognize those signs and symptoms of a patient who is becoming septic? Would they know the difference between "Okay, my patient has a potassium level of 3.3 or a potassium level of 6? Would they understand the context? So when we start to think about knowledge, it's really knowing the information. And you must know stuff to make clinical judgments. So both are equally as important. So with that, if we can move to the next slide, please, we want to definitely get your feedback. So we'd like to launch our first poll question and get your thoughts on this topic. So, when thinking about it, what is the greatest challenge your students face when developing clinical judgment? And feel free to participate along and select an answer, and we'll see those results come through. Donna, are you seeing the poll question results?
Donna Meyer: I am.
Kelley Larson: Perfect.
Donna Meyer: Yes. So interesting. Connecting information across concepts, which is not totally surprising, is 42% have said that, 30% prioritizing what matters most, which, of course, gets into the prioritization questions that we definitely want to have our students get really good at. Next would be the applying knowledge under pressure and recognizing important patient cues at 12%. No one chose building confidence in clinical decision-making. So pretty interesting. But I do think that connecting information about concepts, I can see why that is a winner. As a nursing educator and having spent as Kelley many times with nursing students, I think that holds true for our students frequently. Okay. Thanks for answering that poll. And we're going to do another one later on, so stay tuned. Patrick, you want to go to the next slide, please?
Donna Meyer: So now I'm going to introduce our panelists for today, who are both nurse educators. Dan Eaton is an associate teaching professor at Penn State College of Nursing. He is a certified nurse educator, psych mental health nurse. His focus areas are mental health, community health, and care of older adults. And he's very passionate about nursing, education, as well as evidence-based teaching and student strategies. I can tell you I've been working with Dan for a couple of years now in various capacities, and he definitely is very passionate. He has some wonderful ideas when it comes to nursing education and how to work with students. And Jeri Christensen is almost from more the Midwest, other side of our country, from Pennsylvania, is the PN coordinator, our associate professor from North Dakota State College of Science. She has 32 years of progressive healthcare experience. She's worked in a lot of different clinical areas. She also focuses now in education on fundamental simulation and leadership, and also very passionate because I've worked with Jeri for quite a while now, too. So I'm very excited to have our panelists here today. And what we're going to do is I'm going to be asking the panelists some questions. Again, I want to encourage all of you if you want to say comments in the chat or further add to what they're saying, that would be perfect. We're really excited for that feedback. So we're going to move forward to the first question. Question one, what does clinical judgment mean in today's nursing practice environment? And I'm going to ask Jeri to answer that question first. Jeri?
Jeri Christiansen: Thanks, Donna. Some of the things that I think about when I talk about clinical judgment, and because my focus really is fundamentals and brand new students, so like in your poll, I was probably that 14 or 15 percent because if they don't recognize the cues, they can't connect those concepts. They really need to recognize first. And so I really hone in on that assessment first, getting those cues. Now let's bridge the concepts, but then let's apply. Let's move on. And I like to give specific conversations or situations because I just feel like it's easier to apply if you can think about a real-life situation. And getting them to think, "How do you think like a nurse? We're going to make a plan. We're going to go through all of those steps." But if you can't pull the assessment data out first and then start to connect, we're kind of all in trouble because we can't move forward.
Donna Meyer: Right. Okay. Thanks, Jeri. Dan [inaudible] what are your thoughts on what does clinical judgment mean in today's nursing practice environment?
Dan Eaton: Yeah. Thank you. And thank you to everybody for being here today. Clinical judgment, it's really a core nursing competency. And it's important because it-- we know that it can improve safety, reduce complications. It can reduce errors. And we talk about it so much because it aligns with that next-gen NCLEX, which is all so important for our pass rates for our schools and everything like that. Like we talked, clinical judgment, it's really the nurse's ability to recognize and interpret patient information, prioritize those needs, and then make evidence-based decisions while also evaluating outcomes to provide that safe, effective, patient-centered care. And we all know in today's complex healthcare environment, we're seeing increasing patient complexity and acuity. I cannot think of a setting where I have worked and have clinical experience that has not seen that increase in acuity, changing technology. So clinical judgment is really more important now than ever. And clinical judgment really-- it requires a nurse to integrate knowledge, critical thinking, patient preferences, using that technology, collaborating interdisciplinary, and really being able to respond appropriately to those patient-changing conditions.
Donna Meyer: Right. Thanks. And you brought up a point, too, that I think has really changed in nursing over the years, I mean, and that is how acutely ill people are when they're in the hospital. It used to be-- some of us have been nursing for a while. You didn't see the acuity level. We actually had people that came into the hospital for tests and stayed a couple of days or so. That is obviously very different now. So I think that acuity level that has really-- you're seeing really plays an impact on the critical thinking and clinical judgment in nursing today. I think we'll move on to the second question, if you want to advance the slide. What gaps do you commonly see between nursing knowledge and clinical judgment performance? I'll go ahead and start with Dan.
Dan Eaton: Yeah. A common knowledge gap that I see really exists between what students know and how they can effectively apply that knowledge to real-life patient situations. I see many students that can recall facts and do really great at procedures, but struggle to synthesize that information, recognize patterns and cues, prioritize care, anticipate what potential complications could be. And clinical judgment really develops when that theoretical knowledge is repeatedly applied through practice. It's just like any other skill. We have to practice it. And of course, knowledge, like we talked about, it's important because without it nurses, we can't recognize and interpret that patient data. But knowledge alone, like we said, it's not enough. And students have to know how to apply that knowledge in real-life situations. All too often in nursing, I think we think that a good nurse is somebody that is really good at skills. I used to think that. When I worked in the ER, I was a new nurse. I did pre-hospital beforehand. I could start IVs great. I thought I was the best nurse. And it wasn't until five years down the line, when I really kind of realized and reflected and saw that progression in my ability to have better clinical judgment, that I thought, "Well, I'm not the nurse back then that I am today, and I really have grown." So I think I see a lot of that. And we know novice nurses, they rely heavily on learned rules and memorize facts. And as we see that progression from novice to expert, we see that more kind of intuitive clinical judgment develop. And we have to give those students opportunities in school and at the bedside.
Donna Meyer: Right. You brought again up a couple of good points. I think that and some comments are in the chat right now about that, the task orientation, the skills. And I remember doing post-conferences and saying to the students, tell us about your experience. Today, what did you do? People would say, "Oh, I started an IV." And I mean, that's great. But let's talk about why did you start that IV? And what was the rationale behind that? And what was needed? Was it for antibiotics? Was it for hydration? So moving them from that skill orientation and the why behind all of that and those tasks that are important. Jeri, what do you think about this question? What gaps do you commonly see between nursing knowledge and clinical judgment performance?
Jeri Christiansen: Dan went and took almost all my answers.
Donna Meyer: Oh, that, Dan.
Jeri Christiansen: I know. But truly applying that theory to practice, that straight A student that, "Oh, yeah, I call it booksmart," but they can't go to the bedside and really bringing that theory to practice. Like, "Okay, we talked about this in class, and you rocked it, but we go to the bedside and you're like a deer in the headlights." And then we have the opposite. We might have a student who rocks at the bedside and can put those concepts together, but then we're struggling on the theory side, probably more testing-wise. And I sometimes feel like we focus so much on testing. I would rather have my bedside nurse have those skills, that clinical judgment at the bedside and know what they're doing versus I got an A on every test kind of thing. So I sometimes see that as the gap too. And again, when and how to use that clinical judgment, what are we seeing? It's more than just we're not looking at them as, "This is our COPD patient." I really try to stress that. This is Sally, and she's your human patient. And yes, she has COPD, but what else has going on with her? You could get into some of the psychosocial issues, socioeconomic issues, all can play a part. And we need to see that bigger picture to make clinical judgment make sense or to help facilitate, I guess.
Donna Meyer: Yes. And I know there's been another comment about identifying priority is a major concern all the time with students, I think. So we're going to move to question three, and I'll start with Jeri so that you thought Dan took all your answers last time. We'll let Jeri talk. We'll go back and forth here. So why do students often struggle to identify what matters most in a patient situation?
Jeri Christiansen: Well, I think a lot of times, they lack confidence. They may know, but they don't have the confidence to show it or, "Well, what if I'm wrong?" And again, we've talked already about the task thing, making that transition from task to the application. Why are we doing the IV? Why do we need to do the catheter? Why are we putting an NG tube in? What's the purpose for this? Those are all great tasks to learn, but why are we doing it and seeing, again, that bigger picture? Being being a task nurse versus being a thinking nurse, that's where students struggle. They can get the tasks, but they have no idea why they were doing the tasks. So I really think getting some early intervention in there and really working with students like, "Okay, we're at the bedside." I try to bring as many examples into class as I can, like, "Okay, here's your patient in the hospital. They're doing this and this. Now what?" You're muted, Donna.
Donna Meyer: Sorry. They decided to start chopping trees down outside, and so I'm trying to go back-- an you all hear okay? Okay. So, Dan, why do students often struggle to identify what matters most in a patient situation?
Dan Eaton: Yeah. For us, a lot of those students, they frequently focus on just collecting data rather than really determining that significance, like we talked about. But there's also a number of contributing factors too. For us, and I think we're fairly lucky in terms of our clinical partners, but limited clinical experience, limited pattern recognition, barriers in the clinical setting. Sometimes there's that barrier to administer meds. There was a junior clinical group that I talked to when I get seniors that they're like, "Oh, hey, we only passed meds three times." And I'm like, "What?" I mean, again, it's that skill component. So we have to focus more on the why are we giving those medications, those kind of things. So it's not 100% necessary, but those are challenges and changing from our instructor perspective the way we used to do things. I also think there's a little bit of cognitive overload. I mean, think of these big textbooks and all the information that's in there. And I mean, when I went to school, it was the 200 PowerPoint slides per week, and if you didn't like it, too bad. That's cognitive overload. And I also think it's hard for students to kind of transition away from that, too. When I kind of tried to do the flip classroom approach, my students were like, "Hey, yo, Eaton. What are you doing to us, bro? Why are we-- give us those PowerPoints back?" So I think it's kind of finding that balance. But students really do have that difficult time distinguishing between relevant and irrelevant information. They'll get hung up on something. There's sometimes that fear of making mistakes because we are lucky we have some of the best and brightest students that they fear of making a mistake. They don't want to hurt their confidence. And really, sometimes people or our students have a hard time understanding that it's subtle changes that we need to monitor for. I always tell my patients or my students outside of a rare situation, patients don't just die, right? They give us clues. And sometimes they're subtle clues and subtle changes and recognizing that. You're not just going to go into a normal tensive patient's room and then the next it's 60/40, right? That doesn't typically just happen. There's clues that happen in between that when we're monitoring things like blood pressure or whatever.
Donna Meyer: Thanks, Dan. You brought up a couple of comments that have definitely initiated some chat. One of the things that a couple of people have mentioned is the unexpected, expected cues. Students not understanding and realizing that. The clinical site is also a big issue, I think. Depending on where you're at, the students maybe are not able to do as much at clinical. Sometimes they have to observe. Or maybe your clinical site says, "You can only have three patients on the unit, and you have to kind of send the other ones to this place and that place." So there's definitely some challenges, I think, on the clinical experiences so that students can see and actually develop their clinical judgment. Also, cognitive overload. There is just so much material. We hear that constantly. There's so many resources out there. And students don't even know how to use what they have, and they just totally get overloaded. And one final comment, that many of the gen ed courses don't provide the same rigor that most of the courses do. I think like your ANP and your micro, yes, maybe, but some of the other courses maybe not. They get into the nursing, and they're just like, "Wow, this is absolutely unbelievable." In fact, that's kind of what the founder of Level Up RN found out. When she went to nursing school, she already had a degree, and she was very smart. And she was like-- Cathy Parkes was like, "Wow, this is the hardest thing I've ever done." And so it just shows that there's a lot. So moving on to question four. Question four, and I'm going to go ahead. Excuse me. Jeri, I'm going to go back to you. When students make an incorrect prioritization decision, what is usually the root cause?
Jeri Christiansen: I think one of the root causes really is that misinterpretation of the cue. So we're back to that very first and second steps, maybe they got the data, but they're not reading it correctly, or. Again, at the fundamentals level, I really focus-- we talk about I think sometimes they think vital signs are so, "Oh, yeah, I got their vitals. They're fine." Okay. But are we seeing any trends with a blood pressure that's increasing or decreasing and those more subtle cues, and they're not always able to anticipate what's going to happen? Oh, yeah, their blood pressure's been dropping a little bit, or even things like maybe not as obvious as blood pressures and vital signs, but what about weight? If we're looking at someone who is full of fluid, and all of a sudden, they've dropped 10 pounds, and we're not queuing in that, "Yeah, we've been working on that. And what is that 10 pounds going to mean of fluid?" And working through that. So really missing sometimes or not interpreting those cues correctly can give them some-- can also cause those root problems because you're off on a whole wrong tangent.
Donna Meyer: Dan, what about you? Regarding students making incorrect prioritization, just what's the cause?
Dan Eaton: Yeah. I think a lot of times the root cause really isn't necessarily that they lack knowledge, but really just a breakdown in that clinical reasoning process. Like Jeri mentioned, that misinterpreting of cues. Oftentimes, that failure to connect assessment findings with underlying pathophysiology is a big one. They struggle to recognize or know that patient deterioration. A great example with the vital signs. And my students know that they don't want to say I don't know to me. I know not to try to pull the wool over my eyes. But if I say, "What was the blood pressure yesterday?" They're not going to say, "I don't know." They're going to say, "Well, hmm, okay. I see that that's important. I will find that out." But sometimes they struggle. At first, they're like, "Well, why does he care about that from yesterday? We're here today So there's that difficulty with that, difficulty weighing kind of those competing priorities and making prioritization calls because oftentimes there's competing priorities. There's multiple priorities. And then still, like we mentioned earlier, we see that focus on isolated tasks rather than overall clinical pictures. So really, we try to understand how students arrive at their decision. And that's often more valuable than simply just kind of them having an incorrect answer and just moving on and saying that's not correct. Well, why did you think that? Let's back it up and see what maybe the most correct answer would be, as NCLEX likes to put it, right?
Donna Meyer: There has been some great chats, a lot. Obviously, when people talk in nursing education, what are the main issues today? And the ones that always come up are clinical sites and nursing faculty shortage are the two. And this is showing today that the clinical side issue is really a challenge. I think it is one of the individuals comments about-- it's kind of sad how sometimes they're not always welcome at the clinical sites. And yet that's their next generation that's going to come in and help them and take over from them. And so it is unfortunate sometimes that there are some issues with the clinical sites. I also understand from the other side, I think nurses are pretty exhausted and they want to maybe take some time, but they don't always have the time. I know that's why it's getting so challenging to find preceptors now because they can only handle so much of it. I also like the comment about-- I tell them we're learning to save lives, not just pass the tests. Obviously, that's so true. And another comment, again, what I mentioned earlier about clinical science, cutting the number of students, again, a couple on this unit and then one in they want you to send them to the GI lab or something, which is fine, but what kind of clinical experience are they going to see in that type of thing? And this all plays in to them developing clinical judgment and the critical thinking. So it is an issue, that clinical side. So perhaps that's what we'll be talking about in the future. We're going to move on to question five. So, Jeri, what strategies have been most effective in helping students strengthen prioritization and decision-making skills?
Jeri Christiansen: I really think one of the things that I like the most, and that's partly because I enjoy it too, is I'm a hands-on learner. So I am very much a proponent of scenario-based learning, simulations, even just, "Here's a small scenario. What are we going to do?" If you have multiple patients, we do do prioritization SIMs where they have multiple patients where all along they've been building with just one. Now we're going to have three or four. Who are we going to take care of first? Where are we going to go to first? They all want 7 o'clock meds, but we can't be everywhere at 7 o'clock. And so I really think that is a big piece, is to get students buy-in on that and being able to give them situations that they can relate to. Real-life situations like, "What are you going to do in this case?"
Donna Meyer: Dan, do you want to respond to that? What strategies have been most effective in helping students strengthen prioritization and decision-making?
Dan Eaton: Yeah. Yeah. I think this is a great opportunity for us to get creative, think outside of the box. Kind of the same thing with the issues that we've talked about here, from clinical placement and so on. I truly believe that we can use spaces like this to come together to help work out solutions. And some things I've done, case-based learning, where students analyze and prioritize patient needs, I try to incorporate that kind of in every class and post-conferences. I think SIM just lends itself ideally for this, creating simulations that mimic realistic clinical situations. And it seems nice because we can control what happens there, where we can't necessarily do that in a clinical setting. I think of loud exercises where students are able to verbalize their reasoning process and creating an environment where they're comfortable doing so. There's no shame in not knowing the right answer, but we have to create an environment where students are comfortable to share, talk together in a respectful environment. I use reflective debriefing. We're after clinical or simulation experiences. I think that's really where the magic happens. And I think that we all need to kind of think about that, use a framework. I always have progressive questioning. My students, no matter what, I never run out of questions. There's always more. If you get the first one right, they're not going to let you go. There's more. We'll keep talking, keep going. And then also, exposure to multiple patient scenarios, that kind of build that pattern of recognition, pattern of clinical reasoning over time. And I think a key is also using a variety of different resources. I know certain textbooks advertise, "Hey, complete everything here." But I think it's important to see what's out there, use a variety of different resources, and bring that in; figure out what works best for you, what works best for your students, and give them a variety of different learning experiences and opportunities. We all know there's different types of learners, different styles of learning, and we need to cater to that for our students.
Donna Meyer: Great. So once again, there's some great things in the chat. One of the things that, again, has been brought up about the clinical sites and graduates is that transition to practice. And I think clinical sites are saying they want this of the student, and educators were trying to do that. But again, we can't get much clinical experience. It's hard to get them practice-ready and be ready for that transition to practice. There was a really fun idea in here - and I think most of you have seen it from Nancy - about Stump the Teacher Star Award. So that's a great thing. And we'll make sure that that is a great idea that we can maybe expound on. And this is the reason we're doing the Elevate series so that you all can share with each other and also just be in that space where, "You know what? We're all going through the same thing. We're all trying to figure it out together on these--" for example, the clinical sites, how to teach students with the critical thinking [inaudible] judgment. So you all have just displayed [why?] we're doing this, and we're really excited to have you here and continue this. So I think we will go ahead and maybe pull up our next poll question. So here it is. Which teaching strategy has the greatest impact on developing judgment? Let's see what we come up with here. It'll be fun to find out. People are voting okay. We'll give everybody a little time here because it's kind of jumping around. Right. Make sure everybody gets a chance because we're still seeing some answers coming through. Okay. So this is really interesting because it's very close as far as the answers. In fact, it looks like we have a three-way tie. Oops, whoop. Changed. Changed. Just a minute. I thought we were done. Just had a couple more people pop in. But it does look like case studies seems to be a big, as well as patient prioritization activities as tied with clinical experiences, then simulation and guided classroom discussion, which actually had the least at 8%. The other ones were pretty close in there anywhere from 21 to 26 percent. So it's pretty interesting, but again, the case studies is a great way to work on that clinical judgment and critical thinking as well as your patient prioritization activities, so it's great. So thank you all for this. And we'll continue to add to the chat. That's wonderful.
Donna Meyer: Well, this has been great today. I, of course, want to extend a huge thanks to our presenters, Dan Eaton and Jeri Christensen. We thank you so much for sharing your expertise and your thoughts on clinical judgment. We also want to remind you that we do have a walkthrough on Tuesdays, and if you want to learn more about Level Up RN, the next walkthrough is June 23. You can register. There's the link. So if you want to see more about it and you're not as familiar with it, you can certainly do that. We also want to remind you, if you do not have access yet to Level Up RN, it is complimentary for all nurse educators in the country, basically. So if you're not using it yet and you want to, you can definitely get access to it. I think they're going to probably put the link there or here you are right there on the screen. Sorry. I'm like looking at the chat because I was thinking-- so you could definitely get access to it, and we are going to continue our series. And our next one is going to be on July 30. It will be at noon Pacific, 3:00 Eastern. And it's going to be on active learning tricks for new educators and also current educators, so whatever. So we're new things that we're going to be doing. And so we hope you continue, and I know it's summertime and some of you are off. Some of you are not. But we really appreciate you taking time out of your day, your summer plans to do this. And we're thrilled with the feedback you're providing. And we want to continue these discussions and make them really important for you. So if you have any ideas and thoughts on what you'd like us to do, we are more than willing to hear this. So we're excited about it, and again, I just really want to extend a huge thanks for all of you. Let's see. There's a couple questions. It said when you clicked on the QR, it should ask for payment. So I'm not sure happened there. But you should be able to-- Angelina, anybody, why it's asking for payment?
Angelina Guzman: I think if you see that it's zeroed out to zero dollars. So just kind of-- you need to fill in your name and information. If that's not the case, send me in the private-- or I can private chat you right now. We can see.
Donna Meyer: Well, they're putting the URL up right now, and they said to try that, that it would be better. It might work better. But again--
Angelina Guzman: Oh. Patrick is on it.
Donna Meyer: Okay. Great. Wonderful. We'll get it definitely. And we'll be following up with an email after this today. So if you have any questions, and again, we want to remind you again of that walkthrough that we're doing on Tuesdays, definitely. And then, of course, our Elevate series that will continue. Basically, they will be on Thursdays. They're not always on the third week, but they're definitely on Thursdays, so. And again, they're recorded. A recording will come out of this. So if you can't join, you can always register, and then you can listen to the recording at a later date at your pleasure. So again, thank you so much for joining. We're so pleased you were here today. Again, a huge thank you to Dan and Jeri for joining us. We really appreciate it. And have a good summer. And again, thank you for all you do as nurse educators. Not an easy job, and we appreciate you. Thanks so much.
Kelley Larson: Thank you, everyone.
Donna Meyer: Bye.
