Unifying the Nursing Voice: Leading Teams Who Feel Heard, Valued & Invested In - Not Just Managed!

Thank you for joining me for another episode of the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders, educators, experts, and advocates to tackle some of the greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for the show. So sit back, relax, and get ready to learn that nurses can do anything. All right, Christopher, thank you so much for being on the Nursing Strategies for Success podcast. Why don't you take a moment to introduce yourself to the listeners? Let them know a little bit about who you are, where you started in nursing and where you are today.

Thank you so much, Damion. I'm so excited to be here. I've followed the show for a while, so I'm humbled to be able to share a bit of my story in the hope that it might be helpful for somebody else. That's what we're always hoping for as nurses, I think.

Yes.

Um, being here, I have been, uh, in the nursing profession, uh, for a couple of decades at this point, um, and I would say in the nursing discipline for a few years now, sort of more, uh, perspective and experience within that. Um, I started as a as a home— kind of a certified nurse's aide without the certification. It was working as a mental health worker in an acute care psychiatric facility, uh, working inpatient. Um, did that for about 5 years while I went to school to become a registered nurse. I was a registered nurse for 5 years. Um, and then as I was doing that, I was starting to become a nurse practitioner. Uh, and geriatrics has been the specialty sort of throughout this entire time. Um, and I've practiced now as a geriatric nurse practitioner since 2014. Uh, took a little— had been working full-time sort of throughout this whole time. Um, took a little break, uh, during the pandemic, after the pandemic, really, after burning out a bit, um, more than a bit to say the least. And, uh, decided to go back to school to pursue my PhD in nursing science. I'm now most of the way through that. And now I'm working, uh, continuing as a nurse practitioner but working in a leadership position as associate medical director and the director of education programming and research for a managed long-term care company, uh, providing nursing home-level care for folks, uh, within their homes in a community— in community settings.

Wow. So first of all, hats off to you. You've done so much. So you said a couple decades. Can you give us an approximate— how many years? Like, you talk about like 20 years? Like, how long?

Yeah, no, it's so, uh, 21 years, uh, by the count as of today. Yeah. So I, I got into nursing in, uh, 2004.

Amazing. Awesome. So first of all, thank you, right, for all your years of service. I'm sure the many, many lives you've touched, huge impact. And then I know recently we had a side conversation on LinkedIn regarding one of the last episodes that was released for the podcast, and you wanted to chime in and say thank you for reminding you that your impact as an educator, as, as a leader goes far more than one patient at a time or one student at a time. And that's true because when you are teaching or you're in a space of leadership and you're impacting multiple clinicians, whether it's CNAs, nurses, or people in the leadership team, your impact is magnitude, right? It's multiplied by hundreds because for the one nurse you train, that nurse is now Helping many other people, they train more people in the future, so on and so forth. So your impact, whether it be one person at a time, a classroom of people at a time, or an organization at a time, is so imperative. And it's what we all need to do to make sure that we're keeping the nursing profession viable, keeping it educated, keeping it evidence-based, and trying to develop those strategies so we can improve some of the challenges that we're facing.. And I think that's where you are in your career, right?

Yes. I very much appreciate you saying that because this transition to my leadership position has been intimidating in several ways because I've been, I've been on this PhD in nursing science journey and I was been working full-time with this managed long-term care company since about 2017, actually, variety of reasons why I kind of went that direction. And as I've been working as a nurse practitioner and as I've been sort of approaching this position, this sort of pause in my direct care career to go back to school and pursue this PhD in nursing science was really this amazing opportunity for me to kind of look at what else I could do. And really that's been sort of a theme throughout my entire career. When I was working as a mental health worker, I was looking around and I was thinking I could I could do so much more, I could learn so much more. There's so much more to learn throughout this whole process. And that's really what brought me to become a registered nurse. And my sort of journey leading up to that was— I'm not one of those people that sort of has known that I was gonna be a nurse my entire life. I didn't have any particularly— I have no nurses in my family that I was ever aware of or am aware of. And, but I've always been fascinated by people and how people interact with each other and why we make the decisions that we do. And I can remember all these instances, you know, sort of growing up, like, you know, young, like child formative years of, you know, kind of brokering conversations when there was conflict or sort of trying to be a bridge between people. And as I think about kind of my nursing experience, you're that bridge, you know, between the patient and sometimes the ordering provider, whether it be another nurse practitioner or a PA or a doctor. So you're sort of constantly that bridge and you're constantly negotiating all these different sort of scenarios and personalities and lots of different things. So I think it's been that fascination that's really carried me through and sort of driven me to learn and help and care kind of as much as I possibly could. And really that's sort of kind of been a driving force, I think, in most of my career anyway. And this, again, sort of getting back to what you were saying about my sort of reservations, I think about leaving direct care. I've loved direct care. Working as a nurse's aide, working as an RN, working as an NP. I mean, the most satisfying experiences that I've had in nursing have been working at the bedside. And it was a huge thing for me when I was considering this pause, 'cause I was exhausted. I was working direct care primarily in the community doing home visits during the pandemic. Saw a lot, experienced a lot, was, you know, just that high level of stress, that high level of exhaustion that you're just sort of living with and kind of burning through each and every day. And yeah, and I always kind of told myself, we've always met— we've met those nurses in nursing that probably should have stepped away a few years ago, like they sort of keep working kind of beyond their expiration date. We can all kind of imagine that person, unfortunately. I think there's just, there's a lot of examples that I think lots of folks can probably come up with. I certainly can.

Yeah.

And I didn't, I didn't think I'd become one of those people, but I think I did. I think I sort of nudged up against that a little more than I was comfortable with. And after it sort of snuck up on me and I sort of hit that realization, then it was a sit down with my husband. It was a sit down and sort of like, what do, what do I want to do next. And it was the realization that I think I needed to kind of take a pause from my, you know, from direct care for a bit and sort of see, expand my perspective, recharge my battery. Academia has always done that for me, whether it be board certifications or degrees or whatever it's been. I've just, I've accomplished a lot just scholastically as far as that goes. Always enjoyed continuing ed. Yeah. And when, when I really got into the PhD in nursing science and really sort of understood continuing to understand, I think, sort of nursing more at the disciplinary level, that, that kind of higher level. I think it really helped me connect with the profession and the discipline so much more than I think I ever would have expected. And then it was, and then it was, well, how, what can I do with, what can I do with this? And does that look like me still being a nurse practitioner? Because I've been in this, I've been in this amazing situation where working as an RN, working as an working as a mental health worker and working as an NP. I've been content in all of those job roles. I've been very, very happy with that. And contentment, in fact, is the sort of subject of my dissertation, actually. I can talk for an hour about that. We wouldn't make it to the end of that. But I've been very fortunate to sort of really enjoy the different roles that I've had. So this idea of approaching something away from direct care was really daunting. And it's been nice to be reminded that I can— the impact that I can have can move far beyond the bedside and all of those experiences that I've had and everything that I've learned can expand so much more when I reach out to other nurses and sort of, you know, teach a class or mentor or whatever that might look like in this leadership role.

Absolutely. So, you know, to piggyback on several things that you said here, right? So a lot of what I heard is you saying in order for you to refill your cup, right, to recharge, to realign with your passion in nursing, you found yourself having to step away from the busyness of the direct care, right? And so this is my story, right? I think this is a lot of our stories. Many of us who have been in nursing for 10+ years have found ourselves either pivoting specialties Right, moving from one specialty to the next, maybe taking a break from full-time direct care to maybe part-time to have a little bit more flexibility and opportunity to engage in continuing education, maybe going back for a higher degree, maybe going back for certifications, maybe we're advancing ourselves from CNA to LPN, from LPN to RN, right? Whatever the case may be, I too have found myself being more passionate and more aligned with the call to nursing once I learn more about nursing. Yeah, right. Once I have invested in the professional development to gain a new skill set, a new set of knowledge, so that way I can take that and bring it back to the positions that I may have found myself struggling and/or coming to a place of overwhelm or burnout, right? So a lot of people think about burnout as this horrible, terrible thing. Let's just be honest, every profession, every industry experiences burnout to some level. Everyone. Because human beings don't like to be told what to do. We don't necessarily function well when we're on strict deadlines and constantly having to, you know, produce results. We're meant to be a little bit more free and flexible, and we're, we're supposed to have bad days and off days. We're supposed to have days where we're not productive at all. We just want to lounge around and sleep all day because maybe that's what our body needs. But when you're in a position where you're not afforded that opportunity because you are everyone's everything all the time, like bedside nursing is—

yes—

then it does become overwhelming. You do find yourself getting worn out, burned out physically, mentally, emotionally, spiritually, right? We start to run on empty. And so I found myself, you know, once I get to that point— and a lot of people do this, you probably did the same thing— you get to that point, you say, okay, what's next? Because right now I don't see sustainability with my trajectory. I have to do something different.

Yeah. And I think there's a moment too— oh, I was just gonna say, I think, because I think it's an important point to acknowledge that there can be a huge feeling of guilt in that too, when you, when you hit that moment and you realize that you know, this idealistic sort of image of the nurse is like the, you know, the constantly selfless person, the person that's always going above, you know, his/her/their way to do whatever they can for someone.

Right.

And when we realize the reality that that's not sustainable and that that's not even really a fair image of anybody, to say the least, actually. But it's— but it's amazing that we can still feel that guilt. And I think it's okay to acknowledge that. And it's insightful. To acknowledge that that can be, that that can be a huge factor in this too. You know, we, you know, we all know the value of self-compassion, but it's very challenging to actually put into practice and to take that step back, to zoom out and actually look and say, what else can I do here? What, what do I need in this situation in order to be my best for the people that I'm trying to take care of?

Correct. Because again, we tell the nurses, right, Oh, you gotta take your lunch, you gotta drink your water.

Yeah.

You have to take your PTO. You, when you're not feeling well, call out. But at the same time, not only do we struggle with our internal guilt for leaving our coworkers short-staffed, for leaving our favorite patients or residents without our care when they're the ones who tell us we're the only one who takes care of them as well as we do, but then we're also being guilted sometimes by our employer.

Yes.

Right. We're being told, oh, you know, you're leaving your coworker short, or, oh, you know, this is going to be an occurrence used against you. And if you have 3 occurrences, you get written up.

But we'll be okay. We'll figure it out. Don't you worry.

Yeah.

Yeah.

It's kind of like—

take your time.

We'll be okay. That's like a backhanded kind of compliment, but this is a backhanded insult and you're being ridiculed. Right. So there's a lot to talk about it. I'm not sure we want to go there. Right. But. Finding alignment with the profession through alternative modes. Again, maybe not doing full-time at the bedside anymore because you're starting to get overwhelmed, and maybe you are running on E. So going to a part-time schedule, which I'm on the side of administration now, and I know how detrimental that is for a facility when your full-time regular nursing staff goes part-time or per diem because They're tired.

Yeah.

But at the same time, how are we supporting those people in a full-time position?

Yes.

Are we decreasing their workload? Are you increasing, you know, the numbers of support staff so they can have the support? Are we giving them an extended PTO when they're sick or when they're bereaving or when they have to work on school? No, none of that stuff is happening.

The people that stay almost feel punished because, because they're staying full-time. Versus the person that's maybe doing the right thing for themselves and going part-time or per diem.

Yes, exactly.

Yeah.

And at the end of the day, administration cannot stop someone from changing their schedule.

Sure.

We'll be happy to have that part-time nurse come and work shifts rather than not, right? So there has to be a balance. And so there's a lot of things that we can discuss regarding problems and issues, right? So the burnout thing, we've talked a lot about that. One of the strategies, we just put it out there, diversify, right? You have to diversify your skill set, diversify your education, go back to school, take a break, maybe come up with a second source of income. We talk about entrepreneurship on this podcast, but let's talk about what the challenges that you seem to have found in your career that you have now been working on fixing, right? Or working towards a common goal to improve for the profession. So what is the challenge for you that you wanted to address on this show.

I think a challenge for me that I see is sort of a running theme in my different roles within the nursing profession has been the ways that we sometimes seem like it worked to kind of keep each other down versus building it— versus building each other up, um, you know, at that same level, you know, kind of talking away from that, the sort of gap between administration and practice for a moment. Yeah, you know, I've always been a big believer, and especially in the last few years, I've come to become even more of a believer that that gap can be either a very small gap or it can be a very wide gap. But there will always be that gap to some extent. And I think, you know, the empathy that we show in leadership positions toward the sort of the, you know, our direct charges, the people that we're working with, you know, I think sort of recognizing and being able to get in there and, you know, continue to get your hands dirty, you know, sort of walk the walk, as it were. I think that sort of, that sort of changes that gap quite a bit. And over the course of my, over the course of my career, I've seen nurses in leadership positions that have, I think, done that very well. And then some that have done more kind of lip service to that.

Right.

And so those have been, I think, exemplars for me as now I'm, as I'm now approaching this leadership position. Now I've, I'm about a month deep, just about full-time anyway with it. And you know, as I run into these situations where I'm seeing a lot of these dynamics where there's the infighting and there's the frustration and there's the constantly talking about staffing, we don't have enough, you know, all of those things. Right. It's easy to get caught up in that conversation and then lose that ability to sort of zoom out and take the perspective and say, okay, well, let's really look at sort of the efficiencies and kind of what we're doing here and kind of what that looks like. You know, we've, We've all had this rhetoric for a very long time that there's not enough nurses. And objectively, there are, you know, there is a shortage. There has been a shortage for many, many decades at this point. And I think that recognition itself is an important piece to kind of the whole puzzle that like, you know, the nursing shortage now as we're experiencing it, as we're approaching it, is not something necessarily new. It's something that the profession has struggled with for a very, very long time.

For a long time, for many reasons.

Exactly. Absolutely. And I think And I think for me, that's actually helpful to sort of ground me in a moment where I might feel overwhelmed where this has always been an issue. Yeah, this has always been an issue. And this is, you know, yet another point in time where we continue to move forward and we continue to figure it out and work with it. And I think one of the messages that I've learned over the course of sort of seeing these conflicts and the ways that we all sort of shake our hands toward the things that have been, issues for longer than most of us have been around and alive, as far as that's concerned, is to really, what can we do to sort of unify our voices within that? And what are some of the ways that we can celebrate the diversity within our profession? Right. Just for an example, and it's one that my mind has changed on quite a bit, actually, in the ways that we look at that we can enter the nursing profession. You know, there's the diploma programs, there's the associate's degrees, there's Bachelor of Science in Nursing, there's, you know, the folks that have have no degree in nursing whatsoever, and they go into these sort of graduate entry programs where it's all an accelerated option. And I think for myself anyway, I think it was very easy, it's been very easy to sort of say, "Well, if they had just, if we all did it this way, if there was sort of one standard kind of unified way of doing this, then the profession would look very different. We would all be on the same page in the whole thing." But that's naive. That's really not accurate or true at all.

Not at all.

And I think it's been, I think the unity that I'm sort of seeing and kind of raising my voice in now more is that is sort of celebrating that diversity and saying, yeah, like there's a lot of ways that we can get into the nursing profession. There's so much that everybody can add to that. What are the ways that we can really collectively raise that voice up rather than focusing on the ways that we can keep each other down or, you know, the eating of the young that we always talk about in nursing. And, you know, what are ways that we can really surmount and get past that? So I've found in kind of my leadership position now with this opportunity to be able to have that voice, you know, with people in the clinic setting, you know, with home health aides in the community setting, you know, with really folks across the footprint that our organization really works within, you know, that messaging and that empathy and just that appreciation for what everybody does really translates. It's just in being able to talk about it openly and have honest conversations and sort of open forums for that.

Yeah, absolutely. So a couple of things here that I'm thinking of, right? So yes, going back to the nurses eating their young, the senior staff bullying or intimidating or—

Entitlement.

Hazing, like the newcomers, right?

Yeah.

Again, none of this is special to nursing. This is human nature. Yes, right. So no matter what industry you enter, you're gonna experience this at some level. Why does it seem to be talked about more often in nursing, and why do nurses feel it a little bit heavier than maybe some other professions? And the simple answer to that is It's a stressful job.

Yeah, it's the, it's the nature of what we do. I mean, it's the, it's the, it's the purview of, of what we're tasked with throughout the day, you know, not just the, not just that sometimes literally keeping someone alive if we're talking about an ICU setting, but, you know, helping them manage some of the most difficult instances that they've ever gone through. And then beyond that, their families, their loved ones, Only that there are other things with that too.

So, you're dealing with dignity issues. You're dealing with loss of life or limb. You're dealing with loss of control. You're dealing with a transition that is very overwhelming and hard to understand. You're dealing with new diagnoses of life-changing illness, right? You're dealing with people in physical pain, emotional pain. You're dealing with staff who are taking on a tremendous this burden for caring for other people who are not their own family. They're trying their very best to figure out their needs, their preferences. There's a tremendous amount of rules and regulations that are put upon us that is higher than any other profession. We have more regulations telling us what we can and cannot do than any other profession out there.

And everyone always seems to have a different interpretation of those regulations too.

That part. I was getting there, right? That part. And this is where there's been that longstanding argument about entry into practice, a certain point, because some people theorize that if everyone has the same entry point, there's less opportunity for misinterpretation, which I kind of agree with to a point. But nursing is way too diverse and needs to remain diverse in order to meet the needs of our our communities. You can't have everyone at a master's level RN. It's impossible to keep up with the demands. It's impossible to employ those people, and it's not fair to expect everyone to spend that much time and money and, and energy into becoming master's prepared when there's plenty of job opportunities at a little bit of a lower level to start practicing, whether it's in the nursing home, in a correctional facility, in home care, you don't need to be a master's-prepared registered nurse in order to do those, you know, jobs.

Yeah.

So we need to keep nursing diversified. But going back to kind of creating that unity around how do we appreciate and celebrate and elevate each member of the nursing team from HHA all the way through PhD, right? Whatever it is, however you're contributing, it should be a set standard. This is where I lean in heavy, and this is what makes me love nursing so much. We have a standard. It's been there for decades. The interesting thing to me is, is when people do start to have their own interpretations of these standards or they start to change the standards based on some of the challenges that we have. And when they deviate from those standards for convenience, or for a lack of resources, or for a lack of training—

perception of lack of resources, right?

Yeah, yeah. Or perception of lack of resources, because that's not always the case. Sometimes it's we just get frustrated because maybe we have to work a little bit harder to make it work. But if we collectively work together, we can make it work.

Yeah, to the full scope of your practice. Yes, absolutely.

But, you know, I'm in the classroom all the time. I'm teaching these new grad nurses. I'm teaching nurses who have been nurses for 15 years, and they still don't have the basic understanding of what the actual standards of nursing care are.

Yeah. So, and I I think there's, there's, boy, there's, there's so many different levels to that too, because we look at sort of the, the, I think looking to the professional associations, I think is kind of diagnostic of why there's, why it's muddled, you know, where sort of we understand what the standards look like because there are so many professional organizations that you can be a part of in nursing. And I've, you know, I find that very overwhelming sometimes when we think about about, you know, what is the one or two that we can look to? They are out there. And I think at the end of the day, my perspective, I think, on this is changing as well. While I would like there to be sort of one or two because I think there would be a unified voice that could come along with that, I think I'm coming around to the fact that maybe it is also a beautiful thing that there's such a diversity in the number of different professional organizations that we have to be, you know, these bigger voices at like the, you know, the regional, the state, the federal level, you know, when we're talking about setting these standards and helping people understand what they are.

Yeah. And so the different organizations, which I belong to many, because just like you, I love to learn and I love to see what each organization has to offer. Um, many of them are formed because they focus on a very special area of nursing. It's a specialty focus, right? So specialty focuses are important and they should set the standards for those specialties because it's impossible for one organization to touch on every specialty. So yes, that's why nursing has so many professional organizations, because we have so many different areas of human life that we have to cover, right? From while the baby is developing inside of mom all the way through death. So the entire human spectrum, nurses need to know. We have to have a foundational understanding of what to do during those different phases. And basic training for nursing covers all of that on the surface level. And as we specialize, we go much deeper and become much more specialized in those areas.

I think this is where—

That's why we have so many of those.

Oh no, and I know, and I'd appreciate that. I think my, my perspective with that sort of is driven by my population, my specialty of choice. It's a population specialty. It's geriatrics. And as a geriatric specialist, when people ask, well, what do you really do? You know, when we think about the aging process, like it's not just one thing that's getting older as part of your body, this, this whole, all of the parts of your body. The whole system and, you know, the energy surrounding it, the environment, you know, the way that you're interacting with it, all of that is all aging at the same time.

Correct.

So that, I think, holistic perspective and appreciation for the way that we— for the way that we age and what that means and how it's felt and all of those things, I think, has kind of colored my perspective to some extent with that, because I'm— I sort of specialize in everything because, you know, you know, you know cardiology, you know pulmonology, you have to know all of it with geriatrics because, right, you know, heart and lungs and everything else gets older along with everything, gets weaker, everything becomes more susceptible to illness and damage as it—

as someone gets sick. And yeah, so understanding how the body works as it ages, what risks someone is, and then what treatments work best for that age group, right? Because a treatment for a 90-year-old will look very different than a 20-year-old.

Oh, absolutely. And then that— and the perspective has to be different, too. You know that older adults are not just old adults. They are their own. They're their own group, you know. And even within that, when you've met one older person, you've met one older person.

You can't— that one older person.

Exactly. You've never—

very different.

Yes. You can't generalize from one to the next.

Yeah. Just like you and I, we're very different people. We could be around the same age. We could be from the same demographics, maybe socioeconomic status, whatever. We're still very unique. We have our own differences in chemistry and belief systems and culture. Like, it's very different, right? So, and that is something that I think most nursing staff recognize. Most nursing staff, especially those people who have been around the block, maybe more than just one job, they, they understand that pretty quickly. We learn that each person is their own unique individual, and we have to learn those preferences. We have to learn how they respond to treatment. We have to learn what what works for them and what does not work for them. And we have to do our due diligence and communicate and document that. So the rest of the team is also privy to that information.

Sure.

So we work well and in harmony to take care of the patients. I think for the most part, we do a pretty good job at that.

Agreed.

But going back to what you were saying, why can't we implement those same standards for each other?

Yeah, I was, I was, I was just thinking that with the You know, if we take those same standards and that same appreciation and now apply it to what you're doing in a leadership role, you know, now apply it to the people that are, you know, sort of looking to you for guidance or, you know, kind of looking to you in that leadership role, right? You know, and that's, that's where I think it's kind of radical, but really not that radical to say that, like, I don't think as a leader, like, I think I think in my head, there's this feeling of like there's this one special thing that I've got to do. There's, you know, but at the end of the day, I think the secret sauce is that there is no secret sauce to it. It really is just basic human compassion and basic human empathy and taking all of those ways that we would consider good care at the bedside, taking that good care and expanding it to the people that we work with. You know, I think that's—

Absolutely.

There's no real magic there. To something that you've said before that's really struck with me and something I believe fully as well is, you know, it's not showing up with a pizza one day. It's not sugaring everybody up with a box of donuts. It's dignity. It's recognizing people's time. It's recognizing that we can't physically, emotionally, spiritually, you know, disconnect from all of the stuff at home. We can't leave that at the door. That is, we travel with all of these stressors, all of these the things that we carry. And it's— there's a rhythm to that that we need to appreciate and just recognize, you know, rather than saying, you know, you know, the suck-it-up buttercup, you know, sort of philosophy of like, you know, no, just like, you know, you just have to do better because these people need you, that kind of thing. No, like, that's never made sense for humanity, for sort of working with humans in general. And it doesn't make sense in the nursing profession either.

Exactly. And so, you know, I think a lot of that has to do with with just the kind of beast that our healthcare system has become, the money-generating organization that it is, right? It is a money machine.

Yeah.

So much wealth has been built off of our healthcare system. And so those folks who own, they want to keep it that way. I'm not against that. I'm all for it. Let's all become millionaires. Yay, right? Let's do it. However, you can't do it on the expense of other people. You can't do it at the expense of safety, at the expense of at the expense of, you know, basic human rights. And if we are very quick as a profession to excuse someone who's grieving in the bed when they cuss us out, when they throw things at us, when they, you know, are just really being difficult and threatening us, if we're so quick to just say, oh, they're grieving, they don't mean anything by it, let's use therapeutic communication, in, let's go in as a team and see what we can do to resolve their anger, frustration, and come up with a plan so that they're happy and we're all happy. If we spend so much of that energy doing that for patients every single day, why can't we do that for our coworkers?

Yeah. How would the world be different if we could do that for our coworkers?

It would be amazingly different. So much easier. Yeah.

It would, yeah.

Nurses would not hate their job if it were that way.

Yeah, there'd be a lot more satisfaction.

I think there would be a lot more satisfaction. So for those leaders out there listening, right, this is a call to action. You have to do better with the way you respond to your team's behaviors, right? Just like we say for a patient that a behavior is an unmet need. Why is it not the same for our coworkers? Oh my gosh, for highly educated, highly trained individuals. Well, guess what? Not all of us are. Many of us have an 8th grade level reading. Many of us have a 2-year college degree. Many of us have only been in a formal academic institution for 12 months of our life, and we're licensed because that's what the different states allow. And that's OK. We have to work with that. So you can't hold everyone to the same overarching standard that you have to be this astute, unbreakable, perfect image of professionalism, especially when the leadership sometimes are far from representative of that level of professionalism.

Yeah. I wanted to sort of double-click on something you said there with the unmet need. I was just recently involved in the orientation of one of our new nurse practitioners. And I found myself sort of talking with her about that because we, we get a lot of folks in our program with an incredible amount of complexity. You know, they've got the problem list that's a mile long, you know, very challenging psychosocial situations, lots of different things. And, you know, we were having this conversation around, you know, this person's been in and out of the hospital and they've got so much going on. And, you know, but they've got— but she said, but they've got all their needs met. You know, they've got the, you know, they've, they've got their healthcare taken care of because they've They've got our program. You know, they've got, you know, a loving daughter. They've got a family member. They've got this. And she's like, you know, I just— why are they back and forth? And I said, you know, the thing I always come back to is what is the unmet need for that person? You know, what— who has asked her or that, you know, has asked the actual person, you know, what they think they're sort of missing with this? Because, yeah, objectively, maybe they've got, you know, all of the bases covered there. But if there is that unmet need and if you're not talking about that, then everything else that you're doing is just— you're just sort of shuffling pieces around the board and you're not really getting to the heart of the matter. And I think that's really where nurses excel is being able to get to the heart of things. That's really the purview of what we look at, the phenomenon, you know, the phenomena that we really get into is what it is to feel sad, what it is to feel content, all of those things. I mean, that's really what, that's really the purview of nursing when we talk about it from the disciplinary perspective anyway.

Exactly. And when it comes down to education, because now you're in this new role, right? What I find frustrating, right, for me, is that when someone makes a mistake, right, when a nurse makes a med error or a CNA acts unprofessionally in a heated situation, or a, um, nurse might give misinformation to a family member because they're not so poised to use that perfect script of, "Let me get back to you, Rose," right? Like, they don't know that, or they're overwhelmed and they don't think to say something like that, and they say something that offends the patient. It gets down to administration. What I find very frustrating is that there's an assumption that the staff have not been trained. There's an assumption that they don't know what they're doing. With no objective investigation at all. Yeah, that also has to change.

Assumption is the key word there.

It's, it's really overwhelming for educational teams, leadership, the nurses and CNAs themselves to be accused of either violating a policy or protocol, protocol without objective evidence of such or making general blanket statements like, oh, they must have not been trained, or maybe they don't know what they're doing, which maybe people don't realize this, but it could be interpreted as a direct representation of the people who did their orientation and training.

Sure. Yeah.

And so like, I'm not one personally to get offended when people make these general statements, but when it becomes the norm, when it becomes the expectation that every time someone makes a mistake, The educator has to fix it.

Yeah. It's hard not to take that personally, but yeah.

Right? At this point, it's like, when are you as the leader going to do your own assessment? When are you going to take a step forward and go observe the person to see if you can identify what the problem is? Sure. Because if one person is saying they've already been validated for their knowledge and their ability to return demonstrate that they know how to do it. It. Why do they have to go through an end service again?

Well, and to sort of to put an even less fine a point to it, like sometimes a mistake is just a mistake.

Sometimes it's just a mistake.

You know, like, I mean, we're again, like hearkening back to what we were talking about before that we're working in these incredibly stressful circumstances.

Right.

And I'm going to appropriate a quote. I can't think of who said it just now actually, but it's, you know, people don't rise to the level of their goals, they fall to the level of their systems.

Yes.

And I— so that's something I've been thinking about a lot more, to say the least. When we think about, you know, if a mistake happens and it's a one-off, then, then, then it's a mistake.

It's a mistake.

You empathize with the person. It is what it is. When you see these patterns, when you see these themes, you know, starting to sort of emerge more and more, that's where kind of looking at the perspective of sort of the system and being like, okay, like You know, how are we creating a situation where this is happening more and more as far as this is concerned?

Correct. And so again, going back to the blame game, right? Going back to saying, oh, maybe they weren't trained, or maybe the educator didn't do their job, right? Have you ever considered if the, if the orientation and the training has not changed, but yet there's an increase in mistakes happening on the floors, have you considered that it might be a factor outside of education and training? Have you considered it might be a staffing issue? There's not enough support staff. Have you considered that we have the same nurses working doubles 5 days a week, so they're exhausted and they're much more likely to make mistakes, right? Have you considered that maybe there's an irregularity to the staffing patterns, or you're floating people between units too frequently so they're not developing, uh, understanding of flow and patient needs and working with different members of the team? All of these are factors to consider. But I'm in New York City and in New York City, things are very busy and very transient. People come, people go. It's kind of a reality of the, the place we're in.

Sure.

But there are many strategies to manage this if you collectively work as a team.

Yes.

And going back to what you're saying, if you create unity among the staff, if the leaders are seen more frequently on the floor, helping to problem solve and coach and mentor and have little mini huddles to say, hey, Hey guys, thank you so much for all of the extra work you've been doing. This is an initiative that we're doing for the whole building, so stay tuned. I just wanted to inform you. Do you need anything? Actively take notes and follow up on those things.

Yes.

The staff would feel much more appreciated. They would feel much more inclined to work a little bit harder, and they would trust their leadership that they have their best interest in mind.

Right, rallying around shared purpose and values. Yes, totally.

Exactly. So when there seems to be this divide, this lack of unity, it's because those things are not happening, right? The CNAs are not being given a good report by the nurses. The nurses are not having long conversations about the importance of why they should be monitoring this person or that person a little bit more closely. Maybe if the vital signs fall in this range or this range, can you come let me know right away? This particular person just went through this surgery, and so they're going to be very sensitive to pain. So if they say their pain is approaching a 4 or higher, you have to let me know right away. And then if you need help, come get me and then be available, right?

Yeah.

So if that happened on a regular basis, the communication between nurses and CNAs would improve. The teamwork would improve. Same thing with the managers. The managers had those conversations with the staff and then jumped in when things got crazy instead of saying, oh, I have a report to do that's more important because I'm sorry, but documentation can wait.

Well, and there's a comment there about honesty and transparency too, you know, because when we're talking about and sort of, you know, I'm not going to say sort of cheerleading, but when you're trying to rally people around these purpose and values and things and we're using those words, but it's obvious that there's a disconnect there. If the more I sort of, you know, sort of cheerlead it, if there's— if people aren't feeling that, if their experience is something very different and I'm not trying to see that unmet need, or if we're not having that active conversation, then that cognitive dissonance that they're going to experience when I'm saying one thing but they feel something totally different, if we're not being honest and sort of transparent with that discrepancy, then we're not moving anywhere as well, actually. So I think, again, these, this, this, the importance of sort of these forums and being able to have not just these one-on-one conversations, but these, you know, these opportunities where we can have these huddles, even if it's just a moment or two to say, wow, like, today's really been a, today's really been a storm, you know, like, what can we, you know, let's just acknowledge that for a second. Can we take a deep breath? Is there anything anybody wants to talk about right away before we sort of get back into the mix there? I think there's a lot of ways that it doesn't have to be— you know, a 45-minute hand-holding session. It can just be a huddle sort of throughout the day, basically interspersed. People can count on that as an open forum where they can be validated. You know, there's just a lot of opportunities there to be creative, I think, rather than sort of the things that we think of, that self-compassion isn't just, you know, taking a week off and, you know, sitting on the couch eating bonbons. Sometimes it can be that.

And that's sometimes it has.

But I think that's fantastic. You know, Yeah, threaten me with a good time. But I mean, you know, but at the same time though, that's also recognizing that that's not the reality of like a shift, you know, that's not the reality of, you know, sort of the average working day that a nurse is going to experience. But there's a lot of creative ways that you can validate people's experience though.

Exactly. And so, you know, one of the things that I found is so beneficial and a quick way to build a sense of respect and unity and collaboration is when you make time as a leader to be on the units. You don't have to go with a purpose. Be intentional though, right? So for me, as like an assistant director of nursing, director of education, like dual role, right? I would go with the main purpose of being present. That's my goal, right? My main goal is to be present and available for staff so they see me, they can They can ask questions, they can clarify, and I can give a helping hand, right? So I carved time out in my busy, busy schedule to round on the units. And so when I would round, I would be doing my own assessments, kind of doing my own, you know, audits, not making a big fuss, not bringing issues to people's attention in the middle of them being busy, because that's not the appropriate time to do that. Nope.

Time and place.

Not yelling at people because their badge isn't on or whatever. But making notes, taking notes, kind of observing. And then when I do see a call bell, or I do see a nurse struggling, or I have a CNA that needs help, I help. No questions asked. None of this, I'm busy stuff. Just help. I've already carved that time out. So why not do the most I can? If there's a patient's family member standing in the hallway with a picture, looking for someone to say, hey, Hey, can I get you? I just do it. Hey, do you need some ice water? Let me help you with that. If you see trash on the floor, pick it up. You see a CNA struggling to move a wheelchair, and it's— you go in and you help them. No questions asked.

Yeah, these are not monumental things. And yet they make a world of difference.

Oh my God, do they? And it only takes a little bit more of your time. And I do that a couple of times a month. And you know what? They love me. They talk to me. They feed me information. They trust me. They confide in me when staff aren't quite meeting the standards of what they would need to have a successful team. They tell me when people are going through personal struggles so that way the leadership team has a little heads up. So we're not just assuming they're slacking or not doing their fair share, right?

And you're less blindsided too when these things happen. You've actually got some forewarning.

They give me so much information that is so helpful to the entire organization.

Yeah.

All because I've been present and approachable.

And that difference between being proactive and being reactive just reverberates throughout an entire system. It's just amazing.

Yeah. But the key is, is that everyone has to be on the same page. Yeah, it can't just be one leader of the team. It has to be everyone. So for those, you know, leaders out there, again, whether you're the head guy or gal or you're low man on the totem pole, if you have a team, you have to have these meetings, you have to have these conversations, you guys have to strategize and say, look, let's take turns. Right? Let's take turns rounding. Yes, you have to do environmental rounds, you have to do leadership rounds, whatever, but those are very focused. Like, you can't be spontaneous like what I'm recommending. Yeah, you have to carve out time to be spontaneous. You have to carve out time to just show up and be present and just help them as much as you can. And it shouldn't be just the educator's job or just the unit manager's job or just the assistant director of nursing. It needs to be Everybody agreed, see, you know, all the way down, right?

Absolutely.

Um, because then you have a solid team, everyone knows you have each other's backs, and what Damion knows, the next person will know. So there's no secrets, there's no division, you create that unity, and then you work as a team to handle the discrepancies, the behaviors, the mistakes, the unprofessionalism, or whatever else comes with the territory. Because no matter how great of a system you have, these things are going to occur. Because we're all human.

That's— yep, that's the environment we work in. Yes.

Amazing. So we talked about a lot regarding kind of bringing nursing together.

So if—

so other than the strategies that we've shared so far, do you have anything else you would like to add that people can implement into their daily work right now? It could be at the bedside or it could be from a standpoint of a leader.

Yeah, I think just keep going. You know, keep talking, keep being present and just validating your experience and other people's experience. And just that change in mindset will, again, just reverberate through the entire system and you will probably feel more satisfied too. So maybe there's, maybe there's something in that, hopefully.

No, there's definitely something there. And so, you know, one of the things that I tell everyone, cause you know, We're all guilty of it from time to time, but I try to reel myself in when I feel like I'm slipping because I do try to be a role model, right? When you're starting to have that negative talk, right, about the job, it happens. We're all going to do it. But you have to know when to reel it in and then turn what you're frustrated about into something positive, right?

And productive. And productive.

Productive. Exactly. Exactly. So I do believe that toxic positivity is detrimental. I do believe always being happy and always being optimistic is fake. It's not real. And it's, it can create a lot of, um, disenchantment, right? Because once the person feels like you're being phony, you lost them, right? So sometimes we do have to speak up and say, this is a problem for me. I'm very frustrated. I'm very overwhelmed. This is not a safe situation and we need to fix exit, right? Sometimes those conversations need to be had, but what I challenge everyone to do is instead of spending all the time talking about what's wrong, try to focus on what's right and what we can do about it right now. Mm-hmm. Right? Because there's always something you do right now. So if you have a coworker that seems to be going off on a tangent about how unfair everything is, their assignment is heavy, you know, they're not taking their break, this is ridiculous, they're gonna quit. You could easily chime in on that conversation and just escalate it, and both of you are ready to quit. But instead, I always find that it's very helpful to look at the person and say, what do you need right now to be able to kind of gather your thoughts? And let's just focus on getting through the day. Do you need me to do a med pass for you? Do you need a few minutes to sit down, go get something to eat and drink? Your sugar might be getting a little low, right? Do you need to eat something? What can I do to help you? You would be surprised how many people say, Damion, thank you so much for asking, but I actually don't need anything. I just needed someone to hear me. And I say, I hear you loud and clear, my dear. I hear you loud and clear because I, I know what you're going through, right? I'm not far removed from what you're dealing with. Even in my role, I'm not on the med cart right now, but I am dealing with of the same situations, the same frustrations, and your frustrations are mine as well because everything trickles back down to me. So staffing, you know, compliance issues, mistakes, you know, complaints, grievances, someone quits, someone's hired, whatever it is, it all trickles down to me anyway. So I hear you, I feel you, but please, if you need help, call me. If you need someone to just spot you for 15 minutes while you go grab something, I'll do that. It's not a problem. It's amazing how easy it is to just say, hey, how can I help you? Let's focus on what we can do right now in the moment. And then later when the time is more appropriate, we can get into a much deeper conversation and strategize about what could we do differently.

When you're honoring that dignity, correct. It opens up the door.

Yeah, exactly. And so the other challenge that I would like to just put out there for leaders is you have to make the time to actually circle back. Back to these problems. Yes, right. You can't—

there has to be follow-through.

Yeah, you can't just keep pacifying people and then expect for them to be satisfied with that. Lip service only goes so far. And saying, oh, we need to do this and we need to do that and we need to do this and we need to do that, but it never gets done. Yeah, right.

We're working on that. Tomorrow's a new day. No, that's— people need to— people need to know right now what's happening. Yes.

And then hold each other accountable for actually starting, even Even if it's slow and incremental, you have to be moving forward that goal. You have to be moving towards working on that problem. If you don't ever put in the new protocol or the new resource that can help to alleviate some of the workflow issues, then you're not really doing anything to improve the process. It's just, again, you're just talking and waiting.

Running in circles.

So, yeah, amazing. All right, Christopher, so if people wanted to connect with you, learn from you, collaborate with you, product services, whatever you might have available to share. How can people get in touch with you?

Uh, you can find me on LinkedIn, uh, just Christopher Norman, C-H-R-I-S-T-O-P-H-E-R, uh, Norman, N-O-R-M-A-N. I'm there on LinkedIn. I love to connect with folks, to hear about other people's experience. I am constantly learning and, uh, and would love to just connect with anybody that wants to reach out.

Amazing. Awesome, Christopher. So I'll make sure that everyone has your link LinkedIn profile in the show notes of this episode. And I want to say thank you for taking the time to be on the Nursing Strategies for Success podcast, sharing your experience, sharing your perspective. Welcome to the newfound level of administration slash education. It's a very interesting place to be. Um, you're going to be happy with a lot of it, and you're not going to be happy with a lot of it, but that's why we're here, right? That's why we're in these spaces, so that way we can leverage our prior experience, learn new things along the way, merge those two together and create the new standards of care.

Yeah.

Whether it is training, whether it is patient care services, whether it's organizational structures, we have the skillset and the know-how to keep nursing at the standards of care. And just one last thing about that, when you really wanna lean in on in getting everyone on the same page. Don't deviate from the actual standards of care. I'm not talking about regulatory, what the state wants. I'm talking about what our licenses want, what our state practice acts wants, what the NCLEX expects us to do in different situations, the nursing process, right? The theories of nursing practice. We have to stay true to those foundational, um, theories, right? Those foundational standards. Because an HHA follows the same level of infection control standards as a registered nurse. So when we deviate from those standards, that's when we start to get muddled. That's when we start to have divide. Just go back to the books. It's really that simple. Go back to the books. This is the evidence. This is what we need to follow. Yes, there's always going to be changes and recommendations and new science specific breakthroughs that are going to challenge maybe some of the evidence that's been in the past. But that's why we need to stay up to date with this stuff and then pull it out and just update everyone on the standard, but then hold people accountable to that standard. Don't just say, oh, today's busy, I'm not going to care if people aren't washing their hands. Absolutely not. They should always wash their hands no matter what, right?

Agreed. Very well said.

Yes. Awesome. Very good. So thanks again for being on the show. I can't wait to connect. I need to come upstate anyway. We need to come up there and visit.

So that'd be amazing.

We'll hang out soon.

That'd be great. Thank you so much for having me, Damion Jenkins. This has been a pleasure.

My pleasure. Take care.

You too.

And that concludes episode 6 of season 4 of the Nursing Strategies for Success podcast with this episode's guest, Christopher Norman. We hope that everything that we shared in this episode will help you to become the nurse leader that your teams need you to be. All the ways to get in touch with Christopher will be in the show notes of this episode. And as always, if you have any questions about anything shared, please visit thenursespeak.com and get in touch with me. I would love to have a conversation with you. So until next episode, take care, be well, and remember that nurses can do Anything.