The Heart of Nursing Leadership (ft. Dr. Kathleen Winston)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now your host, Ed Marx.

Hey, Ed Marx here. Another edition of Digital Voices, one of my favorite topics, all about nursing and nursing leadership. And there's no one better to talk about nursing leadership with me than Dr. Kathy Winston. Kathy, welcome to Digital Voices.

Thank you. I'm very excited to be here today. Thank you for the invitation.

Yeah, this is gonna be a lot of fun. Really important topic. Nursing is where the healthcare rubber meets the road, and we've sort of known each other mostly online via LinkedIn. But Kathy, I know you've listened to Digital Voices before. The very first question we ask is, what songs are on your playlist?

Uh, yes, I did. I, uh, just listened to one this morning actually. And I thought about, I wonder what I would say if someone asked me that question. I looked at my playlist and I thought, oh my gosh, it'll take forever to tell him. I'm obviously very diverse in my song choices and what I— the genre of songs that I love. I guess it's more about when I'm feeling in a nostalgic mood, I'm all about the oldies, which I guess oldies change according to what generation we're in at any given time.

Right.

My oldies are getting older, I think.

Right.

And, um, and I have a daughter who was in musical theater, so I, a Broadway tune can always pick me up. And, uh, I have to say, my parents must have really influenced me because when I, when I really want old school kinds of crooners, I found that I had some, I had classic crooners like Nat King Cole in my, in my playlist.

Yeah.

And then of course, you know, I never go wrong with a good, um, with a good country song from the '90s.

Yeah. No, that sounds, that sounds pretty good. Yeah. It is funny that the songs that you subconsciously listen to when your parents had the radio on in the car or something back when in your youth sticks with you and you still kind of like some of that music today. I found the same sort of thing happening in my life. Hey, what about life message or mantra? Are there words that sort of guide you or that you live by?

Oh goodness. I think, I think there are a number. But the one thing that I find myself saying often, both personally and professionally, to individuals in a conversation, is I'm a real believer that not every day is a good day, but that there's something good in every day. And that I look to find at the end of the day, what is it sort of in that grateful mode, right? In that gratitude perspective, what is it that was good today despite all the things that were challenging?

Yeah, no, that's a good way of looking at it. Right. Because not every day is that perfect optimal day, but yeah, you can definitely find something good in everything. That's cool. Kathy, tell us a little bit about yourself. Like, what is your story? Where did you grow up?

Oh my goodness. Um, my, my growing up years were as diverse as my playlist. I was the daughter of a United States Naval Academy graduate. And therefore a career military. In those days, uh, you, I get dated here a little bit. In those days, there was only, uh, Annapolis, the Naval Academy, and West Point, the military Army Military Academy. But my father was a, a pilot. He loved to fly and also an aeronautical engineer. So when you graduated from either Annapolis or West Point, you were allowed to commission to any branch of service. And he commissioned to the Air Force.

Mm-hmm.

Because he wanted a large family and did not want to be out on ship a lot and have a lot of distance. So anyway, I grew up as the daughter of a, of a career Air Force man. And we lived in probably, I couldn't name the number of states, but lived all across the country, moved pretty much yearly. So summertime, when other people think about vacation, what's their summer vacation? Ours was usually moving to the next duty station and the travel that was involved in that. My parents were. A real product of what many years ago we thought of as our, as sort of our American dream. They were, my father was 100% part of an Irish immigrant family through Ellis Island out of New York. My mother, hence my maiden name is O'Grady.

Yeah.

My mother was the product of an immigrant family straight off the boat to Ellis Island from Italy. Uh, those two, those two groups were, uh, not the most compatible at the time. So an Irish-Italian marriage was an unusual one in, in its day, or certainly a controversial one. I have 6 siblings, um, 7, 7 of us in total. And, um, my father was also missing in action in the Vietnam War. So my story, while it has a very early component of really being somewhat stereotypical of the '50s and the '60s. It also became a part of the many social concerns that occurred and were associated with the Vietnam War. And so I went from sort of an idyllic childhood to a much more traumatic and stressful one, which I think probably has served me well in my adult life.

Yeah. Wow. That's quite some story. Yeah. And sorry to hear about your dad, but I'm thankful for his service, you know, and leadership. And obviously he produced a great family with yourself as the key part of that. So thanks for sharing your story. Was there a pivotal moment in life that fundamentally changed your trajectory? Was that it, or was there anything else that happened in your life?

I think that was it. I think I was 12 years old. So there were 7 children. The oldest was just 13. I was 12. The youngest was 2. I often joke that had my father, who was in his very early 30s, had returned home, I'd probably have another 6 siblings. So, you know, maybe God's hand was in that after all, for those of us that were on the oldest part of that.

Yeah.

But I think that That particular experience at a young age caused me to become an adult a little sooner than I might have been. I became sort of a surrogate parent and certainly a caretaker, a shared caretaker of my siblings. And that certainly was a turning point in pretty much how all of my life proceeded. I think even geographically in terms of where I lived, we had moved every year. And my father had never been stationed any further west than Texas up to the point that he was getting ready to go to Vietnam. And the Air Force base that prepared the pilots for going overseas was in Las Vegas, Nevada. So once he was shot down and listed as MIA, there was a lot of, a lot of unknown years in our life. And so we remained in Las Vegas. I always thought, I'm sure my family always thought we would return to the East Coast. And probably spend, um, uh, my, my growing, the rest of my growing years and adult life on that side. But because of that move to the West Coast, the, the loss of him in the war, my entire life, including my education, all changed.

Yeah. Yeah. Wow. Again, what a story. And thank you for his service. My dad was also in Vietnam and I was the youngest of 7. Thankfully he returned, but I definitely have a deep appreciation for the sacrifices made. And so thank you to Your mom and your dad, you know, for all that they've done. So you obviously went into nursing. How did you choose nursing?

Well, you'd think after I tell you that story that I'd have this, I'd have that or some other really sort of exciting story to tell you.

Yeah.

But my entrance into nursing is sort of boring, but it's interesting when we talk later about things that happen in, that are happening in nursing. But I had a really good girlfriend when we were planning to go off to college. I was thinking in that era, the early '70s, I was thinking about broadcast journalism, looked very appealing to me. I thought I'd be Oprah before Oprah was Oprah. And she looked at me and she said, oh, Kathy, we're probably going to meet our husbands in college and we should have a good job that we could fall back on When we, in case something ever happens to them. Well, that probably unconsciously spoke to my own childhood experience. And so I, I took her advice and guidance and together we marched into the University of Nevada, Las Vegas Department of Nursing. And I thank God every day that I fell in love with it. And I really found my dream job without ever having dreamed it.

That's awesome. That's a great story. And Eventually you get into leadership. How did you go from, I assume, bedside nurse and then into leadership?

Yeah, well, I was really fortunate in that I was in what we called in those days a 2+2 program, which meant that it was before we had a lot of registered nurse programs that were at the associate degree level. So in a 4-year university, you were in your baccalaureate program, but you were Granted your associate degree on that pathway, and you were eligible to sit for licensure. So I was a registered nurse at the age of 19.

Wow.

Now, I'm not sure who was foolish enough to gimme a license at that time.

Okay.

But they did. And, um, I'm grateful every day that no one died as a result.

Yeah.

But, um, so I was a bedside nurse for, at the age of 19. So being young, I really did have the very informal mentoring of a whole host of clinical nurses out there, many who were so much older than I, maybe 30. And there I was at 19 thinking the great wisdom was going to come out of these 28 and 30-year-olds that were my leaders. I had in that period of time between 19 and about 27, I had wonderful and And again, really diverse experiences in the hospital during a period of time when even critical care and really very ill patients were found on the floor. And so in my later 20s, I started to think about what other kinds of opportunities might there be in nursing that I would really enjoy doing aside from the bedside. And so I thought, well, I'm gonna go back and get my master's degree. In my master's program, I'm going to explore that. I was a critical care nurse at the time, and I did often find that for me, as much as it was important to be highly competent and capable in that critical care unit and have the skillset and the energy that came with being a young nurse, I also was drawn always to that patient waiting room, that family waiting room. And I spent a lot of time, as much time as schedule and the patient care needs would allow, with those family members and trying to support them through what was a really vulnerable and stressful time in their lives. And that led me to thinking about nursing during my graduate time outside of the hospital. What other kinds of things might I do? And, um, so I've done everything from bedside care on a medical surgical floor, which gives you a great foundation for your work, to critical care.

Mm-hmm.

To really seeing excellent leadership in those environments. And then in my graduate program, finding my way into community and public health nursing, as well as school health. And thinking about maybe academia was where I wanted to go. That how, if relationships are the core to what we do, and I strongly believe that they are, that for me, being able to help share with the next generation of students in nursing education, would be a way for me to serve in a different kind of leadership role, not just leading the, with my parent patients and their families or my colleagues in the, in the hospital setting, but helping to, uh, inspire some of that in, in new nurses, regardless of their actual chronological age as they came into the discipline.

Yeah, no, that's awesome. And, and you, you also ended up like as a dean of nursing. Tell us what, what that's all about.

Well, um, Once I was in nursing education, I was a faculty member for a long time and enjoyed that tremendously. And sort of the trajectory of things that happen is time in service. And you take a leadership role serving on certain kinds of committees and you find your, you find your specific interests even within. And I did have an opportunity for a young nurse, actually, when I was a more seasoned academic, had come in one of her first nursing jobs. in education, and she was running our skills lab. Well, that young woman evolved and became a director of an associate degree nursing program. And she really attributed my influence upon her to taking that direction. And then she asked me if I would consider looking at a role of a dean and director myself. And so I took my first position in a community college as the Dean of Nursing and Health Sciences at Pasadena City College in California, and also spent time as a, a dean in a public California State University system and finished my career at the University of Phoenix, where I was the dean for the, the university for the entire country.

Yeah, that's, I mean, that's super impressive career. And I know you're particularly passionate about building nurse leadership pipelines, cuz we all know that we have a shortage of nursing and what are we doing about it? And I know that's a particular area, like I mentioned, of, of passion for you. What are some of the key factors why we're having a shortage? And then I wanna talk about what can we do to reverse that?

I have to say, I suppose I could give you another mantra, and that is everything old is new again. So if you've been around as long as I have, so I started really young and now I may be, I may have been one of the first RNs out there. I may end up being one of the last. But as I think about it, I think about the The nurse, the nursing shortage and, and how I have been hearing about the nursing shortage for several decades, right. And we expected it in during a certain period of time. And then my generation of which, like many disciplines and professions and careers, that baby boomer generation was a large part of our population.

Yeah.

So we expected with retirements and aging of the population that we would see that nursing shortage. And that continues. To be a variable. However, it didn't become the variable as early as we intended or predicted it to be because many of us just didn't go away. I always tell that to those Gen Zers out there that I'm not going anywhere just yet. So I've still got a few things to teach you guys. But we do know that in, I think they're saying 2032, we really are gonna have significantly more jobs than we are nurses to fill those jobs. And the fact of the facts that contribute to that, obviously the aging of the population, the opportunities for women who nursing continues to predominantly be a female profession. And while we've done a nice job of increasing the percentage of men in nursing and continue to advocate for that, it feels a little bit like it's a slower growth pattern than it was when we first moved in that direction.

Yeah.

So it continues to be a predominantly female profession, and women have as many or more options today than they have ever had. And those things really do contribute to what we've been talking about for a long time, which is we're gonna have this nursing shortage. So what are the, what are the things that we need to do about that?

Right?

Yeah. That's really the question because it hasn't changed, right? We've been talking about it. We know it's continuing. And I think some of the strategies and some of the opportunities that we have for improving that are everything old is new again. We should try them again, continue with them, and then think about what some of the new ones are. And for me, I think one of the first things is I'm not sure we've done a really excellent job just yet at defining the profile of what we need in nursing to manage the shortage? Because we do have lots of nurses and we have lots of nursing opportunities in terms of employment. But I think sometimes where we really have the shortage when we talk about the shortage is at that bedside. How do we keep our nurses at the bedside? And it's true, we need advanced practice nurses, nurse practitioners. We're going to need more and more in ambulatory care having advanced nursing. We absolutely need— have a huge shortage in the nursing education arena, which then has a trickle-down effect into what we have by the bedside. So there's a host of things that we can do starting, I think, with really defining where the needs are and what is that leadership profile that's needed to help us get there.

Yeah, that, that's really good. And yeah, I also think that with all the latest technology that's coming in, like AI and things like that, that's going to make Nursing recruitment and nursing workforce. Interesting to watch. You know, do you have any predictions on how things might be impacted with tech, positive or negative?

Well, I hope all good because, because interestingly enough, back in the '90s when we, when we saw the, that la— that dot-com bust that happened. Yeah. When that occurred, we saw in nursing education a huge number a significant number of people that were in Silicon Valley and the technology computer industry, all looking at nursing. Nursing at that point was predicting a shortage, expecting to fill a need. And salary compensation had improved significantly, though people will tell you that that's become more flat now. However, at that time, and so we attracted people with that kind of background.

Yeah.

Into the field. Now, the, the good, bad, and the ugly of, of everything, or I guess maybe a better way to say it is the gift and the curse, is the gift is we had lots of prospects, well-educated individuals who'd already been out in a career with those gifts being able to come and see if they could translate into nursing. The curse of that is that nursing in its uniqueness of what its foundation and core is about does require a really unique and very specific type of individual. And that may or may not be someone who came from that kind of technology industry.

Yeah.

So now fast forward all this. So what we saw was we saw a surgence of that, but we also saw that it didn't help us fully address what nursing needed, not just in terms of shortage, but in terms of our actual clinical practice. But here we are today, and I think, oh my goodness, it makes me glad that I have decided to persist, which sometimes has been my middle name, and stay current and let those young people teach me a few things along the way so that I can use that technology to improve the practice of nursing, the education of nursing, and, and to really advocate in my role as a leader. For how nursing can balance both the gift of care and compassion, but also be courageous enough to say, how do we use AI to make the electronic medical record or health record much more supportive approach to our documentation and give us the opportunity, which I think is huge, to be back with our patients at the bedside? I feel like that's been a gap in our practice for a while.

Yeah, that's a, that's a really good point. And I, and I believe the same thing.

Yeah.

That we can leverage this technology for good and give nurses a better experience and more time at the bedside. And, and the other thing that's cool too, Kathy, as you know, it creates all these other opportunities for nursing. You know, when you bring nursing together with tech, creates a whole new career pipeline. So it's really cool. Now you mentioned something I want to go back on a little bit, 'cause you referenced like nursing requires something special, compassion, empathy. Yeah. Can you learn that or is it something that most just have and they gravitate towards nursing? Or can you kind of, do you learn it as you evolve as a nurse?

I think that's both. I think like a lot of things, it's just inherent in some individuals and it just really becomes a calling. Love that. I love that there are people who still feel that nursing is their calling. And while I don't believe that I personally was called to nursing, I thought I was called to Oprah Winfrey Show.

Right.

But I really look at how well prepared I was for it through my childhood experience. I was a caregiver at a very young age and I understood responsibility. And so I think most importantly is bringing to, bringing to nursing a real, um, a real value and core foundation of integrity. And with that, all of those other things that we need from skill to compassion can be developed and evolve.

Yeah.

You certainly have to have a natural desire for being in relationship. And so we also think about technology right now with AI as sort of, or with younger generations as spending so much time with screens that how do they, how do they navigate relationship? But I think sort of the human component in all of us is there's the great potential for relationship. And I think nursing is really a relationship experience for both that patient and for that nurse. And you become a much more compassionate, caring, and loving individual when you're in the world of nursing, working with vulnerable individuals at their most at that most vulnerable time. And you, you find out there's real value in who you are and what you contribute.

Yeah, that's very well said. Kathy, if you were speaking to graduation classes, and I imagine you may have done this, uh, but if you were speaking to a graduating class of nurses, what would you tell them?

Oh, I tell them lots of things, of course.

Mm-hmm.

But I mostly tell them that our job as their, as their mentors and their leaders, their faculty and their families and friends is to help them gain confidence and to find courage. And that those 2 things will allow their competence and their commitment to thrive in their, in their work ahead.

Yeah, I love that. Kathy, you're a super accomplished person and have done a lot. So there has to be times though that you take a pause and refresh. What are the kinds of things that you do? to just kind of relax and chill so that you can, you know, really engage fully when you're in the work mode?

Well, I really appreciate that question because creating balance, I think, is one of our— certainly for my generation and certainly for myself. You know, when you're, when you're a bit of a Type A personality, you don't model the best example of what it is you really say you believe. And so having intention about finding balance in one's life, I think, is huge. And so I used to be one of those leaders. We'd go around a leadership meeting and all the deans would be asked the question like, um, what's your hobby? What's your first hobby? And I would like start breaking into a sweat because I had no hobby. And so it would be like, my hobby is work. My hobby is work. But when I, the older I get, a little more, a little more wisdom and insight, I realize, oh, I've had many things that refresh me in my life. Um, I'm right now, after living 40-plus years in, in Southern California, where the bulk of my career occurred, I now live, um, of all places, on a lake in Lake of the Ozarks. And if I need to step away from a project that I'm doing or an activity that I'm involved in or a committee that I'm doing some work for, I can take a walk and step outside that lake and just experience the beauty and the peace. And so sometimes it's the good and the beauty that brings me kind of the truth about balance. And so that's what I do. And as I enjoy that beautiful lake, and I enjoy it most of the— mostly after all the summer tourists have left, and we can go out on our tritune and just enjoy a peaceful boat ride. So that's a wonderful thing. I also have a little bijou, and if I can tell you that it's true, That your heart rate and your blood pressure is lowered when you have a little, when you have a little dog that loves you unconditionally.

Yeah, true. No, those, that, that's good stuff. Kathy, this has been a delightful conversation. We talked about some of the songs on your playlist and, and the mantra finding something good in every day. And we talked about your, your life growing up and, and again, thank you for your father's service and may he be found. And, uh, that, that's just amazing. Very, very touching and how he influenced you in your career. And how you got into nursing and then became a leader through nursing, ultimately a dean. And then we talked a lot about the conundrum we face today with nursing shortage and how we might be able to build that pipeline back up. And we talk a little bit about leadership and the important things that you would say to younger people in their career, like have confidence, be courageous. Is there anything we missed or is there anything you wanna double down on? I'll give you the last word.

I think just to remember that the gift of nursing, both to the general public and for the individual that's looking to become a nurse, is that you're given the opportunity to make a difference in a meaningful and impactful way. Maybe not in a profound or really visible way to the larger community and world, but in the most intimate ways. That's a gift that not everyone is blessed to receive.

Dr. Kathleen Winston, thank you for being a guest on Digital Voices.

Thank you so much.

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