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The Nursing Crisis is a Dumpster Fire · Nurse Leadership Dumpster Fire

• speaker-0: Hey dumpster pals. Today we want to talk about one of the biggest dumpster fires going on in all of healthcare and nursing leadership. And that is the nursing workforce crisis. So we have been hearing about this nursing crisis for years and years. Or the staffing crisis. But what is actually going on? Yeah, what is happening? It's definitely complicated. It is complicated. If you guys know about this guy named Dr. Mike, he is a doctor that has a YouTube channel. And he's like super famous. And he just did an episode with Nurse John, who's also a super famous nurse who does Instagram reels about making fun of nursing and and just being what a nurse actually is in a comedic way. In a in a yeah, in a very funny way. But they did an interview and they were talking about why are nurses leaving the bedside. And so we wanted to go into some of those clips and talk about what's going on. And what can we actually do about it in leadership as a frontline manager? First, let's review some of the facts about what the current state actually is. So back in 2021, when we actually were in a healthcare crisis, it was the middle of COVID, the Delta variant was going rampant and people were dying like crazy. We actually did have a giant spike in turnover. And the turnover had gone all the way up to 27.1 nationally, which is really high. Cause for years and years before that, it was Sort of in the upper teens, lower twenties on average. And part of the reason that that stat looks lower than maybe it sounds is because you're looking at it from a giant national perspective. You're including all of those people. So when you have a large denominator, those numbers, those small percentage changes make a big difference. Then when you get to twenty-two to twenty twenty-four, the turnover rates start to gradually decrease again. They went from about twenty-two point four percent. Down to 16.4%. But last year, which these numbers come from the 2026 NSI National Turnover Rate Report. ⁓ so the most recent numbers we have are from 2025. And in 2025, though, we had another uptick in turnover rate. We went from that 16.4 up to 17.6. So why did we have a bump this year? What's going on now that's different? From before. I don't know, but that's a lot because when you're talking about those small percentages, you're talking about a deficit of a hundred and fifty-eight thousand or more unstaffed full-time positions. That's so many, it makes my stomach hurt. So why is this happening? We want you guys to drop a comment on why you think this is happening. Yeah, what's changing in the last year to two years? That's different because we were on a trajectory of improvement. Let's quickly talk about what the cost of actual nursing turnover is. Ooh, good one. That's a good one that it impacts all of us. And it's information that can help you take this data to your team to get things that you need. Yep. And fun fact, we have a video that we did very recently about how to use health metrics, team health metrics, to communicate to your executive leadership team what you need. So go check that out if you want to know more about that. And you will find this NSI nursing report in our comments so that you can go check out the actual data yourself. But how much does it actually cost to lose one nurse on average for a hospital? It's it's pretty costly. It's at least $60,900 for one nurse because that is turnover. That's you have productive time. Yep, because they have to reorient. So that counts against you. And it's just expensive. Yeah. The average hospital actually loses about five point one nine million dollars in turnover of nursing staff. If healthcare corporations could improve their turnover rate by one percent only, it would save them on average two hundred and ninety-five thousand dollars. ⁓ my gosh, one percent. Yeah. So what what what can we do about this? Well, one of the big contenders of the problem is honestly pay. Yeah. The cost of living has skyrocketed and the inflation rate has been so high and wages are not keeping up. Yeah. What what is your experience with that? Yeah, well actually I wanna share a clip about that. ⁓ that was from our video we were just talking about from Dr. Mike Liz. speaker-1: If a meat costs thirty dollars now when it used to be like ten, my pay should be increased, I don't know, two, three, four dollars or a bit more because I need to be able to feed my family. Right. I can't be just going to work and helping these people get back on their health while I'm killing myself and then go back and still feed my own family with a money that's not enough for me to do that. And plus like Cities like New York City, there's so many nurses in here and this city is so expensive that this nurses needs to be able to afford the rent or the house or whatever they need to survive and be able to go to work. speaker-0: They're talking about the cost of living going up and that nursing salaries aren't keeping up and that you know, but that's not just a nursing issue, that's an everyone issue. Yes. However, if nursing keeps a cap on their rates, this this becomes a political issue. And I'm gonna explain why. Because for example, say a local hospital is corporate level private pay, whatever, or not for profit, but they are for profit clearly. It can happen across the country. Say one area has a stranglehold on a certain section of the country and they keep their wages pretty low. Well, federal government isn't allowed to significantly pay their employees higher. So now all the federal workers in the company have to keep their pay at that same level because they're not allowed to make a certain amount more, regardless of the situation. So if you have a a corporation holding that down, it impacts everybody. Yeah. So yeah, if you have a monopolized healthcare organization who's lowballing the cost of paying nurses, that is affecting everyone around them and the whole economy it itself. ⁓ and so this is why it's so important for us in leadership to learn how to use the these numbers and talk about the costs that aren't being talked about. It's not just the cost of the nurse, it's not just the cost of the benefits, it's true, but the cost of not having nurses and the loss, that's where we really need to use that. And those executive leaders, like they speak in numbers and dollars. And so we have to learn how to speak their language so that we can make sure that this hurts where they feel it, which is in the pocketbook. And then the other thing we also have to do is if you want to go back to the U O N L conference I went to, we had a discussion about that. And what they they talked a lot about being involved politically. If you have the time and ability to be involved. I definitely recommend it, especially as nurse leaders that can speak to their numbers and their specific things. I think that's really important. I will say one good benefit of working for the federal government is the turnover rates are significantly lower. Yeah. As low as ten percent for their turnover rate. So there's that to consider. Yeah, and there's lots of reasons for that. ⁓ I know for ⁓ for me personally, I work for several VAs or I've at least been detailed out to different VAs and I've never seen a VA shortcut their nursing patient ratios, and that's a big deal. Another thing that's part of the issue, I think, with nursing pay is that we don't have nursing as a line item itemization on a healthcare bill. Correct. So everyone else in the hospital gets a line item, right? You get lab, you get your doctor bill, you get your P T, yes, O T. And this is all in part of the Transparency Act where we're trying to be transparent about what it costs to the person. But nursing is just bundled up as part of the room and board. Yeah. So if you're a a patient and you're looking at your bill from staying in the hospital, you're not going to see nursing on there anywhere. And so that sort of degrades the value of what your nurse is. So it's kind of crazy to think that the nurse is at every step of your stay in the hospital. But you don't see it on your bill. Right. If the you don't have a nurse, you don't have anybody to communicate the needs or changes the patient is experiencing. You have a doctor, you have physical therapy, you have lab, they all pop in and out, right? They're the only person with that patient for the whole day is the nurse. Yeah. Even like if you go get your car fixed in an auto shop, you're gonna see the cost of your materials and the cost of labor of the mechanic. Right. So like why does every other industry itemize out the specialty except for nursing. And that's a problem. And that is back to what Teresa is saying about political involvement. That's a political move that needs to happen because this is nationally. This isn't just like one or two hospitals. This is the way that we do healthcare in America. It is correct. That's what we do. And so if you work for an organization that has a more open leadership executive team that can be open to conversations and values what nurses say, if you can use that influence to help Increase wages of nursing in your area. Every hospital that does that is going to have a cascading effect on the rest of us. So there are multiple ways to attack this, which from the frontline leader, you can feel it's easy to feel like ⁓ I don't have any power, I don't have any say. That's true. You can feel that way, especially as a frontline manager that is dealing with the so many fires just at the front line. I mean, you have personnel issues, you have equipment issues, you have ⁓ supply issues, you have staffing issues, like there are things happening constantly that you are dealing with for sure. But I think if you can find a little bit of time to put some energy into that and at least understand the metrics and help the conversation happen, the more we talk about this, and we are the biggest industry, we are the biggest workforce in healthcare. So if we can ally together to help change that conversation and that narrative, we actually can put peer pressure. And make those changes and improvements. Agreed. So, Cindy, who do you think is leaving the workforce? Do you think it's related to generational differences or do you have other thoughts that are causing people to leave? Well, I do have my own thoughts, but I also want to show another clip from Dr. Mike's episode that they talk about some of the stuff that's going on that I think would help give us a little bit more information. I love that. speaker-1: What happens is because we're all burnt out, we just bark at each other and bite each other when we shouldn't be doing that. Yeah, why are nurses so mean to young nurses? There's a thing called nurses eat their young. Okay, so how do we how do we go through this? I think it's issues that the older generation of nurses needed to s suck up and be okay with that they think because it works for them it should work for the new generation of nurses who can realize that like, no, I don't have to feel bad calling sick. If I'm sick today, I'm sick today. And it doesn't matter if I just started this job three months ago, if I don't feel good, I can call sick. But then the older generation is like, I've been working here for 40 years, or but now we have more confidence as younger nurses emerges and like this whole society is changing, that people are realizing that you know what, you can have boundaries. You can say no to things that doesn't make you feel comfortable. Like if your manager comes into you and tell you like, Hey, we're short today, are you are you not feeling bad with your coworkers working this late? No, I don't feel bad. I feel bad about myself staying more than I could. Yeah. But before that, like two decades ago, absolutely I'll stay for another four or five hours. And next thing you know, you've been working sixteen hours. And you're like, ⁓ Part of the job. Part of the job. speaker-0: So the nurses eat their young phenomenon. Yeah, that's gotta stop. We can't keep doing this. We're not keeping new nurses enough as it is, and we can't keep eating our young. I've noticed some of a change in that trend recently. I think more of those eat your young people have started to retire, but not all of them are gone. And some people have been trained to then behave that way. Yeah. And there's another part of this video which I I didn't save this the clip of, but he also talks about the history of nursing, which I think is an interesting concept. He talks about that the the history of nursing is that it's a predominantly female industry. Correct. And we also live in a society that's predominantly women take a second back patriarchal. We're in a yeah, a patriarchal society. Which is Changing. I think it's getting much more equal than it used to be. But historically, the like the baby boomers, they were very much in that patriarchal industry. And as a female nurse, you weren't allowed to speak up for yourself. Like boundaries, you were shamed if you had boundaries. Yes. Or punished. Or fired because you were unpredictable, difficult, emotional. Hysterical. Yeah. So I think that some of that is stemming from like a societal problem, which is an interesting thing to think about. It is. I think when you look at women led areas in the country, yeah. Those are the chronically underpaid teachers. Yes, undervalued professions. Yep, for sure. Which is crazy because like those are the professions that are actually like taking care of people and like raising our children to become adults. And like we aren't even investing enough money to make sure that the people who become adults later are good people. Right. So we talked about that it is changing, but the numbers of turnover are still really high for new new grads. Right. The retention of keeping new nurses it back in the baby boomer era was better, but that's because They tolerated stuff they didn't have to tolerate. And now we're not. So now twenty-nine percent of all nurses, ⁓ the turnover of nurse new nurses happen in the first twelve months of employment. That sounds wild. Yeah. And then by by year two, fifty percent of them are leaving. And we're not just talking about leaving jobs, we're talking about them leaving the actual field of nursing to do other things. Guys, this is really bad for society. If we don't have nurses Who's gonna be the ones taking care of the patients at the bedside? Are we gonna pay for doctors to do that now? Or AI? Is doctor going to do yeah, you is AI going to be able to start your IV and figure out your medications and give you IV drips? And monitor you all day long? I mean, I'm sure there's a certain sense that it can, yes, but there are aspects of being a human and receiving human touch when you're not well that is actually very important. There are a whole bunch of nursing theories out there about the importance of human touch. in healing. So then the next issue from that is the bottleneck. What is that? So the baby boomer generation is way bigger than our current generation. And they are retiring right now. And so we're losing a lot more nurses than we're getting in. So we're having what's called a bottleneck situation where you have nursing schools are turning out 65,000 nurse new nurses every year. But because There aren't people teaching because again, another underpaid area of healthcare, even more underpaid than staff nurses, are faculty educators. And so you don't have enough faculty staff to actually teach nursing students. Yeah. And I think just to be clear, you're saying that they turn away 65,000 qualified applicants. ⁓ yes. Sorry, I said that wrong. Yes. They are turning away sixty-five thousand qualified applicants. So it's not that there's no want of people to go into nursing, but there's no one to teach them. ⁓ okay. Wow, that's challenging. So, and now you we're having this crisis where people in the age bracket of about 35 and under are quitting the bedside faster than they ever have in history. So new grads can be pushed through orientation, but this bottlenecking and and retirement and the turnout of new nurse grads is causing us to have a one hundred and five percent turnover rate within five years. ⁓ wow. So every five years you have a completely new unit of staff on the majority of units in healthcare. Wow, that's actually true. When I think about it, when I've when I the last time I left one of the hospitals I worked at, I came back a few years later and I don't know anyone. Yeah. Maybe one or two people. And I'm I mean, this is just me trying to spitball here, but that does not seem like that's going to create great patient safety. No. Okay. Think of yourself when you were a new nurse one to three years to where you were when you were had been a nurse for almost ten. No my gosh. I was not the same person. I was so scared. I questioned myself all the time. I made a bunch of dumb mistakes. Luckily I didn't hurt anybody, but like if nobody's there to teach you how to do it and guide you. Or the ones that are there are being mean to you because they're bullying you, then how are you going to sustain and wanna be keep doing this? Yeah. So true. So Nurse John was talking about how the older generation views something like getting sick. So we wanted to do a little reenactment of what this might sound like. Hey Betty, I'm throwing up and running a fever. So I'm gonna call for my shift today. Sorry, I don't feel good. When I started in nineteen eighty-four, I s I worked a twelve hour shift with a broken arm and a kidney stone and I was pregnant and blindfolded. You've only been here for three months. You can't call out sick yet. But so comment below any comment that has been said to you about this. Like what were you told that you couldn't do because it was hard for them? Yes. The I had to do it like this, so you have to do it too. What do we call this? Martyr, martyrdom, mart martyrdom, martyr syndrome. I think you made that up, but I think it sounds good. But it's like it is. It's being a martyr and saying you should be like I was. And and we don't want that. We don't want that for our future. I don't want that for my my kids. No. Who wants that type of work environment for their children? And The other thing that we'll get into is about the abuse that nurses face. What will that's a whole nother story. Which it's so weird that those of us that had these negative experiences, like that we wouldn't be like, ⁓ that happened to me. I don't want it to happen to somebody else. Like, why does this history keep getting repeated? ⁓ it's actually a very common human experience. We do repeat history. You can go through our history books and see. They look the stories are slightly different, but the theme is the same. Yeah. So where are we headed? Apparently back to where we started. Yeah. Unfortunately, we're in a circular We circularly circularly argue with ourselves and put ourselves in the exact same spot. I don't know why. I'm having a circular argument with myself. Okay, let's talk about the other probably maybe one of the biggest reasons that I think people are leaving right now. If I think it's true. I'm gonna show you guys one more clip. speaker-1: Physical abuse in nursing. Yeah. I think that happens every single day. And it's in the news that nurses get stabbed, nurses get shot, nurses get, you know, physically, literally, like almost dead while working. It'd be it's funny because, you know, abuse should be something that we are warned about when we get into healthcare, or at least for my profession, but it is something that we are being trained for. Because we should expect it to happen. It's like, hey, you're a nurse. I'm gonna teach you a few things that you can do to protect yourself so that you get you don't die. You know what I mean? Here's a martial arts training, yeah. And the martial arts training are not even good because they show you the crappiest way to like, you know, protect yourself. It be it almost became like, hey, we're preparing you for the worst. Yeah. And you should be okay with that because you chose to be one. And that's that's a crazy thing for me to for us to accept and just normalize. Do you think ⁓ some changes need to be made? ⁓ like should it be rule changes, should it be mandatory punishments for patients, more security? Like what would you like to see done? I think so. I think so. There should be changes in healthcare and it always starts in You know, they're always like, Well, let's buy this new computer that can help us chart faster. No, we don't need that. We actually need staffing. Okay. Safety. Safety for every single nurses who are caring and protecting all these people in the hospital. How about we in place safety for nurses so that they don't have to fear going into work and one day get stabbed by a random stranger on a parking lot before she gets to work. Yeah. Because we also have families. And I one thing I always tell my audience and my community is that at the end of the day, you have to realize that the most important patient is yourself. Because once you are able to recognize that you need to take care of yourself first before you can take care of others, it's gonna be hard for you. to get out of a system that is made for you to feel like suffering is okay. speaker-0: So Nurse John is talking about that nurses are being assaulted. Very real. Yeah. It does happen. I worked at a facility once and we were having some issues. So they brought in some new people to evaluate and give us some ways we could handle this, like de escalation and yada yada yada. And it was a retired officer. And when he rounded with nurses and visited with them, he said You guys experience far more abuse than I ever did as an officer my entire career. That is so crazy because like what he's saying where they're like, ⁓ you became a nurse, you should expect to have to deal with physical assaults. I don't think that that ever was a conversation I heard when I was a nursing student. And I never would have gone into nursing if I thought I was gonna have to get into physical altercations. Yep, but when you get into the hospital and you start I I think it's subtle at first. I think it is in nursing school, but we don't think about it. We're like, ⁓ well, they have this issue, that's why they're acting that way. ⁓ well, they have dementia. They didn't know they were hurting you. And sometimes that is true, but it doesn't mean it's okay. Yeah. They're ⁓ excusing the behavior. Excusing the behavior, intellectualizing the behavior, and making it seem like the outcome or the impact is not As important as like is the impact of a of a nurse being assaulted by a patient with dementia going to be any different than a police officer who gets held at gunpoint with an actual criminal? Both are unfortunate situations and both are going to have a probably a traumatic effect. But I think the difference is that a police officer does go into becoming a police officer expecting to see violence and they're allowed to carry protection, like they can carry a gun. I'm not even allowed to carry a small can of mace onto my campus of where I work. Like no weapons. I'm I have a whistle. Right. If you're lucky. Yeah. And the whistle can be used if you have it on a lanyard, could be used as a weapon against you. Yes. So true. So where are we seeing this violence happen most often? Two areas are the most significant. places of turnover and and violence and that's gonna be your emergency room departments of course, but the highest one is actually behavioral health, which not to be rude, is a little bit expected because there's obviously behavioral issues, but that doesn't mean we should tolerate it. There should be consequences to that behavior. So the t the turnover rate in behavioral health is twenty two point five. Yeah. And in the ER it's it's over twenty point seven percent. But I think what I don't want to miss here though is that it's happening everywhere. I'm seeing it on med surge units, I'm seeing it in ICUs, we're seeing it in community care centers. Like it's happening everywhere and there's definitely like a a a scale where it might be verbal abuse up to physical altercations, but it's it's kind of wild that, you know, you're you're here to take care of people when they're feeling their worst and they're the most vulnerable, and yet you might get attacked for that. So true. So tell us about what you saw at the conference you went to. ⁓ yeah. So the last leadership conference I went to was AONL. And I was specifically trying to seek out this topic because we are having this issue in my local area. And I have been struggling to try to figure out what to do about it. Because I mean, even when you're like listening to Dr. Mike and Nurse John's conversation, they're saying things need to change, but I didn't actually hear any specific things that That they said, ⁓ do these things, except staffing. Staffing does make sense. Correct. Biasly. How do you actually implement safety? What is the right answer? ⁓ so I went to this session and it was called the bundled package to manage violent patients. And it was a hospital on the East Coast. It was a very big organization. ⁓ but where they were geographically located, they were surrounded by Assisted livings, memory care units, a behavioral health ⁓ inpatient unit, basically all of the psychiatric and the neurocognitive patients, they all come to that hospital. So they were seeing violence from both ⁓ high rate from psychiatric patients, but also from neurocognitive or patients with dementia. And they implemented programs over a five-year period. But the thing that was really amazing to me and how they did this was their executive leadership team made this a priority and they worked collaboratively together. Their chief financial officer was invested, their chief of security or their police department was ⁓ was invested, the behavioral health department was invested, the nursing, the CMO, like everyone was like, we have to fix this problem. And it started with that. That's usually In order to affect change, we have to identify the problem and work as a team together, no matter what realm you're in. Yeah, because I have seen over and over where the front line is like we have a problem and executive leadership minimizes it or doesn't validate it, or they say, Yeah, but it's only one or two patients that happens to. But you're missing the impact. Like it comes back to that impact and what that cascading ⁓ effect is. So let's go into what leaders can nurse leaders can do right now to help protect and start advocating for our teams. The first thing, immediate debriefing. Yes. Just show up. Every time I hear about a patient being violent on one of my units, even if it's not my unit, if it's just in my hospital, I am like, I am up on that unit. And I am like, how are you guys? What do you need? Are you injured? Do you need Support? Do you need to have a night off? Can we get your shift covered? Like just literally showing up is one of the very first things because, like I said, nurses can feel like they're not being heard. And we can make a difference about that from our seat. Right. And that's just being there supporting and just even when it's hard and you don't have the answers, showing up and saying, How can I help? even if you don't have anything. is a huge aspect of that. Yeah. The next part is going to be advocate for security. Yeah. And so this is again, I think we've been harping on the whole metrics thing the last few episodes. But again, like you need to go in and look at your data. Do you have a violence prevention coordinator? Do they have disruptive behavior reports that you can trend and you can look at to see like how many encounters or interactions of these are happening? Are your restraint numbers going up? Are employee injuries going up, like pull that data and bring that to your executive leadership team with your turnover rate, with your exit reviews and say, My staff are leaving my unit. This is why they're saying they're leaving it. And here is the evidence to support that. I need more security. I need a police officer on my unit who is going to be monitoring to watch for the indicators that somebody is about to do a violent in ⁓ action. Right. I was even ⁓ reviewing ⁓ a policy recently about behavioral health and hazardous item checks. So we we already have this activity implemented. One of the things that you can use as a tool to do your ⁓ hazardous item check is a wand to identify metal over their equipment, but we're not allowed to use it on the patient. And I think that's part of the problem is like we're Who are you supposed to use it on? You're only their supplies that they brought and their personal belongings. But not the person. And I'm like, That makes no sense. Right. Where do you think they're gonna have their knife? It's not gonna be in their backpack, it's gonna be on their person. Yeah. And I'm just like, this is an exact example of that. The other thing you can do is create work groups, make algorithms to help show staff what to do. Yeah. Add to their training. I've noticed that a lot of times when a violent situation occurs, the worst part of the whole thing is that nobody knows what to do. Nobody knows what they're allowed to do. Nobody knows who's going to do what. They don't know how to communicate. Like we need to treat this like a coat blue. Right. And then when it goes wrong, the nurse is punished for doing something wrong. Absolutely, which is so awful. It's like I didn't know what to do. I just knew I needed to protect myself and or my peers. And so I did a thing that I thought was the best. And it was ended up getting me in trouble. Yep. And that type of thing is what why nurses leave. So the other thing that we can do in leadership. No matter what level you're at, are you a frontline manager? Are you a director? Are you a CNO? We can implement pause. So when you're working for a facility that is pushing efficiency and bed turnover so hard that you don't get a chance to even stop and pause between one horrible experience and another. Which I mean, I don't I have talked to countless of nurses that this happens and there's tons of stuff out on social media about this. We did implement this at one hospital. We called it the I think it was one of the trauma hospitals I worked at and we called it the trauma pause and we had after a big trauma thing, we gave a few seconds, everyone in the room stayed and we paused for a few moments. But how often have you and drop a comment and let us know. How often have you been on a code, had just adrenaline running, you're pushing meds, you're doing compressions, the patient dies. And then your charge nurse is like, we got to get that patient out. And your new assignment is coming up from the ER right now. Like you don't even get a chance to go pee and and eat a snack. Yeah. Or you are in with a difficult patient, you're trying to de-escalate them. They swing at you. They hit you this time. And then you got to go into your next room and go give meds. You don't even have time to be like, I just got hit. And be empathetic to the next person and have something to give. So yeah, like we as leaders, we need to prioritize pausing. Because the efficiency is not enough. Like it's not more important than the well-being of our staff. And if we continue to abuse our staff and and let that be the status quo, we aren't going to have a workforce. And so we have to make that, we have to stand up and say, we are not going to push through. We are going to allow for a pause. If nobody is dying next door, That patient can wait five more minutes in ER. Even one minute would still be better. They've shown ⁓ evidence of improvement of just a few moments of breathing. Just a couple of minutes of taking a pause and catching your breath and just allowing that to set in and have a few moments to either the group, yourself, whatever. Yeah. So we want to kind of get into those take-home messages for nurse leaders, nurse managers, wherever you are. We have to advocate for our staff and ourselves. We are nurses. We Are a team and it's not just about numbers. So how do we do that? Actionable strategies for nurse managers are gonna look like, well, we need to acknowledge that while corporate suits lock themselves up and look at spreadsheets, there are actually people on the front line taking care of patients who are having an experience, a human experience. And a true floor manager has the immediate power to do something different and to enact change. How would I do that? Well, I think that you start with a culture of everyone needs to understand that if something negative happened on the unit, if you were not involved in that, can you step in and help? Can me as the manager, can I step in and cover your patient so that you can go for a 10 minute walk? What if I have been a manager for 10 years and I really haven't done a lot of floor stuff? How do I support my staff? Because that does happen and I think that's also okay. Yeah. But how do we take those moments? I mean, go back into orientation. Yeah. I had a manager ask me if I could orient them because they felt like they didn't know what to do on the floor anymore. And I felt really that was like a honorable thing to do. I think so too. Acknowledge what you can do and what you can't do. And if you really can't, be strategic. Go listen to phone calls, go answer call lights so people can step away for a minute. You still know how to answer basic questions. You still have the ability. You may not know, but the anything could be delayed. few moments you still have to do your BLS so you know how to do CPR if something goes wrong. Don't doubt yourself and your skills. You're still a nurse. And think creatively outside of your unit. You know, do you have a nurse who needed a break from ICU and left and now they work on your cardiac telemetry unit and they're having a slow day. Can you call them up and say can you come up here for 20 minutes and give my my nurse a break? They still have the skill set. They're still competent. And that can give you some workplay. And do the same thing for your other units. If your other if your colleague units are struggling and you're having a slow day, support them in the same way. Like we can start by demonstrating the behavior that we want to see that's going to make people feel safe and make people feel heard and make it seem like we're not just trying to rush through and make and turn nurses into robots. Yeah, we are humans. So who are things we can do is own our mistakes and building true psychological safety. So instead of being infallible and perfect all the time, it's okay to show that you make mistakes and then apologize for them. This is where I think being a truly authentic leader shows up. And I think if you guys want to know what that looks like, we actually have a video about when you mess up because you're going to, you're going to mess up. Yeah. But how you respond is where you're going to actually build that trust and rapport with your team. And when you're a manager that openly shares your own fears and weaknesses and you get vulnerable with your staff, that also helps them trust you and makes them feel like you're actually on their side and you're part of the team. And not that you're up there from your tower judging them and watching their metrics. The metrics are a tool for communication. They are not what healthcare is about. They're not a tool to beat your staff with. Correct. And then really, you need to be a shield to your team and you need to advocate. If upper leadership is pushing you for higher efficiency and you know that what that is going to do is going to have a cascading damaging effect. You need to be a willing to step up, but you also need to know how to use the data to tell the story. Lastly, collaboration using our physician partners. to work with us to help break down those silos between doctors and nurses because the truth of the matter is is we are coworkers, we are peers and we need to act as such because that violence doesn't just impact the doctor or just the nurse. It impacts both of us. And this I think is another one of those historical behavior patterns that we've done in healthcare where we're like, ⁓ the doctor's the doctor, the nurse is the nurse, and we butted heads historically. Nursing staff gets frustrated with doctors because they feel like the doctor isn't respecting them or is making a bad judgment call. And maybe the doctor thinks, ⁓ you're just a nurse, you don't have the same background as me or education. Or you just don't have the same picture that I have. I have a bigger picture and I know more about a certain thing than you do. ⁓ and I think that's okay. But understanding how to recognize each other's place and role and value that is our Biggest missed opportunity. This is a perfect point to bring in the stay curious model. Yeah, for sure. Because if you stay curious about your peers and your coworkers, you're keeping an open mind and like, hey, help me understand why you want to do that. I'm thinking in my experience, this is what I've seen, and I don't understand why we want to do it this way for this person. No, I've totally used that when I was when I had a a newer doctor or resident who was making what I thought was a weird call. And I was like, well, I just want to understand your rationale for why you want to do it this way. Cause I've never seen anyone do it this way. So do you know something that I don't? Because I'm just curious as to what led you down that pathway. And that can open up a conversation because then maybe they're like, ⁓ what else have you seen? Yes. And it's again the whole nurses eat their young. We have to stop that negative behavior between our doctors and have nurses and doctors being mean to each other. Stability and respect needs to be a top priority. And it goes both ways because I've seen nurses mistreat, especially like if you work in a hospital that has interns and residents. I have watched, like as a as a culture, we can be just as mean to new residents and doctors as we are to new nurses. And that's been just socially acceptable. And that's not okay either because we're just like making that gap wider. Yeah. Where if we are offering support and education as a resource to them and saying, hey, I've been working here for a long time. I know our processes. I know how the work flows. If you ever need help, please come ask me. You opened up a doorway for a relationship and you have done s a service for nursing to build trust going forward. So now instead of that doctor feeling defensive and like they don't want to listen to the nurse because they had negative experiences, they're going to be thinking about that nurse that actually threw them a life raft and helped them feel more successful when they were starting out. It's true. So really at the end of the day, the fundamental truth is exactly what Marx John said. I really liked he said the most important patient in that building is you. 100%. So as the nurse, as the leader, as everything, always take care of your needs first. And as a team, let's take care of each other. But you have to have your you have to put your oxygen on first. Yeah. If one or two people are always picking up the overtime shifts, And staying late, then the rest of the team is gonna suffer. It you have to share the love. If you've got a difficult patient on your unit, like work together to help meet that need. Like give people breaks. Everyone can work together to conquer these difficult things. We're so much stronger as a team than we are individually. ⁓ but know where you are in your ability so that you can speak up and say, I had a really bad day yesterday. Yeah. I don't think I can take that patient again. Yeah. I think it's okay to, even though for continuity of care, sometimes it's nice to have the same patient, it's also sometimes safer for you and the patient to not take the same assignment again and speak up for yourself. Say you can't. Yeah. Now, not every unit does assignments where you have the opportunity to say that. So you may need to tell the charge nurse before you leave that day. the day before and if you don't remember the night before because some assignments are made a beforehand and some hospitals you get to pick your own assignment or different units that that may vary across the spectrum. So do you work somewhere where you feel like the leadership has lost their way? Like and subscribe, keep an eye on things. Let's slowly work towards changing that. Become the leader you need. Let's start changing and shifting the way we're handling this and make nursing the career that I love. And please drop a comment. We would love to hear what your experiences have been around this. As a frontline nurse and as a leader, have you seen leadership handle this well? You know, when we were in the midst of COVID, I remember asking who out there has figured this out? Somebody has figured this out. And so let's share our successes so collaboratively we can find better solutions as a team. This workplace violence. situation is relatively a newer developing issue. ⁓ it's getting worse. Yeah. And I think it's gonna continue to get worse. And we have got to find solutions. We've got to figure this out. And so if you have a success story, please, please tell us what it is. We wanna know. So thanks for listening and ⁓ we will drop some references in the description if you want to see where we got some of this information.