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Episode 5 Interview: Keeping the Frontline Perspective · Nurse Leadership Dumpster Fire

• speaker-1: Hey everyone, welcome to the Nurse Leader Dumpster Fire Podcast. I am Teressa, your co-host. speaker-2: And I'm Cindy Mary, your other co-host. speaker-1: And this is Brittany Garcia. This is going to be our very first episode where we actually have someone else to interview and talk to. Brittany has been a nurse leader for several years and we just kind of wanted to bring her on and talk to her about her experiences and go over things together. So. speaker-2: If this is your first time tuning into the podcast, this podcast is for new and experienced and aspiring leaders. And our attempt here is to talk about some of the mistakes we've made and hopefully help you learn those lessons, not the hard way like we did. Yeah. speaker-1: And then for just for a disclaimer, we all do work for the VA, but none of this has any reflection or purpose at the VA. And if we tell any stories, we are going to change names to protect HIPAA and or privacy laws for other people. So just be aware that we are making sure that we are not crossing any boundaries we shouldn't. speaker-0: ⁓ thanks for having me. feel so special. I really do. I'm so, I'm so impressed. speaker-2: Thanks for being here, Brittany. You are a speaker-1: Yeah. So one of the reasons we wanted to interview Brittany just to make it ⁓ clear is first of all, Brittany has been a nurse leader and a nurse for several years and she has worked at the VA for a long time. And her perspective, I think is really different in the sense that she has a really unique ability to maintain her focus as for the frontline staff as a nurse leader and continue to advocate for them. ⁓ in an outward way while respecting the needs of the facility at large. And I just think that's a really unique skill, but I don't think she had to be taught that. think she naturally just had that. do you think, Cindy? speaker-2: Yeah. speaker-0: Well, well, first of all, thank you. mean, it means a lot that you see that in me because I do, I do try, I do try to, I do think more than anything, I am a staff nurse. It's, it's where my roots are. And I think being a staff nurse for so long, for I was 17 years. And I never really meant to get into leadership. It just kind of happened. was kind of, I don't know. Yes, kind of, kind of a little bit. ⁓ I had a manager really try to push me to try the assistant manager role, which I didn't want to. But it's like his confidence in me made me think, okay, well, maybe I'll try this. ⁓ And so I did. And then I liked it. I loved being an assistant manager. speaker-2: told. speaker-1: That's a good one. ⁓ speaker-0: because it was half and half, was half administrative, half floor. So I to staff and I still got to kind of interact with the staff and then COVID hit and they needed a manager and it was like six months in to me being an assistant manager. So I was brand new and they wanted me to go be a manager of a whole different unit. ⁓ And I mean, I really, speaker-2: Best of both worlds speaker-0: truly did not want to. I was like, I'm not ready for this. ⁓ But anyway, well. speaker-2: you, when you took that position, you were taking over a manager who was, I don't know, burned out and really like the culture of the unit was not good when you started. And I remember people being really happy that you were there. I maybe because of that, like ability to relate to them as, you know, a peer first and like, like understand their experience. ⁓ But yeah, coming into it, like, I guess. My experience was very similar coming in like really fast, but the culture was kind of bad when I came in. And so to me, it was like both a gift and a curse because the unit was kind of a mess, but it was kind of easy to get buy-in after that because it was like the bar felt kind of low. speaker-0: ⁓ that's exactly kind of how it was. I was lucky because I feel like the staff of the unit I managed was very, showed me a lot of grace. And I've since learned not every team is like that. And so I was lucky. I was lucky to have that team. But not only was I new manager over a new unit, it was COVID. And so that was kind of my introduction to management during COVID and that... speaker-2: Mm-hmm. speaker-0: That was, it was just a nightmare really. But I think. speaker-2: Did you have a lot of turnover during COVID? What was your turnover like during that time? speaker-0: I mean, I think it was pretty normal. I mean, when I started the unit, it was short. They had had a lot of turnover before I got there. so the good thing about COVID is because it was so difficult for nursing, they let us hire. Even though it was hard to get people on, they relaxed because it was like, need nurses. It was a time where it was very hard, but at the same time, was people knew that we were needed. And so it was probably good that way. So we were getting people. So yeah, that's helpful. It was really helpful. speaker-1: When you first started hiring ⁓ and learning that process, by the way, just in general, hiring can be complex, not just systems-wise, but making sure you're choosing the right people. And I think that's a challenge that I think every leader at some point is going to face. But when you are choosing people and interviewing people, is there anything specific that you looked for when you were interviewing or hiring? speaker-2: where you just like, need bodies, get them in now. Because it's COVID. Maybe a little bit. speaker-0: I mean, we were desperate. I was desperate for my team. You I wanted to get them help. And I think they knew that. I think that was probably because I just came from bedside. I was very empathetic to them. And I tried to help. I tried to step in. And it was funny because I didn't have to do much for them to appreciate it. You know, I would answer a lie or... go do some blood sugars and they would just be like, you know? And I realized like that shouldn't be that shocking, you know? speaker-2: I agree. Yeah, I think there was, I had moments where I was like, I mean, I guess I just didn't realize that this wouldn't come natural to another leader or I guess it kind of goes to a testament of the culture that you were walking into that they were so starved for someone who can support the team that when you all you did was say, hey, I'll go answer your call light and they're like, wow, you're amazing. Yeah. speaker-0: For sure. so it did, I mean, that though kind of helped me get through it. know, it's like, there's so much to be said about being appreciated. You know, I think money is one thing, but I mean, feeling like you are, have a purpose or there for a reason. ⁓ I think, especially during COVID, it was, I felt like we had this bond, kind of trauma bonded. ⁓ yeah. ⁓ I think nursing in general can relate to that. speaker-2: Especially through high intensity situations like that. speaker-0: Yes. It's like you've learned who to trust. speaker-1: Yeah, you do. I agree with that. think you're right. A little bit of like a shared trauma experience bonded. Not necessarily like that like push-pull, but like our experiences. Like people are never going to understand our experiences as healthcare providers. And you can't describe that to an outside person. You can't just like, and that's just always going to be how that is. It's similar for police too. I'm sure they can't describe their experiences either. Right. Or any other type of service or civil service type role. ⁓ Fast forward after COVID, you, Brittany, remained the manager of that unit for several years. ⁓ speaker-0: I was only supposed to be detailed for... speaker-2: Yeah, ⁓ she was voluntold and then the position actually opened up, right? speaker-0: And by then I was like, I'm here for you guys. You know, we, like I said, were kind of I wasn't going to leave them, but like to your, with hiring, that was what I was going to say. ⁓ I was trying to find people that were team oriented. That was a big thing. It's like, are you willing to, you know, step up because it's hard. It's, it's not easy right now. It's so hard. ⁓ Are you going to, it's gotta be more than. speaker-2: Yeah, you drink the cool speaker-0: just about yourself. You gotta be willing to join this team. speaker-2: You're there for like a bigger reason, just a paycheck. ⁓ speaker-0: Exactly. So I'm sorry, I just want to. speaker-1: No, no, no, we didn't ever actually finish that. was a good point. ⁓ So what I was going to go to next is once after the detail was over, you did end up applying, you got the position obviously, and you maintained that role. then Cindy and I actually came in and some other changes happened within our leadership. ⁓ I was the assistant manager of the ICU, Cindy was the manager of the ICU, and you had been a manager for a minute, a couple of years by that point, I think two, one or two. speaker-2: Yeah, were you, I'm trying to remember, had you been the manager for a year or two years when I started? 2021. Okay, yeah. So you were still pretty new. Yeah. speaker-0: When did you start? So a year. speaker-1: So then a lot of movement happened. You got detailed to the chief level or director over the critical care team for while. And because I was really new and Cindy was really new and there wasn't anybody to really cover the unit she managed, Cindy was then moved to that for a few. Telemetry unit. we were over ICU. But anyway, so now it's like telemetry ICU, critical care team. So we all kind of were managers. All brand new. speaker-0: And we were all brand new. speaker-2: And can you talk about your experience being detailed as the Associate Chief Nurse? speaker-0: Yes. So that was another thing that I was kind of thrown into. It's like, not only am I not comfortable being a manager yet, and I mean, I still feel like I have so much to learn. And again, back then, it's not like this now, but I think it was probably during COVID and there was just so much going on within nursing. There wasn't a lot of stable leadership. Every... There was all sorts of detailing going on. speaker-2: There was no one to turn to. There was no experts. You were like, how do you do this? Do you know how to do this? No, think maybe so-and-so knows how to do this. And it was just like hopping around until like, you're like, I need to hire somebody. How do I hire a person? speaker-1: We, at W.A., we do a lot of the backside. speaker-2: Yes, managers at the VA are a little bit of a jack of all trades. speaker-0: Yeah, so they asked me if I would detail to the chief role, which I mean, I was like, no, I don't think that I'm ready to do that. But I will say the leadership ⁓ is as hard as it was for us. ⁓ I try to look back and think how hard would it be for them too. speaker-1: Throwing that out there. speaker-2: Yes, I think that too. What? speaker-0: how difficult would that be? know, it's like they're begging me. You know, and I'm like, poor you, you're begging me. You know, that just kind of goes to show where we're at here. speaker-1: Yeah. speaker-2: We don't many options. So I guess we'll take Brittany. speaker-0: Please, Brittany. It's like, I don't know. speaker-1: felt the same way, because I was also then put into a role that I was like, I don't think this is a good idea at all. I think you guys are making a terrible choice. I mean, if you really need me to do it, I guess I will. speaker-0: Well, and that's the thing too. I kind of, at that time it was like bigger than me, you know? I really did. I was just like, I don't want to do this, but I have to. I have to help. speaker-2: And I remember you said, I will do it on one condition. Do you remember that? Your condition was, cause you had just hired your assistant manager and you were like, I don't want to leave him. And so that's why I that detailed into your job. Because you were like, need, I will do it if Cindy can go be the manager of the telemetry unit. Cause I need her to help bring in this other brand new person who has no idea what he's getting into. speaker-0: ⁓ yeah him? I knew how it was. I just didn't want him to be thrown to the wool. speaker-2: fill that. Right. You wanted him to have a better experience than you guys. speaker-0: Yes. And so it worked out actually really well because I know that, you know, then you came down and I felt so much better about it. really did. But yeah, so I was detailed as a chief for, think, four months. And then it was funny because they wanted me to extend and me and you had talked and you were more, you were interested in that role more than I was. I just wanted to go back to my unit, you know. ⁓ speaker-2: Yeah, I so. speaker-0: manage my own unit and so be kind of sweet. You know, I told leadership Cindy's interested. I'd go back to my unit. speaker-2: I remember we had a fabulous, had a, the day that Brittany went back to her job as the manager and we had our first like team meeting and you said, I don't know if you remember this, you said, I got 99 problems and being ACN ain't one of them. It was so funny. speaker-0: I don't remember. speaker-1: ⁓ ACN is associate chief nurse of, and then it'll be of a certain line, the service line of whatever that is. It could be emergency medicine, critical care, whatever you call it, or ⁓ OR or ambulatory care, just depending, just throwing that in there. We use a lot of acronyms at the VA that nobody else uses, so I always have to feel like I'm the tele... speaker-0: Yes, yes, yes. speaker-1: I love that. ⁓ My experience with that whole situation, just throwing it in there. I also was pretty new. I was an assistant manager and I ended up being detailed as the ICU nurse manager and it ended up being for a total of a year, which I felt completely unprepared for. ⁓ I just tried to, I thought it was only going to be four months. So I just was like, well, I'm just going to stay the course. I'm not going to try to make any changes. I'm just going to, my job right now is to maintain and stay on the path we had started. ⁓ And that was my goal. speaker-2: Thanks speaker-1: I will say the one difference I noticed as a new, the newest person of the three of us in leadership at that time within that system, both something that both Brittany and Cindy brought to the team that I felt was really important for me was camaraderie among all of the areas that was not there before. was, we had a group huddle meeting and whatnot. But there was no level of camaraderie and like leaning on each other. was like fend for yourselves. Good luck. Everyone should do own thing. speaker-2: She's talking about within our little manager team. So we had three departments between us and we had all been sort of functioning in our own service line. And like we report up to our associate chief nurse and the relationship between us would be like one, you know, bi-directional, but between each other, we really didn't have a lot of. time we spent together and I think you started that as when you took that role and I really liked that and so I kept doing that and that was something by the end of this year we all had trauma bonded because we were all just like so trying to figure all this out and things were going crazy. We were coming out of COVID by now. The mood of healthcare had shifted so much in those last couple of years. speaker-1: Well, then it had shifted to ever people hated nurses at first. Yeah loved us and now everybody speaker-0: the arrows and then. speaker-2: We had lost so many staff because during COVID, there was all these very lucrative travel assignments and people were like, well, if I can make $150 an hour, if I go travel, why would I stay here? And so then we couldn't even get people to come work because we don't have those same, we couldn't just increase salaries or throw bonuses at people. The VA does not work that way. So we had to be very creative. speaker-0: disciplines would even talk about that because we ourselves had travel nurses. And I remember like rounding with the docs and they would talk about, it was almost like they were bitter that nursing, you know, was in this position. And it's, mean, there wasn't much we could do, but it was very hard to, yeah. But then that's that switch. Cause then it was like, okay, we can't keep nurses. And then when COVID started to trickle, speaker-2: Yeah. speaker-0: and travel nurses weren't as in need, then people's trade started to come. speaker-2: Yeah, yeah. Stabilize. speaker-1: And the ICU alone, from a turnover rate of like 50 something per 53 or 54 % down to a 9 % the next year and then 11 the year after. And that's just that one unit that I knew we tracked. it was interesting for sure. So after all that, then a couple of years down the road, we all had been doing these jobs for a minute. And I think that was a lot of stress for each of us to carry. I decided I thought I was going to stay in ICU forever. Never did I ever consider I was going to go somewhere else. But an opportunity popped up. Cindy encouraged me. A couple of people encouraged me. One of my own educators, my current employee still encouraged me to apply. And I was like, fine, I'll just see what happens. So I did. And I ended up being an assistant chief. But in that same thing, everybody kind of shifted again. And Brittany got to a point where she wasn't sure leadership was going to work for her anymore. She wanted to go get her masters. And she was like, I don't know, tell us your experience with that. speaker-0: Yeah, so it was about after probably three, three and a half years. I was, I was completely burned out. ⁓ speaker-2: What did that feel like? Like what symptoms were you having? speaker-0: So just, I felt like I went from like, what can I do for my team? And we've talked about this, like, what can I do for my team? I'll do anything. you know, too, I actually had somebody come in my office one day and she said she had been out sick and she came in and she was just like, I just, I just want you to know that it hurt my feelings when, ⁓ when I came back, you didn't even really ask like how it was or. You you were just kind of like, your back, you know? And it kind of hit me like, wow, it's true. That's kind how I feel. Like I started to lose that empathy. speaker-2: bit. But I do want to pause and just say like that's not a normal thing for a nurse to feel comfortable to come say to their manager. True. So I feel like that also, you know, demonstrates that you had created such a safe culture that a person could come up to their supervisor and say, Hey, you hurt my feelings. That's not normal language between like a staff nurse and a leader. Yes. speaker-0: Right. speaker-1: but it's healthy linguine. speaker-0: Well, and I think she saw a shift. speaker-2: Sure, so she's pointing out like, hey, something's changed. speaker-0: Right. And so I kind of had to look internally, like, how is this is, is maybe in this position, what's best for the team, you know, and again, I mean, it was just, there's so much that goes into leadership. It's, there was a lot going on. There's a lot of, you know, just again, turnover. It's, it's, we had a lot. speaker-2: A lot of organizational changes that kept coming down and things, you know, we had a lot of turnover in our executive leadership. Yes. So the whole hospital was feeling pretty unstable at that time. Right. speaker-0: HR tasks were just unbearable sometimes. It was like I couldn't even really do the things that made me happy in the role. ⁓ And so my goal was to go back. I was in school. I was going to get my master's in informatics because I thought I'm not going to get in leadership because I'm probably not going to stay in leadership. So I did. ended up wanting to focus on finishing school. And so I actually wanted to go back to the bedside. I did. I actually went back to, I applied for a float pool, which the reason why is because they have this great incentive. If you work for a float pool, it was 72 for 80. So you could do three 12s. other, at the VA, we have to do 80 hours. Most nurses have to do 80 hours. speaker-1: hours. speaker-2: Well, and 72 hours is normal in all organizations, but at the VA, you get paid for 80 hours in this role. Yes. So that was like quite a big deal that you can cut your hours and not lose any pay by cutting down those hours. that, it's obvious. Like if you get that opportunity, like why wouldn't you jump on that? speaker-0: Well, and then another thing they did too is they, a big change they made with managers is we did work for tens and they made a change to where we had to do five days of. And that was really hard too, because when you manage a 24 seven unit, you're not just there for eight hours. You're there. I mean, you're getting called, you're getting texts all hours of the night, weekends. And then they took away that extra day. speaker-2: So was it like it compounded? Like you were already feeling burned out and now like this extra wiggle room you had to try to recover in between is gone. speaker-0: That was kind of the icing on cake. just like, I don't know. And so yeah, I did. I went back to the floor. speaker-2: How long were you on the floor for? speaker-0: I only went back to Float Pool. was there for a little over a year, which I really loved. I did like the Float Pool because I had worked in acute care the first 17 years of my career. then, so acute care is one service. And then when I was the tele manager, I was among emergency medicine service. I had gotten to know a lot of people. great thing with football is I got to go to all these different areas and you know just maintain those relationships and I really did like football. It had been a few years since I'd been on the floor and I felt it. ⁓ I realized I'm not a spring chicken anymore. ⁓ speaker-2: it night shifts again? I did. ⁓ and weekends? holidays and all the same. speaker-0: Yeah. So yeah, I had to do, had to go, which is fine. It was so nice to just have to work three days, but it was, you know, I mean, speaker-2: Not what you expected. speaker-1: Would you say the three days allowed you to also finish up your master's degree? Yes. Because you had the capacity. speaker-0: I I finished it up fairly easily because I had so much. speaker-2: And you did it pretty fast, you? You did it like a year, didn't you? Yeah, which is pretty... You guys are superheroes. I did not. I took the full two years for mine. I'm special ed. ⁓ speaker-1: I did mine in a year or ⁓ No, I think Brittany and I don't love school. No. And so we were like torture us for years to do accelerated, make me do every single thing, push, push, push. Let's get it done for the longevity and for the rest of our future. But it was like, I can do this for a year. can, can buckle down. I can work really hard for a year, but I don't want to keep doing this for several years. speaker-0: Let's get speaker-2: I had just started my degree when I got kind of shoved into management. And so I was trying to learn how to be a manager and be in grad school. So I think that was also played in a little bit. just couldn't have, I didn't have the bandwidth to go home and focus on school because I was so exhausted just trying to learn this really complicated new job. you, okay. So you went back to the floor for a year and then did something change? speaker-1: That makes sense. speaker-0: Well, so in my time on the floor, I would get so frustrated. There were so many processes that I was just like, oh my gosh, we need to fix this. We need to do this. I realized that as a, I mean, I would tell people, I would email people, but I did notice it didn't matter as much coming from a foreigners. It just didn't, not that, I mean, speaker-1: This does not work. speaker-0: Not that they didn't listen, because they did. But I really, ⁓ there were things I was very passionate about improving. then, ⁓ speaker-2: harder to take a really front and center role as a staff nurse because you don't really get dedicated time away from the bedside. Right. So even to just spend time on it would be hard. speaker-0: I went everywhere. so I noticed, and it was really good because it gave me a lot of perspective ⁓ for all the areas. They really, there's always been this kind of culture like us versus them. And, know, one unit, you know, will hate on another unit. it, I just was like, I, it made me have respect for all the units and see that they really all do have strengths, weaknesses. ⁓ They all work really hard. ⁓ And so that I was I was really thankful for that because you know, you only know where you work, right? You don't see the ins and outs of all speaker-2: very easy to ⁓ get in your little bubble and be like, all I care about is what's affecting me and the people around me. And if you just aren't seeing those effects, it can be easy to just assume that it's not happening or it falls out of your projected. speaker-1: One of our mutual friends calls this me town. speaker-2: ⁓ I like that. speaker-0: That's ⁓ speaker-1: when you get stuck in MeTown. And that's Amber Boleyn. She always says that. I'm saying her name because eventually we're going to be interviewing. Yes. speaker-0: That's exactly right. So I started to gain a lot of respect and appreciation for the CNOs. speaker-2: CNOs at the VA, this VA actually is like a house supervisor. Even within VA's, we call it something different and my VA now, they call it the RN on duty. speaker-0: Yeah, it's actually they changed it to the nurse of the day. You still think of them as CNN because it's just so. speaker-2: ⁓ interesting. ⁓ speaker-1: I'm actually curious. we call them, so I feel like this might be called different things across even the country potentially. So this is the nurse that kind of helps with the admissions and the transfers and oversees the entire hospital when executive leadership isn't there or available to do so. And essentially what they do is help make sure staffing is safe on the floors, make sure patients are sent to the right place for the right reasons. They really are that filter for that. And it's a big job. I would say that's the one job I never wanted to have. speaker-2: Well, you have all of responsibility and you have very little power. speaker-0: Yes, that's exactly right. speaker-1: Yeah, most men. speaker-2: Really don't get, well, I don't know if they changed it now, but it used to be, you didn't even get a different differential and pay as a floor nurse. So you had all this responsibility and then you had no power and you didn't even get paid for this like extra responsibility because you were getting the same as like just any other floor nurse. speaker-0: Yes, and they do have a different paste down now. speaker-2: Yes. So yeah, and we do too at ours, but there was a long time that it was, it was just like whatever grade and stuff you were at, that's what you got. It was the same across the board. Yeah. I can't believe people even stayed in that job, but we did, we had stable. We did. We did. I don't know why. They just must've been. speaker-0: Which is We had some really comfortable, experienced, stable CNOs. But yeah, so a position opened up, an assistant chief position opened up over acute care, which would directly supervise the CNOs and a couple other things. And I kind of thought about it was, I mean, to be fair, it was a pretty big pay raise. That was, speaker-2: Yeah. Sure, that can help in the decision making. We can't pretend that money doesn't speaker-0: Right. It's not everything, though. If I was thinking it was going to be this terrible job that money, doesn't matter. don't want to work. don't want to have a miserable. Right. But I love the idea of the assistant chief role was new. Tressa was one, but she was like, think the first one facility. And so I love the idea of being an assistant because again, I had been thrown in to management, thrown in as a detail. And I thought. speaker-2: Money is ⁓ speaker-1: One of the first ones at our facility. speaker-2: in our speaker-0: What a great opportunity to be the assistant, like not the one completely responsible for the service. speaker-2: And the person who was in the full chief role is pretty also a very great leader. And so like, yeah, like I could see just being like, well, I want to go work with this other person who I think would be a great partner who could help me learn and make the experience feel positive and allow me to like become my best version of the leader that I think I probably could be if given the fertilization to grow. speaker-0: Exactly. Exactly. was, I thought she'd be the perfect person to work with. And again, I was, I had worked in acute care for so long and I, I just really thought this would be a good opportunity. So I was like, I'm going to apply. And I did. And so got that position and that's where I've been a little over a year. I like it. Most days. speaker-2: And how long have you been in that position now? And how are you liking it? Would you say that you've changed anything to help you feel, to like prevent your burnout inevitably, like so that you don't get to the same place you did before? speaker-0: Yes, I think, ⁓ well, it helps having who the person that is the chief is very supportive. I feel like we kind of have each other to lean on. have her back. She has my back. I don't feel like I'm alone. yeah. And, and she's very, she's just very supportive. ⁓ And yes, I do think that realizing, ⁓ just trying not to take things home, you know, and I do sometimes. speaker-2: That's huge. Do you have any strategies for how you do that? speaker-0: ⁓ I think just over time I've grown wiser and I've just kind of become a little bit more resilient to that and, and realize that. know, dwelling on it and worrying about it. It just doesn't help anything. speaker-2: Yeah, it doesn't solve the speaker-0: And so, you know, I just, try to realize that and, and just, I would used to panic when I would get a call, you know, from the nurses, I'd be like, oh my gosh, what are they gonna ask me to do? What do I need to do? I need to save them. know, I'm, I'm responsible to save them. And I just, I try not to think that way anymore. And I just kind of think, calm down, you know, just be there to support. And usually 99 % of the time it's fine. speaker-2: Mm-hmm. speaker-0: It's not a big deal. just realize that there's only so much you can control and do your best. normally your team appreciates that, ⁓ you know? speaker-1: I think being authentic and just telling them that you don't always know or always have the answers is kind of a power, not really a power move. It's not an intentional power move, but it is a power move in the sense that it gets you what they need and what you need to be more successful. ⁓ One of the other things I was thinking of when you were talking is, ⁓ also I just forgot, so go ahead. speaker-0: I speaker-2: Well, I was just going to say in a lot of our conversations offline recently, there's been discussion about ⁓ the perception that non-leader nurses have about leader nurses. And there's kind of a bad rap for nurse leadership. There's a lot of, especially during COVID. I can't speak to the reality. I wasn't in leadership until COVID was already in play. ⁓ But there was a lot of media going out that was really negatively slanting leadership and that, it was very much like leaders are here for the power and they don't actually care about the frontline staff. we knew that we did not believe that. But I think being in a leadership role and having done a few of them now, I've seen that it's hard to communicate that to the frontline staff. And so how do you help them? believe and trust you that you are doing the right thing for them. Because just doing the right thing and just really advocating for them is not necessarily going to help them see that. speaker-1: They don't see what you do behind the closed doors. don't see the meetings that you have to attend for different reasons. And that's okay. They don't need to know that. It's not a big deal. That's part of being a leader. One of the other things that I, now I remember what I was thinking ⁓ when Brittany said something like she felt like she had to save them. That was something that when, when Cindy and I were together, one of the things I said, and I, and I pushed this pretty hard. ⁓ And I think we did a good job, but I. speaker-2: ⁓ speaker-1: did not want phone calls all the time. So when our charge nurses would text us or call us, I would respond with questions for them to help them figure it out themselves. Because at the end of the day, that is the shift they're working. And the message we sent to our charge nurses is like, you can speak for us when we're not here. And I just, if there's something major that happens that you need support with, absolutely, I have your back. But what I want you to do is know that I have your back, whether I know what you're saying or don't know what you're saying. speaker-2: And we just tried to give them parameters to like, know, like, I think we, did like an in-service at one point that was, you know, like calling off overtime, for example, and you would say, okay, here's a scenario. You have this many staff and you have this many patients and this is the level of the acuity and like, tell me what you would do and then have them just think about it. And I think that was my goal was I just want you to think about it. I just don't want you to be like, Here manager, make this decision for me, because we knew that we would not sustain if we were always having to answer every question in every scenario. speaker-1: The other thing I also pushed our team to do is to lean on the CNO to follow their direction. Right. Not to fight them all the time, but also to make sure that they're not every CNO or house supervisor has the exact same skill set. So there are times when you do have to question them because they may be wanting you to run shorter in the ICU or the ER. speaker-2: So you have to be able to speak to why. We had to teach the staff some language. speaker-0: Yes. speaker-2: Do you feel, have you been doing that now in this role? you think, do you feel like you're doing that better now in this role than you were previously? Like, guess, I guess trying, how have you helped empower staff to make their own decisions so you don't feel like you have to come to the rescue every time? speaker-0: You mean doing like speaking Right. think so supervising the CNL is a whole other ballgame now too. I see as a manager, as when I was the manager, I was kind of on the other side and I would question them. Yeah. And I would say, well, you know, I, and now I see this whole other perspective and they do get a lot of pushback and ⁓ you know, everybody's questioning their decisions and it's, sometimes, you know, speaker-2: ⁓ yeah. speaker-0: They get jaded. They get jaded to where it's sometimes their approach isn't great. And that's what I've tried to work with, work with them with is like, if you can't give somebody staff, if they're calling you for help and you can't give that, it's kind of how you say it. Yeah. You know, and to be fair, they get a lot of disrespect. And so I think sometimes it's easy to respond. speaker-2: Yeah. speaker-0: little with disrespect and what I try to say is, you know, don't respond to bad behavior with that behavior. I know it's easy to say, you know, but it's okay for you for somebody to ask why you did what you did. You know, do I think you need to sit there and plead your case and, you know, explain? No, but, but you can like just explain to them why you made the decision that you made and not everybody's going to agree with it. They won't, you know. speaker-1: Yeah. speaker-2: Well, and I think on this podcast in more than one episode, we've talked about that doing the extra effort, like explaining the why or doing the back work to build the trust in the relationships, it can feel like I don't have time to do that. But what I feel like we are our goal, hopefully through this podcast, we can help leaders and I think people who maybe even are in unofficial leadership positions like that one. to say that extra effort will actually save you time down the road. Because then, you know, like I remember we had specific CNOs who we'd say, if this CNO tells me I don't have staff, I believe him. Because he had spent so much time in the past saying, I've already gone through this option and this option, I've asked this people. And they explained what their process was to get to that conclusion. Whereas other CNOs maybe just said, I don't have anyone. And you were like, well, do you really not have anyone? Are you just saying it? Cause you don't want to go ask anyone. But you know, like it's, don't know, I've been finding and it's hard to deal with as a leader, but I think I've seen myself even do that where I jumped to the worst case scenario and I'm like not assuming good intent. And I think that's kind of a natural human response. And so like, we have to try to cure that through speaker-0: Right. speaker-2: patience and kindness. speaker-0: Yes, exactly. and then, you know, for the CNOs, a lot of people, well, some units will think we need staff. I know that this unit is over staffed. please send me staff from there. not only do they have to deal with that, they have to deal with the units floating their staff. So I don't know if this is how it is everywhere. Nobody likes to float. speaker-1: Nobody likes to float in the history of ever any hospital. speaker-0: And that is a huge battle when staff from one unit have to float to another unit. The CNOs get a lot of grief about that. so, I mean, is that how it is at your VA? speaker-2: Tail is oldest time. Yeah, they get a lot of pushback too. The position, we call it the R-Nod, and ⁓ the position's used slightly different. Like for one example, instead of the staff calling the charge nurse to call in if they're calling in sick, they call the R-Nod directly. So they manage all of the sick calls. So they really do have the whole story, which that is helpful. The negative of that I have found is that... The charge nurses don't get as much information. so they, feel like, get a little bit handicapped by not knowing all of the, you know, the... Yeah, the intricacies. you. ⁓ But yeah, they definitely get a lot of pushback. speaker-1: details. just from previous facilities I've worked at, I think we could both, at both facilities do a little better in the sense of it at large level one trauma centers, you are not allowed to not call not only the house supervisor, nurse of the day or nursing supervisor, whatever it is called. ⁓ you have to call that person or the staffing office, depending on which one it is or, and your unit. have to call both. And so it's more than one call. You could be sick as a dog. Interesting. speaker-2: We're both like only doing half of the situation. Yeah, because if the staff calls the R-Nod and the R-Nod doesn't have time to call the charge nurse and they don't know and they're like trying to get set up for the next shift, they may not have the information that they need. speaker-1: Another rule that is very different from the VA, these are just little things that it doesn't really matter, but just small things. Other facilities require a certain timeframe before your shift starts to call in, or it's considered a no call, no show. That is not true at the VA. So it can be very tricky because you can have a very last minute sick call and you have to... And there isn't, which is okay because at the same time, you're a human being and you will have... speaker-2: There's no repercussion for it. You don't want people to feel like they have to come to work sick because they're, you know, they can't like my, my, have a teenager who works, ⁓ you know, like entry level jobs. And when he was working his first job at like a fast food restaurant and he would be super sick and he'd be like, Hey boss, I am, I have a fever. Like I am so sick. And she'd be like, leeway. she'd be like, okay, go find someone to cover you. And it's like, you're like dying in bed and you are expected to find someone to cover you. Like, so yeah, there's a middle ground somewhere. There's and cons. Yeah. speaker-0: But yes, I do think when there is no repercussions, certain people tend to take advantage of that. that can be your problem. Yeah. Yes. speaker-2: You're always going to have people like you. speaker-1: So true. speaker-2: ⁓ If you, like, if a new person who just accepted a new leadership position, if you were to give them, like, I don't know, one or two of the tips to help them get started, like, what would be your number one, number one or number two things you would say? speaker-0: get started. ⁓ there's so much. So for me, I think it's really important to stay grounded. Really important to always understand, you know, your staff's perspective. I think to build trust, I think it's always good to be willing to get your hands dirty. Like I do think that when managers don't step in enough, I think that speaker-2: I know, right? speaker-0: It doesn't take much. There's been a couple of times when it wasn't even that much. It was maybe three or four times the whole three years I was on telly. I would come in, you know, and it did it. It's all it took is just, you know, one or two times that they realized like, okay, she's, she's willing to do what she expects us to do. speaker-2: You're not asking them to do something that you would not do yourself. speaker-0: That's, think, so big. Like, don't expect anybody to do what you wouldn't do. And if you can't, advocate. Advocate for why, you know? Because there are times where I do think the staff is asked to do unrealistic things. agree. You know? And I think people are so far removed from the front line that they don't realize what they're being asked to do is just not realistic. speaker-2: When you were talking speaker-1: it that they came up with that there's a solution to something that you're like, that isn't going to work at all. Exactly. It doesn't even go with any of their workflow or any of the things they do. And that's always tricky when that happens. speaker-0: Right. And you have to be careful because sometimes, you're too far that way, it's like this balance, you know? I mean, some people will say, we can't do anything, you know? And so that's why I think it's important to be willing to do it. So you know firsthand, yes, you can, or no, this isn't feasible. speaker-2: Thanks. Not. Yeah. Well, and I wonder if it helps a manager not become so jaded. I have found, I have had a hard time because now I'm at an associate chief level and I don't interact with the frontline staff unless I purposefully go there, which I do. I like to try to have a front face, you know, and connect with the frontline staff, but I'm not in it with them every day. I'm not sitting on the unit. I have an office away from the main units and I have found myself just. getting frustrated with responses. And I think I have to tell myself, like, are you forgetting what it's like to be at the front line? And I think when you do step in, it's a good reminder, right? It helps you as the leader not get pulled away. And I think it can be a protective factor for becoming jaded. speaker-1: Yeah. speaker-0: Yes, ⁓ yeah, absolutely. And I think that's so important is to realize and recognize when you are getting further and further removed. speaker-2: Right. And what are you going to do about it? Yeah. Right. speaker-0: Yes, exactly. speaker-1: I like that. So like that. I was just kind of circling back to Brittany's original thing, like what burned her out originally was recognizing that she no longer had empathy. so you're saying that like, making sure that you keep, not only is it valuable for the staff to see that you're willing to do what they're willing to do, but it's also valuable for you as a leader because it brings you back and keeps you grounded. So staying grounded is one of them. Maintaining your empathy. And what would be, is that? Are those the two main that are big for you? ⁓ speaker-0: And just, think... ⁓ There's so many things that you need to do. Just, you know, showing support. Make sure you're being, you're being supportive. But I mean, there's, there's a balance, you know, you, you want to be supportive, but at the same time, you need to be supported too in your position. And so sometimes, ⁓ I feel like staff can become selfish, you know, you're not realize everything you're doing to help them. I think just trying to maintain that balance of, you know, ⁓ self love and supporting your staff and just Being willing to speak up. think a lot of leaders don't speak up. just, they, mean, there's a manager that I work with that I know works probably, you know, two hours extra a day. And it's like, don't do that. know, if things are hard, you need to speak up. Because if you leave that position, somebody's not going to be able to. ⁓ speaker-2: ⁓ yeah. Well, that's why think that's why secession planning is so important. Yes. Because it's not just that it's not, I think sometimes leaders are like, well, I don't want to burden anyone else with this task. But if you don't do that, you end up setting everyone else up for failure. We had a person in our leadership recently who was there for a long time. want, mean like 40 years and had taken on so many roles. And when he, he retired and when he left, it was like, it's been mayhem. We're like, had no idea what was going on and the processes are all antiquated. There was a lot of issues going on and it was just like, but nobody knew what he was doing. Like nobody knew cause he hadn't delegated anything to anyone. And now you're like brand new, trying to figure it all out with like nobody to ask a question to like what happened here. speaker-0: Exactly. You have to kind of choose your battles, but know when to battle, know when to speak up and say, I need help or this whole process is not working. We need to improve this system. I think that makes a huge difference, but you also don't want to be that person that's just never happy either and never satisfied and always having problems. You want to be able to, you know, solve or solve your own problems sometimes too. speaker-2: This reminds me of Teresa in my favorite leadership book. speaker-0: What's that? speaker-2: you know what our favorite leadership book is called? It's called The Dichotomy of Leadership. was I guarantee you. speaker-1: don't know the name of it, but I know it. ⁓ was going to say extreme ownership, but I knew it wasn't that one. But it's the same author. speaker-2: But it just talks about there's always a balance. It's like accountability versus engagement and standing up for people versus holding them accountable and like all of it, there's this like fluid balance. It's not easy. You have to delicate. Yeah, mean, managing sick leave and supporting your staff and what they need while also keeping the doors open. So patients have a place to go. It's like, yeah, it's a, I don't think there's enough. energy that has gone into talking about the tightrope that a manager has to walk. speaker-0: Right. And some of them are really good at one thing and not the other. You know, they talk about the type of leaders, know, the politician and the dictator. You know, I've seen all of those, but I can't remember the one that's like ideal. Yeah. speaker-1: Transformational or a servant leader is kind of somewhere in the middle. actually fall between the two. I don't do either one very well, all the way or extremely well, because transformational is like consistently changing and like supporting that and encouraging that, which I do a lot of times. And servant leadership is somewhere along those lines as well, but I don't want to be a servant 100%. I want to serve the people I work with, but I'm not. speaker-2: going to it for them. That doesn't mean I just do it for you. Right. And I think that for a long time, the servant leadership model was highly encouraged and was the buzzword of the right type of leader to be. There was no other correct leader to be. Yeah. speaker-0: So. speaker-1: myself 100%. speaker-0: I do that for so long. speaker-1: I don't think that's the true meaning of servant leadership, but I think that's the interpretation that can come across with it. And it's like, no, no, no, that's not exactly what it means. ⁓ When you were talking about the guy that has that everything fell apart to me, that's a system problem. And I frequently say, I do not want anything to land on only one person. speaker-0: Information hoarding. speaker-2: I hate that. Or like we've been doing, this has been coming up recently, we've been doing annual evaluations and ⁓ there, so for the VA and all of government evaluations got way more strict and like specific about what criteria you have to have written down. And one of the things I keep saying that people have been having a hard time understanding is if you develop a process or like whatever you're talking about, speaker-1: That drives me crazy. speaker-2: If you can't take yourself out of this storyline and it still works, then you didn't do a process improvement project. You did a you and your practice experience. So, which is fine if you're a new nurse, but we've been talking about like nurses that are functioning, you know, are charge nurses and our mentors and our unofficial leaders for what we've been looking for is process improvement and quality improvement. And, but I've had to think about it that way. like what you're talking about, this isn't really process improvement unless you can take me out of the story and it still works. speaker-1: I tell my staff that all the time, seeing a group of educators, like I'm like, okay, well, if you quit tomorrow, can someone step in and fulfill your role or it's going to be a process obviously you don't. speaker-0: It needs to be process. speaker-2: You need to be able to step away and someone could walk in and plug and play. It shouldn't feel like you're having to rewrite the book. speaker-1: from the get-go. speaker-2: Yeah. Which it did feel like we were doing in the beginning, going back to what we talked about before, because it was like the people that knew how to do what we did were all gone. They all left. speaker-0: Absolutely. speaker-1: And we then, think, tried or attempted all three of us, attempted to try to create systems that would be passed, like some more sustainable or sustainable. We did start some succession planning. One of the things Cindy and I started in the ICU, and I don't know if you ever did this, we, you're not supposed to select lead charge nurses consistently, but we kind of did that for the weekend crew because they needed some more support and consistency. And so we had a day shift charge nurse and a night shift charge nurse that was pretty consistent on the schedule. Like the staff knew when they came in on these days, this is who their charge was going to be and this is what was going to happen. And that was succession planning. And one of those people ended up becoming the ICU nurse manager now. ⁓ I think that developed them a little bit enough. Not perfectly, obviously they're still going pain. speaker-2: Do you like a ability to sort of practice those skills in a safe environment where you can make mistakes, but it's not like there's, it's a, it's a low risk mistake. You know, it's, it's not going to have high consequences if you write, if you screw up something over the weekend versus, you know, if I make a call as a manager, as an associate chief nurse, like some of my decisions can have like huge sweeping cascading domino effects. You know, and if I don't have the experience to be able to like really like do the chess moves in my head and think about like, what are the pieces that I'm going to miss that are, this might affect. ⁓ then that can be that it's more impactful. having, having a test play area. speaker-1: Well, I think we should conclude. ⁓ just thought we really wanted to thank Brittany for coming. Thank you, Cindy. Thanks for the engagement. We really enjoyed this. speaker-2: ⁓ if you're watching us on YouTube, please like and subscribe. That is very helpful to us. ⁓ we have an Instagram account called the nurse leader dumpster fire podcast. Yeah. We have, ⁓ email addresses, Cindy at aria nurse.com. Thank you. I don't know my email address. speaker-1: our inner circle. at aria-nurse-circle.com and teressa at aria-nurse-circle.com. So if you have any questions, comments, concerns, definitely reach out on any of those platforms, comment on some of our videos, whatever it is that works for you, and we would love to get back to you. speaker-2: And we would love to know what you want to hear about and what discussions you want to come watch and hear. speaker-0: and your experiences. Like it'd be just to compare. speaker-1: ⁓ Yeah. What did you find that you connected with on this podcast between the three of us that we were talking about? We would love to hear from that. Brittany would love to, and we'd love to get that information back to her too. Because it's hard. You sometimes feel very alone as a leader. And I think that's one of the things we're trying to address. So thank you all for coming and watching us. Okay, bye. speaker-0: Bye!