“When nurses first came into hospital environments, they came in and provided a level of surveillance, if you will, for the people who were there pending care by their physicians, whether it be having their blood pressure read regularly or some kind of poultice or whatever it happened to be. We still do that, but we do it in a more technical and complex environment. The role of a nurse doing surveillance today is much different. When you look at the complexity of the equipment, the procedures, the number of people who interact with a patient on a daily basis, the nurse’s role, while we’ve always been advocate and coordinator of care, it takes on a more heightened responsibility today. That ownership of that patient care and understanding what is truly not only in the best interest of the patient, but something that’s important to the patient. We have to always guard against using our influence, our position, or our opinion when giving a patient information.  The goal with a patient, for me as a staff nurse when I used to do it at the bedside, and even today is giving a patient as much information as I can that helps them make a personal choice about their health.” 

“One of the first things you learn in nursing school is you collect data, you assess, and you plan. But every plan that you make needs to be an individualized plan. And that’s time immemorial for nurses. With a lot of the challenges we’ve had, we need to be very conscientious about what our patients need now. Multicultural, equity, diversity, inclusion, social determinants, all those different important items and issues present themselves today differently and more, I guess, readily recognizable.  

So that savvy nurse at the bedside who’s doing that care planning has to possibly go beyond the day or beyond the time the patient might be in the hospital and extend conversations with other members of the team to make sure that transitions for patients are what they need to be. Because if I have a patient who’s on a limited income and they have to make a decision between buying medication and buying food because of their socioeconomic situation or where they live, maybe they live in a food desert. We didn’t have food deserts when I started this, but now I need to understand what they are and figure out how to solve for that. Now we have more support than we had before. We have case managers and social workers and all sorts of community resources that may not have existed 30 years ago or 20 years ago. So how do I connect that patient to the right resources as they transition home or to wherever their next stop is and ensure those occur? How do I share that information by educating the family and the patient?” 

“When my grandfather was probably in his eighties, and he had always had an enlarged prostate. And of course, we all know it was either benign or it was cancer. But he just kept going down to the VA. Having his checks every however many months they told him to, and checking his meds, and then having his hypertension check, his high blood pressure check. And so he finally got to the point where his prostate was causing him trouble to urinate, so he had to come in for a procedure. I was a nurse manager at the time, and I went to visit him after his surgery. And he’s sitting there in the bed, and he says, ‘All right, I got the big C.’ In the olden days, that was what people called cancer because they didn’t want to say the word. And I said, ‘okay, all right, what do you want to do?’ And he says, ‘I want to go home.’ I said, ‘well, do you want to treat the cancer?’ And he’s like, ‘no, I don’t think I do.’ I said, ‘all right.’ Well, in comes his young primary care physician, because that’s back when they took care of you when you’re in the hospital. And she was a good friend of mine, and she says, ‘all right, Mr. Murphy, here’s the deal. We’re going to do the bone scan, we’re going to do this, we’re going to do that, we can do this on Thursday,’ yada, yada, yada. And he looked at her very quizzically, and I said, ‘Debbie, I don’t think he wants to treat the cancer.’ And she was like, what? And he looked at her and he said, ‘I’m 80 some odd years old.’ He says, ‘I’m okay, I don’t need to do this, I don’t want to do this.’ And so she’s like, ‘oh, wow, Mr. Murphy. Okay.’ And then she left. And he said, ‘What do you think?’ I said, ‘Well, the treatment is sometimes worse than the disease.’ So I said, ‘How do you want to do this?’ And so those are all the conversations we had. And as we were closing our conversation, he said to me, you can’t tell your grandmother. And I’m like, oh, for God’s sake. Anyway, that was our little secret. He lived another five or six years and then passed away very quietly in his sleep. Ultimately, he made decisions. He got the information he needed. He decided he didn’t want to do anything about it, and he owned it. But that’s one of those transformational moments when you learn the importance of a patient having information.” 

“When you’re a new leader, you think you have to know and do everything. And this is a really small, inconsequential thing, but we were trying to plan the Christmas party, and I was really new in my role, or I should say the holiday party. And I used to do the holiday parties when I was a staff nurse in the emergency department all the time. No one was stepping up, so I said, ‘You know what? I’ll handle it.’ So totally forgot about it because I was so busy. Made the reservation last minute, and suddenly I’m in a staff meeting one day, and I said, ‘I didn’t need to do this. I didn’t need to be the expert or the person to do this.’ And that was probably my first ‘Aha!’ moment about I don’t have to do everything. We had the holiday party, we had a blast, but ultimately, I didn’t need to do everything. And I think that was a relief in some ways. And it also laid the groundwork for the team there and I to work together to create a new care delivery model. Because what we learned was each of us had a job, and it was our expertise in that job that we brought to the table as key stakeholders to have a conversation about what things could look like, with the commitment to safety and quality and our patients at the center of our conversation. So that just continues to fuel the importance of connections and relationships and the significance that they play no matter where we are and what we do in healthcare and beyond. But that was new leader ‘aha’ moment number one.” 

“I don’t even remember who told me this a long time ago, but you play for two teams at work. You play for the team you’re on, and you play for the team you coach. So for me today, I’m nursing’s coach, but I’m a member of the CEO’s team. That means there are two roles that I play. And the team I’m on, the CEO’s team, that group of people are the people that I rely on and I trust to work on different things and keep each other informed because we’re so busy, and academic healthcare and medical centers are very complex, and there are a thousand things going on at one time. But because of relationships that we’ve made with one another on that team, we all know the position we play… 

And then on the team I coach, I’m trying to make sure that those kinds of interactions and relationships are created across that team, and that’s with the whole team of nursing leaders. So it gets a little bit more complex because they all know nursing, but sometimes it’s easy to assume that they know each other’s path, and it’s not always true. Having a safe place to have that dialogue is another one of the things that I have on my plate as the coach. It’s making that playbook right.  

That’s probably something that I’ve learned as a leader as well. It’s to rely on the people you have around you and trust. I am really very fortunate in this situation here. We have a very trusting and supportive environment. Not everybody has that. And sometimes when you’re brand new to an organization, you need to find that, and it takes a lot of time because you have to look somebody in the eye and sit down with them and learn who they are. So we’re right back to relationships again.”  

“I think since [COVID-19], people just in general have not necessarily been doing well. And I don’t know if it’s from two years of being isolated and not having to be social or if it’s from not feeling good. I don’t know what it is. But we’ve had a significant rise in workplace violence. And it’s not only patient and family against workforce, it’s in civility amongst people on your team. There’s a lot of work still to be done, and even in the safe environment, some of that is happening. But that’s when you have to be tough too, because a lot of what we’re talking about now is nuanced. This is not the stuff that’s easy to see and easy to act on, because usually people don’t do it in front of the leaders. We then have a personal accountability, regardless of our role in an organization or on a team, to speak up on behalf of each other.” 

“The other life lesson that you learn when you’ve been working with people for a really long time is you really can’t bring your ego to work. If you take things personally, you lose your objectivity, and things become very emotional. And when you infuse an amount of emotion into that, you’re not staying fact related. You’re not staying focused on the topic at hand. You’re spinning off and telling a whole different story. So I think you have to really go into conversations, especially hard ones or situations that are going to be difficult, with a level of intentionality to stay patient or person-focused and to be supportive. Because you know what? Nobody comes to work to be bad or to do bad things. There’s something behind that. That’s where you have to treat people personally. It’s back to that individualized care, and you provide individualized care, whether it’s to a patient, a family member, or a person you work with. So when that person when you have that conversation, it becomes a question of, ‘How’d that make you feel? How can I help you show a little vulnerability, be authentic, be transparent?’ If you don’t have the answer, tell them you don’t. But you’ll do your best, right? And all those things you learn in Crucial Conversations 101, and all this kind of stuff, it’s all pertinent, but it has to be genuine. When you engage in a personal relationship or a personal conversation, you can’t go into it knowing you have to hit four points. You have to go into it and genuinely want to be with the person and have the conversation, whether it’s a conversation you want to have or not.”  

Rebecca: “When you think about your calling to this work, what is it that gets you the most excited or really lights you up? 

Karen: “I think it’s people. It’s engaging with nurses at the bedside, rounding, having town halls, and getting to a place with them where they feel comfortable to say, ‘This really stinks, I don’t like it.’ And I know a lot of leaders don’t like to hear that, but boy, if you hear that, you’ve got a place to start. And this is not a bed of roses. We get inundated with a gazillion emails a day, and we have all sorts of stuff, boxes we have to check and things like that. But ultimately, we are here to take care of people. And as a leader, I have two groups I take care of. I take care of the ones that are here for help, and I take care of those who take care of them. And it’s knowing how extraordinary that work is that nurses do and how important their voice is in driving change in health care. We’re the people who are closest to the bedside. We’re the people responsible for the patient’s voice. So we have to be sure that whether it’s at the bedside or the boardroom, that voice gets heard. While I can do everything internally to make sure people do this and share and take best care of patients and grow themselves professionally. As a leader in nursing, I have to turn outside also and make sure that we’re doing the same thing across the different constituents who need to know what we do and need to know how health care can benefit from nursing’s voice as we try to make changes that will result in promoting health, improving prevention, and caring for people in managing disease.”  

“For all of you who want to do this and you’re just getting started, do it. I think that one of the biggest opportunities you have, especially as a new and aspiring leader, is to learn the importance of the strength of teams. When you work together with staff, you start to realize that we’re greater than the sum of our parts. And having had that opportunity early in my career working with the team as a new nurse manager, we were able to build a model on that unit that not only reduced length of stay, but allowed us to barter with hospital administration, to have a gym put on the floor and get our nurses station renovated to accommodate the changes we’d made. And part of that was because of the ingenuity of the staff. We were able to create a self-directed model that provided exceptional care, very personalized care to our patients. And it was so exemplary in the mind of the nursing officer at the time that he had us go to the boardroom and present it. And that was in the olden days where we just had a flip chart. But to get all that done and to sit back—and of course, you’re sweating bullets through your palms—and to have the CFO look at you and say, ‘Is she really a nurse? How come she knows this? How come this team knew to do this?’ That probably was my first insight into people know they need to have nurses, but they don’t know what we can do, and they don’t know the scope and the depth and the breadth of the things that they can accomplish if they take advantage of us. Even if it’s a department-level team to promote and propel health care into a new dimension. So do not ever think your ideas or the ideas of your staff are just the same-old. New team, new day, new time. Go for it. That’s it.” 

“That nurse at the bedside needs to always make sure that not only are they keeping an eye on everything, but they’re actually making sure the patient has a voice in everything. And it has to be the patient’s voice, not the voice we all want it to be. And that can create personal challenges as well as professional challenges.” 

“Your signs and symptoms, your recommended procedures, are textbook for what we believe we should do. But in the context of your life as a person and patient at that moment in time, how does it fit? And that’s the job of a nurse. As the advocate for that patient. Did I ask that question? Did I understand to say that?”

“One of the things people have to do as a leader today is: be sure that there isn’t a resource for that particular thing in your system. If you need to do something with care coordination or you need to do something with some kind of thing that needs to get fixed somewhere rather than trying to orchestrate things yourself or purchase a service yourself.” 

“As leaders, we have to listen all the time. We have to listen to body language, we have to listen to eye contact, and we have to listen to who sat next to each other. The amount of emotional intelligence you need when you’re working with people is: the more you can get, the better.”