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Nathan Oliver has a head full of anatomy and physiology but as a student he felt like he was underwater.
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While his mates were bouncing and strutting about their new skills, Nathan didn't even know how to help a patient take off their cardigan for a shower.
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He realised that learning by doing isn't enough.
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We have to learn through community and reflection.
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You're listening to Better Every Shift.
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I'm Naomi, and I'm here with TV.
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And today we share with Nathan Oliver.
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We're drawing on our lived experiences and our questions to help you bridge the gap between clinical stress and professional efficiency.
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We're tackling the fear of looking incompetent in clinical spaces.
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Lots of clinicians lower to the level of their training during emergencies because they haven't mentally rehearsed the moves.
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A burnt-in memory from one bad piece of feedback can stop a clinician from apologizing or speaking up for years.
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In this episode, we're delighted as Nathan shows us how to use simulation to make the implicit explicit and repair the psychological safety of your team.
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Let us know who you are, how did you get here?
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Yeah.
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Wow.
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My name is Nathan.
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It's lovely to meet you.
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I am a nurse by trade.
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I live in Canberra.
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I did my study at Canberra.
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I spent a lot of time clinically, a bit of everywhere, but mainly found my home in emergency department in an ED in Canberra.
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I remember all my student colleagues being thriving.
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They look like they're having the best time in the world, and I wasn't.
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I found it really quite stressful, actually.
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Especially when we went on placement.
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Everyone would go out on their placements across the place and everybody would come back bouncing and strutting.
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Look at all the new skills they've got.
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But I didn't feel that way.
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I felt like I was underwater and I didn't know.
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I had a head full of like anatomy and physiology, but I didn't know how to help somebody take off their cardigan for a shower.
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Like I didn't know how to make those kinds of moves.
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I became a new graduate and then I was a new graduate nurse, and all my mates were coming back and after work saying, Oh, I've got my cannulation competency and I'm thriving, man.
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And how are you doing, Nathan?
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And I'd say, I'm all right.
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But I wasn't really all right.
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I didn't feel awesome.
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All my mates got it, I didn't get it, I'll be honest.
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And then probably before this was a term that was coined, perhaps, but way back, this was many years ago, this is 20, 20 something, this is a while ago.
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I had a growth mindset thought.
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The growth mindset thought was, gosh, I don't get this job.
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This is hard for me.
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It's not landing.
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But one day I will, and when I do, I want to help other people not feel as lost as I currently feel.
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You know what?
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I it did land, and it took about six months.
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I tell my nursing students all the time this many of you might be feeling this when you go on placemat.
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Many of you will feel this when you graduate.
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Just stick in there, just keep turning up.
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You'll get through it, and you'll come out the other side.
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I certainly came out the other side.
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I felt like it landed for me.
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After a couple of years of various clinical roles and emergency department work and met nursing and things like this, I found myself back heading towards this true north of helping people feel more supported.
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That led me to education, that led me to looking after new graduate programs in Canberra, to the magic that you see when learners' light bulbs switch on.
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That can happen in a myriad of ways, but like often happens in simulation, I've noticed when you get the sort of some little moving bits all together, these light bulbs switch on through rehearsing and debriefing.
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And that led me into this real career choice of mine, which I've spent the last over a decade purely focused on simulation.
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So, like you, I haven't been clinical clinical since about 2010-2011, but I have been thinking a lot about how we learn through simulation.
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I actually ended up packing up family here in Canberra, sold everything up.
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And my partner and my children and I, when the children were still in arms, we got on an aeroplane and we went over to the UK.
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I got a job that was really a career-defining role for me.
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The Associate Director of Medical Education for Simulation in Edinburgh in the UK, NHS Lothian, which was away from nursing.
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I was no longer in a nursing world or a paradigm.
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I was 100% in a medical paradigm, working with doctors and leading their simulation setups and suites with simulation technicians and teaching fellows.
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We had some great impact in helping junior doctors and high-level clinical teams rehearse and practice for really big events.
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Sounds a little bit like some of the work that you have done, Naomi, in the past as well.
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Yeah, on a much bigger scale.
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It was an incredible adventure.
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And I got my master's of education while I was over there, focusing on simulation, and became an executive committee member of the Association of Simulated Practice in Healthcare and had the great privilege of co-directing the graduate certificate in simulation in the University of Edinburgh, doing a lot of faculty development through the Scottish Centre for Simulation and Clinical Human Factors.
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So my whole life has come around how we all can learn through simulation and debriefing.
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And I'll finish by saying, because man, I've just monologued, is getting on an aeroplane, we flew back to Australia three years ago, 2023.
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COVID and children and parents getting older made us think it's time to come back to Canberra.
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So I'm currently now the simulation convener at University of Canberra in the nursing school, looking to see what impact we can have in simulation across the Canberra region.
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And anyone who agrees with me that it could be a really helpful way to learn.
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Yeah.
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I want to say something spicy if people are reading up or carry Kolb around, which is it's a bit of an old way.
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1984 was Kolb's thinking, other underpinnings that are really interesting in the way we all learn as clinicians and as humans.
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For example, this social cognitive piece, it goes a bit like this.
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We think that we have to learn by doing, because that's we've grown up thinking, oh, that's the way I learn, I have to do.
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And we do, we do, but in simulation and in the work that we do, just as a human experience, we also learn in community.
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It's a social practice.
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My students watching their buddy nurses and going, I don't maybe not do it today, but I watched them do it five times, and I think I'll either definitely do that or never do it.
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In simulation, we have the ability to replicate elements of an event.
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We're not trying to make it real, we're just getting a little moment in time, and we're saying, look, imagine if this was a thing that happened.
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Let's work through it, let's do a thing.
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But even if people are watching, by engaging through reflection afterwards, we find that people are learning as a social piece rather than when is it my turn?
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That's important for our work because we've got a lot of people that need to be educated and always a resource challenge, don't we?
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Absolutely.
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Fab, we uh have some challenges for you, Nathan.
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We thought it would be really nice.
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A lot of our work is around how nurse leaders and managers actually support their teams, and part of that is through understanding their work, giving feedback, debriefing, coaching, all of those things.
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So we want to give you some scenarios, and we want you to let us know how you would unpack those.
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So, how would you debrief those?
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Because we think there's value in that for others that can take away from your experience.
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You've done lots of work in this space, you've had lots of experience, you've probably seen it go badly on occasion.
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So, we really want to hear how you would manage some of these scenarios and what we might draw from that for managers if that's okay.
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Oh, what a challenge.
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Sounds lovely.
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Let's go, let's let it go.
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Do you want to kick off the first one, Tubi?
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So you have a very capable but highly disruptive team member.
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So a nurse who's clinically strong, quite experienced, but are often dismissive of practice of junior staff, they're pretty resistant in simulation um experiences and they tend to shut down the feedback.
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And while the team looks up to them because they're very experienced, they also are a bit scared of them and feel a bit bruised by how they bring themselves to work and show up to work.
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So, in a simulation debrief, how would you manage this?
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What would you do?
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Yeah, wow.
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That's one of the big questions.
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When I'm working with people who are debriefers and we're talking about the really challenging moments in debriefing, those unexpected.
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Sometimes you can expect it if you know the team well and it's a very particular personality that you're painting.
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Often you don't.
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And you go in with the best will in the world, and something spicy like this jumps in.
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Yes, it's really difficult.
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My response would sit on a couple of things.
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For a debriefer, there's something about this idea of attunement, of which isn't necessarily an emotional picking up of the environment or the dynamics of the group.
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By looking around, even if you don't know the clinical team and you're in to do a simulation debrief, you do your work to look around and get an impression of who might be the boss here or who has a sense of social capital in this space right now.
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You also have an emotional reader of the room as you're trying to help foster this psychological safety in the space.
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Who is exhibiting signs, perhaps the micro-communication pieces of looking psychologically safe?
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They're quite engaged in their body language, they're nodding compared to uh a collection of people who might be exhibiting signs of being less comfortable in the space.
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They're notably muted, their body language is a bit shut down.
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And then obviously, the person we're talking about may or may not be actually the loudest person in the room.
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Have you ever found that?
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Um the disruptive force is sometimes a loud uh argumentative one, and sometimes it's the silent one in there, but all of their body language is is leaking from their pores, sort of this crossed off.
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Um, I'm not buying this moment.
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So there's something about reading, I think is my first point.
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And um, it's really tricky when you're simulation debriefing, unless you develop that little sort of level of understanding and expertise through your experience, because I've been surprised more often than I'd like to admit when I've gone, oh, I thought they were okay.
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It turns out they were not okay, and nor was anyone around them.
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So feeling it is the first piece.
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The second piece is like speaking to it.
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The way I've worked with these types of situations in the past are twofold in the moment, an unexpected moment for me.
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I'm learning as a debriefer that I need to model for our groups together this thing of making the implicit explicit.
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There's many unsaid things that could be happening in the debrief that people are all thinking, but nobody saying, and I'm not being the sage on the stage who knows it all.
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I'm being the guide on the side who's asking questions.
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But a power that I have is I can model and I can say something like, and Naomi, I'm not making you this person, but for the purposes of this, I'm making you this person.
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Bring it up.
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I can be that person very well.
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Yeah, wow.
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I could say something like, I can't help it.
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I'm look, can I just say what I'm noticing?
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I'm noticing there seems to be a little bit of tension about that last scenario.
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And Naomi, I'm you I noticed that you am I feeling that you didn't really buy into that much.
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I wonder if you're feeling okay.
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Are you doing okay?
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If everybody in the room knows that something's happening by making the implicit explicit, we can nip it in the bug rather than carry a 30-minute debrief.
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Yeah.
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Sometimes afterwards or beforehand.
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And especially in simulation where there's some simulation programs where everybody is desperate to be there, loves it, and has signed up to be there.
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And there's other simulation programs where there's one or two people who have bad experiences with sim.
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If we're talking about simulation, they've been harshly judged, they've not had a good experience, they don't want to be there.
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Sometimes it's remedial.
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Their manager has told them you've been having an issue.
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Your sentence is you have to go to that simulation.
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I know as a debriefer, if someone's like that, it's really unlikely that I have some magic source that's going to bring them around.
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But I can speak to them in private afterwards if I can't catch it beforehand.
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I can come alongside them.
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My job isn't to antagonize as a facilitator.
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Feel the room is my first kind of point on the spicy challenge of which Naomi was the source.
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And the second is try to make the implicit explicit.
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We can be doing that as nurse managers all over the place, can't we?
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In our group conversations, in our team-based meetings, and when we've got some challenging team members.
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Totally.
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We were lucky enough to interview Renee Thompson.
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Oh, yeah, yeah, yeah, yeah.
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And um that that was one of the things she says is you've you've got to be aware of it.
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So you've got to be aware and awake, and then you need to notice it verbally to the person and be prepared to do that.
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And I think it's really key, certainly as a facilitator.
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I facilitate a lot of leadership workshops and other things, it but even as a coach, you have to pick up on it.
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So you've got to be looking and and as you said, tuning in, and then you need to verbalize it.
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So yeah, I love it.
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Very transferable skills.
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Yeah, they are fascinating in simulation and even other workshops, you've actually got a really clear view of the participant group, those people that are behaving poorly, and have got that, they're pissed off that they're there, they don't want to be there, their arms are folded, the whole thing.
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It's really obvious.
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Another thing that really stands out in that is when you call it out early, they either stop very quickly, and the change that you see is immediate, and the group see it immediately, or they escalate and will often take themselves out.
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They'll actually go, Do you know what?
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I don't want to be here.
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Happy days, fun by me.
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Um, but it the being able to see the impact of calling it out is so clear in that environment, in the clinical space that gets lost, right?
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Because they can go and hide in other things, or they get caught up in the other activity, or you as the manager or leader get caught up with other work, but in this space it's so visible.
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Yeah.
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So I that was a great example.
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Yeah.
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I'd offer this though as a connection piece, is there's a little bit of group first aid that may be required when that's all happening because this psychological safety is a very fragile tapestry.
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There's a bit of an art and a science perhaps in doing the speaking out behaviour in a way that's less adversarial, but also making a stand on behalf of the health of the group.
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And I imagine, in that circumstance you just mentioned, Naomi, should that participant say, Look, you know what, this isn't for me, and leave, there'll be a residual tension, there'll be a tear, and then there's further speaking out, there's further explicit conversation that I might do as a debriefer to call that out too.
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Maybe using a bit of humor if it's appropriate, maybe not for the first little bit, but certainly I'm noticing I'm feeling a bit tense.
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Should we just take a deep breath?
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I'm okay, you're okay, I hope our friend is okay.
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We want to reduce some repairing.
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We're both um trained in using something called the emotional culture deck.
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And with that training comes a lot of reading of articles about the impact of emotions and how emotions drive behavior and how they determine what we pay attention to, what we learn, what we remember, how we make decisions and other things, but they're all relevant to that simulation scenario as well.
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You know, what what is that person feeling who's sitting there with their arms crossed and that um what are the other people feeling witnessing that?
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What's the emotional contagion in the group that's happening?
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That is the facilitator, you have some um, I guess, responsibility to attend to, however, you might do that, um, when they're there and if they choose to go as well, there's there's that level of responsibility to to normalize, you know, what people are feeling is you know, it's not always within their control and it can influence how they learn, and we've got to be in a good space to learn.
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Wow.
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I haven't heard of that emotional, what did you call it?
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Emotional culture deck.
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Culture deck.
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Yeah, I don't look, um, I'm just a guest at the podcast, but if you were to put a link to that in the podcast notes, I would certainly pick that up.
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Yeah, I'll be reading that.
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I'm thoughtful about the way debriefers develop their expertise.
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That's what I'm doing my PhD on.
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It's more than just many faculty development programs, and sim absolutely do great in teaching.
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Here's a structured debriefing model and here's a style of questions you can ask, but is less confident or capable at doing some of the other work of debriefing development, like this emotional picking up and how to manage unexpected circumstances.
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And even prepping with what do I want the people participating in the simulation to feel and not feel but they might, and what actions can I take to help them feel more of what they want to feel and manage and cope if they're feeling what I don't want them to feel, because I want them to have the best possible learning experience, and that's always going to be part of it.
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Absolutely.
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And for somebody, to be who mentioned that you haven't done heaps of simulation for a bit, you're reading off the simulation faculty hymnal with the power of the pre-brief and the time that we will take to try and not only think about it, but situate the learners before the simulation ever happens so that we're in that space together.
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Yeah, beautiful.
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So I'm gonna take you back to a potentially fraught state.
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Uh, but I'm gonna ask you to look after a graduate nurse uh who's performing, has been kind of performing relatively well in that routine work, uh, but you're aware that there's been some emergency situations that um that he hasn't coped with.
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Are you running a couple of simulations and he becomes visible um and you're starting to worry about you know are they suited to the role?
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How are you gonna tell the difference between a lack of capability and being overloaded um with stress and anxiety?
00:21:08.490 --> 00:21:11.210
How do you how are you gonna unpack that?
00:21:11.450 --> 00:21:12.569
Yeah, wow.
00:21:12.569 --> 00:21:15.769
Yeah, that's uh you guys don't ask like questions.
00:21:17.370 --> 00:21:19.610
We're like pet deep quick.
00:21:19.610 --> 00:21:21.210
No, we're in there.
00:21:22.569 --> 00:21:24.170
Uh well, uh what would I say?
00:21:24.170 --> 00:21:27.930
Not everybody is suited to every piece of work ever.
00:21:27.930 --> 00:21:30.090
Everybody's different, amazing.
00:21:30.090 --> 00:21:35.769
There's no easy way of telling what lies underneath the deep waters of where someone's at.
00:21:35.769 --> 00:21:44.410
Some things that I do hold if going into that type of conversation would be to try and understand the other person's frame.
00:21:44.410 --> 00:22:02.170
I know that yourselves and your listeners might be aware of Jenny Rudolph, who brought that idea from psychology into simulation world at least, that looking for someone else's frame, I know that I'm seeing that my graduate nurse really struggle in those emergency situations whilst being good at routine moments.
00:22:02.170 --> 00:22:04.410
But I don't know why.
00:22:04.410 --> 00:22:12.890
And the only way I'm actually going to know isn't by making assumptions, which can be the great risk of nurse leaders giving feedback.
00:22:12.890 --> 00:22:37.769
We know what we see, we don't know why it's occurring, and rather than spending the time asking, insight generating, probing, genuinely curious questions, we rather say you are fine at the routine, you keep stressing out, study harder about this area and be better by this certain date, or it's going down a HR route or something like this.
00:22:37.769 --> 00:22:40.329
There could be a plethora of things happening.
00:22:40.329 --> 00:22:42.970
But I'm mindful of this, I like to acknowledge this.
00:22:42.970 --> 00:22:47.769
You ask a diagnostic question, I'm gonna respond for a moment in a different way.
00:22:47.769 --> 00:23:05.850
In my met nurse days, in doesn't have to be nursing, could be anywhere, but when the non-routine occurs, when the emergency occurs, when you walk into the room, you'd like to believe that in that moment you are going to just scale the heights and be the nurse that everybody always talks about.
00:23:05.850 --> 00:23:07.769
You're just gonna accomplish it.
00:23:07.769 --> 00:23:16.410
But the reality is when adrenaline starts to be secreted from your adrenal glands and starts to do the things that fight, flight do, you're not gonna do that.
00:23:16.410 --> 00:23:32.410
For example, here's the thing when you're on the road it this week and somebody, a car cuts you off or beeps or something like this, you're statistically much more likely to have a car accident within the subsequent five or so minutes because your adrenaline's gone, you're not thinking as clearly anymore.
00:23:32.410 --> 00:23:43.289
So, our new grad, a part of the story may be in these emergency moments, it may be the I don't know what to do with my stress in that adrenaline secreting moment.
00:23:43.289 --> 00:23:46.410
We don't rise to our aspirations, is the end of the adage.
00:23:46.410 --> 00:23:48.250
We lower to our level of training.
00:23:48.250 --> 00:23:49.930
We lower to that space.
00:23:49.930 --> 00:23:53.289
There's something about doing some diagnostic pieces.
00:23:53.289 --> 00:24:06.890
Should the person's attitude be for the job and passion be for the job, and they're here to learn and they want to grow and they have the internal impetus, the growth mindset, which I can't overstate enough, under whichever state you can do.
00:24:06.890 --> 00:24:12.329
Then my diagnostic piece is are we talking about a knowledge gap in the moment?
00:24:12.329 --> 00:24:13.289
It's not with you.
00:24:13.289 --> 00:24:14.970
Are we talking about a skills gap?
00:24:14.970 --> 00:24:21.289
The knowledge is there, but you don't know how to operate with communication skills or psychomotor skills.
00:24:21.289 --> 00:24:22.730
Is it a drills gap?
00:24:22.730 --> 00:24:28.250
There's a paper that I was a part of in Scotland that talks about knowledge skills, drills, and performance.
00:24:28.250 --> 00:24:40.730
By drills here I mean a sequence of skills, like an ALS algorithm or an anaphylaxis algorithm, and they're all built from sequential kind of skills that you need to get in a row and you're just going to have it in your muscle memory.
00:24:40.730 --> 00:24:44.009
A new grad will still only be able to do that if they did their training.
00:24:44.009 --> 00:24:52.090
But only if it's recent until this new grad now, again, let's assume that he has a growth mindset and he wants to develop and grow.
00:24:52.090 --> 00:25:09.370
I might suggest that if we've covered all the knowledge, skills, and drills moments of the things that he feels like he's lacking through simulation or through coaching or through feedback or workplace support, then there's something about getting some things in your head and rehearsing mentally.
00:25:09.370 --> 00:25:10.890
Mental rehearsal is massive.
00:25:10.890 --> 00:25:15.610
They do it in athletics, in aviation, for some reason in healthcare.
00:25:15.610 --> 00:25:19.049
We don't prioritize that or we don't make it explicit.
00:25:19.049 --> 00:25:26.090
But when that pager goes off and you're a Met nurse, many Met nurses, they're marching up to the ward, they're not thinking about what they're gonna have for lunch that day.
00:25:26.090 --> 00:25:27.930
They're going, A for airway.
00:25:27.930 --> 00:25:31.049
When I walk in the room, I'm just gonna walk in, I'm gonna assess that airway.
00:25:31.049 --> 00:25:33.610
And then I'm gonna go to brick, and they're just mentally rehearsing.
00:25:33.610 --> 00:25:42.410
And our new grad nurse would do well once all of those sequencing has been accomplished to just get good at mental rehearsal.
00:25:42.809 --> 00:25:45.450
I can't tell you my name when the pager goes off.
00:25:47.850 --> 00:25:52.490
Yeah, it doesn't matter how experienced you are, when it goes off, you go.
00:25:54.410 --> 00:26:06.009
What's the favorite, what's a question you find yourself coming back to time and time again when you're um debriefing a simulation where it is a bit tricky, maybe like one of the scenarios we've proposed.
00:26:06.009 --> 00:26:08.890
What's a question that you find yourself coming back to?
00:26:09.370 --> 00:26:10.809
Well, I love that.
00:26:10.809 --> 00:26:12.730
That's a great question.
00:26:12.730 --> 00:26:19.610
Um before I ask any question, I need to do exactly as you've just said.
00:26:19.610 --> 00:26:26.809
I need to do a little bit of an assessment of myself because I'm I feel like the most prone person on earth to make assumptions.
00:26:26.809 --> 00:26:36.490
It's the easiest thing in the world, and I need to consistently as I debrief check myself moment to moment to stay curious.
00:26:36.490 --> 00:26:41.210
And so that before I ask any question, and with experience, you can do this quicker and quicker, I think.
00:26:41.210 --> 00:26:49.210
I go to a what is my thought process genuinely and the question about to ask, is it genuinely curious or is it fake curious?
00:26:49.210 --> 00:26:52.809
If it's fake, it doesn't take long before the group smell a rat.
00:26:52.809 --> 00:27:01.049
They smell the the inauthenticity of the question, and you're doing something corrosive to this psychological safety where people can speak up.
00:27:01.049 --> 00:27:03.289
So it's got to be genuinely curious.
00:27:03.289 --> 00:27:12.250
It almost doesn't matter what question you ask if it comes from a genuinely curious space where you're holding someone in positive regard anyway.
00:27:12.250 --> 00:27:14.890
I want to do a PhD on debriefing by eyebrows.
00:27:14.890 --> 00:27:19.049
I don't know if your listeners have video, but it's do you think it's true?
00:27:19.049 --> 00:27:20.250
Like you could ask.
00:27:20.250 --> 00:27:26.090
Um, so in the room during the emergency, you seem to be still for a really long time.
00:27:26.090 --> 00:27:28.170
What were you thinking?
00:27:28.170 --> 00:27:34.970
And I could say that with a frown, if we're listening audiobly, or I could do the whole thing, and you'll there'll be a tone difference.
00:27:34.970 --> 00:27:41.930
But it's something like I'm in the room, new red nurse of mine, when the emergency happened and you seem to be still for a while.
00:27:41.930 --> 00:27:43.850
What was going through your mind at that time?
00:27:43.850 --> 00:27:50.090
Uh there's a different tone, there's a different cadence to it, and there's one's a genuine, what were you doing?
00:27:50.090 --> 00:27:52.569
I actually know what you were doing, and I want you to own it for me.
00:27:52.569 --> 00:27:54.890
I want you to guess what's in my head and tell me.
00:27:54.890 --> 00:28:00.809
And the other is the conversation we can we'll have could be any number of conversations.
00:28:00.809 --> 00:28:03.690
I just would love to know what's going on for you.
00:28:03.690 --> 00:28:09.049
It might be anxiety, in which case let's do the knowledge skills drills and let's rehearse.
00:28:09.049 --> 00:28:17.289
It might be I got yelled at before I came in by the charge nurse and said, stand in the corner and just watch.
00:28:17.289 --> 00:28:20.009
So I was standing there not knowing what to do.
00:28:20.009 --> 00:28:21.850
I have one story.
00:28:21.850 --> 00:28:30.890
In the UK, we had a simulation one time, and the point of the simulation with these junior doctors was the simulated patient in the bed space.
00:28:30.890 --> 00:28:36.650
There'd be an accidental double dose of a medication, and it was going to require the patient to have a prolonged stay in hospital.
00:28:36.650 --> 00:28:46.009
The learning behind the scenario was to help junior doctors rehearse having some candor with the patient, being honest with the patient, expressing saying sorry.
00:28:46.009 --> 00:28:56.410
We actually deliberately built the scenario to be one of these Swiss cheese models of failure where an earlier doctor had prescribed it not quite right, and then the nurse hadn't really questioned it and given something.
00:28:56.410 --> 00:29:03.769
The Swiss cheese model, we're not throwing anyone under the bus, but it was for the junior doctor to own it, and it was for the junior doctor say, I'm so sorry this happened to you.
00:29:03.769 --> 00:29:15.529
Now here's the thing that happened in the scenario was no matter how we prompted and moved the scenario to try and see that behavior happen, this doctor would not apologize.
00:29:15.529 --> 00:29:19.289
They were polite, they were open, but they wouldn't apologize.
00:29:19.289 --> 00:29:23.529
The simulated patient was staying in an escalated emotional state to try and bring them.
00:29:23.529 --> 00:29:24.329
It wasn't happening.
00:29:24.329 --> 00:29:26.329
We ended up ending the scenario, that's okay.
00:29:26.329 --> 00:29:28.569
We thought we can debrief through it.
00:29:28.569 --> 00:29:39.850
Now, here's the thing: if in the debrief we were letting our assumptions run wild, in our heads and our listeners' heads, you might already have the type of doctor that you could probably imagine in your head, the agenda.
00:29:39.850 --> 00:29:46.809
You can have all these assumptions about the type of person, the type of clinician, the type of discipline that is less likely to apologize.
00:29:46.809 --> 00:29:50.730
But we didn't want to lead with assumption, that's just not the way we operate.
00:29:50.730 --> 00:29:58.650
So we asked, in that scenario, there was about five or six minutes where the patient was seemed really upset.
00:29:58.650 --> 00:30:02.009
And I noticed that you were holding back.
00:30:02.009 --> 00:30:06.650
And I'm wondering what was going through your mind when you were trying to navigate that.
00:30:06.650 --> 00:30:08.170
He said, Here's what happened.
00:30:08.170 --> 00:30:14.809
When I was a medical student, we went on a medical ward round, and something terrible had happened to a particular patient.
00:30:14.809 --> 00:30:17.850
The ward round was all happening, and they were telling the group what happened.
00:30:17.850 --> 00:30:24.009
And when they finished telling the group, I said, said the medical student, Oh man, I'm so sorry.
00:30:24.009 --> 00:30:25.690
I'm so sorry about that.
00:30:25.690 --> 00:30:28.890
Drop a pin, it was really awkward, he said.
00:30:28.890 --> 00:30:35.930
And afterwards, the consultant removed him from the ward round and said, Do not ever apologize in front of my patients ever again.
00:30:35.930 --> 00:30:37.210
It's not our fault.
00:30:37.210 --> 00:30:39.210
We're not here to be sued by anything like this.
00:30:39.210 --> 00:30:40.730
Do not ever do it.
00:30:40.730 --> 00:30:52.170
That medical student then graduated and spent two years of practice not knowing if and how and whether it's appropriate to apologize because of that burnt memory from that one piece of feedback.
00:30:52.170 --> 00:31:09.210
And it was only in that debrief that we were able to talk to the real thing, which is if you're worried about legal proceedings in the UK, apologies, apologies isn't owning that moment anyway, but from a more human perspective, there's something powerful about the apologies.
00:31:09.930 --> 00:31:16.569
I'm really curious if you've got a tip for educators that are stepping into an educator role.
00:31:16.569 --> 00:31:20.490
What piece of gold would you give to them?
00:31:20.490 --> 00:31:29.049
What thing do they need to be able to do, or what mindset do they need to have to be good educators?
00:31:30.009 --> 00:31:32.410
Oh, that's a beautiful question.
00:31:32.410 --> 00:31:42.410
My response might be mildly controversial, and I don't mean it to be, but they also make for the funnest things to think about afterwards.
00:31:42.410 --> 00:31:43.529
Are you ready?
00:31:43.529 --> 00:31:45.690
Here's my mildly controversial.
00:31:45.690 --> 00:31:54.490
As an educator, we have content that we want to transmit, transfer to our learning group so that they can be successful and fruitful and whatever they want.
00:31:54.490 --> 00:32:03.450
So we put content as king, but I'm gonna challenge the status quo by offering that without relationship, that content's not gonna go anywhere.
00:32:03.450 --> 00:32:18.730
So often, and I say this carefully, all the things like rapport and trust and safety, I'll prioritize all of those things in my stance as an educator above the content.
00:32:20.329 --> 00:32:21.529
I love that answer.
00:32:21.529 --> 00:32:22.250
That is so.
00:33:25.210 --> 00:33:32.569
When actually I'm just gonna go to some work by Rachel Naomi Reman, who I'm not sure if you've heard of her work.
00:33:32.569 --> 00:33:43.450
She's got a book, a couple of books, but um one is Kitchen Table Wisdom and what she talks about, but she's also got an essay which we could probably share in the in the link.
00:33:43.450 --> 00:33:46.650
And it's about are you fixing, helping, or serving?
00:33:46.650 --> 00:33:54.569
And when you're serving, you're bringing your whole self, your darkness, your light, your knowledge, your gaps in knowledge.
00:33:54.569 --> 00:33:57.450
Um, because you're coming as human to human.
00:33:57.450 --> 00:34:03.210
When you're coming to fix, then there's a deficit in the other person that you wow.
00:34:03.450 --> 00:34:04.970
That's actually very beautiful.
00:34:04.970 --> 00:34:09.690
I'd I'll re I'll when you put that in the notes, I'll be clicking that link and listening as well.
00:34:09.690 --> 00:34:15.610
The cognitive load of many of these learning conversations of facilitating these is absolutely heavy.
00:34:15.610 --> 00:34:24.170
There's evidence to show how heavy a cognitive load it is when you're trying to think about what am I reading or what's happening, or uh, where's this conversation going?
00:34:24.170 --> 00:34:25.529
How am I going to get to that frame?
00:34:25.529 --> 00:34:28.329
There's all of this stuff that you're trying to do simultaneously.
00:34:28.329 --> 00:34:33.049
And certainly, novice, all the way through, I'm a bit lost in all of this weeds.
00:34:33.049 --> 00:34:52.969
And to people in that moment, I'd want to reassure with this idea of relationship, Trumps content, which is your group, your team, your the person across the will forgive your clumsiest questions, your biggest guess what I'm thinkings and accidental judgment laden questions, if they know and trust you.
00:34:52.969 --> 00:34:58.730
Conversely, if they don't, man, that you're probably not going to get the best out of the conversation or the learning anyway.
00:34:58.730 --> 00:34:59.610
This has been lovely.
00:34:59.610 --> 00:35:01.049
What a lovely conversation.
00:35:01.049 --> 00:35:05.049
I feel all filled up and could talk for hours of all of these things.
00:35:05.049 --> 00:35:13.929
One good way to land, perhaps, would be I'm doing a lot of thinking about this PhD on how we can get better at doing these conversations.
00:35:13.929 --> 00:35:21.610
I so appreciate how we've been expanding it around simulation, but what it means to all of us, regardless of context.
00:35:21.610 --> 00:35:28.170
Debriefing and these types of conversations, a skill set, like many skill sets, are complex as well.
00:35:28.170 --> 00:35:35.769
And we've talked about mental rehearsal and all these other ways that we want to act clinically, but it's the same with these kinds of conversations.
00:35:35.769 --> 00:35:47.769
If you could go to a wonderful faculty development workshop in debriefing and you could use it once, you'll never really catch some of the things that I think we've been talking about here, like you will by doing it and rehearsing.
00:35:47.769 --> 00:35:56.170
And what I found is I need to I subject my own practice in this way and the practice of colleagues around me to in simulation.
00:35:56.170 --> 00:36:05.929
People get really nervous when they go into a room and they're exposed amongst their peers and people that they respect, they're going to watch them in a room and either manage or not manage as well as they would like to.
00:36:05.929 --> 00:36:10.570
And we say it's okay, it's safe, it's for your learning, let's all just learn together.
00:36:10.570 --> 00:36:21.369
I therefore say for us as communicators, as nurse managers or debriefers, that I think we should put ourselves through the same experience by in seeking to get better at this.
00:36:21.369 --> 00:36:39.449
We do a lot of work around in my networks in playing back scenarios, play back pieces of footage of our debriefs, and we really debrief these debriefs to interrogate them and go, what can we all be learning together about how we do these conversations even more effectively?
00:36:39.449 --> 00:36:48.809
So the thing I'd love all of our listeners to really take and run with is even in the stuff that we've talked about today, there's never a settle-forget in any practice that we do, is there?
00:36:48.809 --> 00:37:00.170
Something about if you're committed to it, push yourself into that slight, uncomfortable space because that's where you grow and watch yourself thrive as you keep putting yourself through it.
00:37:00.170 --> 00:37:01.929
Like me trying to learn to be a nurse.
00:37:01.929 --> 00:37:06.010
Let's just keep turning up so that we get better at what we do.
00:37:07.690 --> 00:37:13.690
Yeah, I I love ending on that because it's really is the spirit of our podcast, too, actually.
00:37:13.690 --> 00:37:15.610
So it's a beautiful place to end.
00:37:15.610 --> 00:37:19.449
We're all doing the best we can, and when we know better, we can do better.
00:37:19.449 --> 00:37:23.929
And sometimes we need to be shown lots of times before we know better.
00:37:23.929 --> 00:37:25.369
And that's okay.
00:37:25.369 --> 00:37:26.970
We're all learning together.
00:37:26.970 --> 00:37:28.409
I totally agree with you.
00:37:28.409 --> 00:37:31.690
None of us is tick the box of human development.
00:37:35.369 --> 00:37:36.170
Thank you.
00:37:36.170 --> 00:37:38.010
Oh, it's been lovely talking to you.
00:37:38.010 --> 00:37:38.889
Thank you for having me.
00:37:38.889 --> 00:37:41.369
What a great conversation this has been.
00:37:45.210 --> 00:37:46.809
Thanks for listening.
00:37:46.809 --> 00:37:57.210
You can check out the show notes and find lots of further resources at bettereveryshift.com.au or via the link below.
00:37:57.210 --> 00:38:03.449
If you enjoyed today's episode or would love further information, we would love you to subscribe.
00:38:03.449 --> 00:38:07.530
And we look forward to seeing you better every shift.
00:00:29.489 --> 00:00:36.530
Nathan Oliver has a head full of anatomy and physiology but as a student he felt like he was underwater.
00:00:36.530 --> 00:00:45.090
While his mates were bouncing and strutting about their new skills, Nathan didn't even know how to help a patient take off their cardigan for a shower.
00:00:45.090 --> 00:00:48.689
He realised that learning by doing isn't enough.
00:00:48.689 --> 00:00:52.049
We have to learn through community and reflection.
00:00:52.049 --> 00:00:55.890
You're listening to Better Every Shift.
00:00:55.890 --> 00:00:58.289
I'm Naomi, and I'm here with TV.
00:00:58.289 --> 00:01:01.810
And today we share with Nathan Oliver.
00:01:01.810 --> 00:01:10.370
We're drawing on our lived experiences and our questions to help you bridge the gap between clinical stress and professional efficiency.
00:01:10.370 --> 00:01:16.049
We're tackling the fear of looking incompetent in clinical spaces.
00:01:16.049 --> 00:01:24.450
Lots of clinicians lower to the level of their training during emergencies because they haven't mentally rehearsed the moves.
00:01:24.450 --> 00:01:34.929
A burnt-in memory from one bad piece of feedback can stop a clinician from apologizing or speaking up for years.
00:01:34.929 --> 00:01:46.769
In this episode, we're delighted as Nathan shows us how to use simulation to make the implicit explicit and repair the psychological safety of your team.
00:01:46.769 --> 00:01:53.969
Let us know who you are, how did you get here?
00:01:54.689 --> 00:01:55.009
Yeah.
00:01:55.009 --> 00:01:55.890
Wow.
00:01:55.890 --> 00:01:56.929
My name is Nathan.
00:01:56.929 --> 00:01:57.969
It's lovely to meet you.
00:01:57.969 --> 00:01:59.890
I am a nurse by trade.
00:01:59.890 --> 00:02:01.089
I live in Canberra.
00:02:01.089 --> 00:02:02.689
I did my study at Canberra.
00:02:02.689 --> 00:02:09.729
I spent a lot of time clinically, a bit of everywhere, but mainly found my home in emergency department in an ED in Canberra.
00:02:09.729 --> 00:02:13.250
I remember all my student colleagues being thriving.
00:02:13.250 --> 00:02:15.890
They look like they're having the best time in the world, and I wasn't.
00:02:15.890 --> 00:02:17.569
I found it really quite stressful, actually.
00:02:17.569 --> 00:02:19.009
Especially when we went on placement.
00:02:19.009 --> 00:02:24.050
Everyone would go out on their placements across the place and everybody would come back bouncing and strutting.
00:02:24.050 --> 00:02:25.810
Look at all the new skills they've got.
00:02:25.810 --> 00:02:27.090
But I didn't feel that way.
00:02:27.090 --> 00:02:29.409
I felt like I was underwater and I didn't know.
00:02:29.409 --> 00:02:35.650
I had a head full of like anatomy and physiology, but I didn't know how to help somebody take off their cardigan for a shower.
00:02:35.650 --> 00:02:38.210
Like I didn't know how to make those kinds of moves.
00:02:38.210 --> 00:02:47.409
I became a new graduate and then I was a new graduate nurse, and all my mates were coming back and after work saying, Oh, I've got my cannulation competency and I'm thriving, man.
00:02:47.409 --> 00:02:48.530
And how are you doing, Nathan?
00:02:48.530 --> 00:02:49.890
And I'd say, I'm all right.
00:02:49.890 --> 00:02:51.730
But I wasn't really all right.
00:02:51.730 --> 00:02:52.770
I didn't feel awesome.
00:02:52.770 --> 00:02:56.130
All my mates got it, I didn't get it, I'll be honest.
00:02:56.130 --> 00:03:05.010
And then probably before this was a term that was coined, perhaps, but way back, this was many years ago, this is 20, 20 something, this is a while ago.
00:03:05.010 --> 00:03:06.610
I had a growth mindset thought.
00:03:06.610 --> 00:03:09.490
The growth mindset thought was, gosh, I don't get this job.
00:03:09.490 --> 00:03:10.450
This is hard for me.
00:03:10.450 --> 00:03:11.730
It's not landing.
00:03:11.730 --> 00:03:20.930
But one day I will, and when I do, I want to help other people not feel as lost as I currently feel.
00:03:20.930 --> 00:03:22.050
You know what?
00:03:22.050 --> 00:03:24.370
I it did land, and it took about six months.
00:03:24.370 --> 00:03:28.770
I tell my nursing students all the time this many of you might be feeling this when you go on placemat.
00:03:28.770 --> 00:03:30.689
Many of you will feel this when you graduate.
00:03:30.689 --> 00:03:32.689
Just stick in there, just keep turning up.
00:03:32.689 --> 00:03:34.930
You'll get through it, and you'll come out the other side.
00:03:34.930 --> 00:03:36.450
I certainly came out the other side.
00:03:36.450 --> 00:03:38.130
I felt like it landed for me.
00:03:38.130 --> 00:03:49.330
After a couple of years of various clinical roles and emergency department work and met nursing and things like this, I found myself back heading towards this true north of helping people feel more supported.
00:03:49.330 --> 00:03:58.130
That led me to education, that led me to looking after new graduate programs in Canberra, to the magic that you see when learners' light bulbs switch on.
00:03:58.130 --> 00:04:10.370
That can happen in a myriad of ways, but like often happens in simulation, I've noticed when you get the sort of some little moving bits all together, these light bulbs switch on through rehearsing and debriefing.
00:04:10.370 --> 00:04:18.290
And that led me into this real career choice of mine, which I've spent the last over a decade purely focused on simulation.
00:04:18.290 --> 00:04:28.290
So, like you, I haven't been clinical clinical since about 2010-2011, but I have been thinking a lot about how we learn through simulation.
00:04:28.290 --> 00:04:32.370
I actually ended up packing up family here in Canberra, sold everything up.
00:04:32.370 --> 00:04:39.089
And my partner and my children and I, when the children were still in arms, we got on an aeroplane and we went over to the UK.
00:04:39.089 --> 00:04:43.169
I got a job that was really a career-defining role for me.
00:04:43.169 --> 00:04:50.930
The Associate Director of Medical Education for Simulation in Edinburgh in the UK, NHS Lothian, which was away from nursing.
00:04:50.930 --> 00:04:53.649
I was no longer in a nursing world or a paradigm.
00:04:53.649 --> 00:05:02.370
I was 100% in a medical paradigm, working with doctors and leading their simulation setups and suites with simulation technicians and teaching fellows.
00:05:02.370 --> 00:05:11.009
We had some great impact in helping junior doctors and high-level clinical teams rehearse and practice for really big events.
00:05:11.009 --> 00:05:15.089
Sounds a little bit like some of the work that you have done, Naomi, in the past as well.
00:05:15.409 --> 00:05:17.089
Yeah, on a much bigger scale.
00:05:18.049 --> 00:05:19.329
It was an incredible adventure.
00:05:19.329 --> 00:05:37.729
And I got my master's of education while I was over there, focusing on simulation, and became an executive committee member of the Association of Simulated Practice in Healthcare and had the great privilege of co-directing the graduate certificate in simulation in the University of Edinburgh, doing a lot of faculty development through the Scottish Centre for Simulation and Clinical Human Factors.
00:05:37.729 --> 00:05:43.649
So my whole life has come around how we all can learn through simulation and debriefing.
00:05:43.649 --> 00:05:52.209
And I'll finish by saying, because man, I've just monologued, is getting on an aeroplane, we flew back to Australia three years ago, 2023.
00:05:52.209 --> 00:05:58.609
COVID and children and parents getting older made us think it's time to come back to Canberra.
00:05:58.609 --> 00:06:08.930
So I'm currently now the simulation convener at University of Canberra in the nursing school, looking to see what impact we can have in simulation across the Canberra region.
00:06:08.930 --> 00:06:12.849
And anyone who agrees with me that it could be a really helpful way to learn.
00:06:13.009 --> 00:06:13.329
Yeah.
00:06:14.289 --> 00:06:20.370
I want to say something spicy if people are reading up or carry Kolb around, which is it's a bit of an old way.
00:06:20.370 --> 00:06:28.849
1984 was Kolb's thinking, other underpinnings that are really interesting in the way we all learn as clinicians and as humans.
00:06:28.849 --> 00:06:33.649
For example, this social cognitive piece, it goes a bit like this.
00:06:33.649 --> 00:06:40.609
We think that we have to learn by doing, because that's we've grown up thinking, oh, that's the way I learn, I have to do.
00:06:40.609 --> 00:06:48.289
And we do, we do, but in simulation and in the work that we do, just as a human experience, we also learn in community.
00:06:48.289 --> 00:06:49.490
It's a social practice.
00:06:49.490 --> 00:06:57.889
My students watching their buddy nurses and going, I don't maybe not do it today, but I watched them do it five times, and I think I'll either definitely do that or never do it.
00:06:57.889 --> 00:07:03.969
In simulation, we have the ability to replicate elements of an event.
00:07:03.969 --> 00:07:09.810
We're not trying to make it real, we're just getting a little moment in time, and we're saying, look, imagine if this was a thing that happened.
00:07:09.810 --> 00:07:11.889
Let's work through it, let's do a thing.
00:07:11.889 --> 00:07:21.969
But even if people are watching, by engaging through reflection afterwards, we find that people are learning as a social piece rather than when is it my turn?
00:07:21.969 --> 00:07:30.289
That's important for our work because we've got a lot of people that need to be educated and always a resource challenge, don't we?
00:07:32.689 --> 00:07:33.969
Absolutely.
00:07:33.969 --> 00:07:38.689
Fab, we uh have some challenges for you, Nathan.
00:07:38.689 --> 00:07:40.449
We thought it would be really nice.
00:07:40.449 --> 00:07:56.849
A lot of our work is around how nurse leaders and managers actually support their teams, and part of that is through understanding their work, giving feedback, debriefing, coaching, all of those things.
00:07:56.849 --> 00:08:05.169
So we want to give you some scenarios, and we want you to let us know how you would unpack those.
00:08:05.169 --> 00:08:07.649
So, how would you debrief those?
00:08:07.649 --> 00:08:14.049
Because we think there's value in that for others that can take away from your experience.
00:08:14.049 --> 00:08:20.849
You've done lots of work in this space, you've had lots of experience, you've probably seen it go badly on occasion.
00:08:20.849 --> 00:08:29.889
So, we really want to hear how you would manage some of these scenarios and what we might draw from that for managers if that's okay.
00:08:30.609 --> 00:08:31.810
Oh, what a challenge.
00:08:31.810 --> 00:08:32.850
Sounds lovely.
00:08:32.850 --> 00:08:33.970
Let's go, let's let it go.
00:08:34.450 --> 00:08:35.810
Do you want to kick off the first one, Tubi?
00:08:38.850 --> 00:08:44.610
So you have a very capable but highly disruptive team member.
00:08:44.610 --> 00:09:01.169
So a nurse who's clinically strong, quite experienced, but are often dismissive of practice of junior staff, they're pretty resistant in simulation um experiences and they tend to shut down the feedback.
00:09:01.169 --> 00:09:12.370
And while the team looks up to them because they're very experienced, they also are a bit scared of them and feel a bit bruised by how they bring themselves to work and show up to work.
00:09:12.370 --> 00:09:18.529
So, in a simulation debrief, how would you manage this?
00:09:18.529 --> 00:09:19.490
What would you do?
00:09:19.730 --> 00:09:20.449
Yeah, wow.
00:09:20.449 --> 00:09:21.889
That's one of the big questions.
00:09:21.889 --> 00:09:30.449
When I'm working with people who are debriefers and we're talking about the really challenging moments in debriefing, those unexpected.
00:09:30.449 --> 00:09:35.009
Sometimes you can expect it if you know the team well and it's a very particular personality that you're painting.
00:09:35.009 --> 00:09:36.210
Often you don't.
00:09:36.210 --> 00:09:41.409
And you go in with the best will in the world, and something spicy like this jumps in.
00:09:41.409 --> 00:09:43.889
Yes, it's really difficult.
00:09:43.889 --> 00:09:47.329
My response would sit on a couple of things.
00:09:47.329 --> 00:09:56.610
For a debriefer, there's something about this idea of attunement, of which isn't necessarily an emotional picking up of the environment or the dynamics of the group.
00:09:56.610 --> 00:10:10.850
By looking around, even if you don't know the clinical team and you're in to do a simulation debrief, you do your work to look around and get an impression of who might be the boss here or who has a sense of social capital in this space right now.
00:10:10.850 --> 00:10:16.769
You also have an emotional reader of the room as you're trying to help foster this psychological safety in the space.
00:10:16.769 --> 00:10:23.889
Who is exhibiting signs, perhaps the micro-communication pieces of looking psychologically safe?
00:10:23.889 --> 00:10:33.490
They're quite engaged in their body language, they're nodding compared to uh a collection of people who might be exhibiting signs of being less comfortable in the space.
00:10:33.490 --> 00:10:37.490
They're notably muted, their body language is a bit shut down.
00:10:37.490 --> 00:10:43.329
And then obviously, the person we're talking about may or may not be actually the loudest person in the room.
00:10:43.329 --> 00:10:44.289
Have you ever found that?
00:10:44.289 --> 00:10:57.329
Um the disruptive force is sometimes a loud uh argumentative one, and sometimes it's the silent one in there, but all of their body language is is leaking from their pores, sort of this crossed off.
00:10:57.329 --> 00:10:59.730
Um, I'm not buying this moment.
00:10:59.730 --> 00:11:02.850
So there's something about reading, I think is my first point.
00:11:02.850 --> 00:11:17.409
And um, it's really tricky when you're simulation debriefing, unless you develop that little sort of level of understanding and expertise through your experience, because I've been surprised more often than I'd like to admit when I've gone, oh, I thought they were okay.
00:11:17.409 --> 00:11:20.370
It turns out they were not okay, and nor was anyone around them.
00:11:20.370 --> 00:11:22.769
So feeling it is the first piece.
00:11:22.769 --> 00:11:24.929
The second piece is like speaking to it.
00:11:24.929 --> 00:11:33.409
The way I've worked with these types of situations in the past are twofold in the moment, an unexpected moment for me.
00:11:33.409 --> 00:11:42.929
I'm learning as a debriefer that I need to model for our groups together this thing of making the implicit explicit.
00:11:42.929 --> 00:11:52.850
There's many unsaid things that could be happening in the debrief that people are all thinking, but nobody saying, and I'm not being the sage on the stage who knows it all.
00:11:52.850 --> 00:11:55.329
I'm being the guide on the side who's asking questions.
00:11:55.329 --> 00:12:03.569
But a power that I have is I can model and I can say something like, and Naomi, I'm not making you this person, but for the purposes of this, I'm making you this person.
00:12:03.569 --> 00:12:04.449
Bring it up.
00:12:04.449 --> 00:12:07.569
I can be that person very well.
00:12:07.569 --> 00:12:09.569
Yeah, wow.
00:12:09.569 --> 00:12:12.769
I could say something like, I can't help it.
00:12:12.769 --> 00:12:14.529
I'm look, can I just say what I'm noticing?
00:12:14.529 --> 00:12:19.889
I'm noticing there seems to be a little bit of tension about that last scenario.
00:12:19.889 --> 00:12:25.889
And Naomi, I'm you I noticed that you am I feeling that you didn't really buy into that much.
00:12:25.889 --> 00:12:27.250
I wonder if you're feeling okay.
00:12:27.250 --> 00:12:28.529
Are you doing okay?
00:12:28.529 --> 00:12:37.569
If everybody in the room knows that something's happening by making the implicit explicit, we can nip it in the bug rather than carry a 30-minute debrief.
00:12:37.569 --> 00:12:37.970
Yeah.
00:12:37.970 --> 00:12:40.769
Sometimes afterwards or beforehand.
00:12:40.769 --> 00:12:49.809
And especially in simulation where there's some simulation programs where everybody is desperate to be there, loves it, and has signed up to be there.
00:12:49.809 --> 00:12:55.490
And there's other simulation programs where there's one or two people who have bad experiences with sim.
00:12:55.490 --> 00:13:01.569
If we're talking about simulation, they've been harshly judged, they've not had a good experience, they don't want to be there.
00:13:01.569 --> 00:13:03.009
Sometimes it's remedial.
00:13:03.009 --> 00:13:06.129
Their manager has told them you've been having an issue.
00:13:06.129 --> 00:13:09.730
Your sentence is you have to go to that simulation.
00:13:09.730 --> 00:13:19.329
I know as a debriefer, if someone's like that, it's really unlikely that I have some magic source that's going to bring them around.
00:13:19.329 --> 00:13:23.250
But I can speak to them in private afterwards if I can't catch it beforehand.
00:13:23.250 --> 00:13:25.090
I can come alongside them.
00:13:25.090 --> 00:13:28.129
My job isn't to antagonize as a facilitator.
00:13:28.129 --> 00:13:33.569
Feel the room is my first kind of point on the spicy challenge of which Naomi was the source.
00:13:33.569 --> 00:13:37.409
And the second is try to make the implicit explicit.
00:13:37.409 --> 00:13:40.370
We can be doing that as nurse managers all over the place, can't we?
00:13:40.370 --> 00:13:48.370
In our group conversations, in our team-based meetings, and when we've got some challenging team members.
00:13:48.370 --> 00:13:49.250
Totally.
00:13:49.490 --> 00:13:52.210
We were lucky enough to interview Renee Thompson.
00:13:52.210 --> 00:13:53.490
Oh, yeah, yeah, yeah, yeah.
00:13:53.490 --> 00:13:59.250
And um that that was one of the things she says is you've you've got to be aware of it.
00:13:59.250 --> 00:14:07.409
So you've got to be aware and awake, and then you need to notice it verbally to the person and be prepared to do that.
00:14:07.409 --> 00:14:10.929
And I think it's really key, certainly as a facilitator.
00:14:10.929 --> 00:14:18.610
I facilitate a lot of leadership workshops and other things, it but even as a coach, you have to pick up on it.
00:14:18.610 --> 00:14:24.769
So you've got to be looking and and as you said, tuning in, and then you need to verbalize it.
00:14:24.769 --> 00:14:25.889
So yeah, I love it.
00:14:25.889 --> 00:14:27.809
Very transferable skills.
00:14:27.970 --> 00:14:46.610
Yeah, they are fascinating in simulation and even other workshops, you've actually got a really clear view of the participant group, those people that are behaving poorly, and have got that, they're pissed off that they're there, they don't want to be there, their arms are folded, the whole thing.
00:14:46.610 --> 00:14:48.610
It's really obvious.
00:14:48.610 --> 00:15:09.490
Another thing that really stands out in that is when you call it out early, they either stop very quickly, and the change that you see is immediate, and the group see it immediately, or they escalate and will often take themselves out.
00:15:09.490 --> 00:15:10.769
They'll actually go, Do you know what?
00:15:10.769 --> 00:15:11.809
I don't want to be here.
00:15:11.809 --> 00:15:14.129
Happy days, fun by me.
00:15:14.129 --> 00:15:26.049
Um, but it the being able to see the impact of calling it out is so clear in that environment, in the clinical space that gets lost, right?
00:15:26.049 --> 00:15:36.769
Because they can go and hide in other things, or they get caught up in the other activity, or you as the manager or leader get caught up with other work, but in this space it's so visible.
00:15:36.769 --> 00:15:37.169
Yeah.
00:15:37.169 --> 00:15:38.529
So I that was a great example.
00:15:38.529 --> 00:15:39.569
Yeah.
00:15:39.809 --> 00:15:51.250
I'd offer this though as a connection piece, is there's a little bit of group first aid that may be required when that's all happening because this psychological safety is a very fragile tapestry.
00:15:51.250 --> 00:16:01.009
There's a bit of an art and a science perhaps in doing the speaking out behaviour in a way that's less adversarial, but also making a stand on behalf of the health of the group.
00:16:01.009 --> 00:16:20.689
And I imagine, in that circumstance you just mentioned, Naomi, should that participant say, Look, you know what, this isn't for me, and leave, there'll be a residual tension, there'll be a tear, and then there's further speaking out, there's further explicit conversation that I might do as a debriefer to call that out too.
00:16:20.689 --> 00:16:27.409
Maybe using a bit of humor if it's appropriate, maybe not for the first little bit, but certainly I'm noticing I'm feeling a bit tense.
00:16:27.409 --> 00:16:28.610
Should we just take a deep breath?
00:16:28.610 --> 00:16:32.370
I'm okay, you're okay, I hope our friend is okay.
00:16:32.370 --> 00:16:34.210
We want to reduce some repairing.
00:16:34.850 --> 00:16:40.289
We're both um trained in using something called the emotional culture deck.
00:16:40.289 --> 00:17:01.329
And with that training comes a lot of reading of articles about the impact of emotions and how emotions drive behavior and how they determine what we pay attention to, what we learn, what we remember, how we make decisions and other things, but they're all relevant to that simulation scenario as well.
00:17:01.329 --> 00:17:08.769
You know, what what is that person feeling who's sitting there with their arms crossed and that um what are the other people feeling witnessing that?
00:17:08.769 --> 00:17:12.049
What's the emotional contagion in the group that's happening?
00:18:24.490 --> 00:18:51.049
That is the facilitator, you have some um, I guess, responsibility to attend to, however, you might do that, um, when they're there and if they choose to go as well, there's there's that level of responsibility to to normalize, you know, what people are feeling is you know, it's not always within their control and it can influence how they learn, and we've got to be in a good space to learn.
00:18:51.610 --> 00:18:52.009
Wow.
00:18:52.009 --> 00:18:55.130
I haven't heard of that emotional, what did you call it?
00:18:55.769 --> 00:18:57.049
Emotional culture deck.
00:18:57.289 --> 00:18:57.930
Culture deck.
00:18:57.930 --> 00:19:06.569
Yeah, I don't look, um, I'm just a guest at the podcast, but if you were to put a link to that in the podcast notes, I would certainly pick that up.
00:19:06.569 --> 00:19:08.090
Yeah, I'll be reading that.
00:19:08.090 --> 00:19:11.529
I'm thoughtful about the way debriefers develop their expertise.
00:19:11.529 --> 00:19:13.210
That's what I'm doing my PhD on.
00:19:13.210 --> 00:19:18.970
It's more than just many faculty development programs, and sim absolutely do great in teaching.
00:19:18.970 --> 00:19:35.610
Here's a structured debriefing model and here's a style of questions you can ask, but is less confident or capable at doing some of the other work of debriefing development, like this emotional picking up and how to manage unexpected circumstances.
00:19:36.009 --> 00:19:57.370
And even prepping with what do I want the people participating in the simulation to feel and not feel but they might, and what actions can I take to help them feel more of what they want to feel and manage and cope if they're feeling what I don't want them to feel, because I want them to have the best possible learning experience, and that's always going to be part of it.
00:19:57.769 --> 00:19:58.329
Absolutely.
00:19:58.329 --> 00:20:18.569
And for somebody, to be who mentioned that you haven't done heaps of simulation for a bit, you're reading off the simulation faculty hymnal with the power of the pre-brief and the time that we will take to try and not only think about it, but situate the learners before the simulation ever happens so that we're in that space together.
00:20:18.890 --> 00:20:19.769
Yeah, beautiful.
00:20:19.769 --> 00:20:24.250
So I'm gonna take you back to a potentially fraught state.
00:20:24.250 --> 00:20:43.289
Uh, but I'm gonna ask you to look after a graduate nurse uh who's performing, has been kind of performing relatively well in that routine work, uh, but you're aware that there's been some emergency situations that um that he hasn't coped with.
00:20:43.289 --> 00:20:57.610
Are you running a couple of simulations and he becomes visible um and you're starting to worry about you know are they suited to the role?
00:20:57.610 --> 00:21:08.490
How are you gonna tell the difference between a lack of capability and being overloaded um with stress and anxiety?
00:21:08.490 --> 00:21:11.210
How do you how are you gonna unpack that?
00:21:11.450 --> 00:21:12.569
Yeah, wow.
00:21:12.569 --> 00:21:15.769
Yeah, that's uh you guys don't ask like questions.
00:21:17.370 --> 00:21:19.610
We're like pet deep quick.
00:21:19.610 --> 00:21:21.210
No, we're in there.
00:21:22.569 --> 00:21:24.170
Uh well, uh what would I say?
00:21:24.170 --> 00:21:27.930
Not everybody is suited to every piece of work ever.
00:21:27.930 --> 00:21:30.090
Everybody's different, amazing.
00:21:30.090 --> 00:21:35.769
There's no easy way of telling what lies underneath the deep waters of where someone's at.
00:21:35.769 --> 00:21:44.410
Some things that I do hold if going into that type of conversation would be to try and understand the other person's frame.
00:21:44.410 --> 00:22:02.170
I know that yourselves and your listeners might be aware of Jenny Rudolph, who brought that idea from psychology into simulation world at least, that looking for someone else's frame, I know that I'm seeing that my graduate nurse really struggle in those emergency situations whilst being good at routine moments.
00:22:02.170 --> 00:22:04.410
But I don't know why.
00:22:04.410 --> 00:22:12.890
And the only way I'm actually going to know isn't by making assumptions, which can be the great risk of nurse leaders giving feedback.
00:22:12.890 --> 00:22:37.769
We know what we see, we don't know why it's occurring, and rather than spending the time asking, insight generating, probing, genuinely curious questions, we rather say you are fine at the routine, you keep stressing out, study harder about this area and be better by this certain date, or it's going down a HR route or something like this.
00:22:37.769 --> 00:22:40.329
There could be a plethora of things happening.
00:22:40.329 --> 00:22:42.970
But I'm mindful of this, I like to acknowledge this.
00:22:42.970 --> 00:22:47.769
You ask a diagnostic question, I'm gonna respond for a moment in a different way.
00:22:47.769 --> 00:23:05.850
In my met nurse days, in doesn't have to be nursing, could be anywhere, but when the non-routine occurs, when the emergency occurs, when you walk into the room, you'd like to believe that in that moment you are going to just scale the heights and be the nurse that everybody always talks about.
00:23:05.850 --> 00:23:07.769
You're just gonna accomplish it.
00:23:07.769 --> 00:23:16.410
But the reality is when adrenaline starts to be secreted from your adrenal glands and starts to do the things that fight, flight do, you're not gonna do that.
00:23:16.410 --> 00:23:32.410
For example, here's the thing when you're on the road it this week and somebody, a car cuts you off or beeps or something like this, you're statistically much more likely to have a car accident within the subsequent five or so minutes because your adrenaline's gone, you're not thinking as clearly anymore.
00:23:32.410 --> 00:23:43.289
So, our new grad, a part of the story may be in these emergency moments, it may be the I don't know what to do with my stress in that adrenaline secreting moment.
00:23:43.289 --> 00:23:46.410
We don't rise to our aspirations, is the end of the adage.
00:23:46.410 --> 00:23:48.250
We lower to our level of training.
00:23:48.250 --> 00:23:49.930
We lower to that space.
00:23:49.930 --> 00:23:53.289
There's something about doing some diagnostic pieces.
00:23:53.289 --> 00:24:06.890
Should the person's attitude be for the job and passion be for the job, and they're here to learn and they want to grow and they have the internal impetus, the growth mindset, which I can't overstate enough, under whichever state you can do.
00:24:06.890 --> 00:24:12.329
Then my diagnostic piece is are we talking about a knowledge gap in the moment?
00:24:12.329 --> 00:24:13.289
It's not with you.
00:24:13.289 --> 00:24:14.970
Are we talking about a skills gap?
00:24:14.970 --> 00:24:21.289
The knowledge is there, but you don't know how to operate with communication skills or psychomotor skills.
00:24:21.289 --> 00:24:22.730
Is it a drills gap?
00:24:22.730 --> 00:24:28.250
There's a paper that I was a part of in Scotland that talks about knowledge skills, drills, and performance.
00:24:28.250 --> 00:24:40.730
By drills here I mean a sequence of skills, like an ALS algorithm or an anaphylaxis algorithm, and they're all built from sequential kind of skills that you need to get in a row and you're just going to have it in your muscle memory.
00:24:40.730 --> 00:24:44.009
A new grad will still only be able to do that if they did their training.
00:24:44.009 --> 00:24:52.090
But only if it's recent until this new grad now, again, let's assume that he has a growth mindset and he wants to develop and grow.
00:24:52.090 --> 00:25:09.370
I might suggest that if we've covered all the knowledge, skills, and drills moments of the things that he feels like he's lacking through simulation or through coaching or through feedback or workplace support, then there's something about getting some things in your head and rehearsing mentally.
00:25:09.370 --> 00:25:10.890
Mental rehearsal is massive.
00:25:10.890 --> 00:25:15.610
They do it in athletics, in aviation, for some reason in healthcare.
00:25:15.610 --> 00:25:19.049
We don't prioritize that or we don't make it explicit.
00:25:19.049 --> 00:25:26.090
But when that pager goes off and you're a Met nurse, many Met nurses, they're marching up to the ward, they're not thinking about what they're gonna have for lunch that day.
00:25:26.090 --> 00:25:27.930
They're going, A for airway.
00:25:27.930 --> 00:25:31.049
When I walk in the room, I'm just gonna walk in, I'm gonna assess that airway.
00:25:31.049 --> 00:25:33.610
And then I'm gonna go to brick, and they're just mentally rehearsing.
00:25:33.610 --> 00:25:42.410
And our new grad nurse would do well once all of those sequencing has been accomplished to just get good at mental rehearsal.
00:25:42.809 --> 00:25:45.450
I can't tell you my name when the pager goes off.
00:25:47.850 --> 00:25:52.490
Yeah, it doesn't matter how experienced you are, when it goes off, you go.
00:25:54.410 --> 00:26:06.009
What's the favorite, what's a question you find yourself coming back to time and time again when you're um debriefing a simulation where it is a bit tricky, maybe like one of the scenarios we've proposed.
00:26:06.009 --> 00:26:08.890
What's a question that you find yourself coming back to?
00:26:09.370 --> 00:26:10.809
Well, I love that.
00:26:10.809 --> 00:26:12.730
That's a great question.
00:26:12.730 --> 00:26:19.610
Um before I ask any question, I need to do exactly as you've just said.
00:26:19.610 --> 00:26:26.809
I need to do a little bit of an assessment of myself because I'm I feel like the most prone person on earth to make assumptions.
00:26:26.809 --> 00:26:36.490
It's the easiest thing in the world, and I need to consistently as I debrief check myself moment to moment to stay curious.
00:26:36.490 --> 00:26:41.210
And so that before I ask any question, and with experience, you can do this quicker and quicker, I think.
00:26:41.210 --> 00:26:49.210
I go to a what is my thought process genuinely and the question about to ask, is it genuinely curious or is it fake curious?
00:26:49.210 --> 00:26:52.809
If it's fake, it doesn't take long before the group smell a rat.
00:26:52.809 --> 00:27:01.049
They smell the the inauthenticity of the question, and you're doing something corrosive to this psychological safety where people can speak up.
00:27:01.049 --> 00:27:03.289
So it's got to be genuinely curious.
00:27:03.289 --> 00:27:12.250
It almost doesn't matter what question you ask if it comes from a genuinely curious space where you're holding someone in positive regard anyway.
00:27:12.250 --> 00:27:14.890
I want to do a PhD on debriefing by eyebrows.
00:27:14.890 --> 00:27:19.049
I don't know if your listeners have video, but it's do you think it's true?
00:27:19.049 --> 00:27:20.250
Like you could ask.
00:27:20.250 --> 00:27:26.090
Um, so in the room during the emergency, you seem to be still for a really long time.
00:27:26.090 --> 00:27:28.170
What were you thinking?
00:27:28.170 --> 00:27:34.970
And I could say that with a frown, if we're listening audiobly, or I could do the whole thing, and you'll there'll be a tone difference.
00:27:34.970 --> 00:27:41.930
But it's something like I'm in the room, new red nurse of mine, when the emergency happened and you seem to be still for a while.
00:27:41.930 --> 00:27:43.850
What was going through your mind at that time?
00:27:43.850 --> 00:27:50.090
Uh there's a different tone, there's a different cadence to it, and there's one's a genuine, what were you doing?
00:27:50.090 --> 00:27:52.569
I actually know what you were doing, and I want you to own it for me.
00:27:52.569 --> 00:27:54.890
I want you to guess what's in my head and tell me.
00:27:54.890 --> 00:28:00.809
And the other is the conversation we can we'll have could be any number of conversations.
00:28:00.809 --> 00:28:03.690
I just would love to know what's going on for you.
00:28:03.690 --> 00:28:09.049
It might be anxiety, in which case let's do the knowledge skills drills and let's rehearse.
00:28:09.049 --> 00:28:17.289
It might be I got yelled at before I came in by the charge nurse and said, stand in the corner and just watch.
00:28:17.289 --> 00:28:20.009
So I was standing there not knowing what to do.
00:28:20.009 --> 00:28:21.850
I have one story.
00:28:21.850 --> 00:28:30.890
In the UK, we had a simulation one time, and the point of the simulation with these junior doctors was the simulated patient in the bed space.
00:28:30.890 --> 00:28:36.650
There'd be an accidental double dose of a medication, and it was going to require the patient to have a prolonged stay in hospital.
00:28:36.650 --> 00:28:46.009
The learning behind the scenario was to help junior doctors rehearse having some candor with the patient, being honest with the patient, expressing saying sorry.
00:28:46.009 --> 00:28:56.410
We actually deliberately built the scenario to be one of these Swiss cheese models of failure where an earlier doctor had prescribed it not quite right, and then the nurse hadn't really questioned it and given something.
00:28:56.410 --> 00:29:03.769
The Swiss cheese model, we're not throwing anyone under the bus, but it was for the junior doctor to own it, and it was for the junior doctor say, I'm so sorry this happened to you.
00:29:03.769 --> 00:29:15.529
Now here's the thing that happened in the scenario was no matter how we prompted and moved the scenario to try and see that behavior happen, this doctor would not apologize.
00:29:15.529 --> 00:29:19.289
They were polite, they were open, but they wouldn't apologize.
00:29:19.289 --> 00:29:23.529
The simulated patient was staying in an escalated emotional state to try and bring them.
00:29:23.529 --> 00:29:24.329
It wasn't happening.
00:29:24.329 --> 00:29:26.329
We ended up ending the scenario, that's okay.
00:29:26.329 --> 00:29:28.569
We thought we can debrief through it.
00:29:28.569 --> 00:29:39.850
Now, here's the thing: if in the debrief we were letting our assumptions run wild, in our heads and our listeners' heads, you might already have the type of doctor that you could probably imagine in your head, the agenda.
00:29:39.850 --> 00:29:46.809
You can have all these assumptions about the type of person, the type of clinician, the type of discipline that is less likely to apologize.
00:29:46.809 --> 00:29:50.730
But we didn't want to lead with assumption, that's just not the way we operate.
00:29:50.730 --> 00:29:58.650
So we asked, in that scenario, there was about five or six minutes where the patient was seemed really upset.
00:29:58.650 --> 00:30:02.009
And I noticed that you were holding back.
00:30:02.009 --> 00:30:06.650
And I'm wondering what was going through your mind when you were trying to navigate that.
00:30:06.650 --> 00:30:08.170
He said, Here's what happened.
00:30:08.170 --> 00:30:14.809
When I was a medical student, we went on a medical ward round, and something terrible had happened to a particular patient.
00:30:14.809 --> 00:30:17.850
The ward round was all happening, and they were telling the group what happened.
00:30:17.850 --> 00:30:24.009
And when they finished telling the group, I said, said the medical student, Oh man, I'm so sorry.
00:30:24.009 --> 00:30:25.690
I'm so sorry about that.
00:30:25.690 --> 00:30:28.890
Drop a pin, it was really awkward, he said.
00:30:28.890 --> 00:30:35.930
And afterwards, the consultant removed him from the ward round and said, Do not ever apologize in front of my patients ever again.
00:30:35.930 --> 00:30:37.210
It's not our fault.
00:30:37.210 --> 00:30:39.210
We're not here to be sued by anything like this.
00:30:39.210 --> 00:30:40.730
Do not ever do it.
00:30:40.730 --> 00:30:52.170
That medical student then graduated and spent two years of practice not knowing if and how and whether it's appropriate to apologize because of that burnt memory from that one piece of feedback.
00:30:52.170 --> 00:31:09.210
And it was only in that debrief that we were able to talk to the real thing, which is if you're worried about legal proceedings in the UK, apologies, apologies isn't owning that moment anyway, but from a more human perspective, there's something powerful about the apologies.
00:31:09.930 --> 00:31:16.569
I'm really curious if you've got a tip for educators that are stepping into an educator role.
00:31:16.569 --> 00:31:20.490
What piece of gold would you give to them?
00:31:20.490 --> 00:31:29.049
What thing do they need to be able to do, or what mindset do they need to have to be good educators?
00:31:30.009 --> 00:31:32.410
Oh, that's a beautiful question.
00:31:32.410 --> 00:31:42.410
My response might be mildly controversial, and I don't mean it to be, but they also make for the funnest things to think about afterwards.
00:31:42.410 --> 00:31:43.529
Are you ready?
00:31:43.529 --> 00:31:45.690
Here's my mildly controversial.
00:31:45.690 --> 00:31:54.490
As an educator, we have content that we want to transmit, transfer to our learning group so that they can be successful and fruitful and whatever they want.
00:31:54.490 --> 00:32:03.450
So we put content as king, but I'm gonna challenge the status quo by offering that without relationship, that content's not gonna go anywhere.
00:32:03.450 --> 00:32:18.730
So often, and I say this carefully, all the things like rapport and trust and safety, I'll prioritize all of those things in my stance as an educator above the content.
00:32:20.329 --> 00:32:21.529
I love that answer.
00:32:21.529 --> 00:32:22.250
That is so.
00:33:25.210 --> 00:33:32.569
When actually I'm just gonna go to some work by Rachel Naomi Reman, who I'm not sure if you've heard of her work.
00:33:32.569 --> 00:33:43.450
She's got a book, a couple of books, but um one is Kitchen Table Wisdom and what she talks about, but she's also got an essay which we could probably share in the in the link.
00:33:43.450 --> 00:33:46.650
And it's about are you fixing, helping, or serving?
00:33:46.650 --> 00:33:54.569
And when you're serving, you're bringing your whole self, your darkness, your light, your knowledge, your gaps in knowledge.
00:33:54.569 --> 00:33:57.450
Um, because you're coming as human to human.
00:33:57.450 --> 00:34:03.210
When you're coming to fix, then there's a deficit in the other person that you wow.
00:34:03.450 --> 00:34:04.970
That's actually very beautiful.
00:34:04.970 --> 00:34:09.690
I'd I'll re I'll when you put that in the notes, I'll be clicking that link and listening as well.
00:34:09.690 --> 00:34:15.610
The cognitive load of many of these learning conversations of facilitating these is absolutely heavy.
00:34:15.610 --> 00:34:24.170
There's evidence to show how heavy a cognitive load it is when you're trying to think about what am I reading or what's happening, or uh, where's this conversation going?
00:34:24.170 --> 00:34:25.529
How am I going to get to that frame?
00:34:25.529 --> 00:34:28.329
There's all of this stuff that you're trying to do simultaneously.
00:34:28.329 --> 00:34:33.049
And certainly, novice, all the way through, I'm a bit lost in all of this weeds.
00:34:33.049 --> 00:34:52.969
And to people in that moment, I'd want to reassure with this idea of relationship, Trumps content, which is your group, your team, your the person across the will forgive your clumsiest questions, your biggest guess what I'm thinkings and accidental judgment laden questions, if they know and trust you.
00:34:52.969 --> 00:34:58.730
Conversely, if they don't, man, that you're probably not going to get the best out of the conversation or the learning anyway.
00:34:58.730 --> 00:34:59.610
This has been lovely.
00:34:59.610 --> 00:35:01.049
What a lovely conversation.
00:35:01.049 --> 00:35:05.049
I feel all filled up and could talk for hours of all of these things.
00:35:05.049 --> 00:35:13.929
One good way to land, perhaps, would be I'm doing a lot of thinking about this PhD on how we can get better at doing these conversations.
00:35:13.929 --> 00:35:21.610
I so appreciate how we've been expanding it around simulation, but what it means to all of us, regardless of context.
00:35:21.610 --> 00:35:28.170
Debriefing and these types of conversations, a skill set, like many skill sets, are complex as well.
00:35:28.170 --> 00:35:35.769
And we've talked about mental rehearsal and all these other ways that we want to act clinically, but it's the same with these kinds of conversations.
00:35:35.769 --> 00:35:47.769
If you could go to a wonderful faculty development workshop in debriefing and you could use it once, you'll never really catch some of the things that I think we've been talking about here, like you will by doing it and rehearsing.
00:35:47.769 --> 00:35:56.170
And what I found is I need to I subject my own practice in this way and the practice of colleagues around me to in simulation.
00:35:56.170 --> 00:36:05.929
People get really nervous when they go into a room and they're exposed amongst their peers and people that they respect, they're going to watch them in a room and either manage or not manage as well as they would like to.
00:36:05.929 --> 00:36:10.570
And we say it's okay, it's safe, it's for your learning, let's all just learn together.
00:36:10.570 --> 00:36:21.369
I therefore say for us as communicators, as nurse managers or debriefers, that I think we should put ourselves through the same experience by in seeking to get better at this.
00:36:21.369 --> 00:36:39.449
We do a lot of work around in my networks in playing back scenarios, play back pieces of footage of our debriefs, and we really debrief these debriefs to interrogate them and go, what can we all be learning together about how we do these conversations even more effectively?
00:36:39.449 --> 00:36:48.809
So the thing I'd love all of our listeners to really take and run with is even in the stuff that we've talked about today, there's never a settle-forget in any practice that we do, is there?
00:36:48.809 --> 00:37:00.170
Something about if you're committed to it, push yourself into that slight, uncomfortable space because that's where you grow and watch yourself thrive as you keep putting yourself through it.
00:37:00.170 --> 00:37:01.929
Like me trying to learn to be a nurse.
00:37:01.929 --> 00:37:06.010
Let's just keep turning up so that we get better at what we do.
00:37:07.690 --> 00:37:13.690
Yeah, I I love ending on that because it's really is the spirit of our podcast, too, actually.
00:37:13.690 --> 00:37:15.610
So it's a beautiful place to end.
00:37:15.610 --> 00:37:19.449
We're all doing the best we can, and when we know better, we can do better.
00:37:19.449 --> 00:37:23.929
And sometimes we need to be shown lots of times before we know better.
00:37:23.929 --> 00:37:25.369
And that's okay.
00:37:25.369 --> 00:37:26.970
We're all learning together.
00:37:26.970 --> 00:37:28.409
I totally agree with you.
00:37:28.409 --> 00:37:31.690
None of us is tick the box of human development.
00:37:35.369 --> 00:37:36.170
Thank you.
00:37:36.170 --> 00:37:38.010
Oh, it's been lovely talking to you.
00:37:38.010 --> 00:37:38.889
Thank you for having me.
00:37:38.889 --> 00:37:41.369
What a great conversation this has been.
00:37:45.210 --> 00:37:46.809
Thanks for listening.
00:37:46.809 --> 00:37:57.210
You can check out the show notes and find lots of further resources at bettereveryshift.com.au or via the link below.
00:37:57.210 --> 00:38:03.449
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00:38:03.449 --> 00:38:07.530
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