Competency That Supports Nurses with Donna Wright

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You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond.
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I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program.
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Thanks for joining us.
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Let's jump in.
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I've been thinking back to a time early in my career when I was training to a new specialty area, obstetrics.
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I did everything I was supposed to, right?
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I went to the classes, I attended the conferences, I checked all the boxes on my competency checklist, spent hours working with a preceptor.
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And then, like many of us, there was that day where I became sort of on my own, working independently.
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And here's the truth: like, even though I had all this preparation, I didn't really feel competent.
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I could recite the material, I knew the steps, but in the real world, with real patience, with real pressure, I just never really felt like I had mastery.
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I tried very uncomfortably for a while.
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And then eventually I realized this just wasn't for me.
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I wasn't meant to be a labor and delivery OB nurse.
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So, you know, really looking back at that experience has led me to think more about competency and that it's not just sort of this clinical requirement, but there's a lot more to it.
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And so today we're going to be shifting our conversation into this idea of competency, what it means, why it matters, what it influences beyond maybe the obvious, and how leaders can maybe simplify that competency process in a way that helps nurses thrive instead of overwhelm them.
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And to explore all of this today, I'm joined by Donna Wright, someone whose work has shaped the way many organizations kind of think about competency.
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So welcome, Donna.
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I'm so excited to have you here with us today.
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Thank you, Nicole.
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Great to be here.
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Love to talk about competency anytime.
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Well, and I don't even think you know this, uh, but I learned about your work very early on.
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So I was an educator at a small rural hospital.
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I was charged with onboarding orientation.
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I was trying to figure out the competency thing and I bought the Ultimate Guide To Competency Assessment.
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And I had great thoughts and ideas of like, this is what I think we need.
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This is so great.
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Um, unfortunately, at the time I ran into some roadblocks with getting uh the other people in my organization on board.
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So maybe we'll talk a lot about that today as well.
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But I've actually been following your work for a really long time.
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Um, and again, even though we haven't maybe formally met, I'm so excited that you're you're here and you're joining us for this conversation.
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So why don't we start off by having you introduce yourself to the rest of our audience?
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Okay, well, thanks, Nicole, and I'm glad I'm here joining you in this discussion.
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Um, my name is Donna Wright.
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I guess I would call myself the competency lady.
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I'll give myself my own title, but I'm uh actually officially a consultant with Creative Health Care Management, which is an international consulting firm that does all kinds of things, helping people prepare for Magnet or uh developing their leaders or looking at their competency processes and programs or looking at relationship-based care.
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We do all kinds of different things.
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So um, that's the group that I'm a part of.
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And however, I have been studying competency assessment for three decades.
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It is a passion of mine, um, kind of a sick career choice, but I love it.
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So um, so I've been um speaking, writing, reading, talking about competency most uh most of my professional career and uh happy to be able to spread that through different means.
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So I've written several books, I do a lot of different presentations and conferences.
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So yeah, anytime I can talk about it, I want to do that.
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Excellent.
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Well, and it sounds like you're more than the competency lady.
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It sounds like you're the competency queen if you've been doing this for not long.
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Okay, I don't know.
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I don't have a scepter, but awesome.
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Well, uh again, really excited to dive into this conversation around competency.
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Um, and before we do, or kind of to to start us off, I think it's always good to just make sure we're we're all talking about the same thing.
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So kind of level the playing field, you know, do some groundwork here.
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So when we talk about competency and nursing, you know, what does that really mean?
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Why don't we just start there?
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Okay.
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Sure.
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Yeah, I think a couple different things.
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First of all, it it's much more complex than we realize.
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And we talk about we want to make sure that people are competent.
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Well, what does that mean?
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Well, I say there's many different um levels or phases that we we assess this at.
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So um, I mean, I'm a nurse, you're a nurse, we and this could be for any professional group at all.
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But you first start off by um preparing yourself in um your profession, which is the professional preparation, going to college, and then passing an exam and getting licensed or certified or registered.
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So everybody does that kind of thing.
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Um, that's the first level of competence.
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Then the second level is really where you're coming into an organization and the question is how do you then express that licensure registration or certification in our area, our organization?
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And that's where people right away kind of get messed up on things.
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Sometimes people want to redo the exams we took, like the NCLEX exam.
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We're not here to recheck that, but then there's always the question, well, what if they didn't know how to do that?
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Or, you know, so there's this apprehension, and that's why we still have to kind of watch that.
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But we have so much stuff in our orientation checklists, so to speak, that get into checking off the basic head-to-toe assessment again.
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Really?
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No.
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So what you're really trying to do is that if you're getting a job in an organization in the middle of rural Wyoming, or you're going to work in downtown Manhattan, New York, these are different places and you need to express your talents in different ways.
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Are you going to be working in an independent clinic where you're the only nurse or other professional available?
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Or are you going to be part of a large team that's doing different things together and you're sharing the work?
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So it is about expression of your skill set into a specific location.
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And that's where I think we mess up.
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We right away slide right back into are they just a competent nurse who left college or competent professional, it could be a pharmacist or a physical therapist or whatever.
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And then we're checking that off again.
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And that doesn't serve us well.
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And like you said, it didn't help you fit in to what you needed to do in that clinical area that you didn't feel comfortable in.
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Why do you think that is?
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Like, why do you think we slip into that?
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Well, we're just gonna check the box and we're gonna check them off things that we they should already know.
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Why, why do we go back down that path?
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Okay, um, we could do a whole eight-hour workshop on this one.
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I'll tell you in brief.
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It it comes down to some trust issues, it comes into all kinds of different levels of trust.
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Uh, and this could be even beyond just the orientation.
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Let's also get into the ongoing competency stuff as well, too.
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But it's like, how do I know that they're like this?
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And as an executive, how can I see that?
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How do I know as a preceptor that they're gonna be good at this?
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Or as an educator, you know, um, how do I trust that the the nursing school they went to covered that or the other preparation area that they went to made sure that they had that experience?
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So I have to say it's not about like you're not a trustyworthy person, but our systems aren't really built to build that trust.
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And I've worked really hard to figure out ways we can do that so we can trust people.
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And that actually loops right back to engagement.
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If you want to talk about engagement today, that is one of the best things where when we have that systematic trust, the trusting kind of things in the system, then you start to eliminate some other problems as well.
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So we'll just keep circling back around to that in this conversation today, that it's trust and it's not trust in a way you always think that they're not a trustworthy person.
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So it's different than that.
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You know, and I sometimes wonder too.
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Um, so I could totally see it being trust.
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I also see, you know, checking the box as sort of the comfortable or I mean, no offense to anybody who does this, but kind of the easy way out.
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Yep.
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And that leads to a second component too.
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There's a fear-driven component that enters into competency.
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I have a I have fear of the regulatory bodies not approving us.
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I have fear of being sued as an organization.
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I have fear that someone's gonna accuse us of not preparing people well enough.
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And then we have a situation with a union or something like that.
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So we have a lot of trust issues, a lot of fear-driven things.
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These are really across the board for a lot of other things in your in any organization that stop us from being truly successful and truly engaged and truly leveraging the talents of everybody.
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Uh, these are some just core principles that um yeah, boil down to the culture in which we create within our organizations.
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So, as much as I am all about like, what do we need to learn about competency to make this better?
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I think sometimes the question too, we need to kind of approach it a little bit different.
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But like, are there things leaders, NPD, need to unlearn about competency in order to effectively move forward?
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Yeah, I think, well, actually, the word you just used is the word learn.
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Um, I think some people right away think competency is all about education or it's about learning, which is actually the second step.
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Don't get me wrong, it's right then there, but it's not the first step.
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Actually, when we think about stuff around competency, it's more about um what do we need to uh be able to have or do in our job or as an organization?
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And do we have the people to be able to do that?
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For example, one time I um, well, I saw this beautiful definition one time of competency.
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Actually, I think it was in the one of the joint commission manuals years ago.
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It was great.
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And it said, uh, competency is all about requirement equals capacity.
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And what they described was what you're required to do or what your organization says they're gonna do, what's your requirement?
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Do you have the people or the capacity to fulfill on that promise?
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So let's say you say we're gonna be a level three trauma center in our organization.
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Do you have the people who know what a level three trauma center looks like or can do the skill in that category?
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If you say you're gonna be a PEDS-friendly environment in your hospital, your organization, do you know what the components are or can you express PEDS-friendly environment in your practice?
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And so that to me starts to change everything where it's not about me, the individual, learning something.
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It's about me saying, I'm in this organization.
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And if we've now been designated as a stroke center, do we have the people who have the capacity to deliver on that, to do what we say we're gonna do for the public?
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So it it just changes the entire thing.
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It's more about what's required in the job.
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And now this is what's exciting as leaders.
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That's really articulation of expectations.
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We haven't even got to competency yet.
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That's what do we expect of you in your role?
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That's a really interesting way to, I think, look at it because I think another thing that we sometimes see, especially with new graduate nurses, is you know, this new nurse is brought in to fill a role that maybe a 40-year nursing veteran has exited.
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And we expect them to be at the same level.
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Yep.
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And that's true for just about everything we do, whether it be, and this is where I'll say I put uh competency in different categories.
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So, you know, you want to be able to do things that determine should someone even come into your organization to be hired.
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And then what do you do during initial competencies, which is the orientation plus getting them grounded into the experience they're gonna be doing?
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So it's more than orientation.
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That's why I use the term initial competency assessment.
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And then after that, the ongoing competency assessment has to be a part of it.
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And actually, that's the strongest factor that cements the DNA of your organization.
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I love when people say, I've been here for 20 years.
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Don't you know I'm competent by now?
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And I say, if you're still functioning like you did 20 years ago, you ain't competent.
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You gotta, you know, you have to constantly keep evolving.
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It's that commitment to I'm always gonna strive and move forward with my organization.
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And that's the the partnership we have.
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Um, and it's not about now I'm competent.
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No one ever is truly competent.
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It's always a it's a dynamic process.
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So that that continuum, that flow, that commitment to moving in the direction where where we've designated we're gonna go, then it's a collaboration after that of the employee and the organization moving together.
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So this may be a simple silly question.
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I don't know.
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Um, but do you think about competency as like a one size, you know, fits all?
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Like all of my nurses on my unit are being held to the same level of competency or requirements.
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Yes and no.
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I'm gonna say is that one size fits all.
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I believe the expectation is the same.
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How we're going to express it can be different.
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So, um, first of all, and and it doesn't mean that we're all at the same level.
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I want to be clear on that.
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But competency needs to describe um the minimum expectation you need in an area.
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For example, if I'm in the ICU, the minimum expectation we have for responding in a code is ACLS.
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You know, that's pretty high.
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That might be on Banner's model, way up to proficient as far as skills go.
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But everyone in the ICU needs to be at ACLS or higher.
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You know, some people have passed the, you know, the ACLS requirements.
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Some people are teaching it in the ICU, you know, so you can have that level or higher.
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It's okay.
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Um, or where another clinical area might be BLS and that or higher.
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So you have to describe the minimum expectation that everybody in the job category needs to have.
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So minimally you need to be here.
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And then you even define it as people come into the organization.
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I'm not expecting them to function like that 40-year nurse that you talked about or a professional.
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Um, but I expect them to be able to get up to this minimum expectation so they can take this basic assignment or do this project or do this work, whatever we're asking them in that role.
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So competency is about you need to be here or or higher.
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Then how you can verify that, that's where it gets creative.
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Oh my gosh.
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That's the part where we can individualize it and allow for different different um personality types, learning styles, engagement things.
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So during the initial competency period, I tend to give um fewer options just because um most people coming in are not looking for a lot of freedom yet.
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They want to just tell me what I need to do and they're focused.
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And that we just need to know that.
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That's where people are then.
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But I usually like to have an option that would be good for a new grad and someone who's seasoned.
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So I almost always like to have two options.
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Don't make a seasoned person go through everything that the new person, you know, like, I know this, I've been an oncology nurse for years.
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Can I just take a test to prove?
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I know, or can I show you my certification in oncology, you know, or whatever.
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So you have to have like maybe two paths for initial uh for verification, but or or two or more.
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And for the ongoing, I like to give, you know, two, three, four, sometimes even five choices where people could bring different things that say, uh, prove that you know how to do this, or you can you can take care of this type of patient, uh, this new ventilator patient we have.
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And maybe we have different verification methods that can be done on different shifts and with different personality styles to it, or things that could be caught during a QI monitor, that you already got caught doing it correctly because you're doing it all the time and you're engaged with it all the time.
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Um, or some other people do a case study because they don't know where to even begin and they can read about it and do the case study or the module.
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So um yeah, this it's kind of all the same for the competency, but the verification or the verification is where you start to get creative and have options.
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I wrote down the you this um word realistic.
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So I like that you because I mean that is something that we've talked a lot about um with a lot of our partner organizations, is we need to just make sure we have realistic expectations for each unique sort of individual that's coming into the organization or each sort of level.
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So new grad expectations, while we still hold them to the same minimum, um, we just need to be realistic in those expectations for them.
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Yep.
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Yeah, and I think that's where, especially during orientation, I lean into the tiered orientation process.
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There's a lot of different tiered models out there, but in general, what tiered says is that you kind of are on a path somewhere and you designate within that tier, um, and and just so if people have never heard of the term tiered orientation, it's kind of like saying first you need to crawl, then you need to walk, then you need to run.
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That's kind of the basic way I describe it.
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So in orientation, uh, you're describing for people the, you know, the whole process you go through, but you might graduate from orientation, so to speak.
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I just use that term, to say with just the the the walking part.
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You we don't expect you to run yet.
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I want you to not only know it, but can apply it at least once.
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Or I need you to be able to do the whole thing because you're in charge and it has to go all the way up to the running phase.
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So you're each competency can have different expectations, but you're defining that.
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And then that puts a map for later too.
00:17:34.000 --> 00:17:42.079
So I'll go back to the ICU and you need to be able to complete ACLS and prove that you can function in a code.
00:17:42.079 --> 00:17:46.799
But in a year and a half from now, we expect you to be a code leader and do the debriefings.
00:17:46.799 --> 00:17:52.000
You see how I just took a new grad and helped define the path they're gonna take in the ICU.
00:17:52.000 --> 00:17:54.960
They're gonna get to a higher level, but not during orientation.
00:17:54.960 --> 00:17:56.640
Just function at a code, please.
00:17:56.640 --> 00:17:58.079
That's what we want to give you good at.
00:17:58.400 --> 00:17:58.640
Right.
00:17:58.640 --> 00:18:06.880
And I think that's a mistake maybe a lot of organizations make is that they're not always realistic in their expectations for new grads as they come in.
00:18:06.880 --> 00:18:12.000
They're they're seeing that, you know, a nurse is a nurse is a nurse, um, regardless.
00:18:12.000 --> 00:18:28.160
And so uh, you know, I guess just as you're kind of talking about that, that's something that's kind of like percolating in my brain here about how this might be an area where we need to begin to really work with organizations to kind of rethink um how they do this.
00:18:28.400 --> 00:18:28.720
Yeah.
00:18:28.720 --> 00:18:33.119
And our systems, our systems don't necessarily support it very well either.
00:18:33.119 --> 00:18:40.960
So I think sometimes it's not just uh let's change some competencies, it's let's we need to change some of our systems too that support it.
00:18:40.960 --> 00:18:45.279
Because I think educators feel panicked that I have to get everything into orientation.
00:18:45.279 --> 00:18:49.039
Well, no, that again is not realistic, exactly what you said there.
00:18:49.039 --> 00:18:56.160
Um, or how can we do this so that we have this pathway or plan or uh you're creating a portfolio for yourself?
00:18:56.160 --> 00:19:00.400
And and yeah, there's all kinds of different ways you can do this to make it better.
00:19:00.400 --> 00:19:04.240
And actually, these things end up saving money and time in the end too.
00:19:04.240 --> 00:19:06.079
So this isn't, I don't know.
00:19:06.079 --> 00:19:09.920
We just have to rethink how we do our systematic processes.
00:19:10.160 --> 00:19:18.240
Because I remember being a you know educator in a hospital, and you know, we want to get this orientation checklist done by the end of your preceptor time, right?
00:19:18.240 --> 00:19:25.920
Um, and totally not realistic, especially in a rural hospital where we might see a chest tube once a year.
00:19:25.920 --> 00:19:32.319
Like it's not gonna happen in the you know, six to eight weeks or whatever we were giving them at the time uh to get that done.
00:19:32.319 --> 00:19:43.759
And so um I like this idea of it doesn't all have to be covered in the beginning, like again, figuring out what that minimum is, kind of working towards that standard, but then giving them space to grow.
00:19:43.759 --> 00:19:48.319
So uh I think that's just a great way to kind of look at competency.
00:19:48.799 --> 00:19:54.559
And I don't know if we are always so good at even articulating what we expect, even for ourselves.
00:19:54.559 --> 00:19:59.119
You know, um, you know, we hear all the time hit the ground running after orientation.
00:19:59.119 --> 00:20:00.720
I want them to hit the ground running.
00:20:00.720 --> 00:20:02.319
What does that look like?
00:20:02.319 --> 00:20:07.519
And um, you know, we need to be clearer about that so we can help them understand.
00:20:07.519 --> 00:20:11.279
We expect you to look like this at this point and then like that later on.
00:20:11.279 --> 00:20:15.359
And we miss completely miss certain things that they desperately need.
00:20:15.359 --> 00:20:19.920
Like during orientation, people need to feel like they belong to the group.
00:20:19.920 --> 00:20:22.880
And we sometimes they get a connection with a preceptor.
00:20:22.880 --> 00:20:28.720
We hope sometimes it doesn't happen, but but the whole group and and building trust with the whole group.
00:20:28.720 --> 00:20:37.279
We need to help them with just even how to do days and nights and nights and evenings and how to, you know, manage home life and hear and park your car somewhere.
00:20:37.279 --> 00:20:43.920
I mean, we tell them stuff, but we don't always help them truly manage that and embed that into who they are.
00:20:43.920 --> 00:20:52.720
Um, some of our well-being stuff and and professional uh parameters of wellness around what we do and how to do that every day.
00:20:52.720 --> 00:20:56.640
There's so many things that I am now redoing in orientation.
00:20:56.640 --> 00:21:03.519
So we're moving from that checklist of head-to-toe assessment to something that's much more professional driven.
00:21:03.519 --> 00:21:15.519
And I want to see the verification that the employee has back more of professional curiosity, of understanding how to engage in communication with somebody outside your department.
00:21:15.519 --> 00:21:19.680
Um, get a hold of a doctor that's hard to get a hold of, things like that.
00:21:19.680 --> 00:21:23.279
You know, the things that we know are really the secrets of the job.
00:21:23.599 --> 00:21:37.680
Well, and I think that's something that, you know, is always kind of a topic of conversation around residency and new grads is we have the clinical sort of hands-on technical skills, and then it's like everything else.
00:21:37.680 --> 00:21:46.559
And it seems like people are much more concerned with the hands-on clinical type skills than the everything else.
00:21:46.559 --> 00:21:49.759
And so I guess what's your thinking around that?
00:21:49.759 --> 00:21:54.000
Are these competence or are some of these competencies more important than others?
00:21:54.000 --> 00:21:57.039
Do we, you know, look at these competencies differently?
00:21:57.039 --> 00:21:59.119
Maybe you can talk a little bit about that.
00:22:00.240 --> 00:22:09.119
Yeah, I think where we're at right now is we often divide up our our roles, however we define it, into uh a list of tasks.
00:22:09.119 --> 00:22:11.519
And we've all felt that way for a long time.
00:22:11.519 --> 00:22:13.440
And we check off all these tasks.
00:22:13.440 --> 00:22:21.200
It could be protocols or procedures people have to do, or we look at their charting, or we have them take a test of knowledge, things like that.
00:22:21.200 --> 00:22:35.440
And I feel like sometimes an orientation, it's like we're telling the new person um, we're going to give you a new car for orientation, and it's here in these boxes, and you have to put it together yourself.
00:22:35.440 --> 00:22:38.079
So the parts are all there.
00:22:38.079 --> 00:22:39.039
Don't get me wrong.
00:22:39.039 --> 00:22:44.880
Somewhere in these boxes is a Lamborghini, but you got to put it together yourself.
00:22:44.880 --> 00:22:51.279
And this is where I hear so many times people say, you know, they'll ask the team, how's that new person doing?
00:22:51.279 --> 00:22:58.880
And the team will respond, well, they were checked off for everything, but they still don't really get their job.
00:22:58.880 --> 00:23:02.480
So what are we missing in that?
00:23:02.480 --> 00:23:10.000
And I think we haven't made it um, we've taken the test and we haven't made it comprehensive.
00:23:10.000 --> 00:23:21.759
Um, so I'll give you an example that I think can actually uh deal with some of the trust issues and the fear issues, the belonging, the all that kind of stuff and the skill set at the same time that we need to check off.
00:23:21.759 --> 00:23:30.240
So um I've got several groups now that are saying during orientation, you get like a list of five or seven essences of the job.
00:23:30.240 --> 00:23:35.119
Like you find the job in this area, kind of these are the essences of who we are, you know.
00:23:35.119 --> 00:23:49.039
And so we say, while you're caring for a patient with your pre-educator andor preceptors as you're going along, you need to um at some point along the way uh contact a doctor, get a hold of them, and have them call you back and maybe change an order or something like that.
00:23:49.039 --> 00:23:51.839
You have to set up some communication with another department.
00:23:51.839 --> 00:23:57.680
You have to discuss some things with the family or do some teaching with the family or look at something with the family.
00:23:57.680 --> 00:23:59.519
You need to adjust the care plan.
00:23:59.519 --> 00:24:04.160
You know, these are different things, not all with the same patient, but with different people along the way.
00:24:04.160 --> 00:24:10.960
And then you put together kind of a case presentation with these five to seven different components that you have.
00:24:10.960 --> 00:24:19.440
And you can use one patient or two patients in your case study if you have to, you know, go to more than one to get your story that you're gonna put together or your couple stories.
00:24:19.440 --> 00:24:27.519
And then at the end of orientation, once your preceptor says, okay, we've checked everything off on your list, I think you're ready to present your story to the team.
00:24:27.519 --> 00:24:36.400
So then you go back to like a staff meeting or something where the whole team is there, and you say, you know, the preceptor says, I'd like to introduce, you know, or a new person.
00:24:36.400 --> 00:24:40.240
Many of you have worked with this new person, but they're just about ready to finish orientation.
00:24:40.240 --> 00:24:42.480
And why don't you share your case study?
00:24:42.480 --> 00:24:45.200
And then they go, okay, here's where I called me, you know, Dr.
00:24:45.200 --> 00:24:46.480
So-and-so, and blah, blah, blah.
00:24:46.480 --> 00:24:48.480
And I helped with this, and then I have to adjust that.
00:24:48.480 --> 00:24:50.079
And I did that to help the family.
00:24:50.079 --> 00:24:51.279
And here's my presentation.
00:24:51.279 --> 00:24:53.759
And people like, wow, awesome work.
00:24:53.759 --> 00:24:55.759
You able to get a hold of that doctor.
00:24:55.759 --> 00:24:57.599
He's so hard to get a hold of.
00:24:57.599 --> 00:24:59.839
And you set up a thing with physical therapy.
00:24:59.839 --> 00:25:01.119
Good for you.
00:25:01.119 --> 00:25:09.279
So I, as a staff person, now start to see you as someone who I met maybe, you know, a month or so ago, two months ago.
00:25:09.279 --> 00:25:12.079
And now I see, wow, look at the progress you've made.
00:25:12.079 --> 00:25:16.559
I feel much more welcoming to bring you into our team and I feel comfortable with you.
00:25:16.559 --> 00:25:23.279
You have shown how you can put the whole picture together and do the entire kind of job, and you're bragging it up.
00:25:23.279 --> 00:25:26.319
And your preceptor's right there to make sure that you don't falter.
00:25:26.319 --> 00:25:29.200
And I think that starts to put everything together.
00:25:29.200 --> 00:25:31.359
And what if we got rid of the checklist?
00:25:31.359 --> 00:25:38.000
We just used that as a tour guide, and we said, you have to have your team endorsed that you're ready to go.
00:25:38.000 --> 00:25:40.000
And right there it would change everything.
00:25:40.319 --> 00:25:40.960
Wow.
00:25:40.960 --> 00:25:44.960
That is a very interesting, I think, approach to this.
00:25:44.960 --> 00:25:50.880
It sounds, I mean, it sounds really, I mean, it makes a whole lot of sense, right?
00:25:50.880 --> 00:25:53.599
That that is kind of, I mean, that's the ultimate goal.
00:25:53.599 --> 00:26:01.200
That's what that's the outcome that we're really after is to have nurses that are working on our units that can do those sorts of things.
00:26:01.200 --> 00:26:09.599
But we segment everything out and we break everything down and we do everything sort of in isolation.
00:26:09.599 --> 00:26:18.880
And I think that, you know, thinking back to the example I gave at the introduction to this episode of like I was able to do all of these things, I could recite this information.
00:26:18.880 --> 00:26:24.079
It it was harder for me to put all of these OB skills um, you know, together.
00:26:24.079 --> 00:26:32.079
And I it it makes me just wonder if we had taken a different approach, you know, would that outcome have been different?
00:26:32.480 --> 00:26:32.960
Yeah.
00:26:32.960 --> 00:26:33.359
Yeah.
00:26:33.359 --> 00:26:40.240
And I think, and along the way too, I think it helps people to see if they're in the right specialty because maybe you weren't, maybe you were, I don't know.
00:26:40.240 --> 00:26:53.359
But also to say, you know, in that OB position where you, you know, did you see the complexity of like family dynamics and GYN, OBGYN is complicated sometimes and that some people thrive on that?
00:26:53.359 --> 00:26:59.519
How to help that, you know, bring that new person into the world, but in a situation that is not always easy.
00:26:59.519 --> 00:27:04.720
You know, and I see that how could we help people embrace that in a different way?
00:27:04.720 --> 00:27:12.079
I just think what I just described to you was a lot of changing systems, but it doesn't take a lot of radical stuff to do that.
00:27:12.079 --> 00:27:19.680
It just takes some purposeful action to say, are we ready to move from a checklist that has not served us well over the years?
00:27:19.680 --> 00:27:35.119
And we we know that, to something that that, I mean, maybe even ticks off more of the boxes of a broader scope, a more comprehensive way to look at our role than just the skills or protocols or procedures we have to do.
00:27:36.000 --> 00:27:59.680
So this might be pretty obvious, but you know, so much of I know so much of our discussions in our um nursing professional development groups at the national level, at ANPD, there's so much discussion around competency beyond sort of the regulatory aspect of competency.
00:27:59.680 --> 00:28:03.759
Why is this such an important topic for us?
00:28:04.240 --> 00:28:06.640
Well, I think um twofold.
00:28:06.640 --> 00:28:10.480
One is bare back again to the trust and things to make sure that we have the people.
00:28:10.480 --> 00:28:16.720
Because to be honest with you, when it comes to being sued or dinged by some survey group, they hold the organization accountable.
00:28:16.720 --> 00:28:18.960
So the organization just goes right into it.
00:28:18.960 --> 00:28:22.720
You know, even in a lawsuit, very rarely does a professional get sued.
00:28:22.720 --> 00:28:25.920
It's more, unless it's a doctor, but it's more the organization.
00:28:25.920 --> 00:28:31.359
And the whole key to the lawsuit is did you make sure that they were competent?
00:28:31.359 --> 00:28:34.400
You know, that's really the what the lawyers are going after.
00:28:34.400 --> 00:28:39.440
So it isn't, you know, must watch the individual, it's the organization that they have systems in place for that.
00:28:39.440 --> 00:28:41.039
So that that's one part of it.
00:28:41.039 --> 00:28:44.240
And then the other part is that the world is changing just so fast.
00:28:44.240 --> 00:28:55.519
I will tell you that, and this is more than just post-pandemic, but you know, the half-life of information from the 1980s to now, in just 40 years, has just exponentially grown.
00:28:55.519 --> 00:29:02.400
From 1980s, it was about two years that the half-life of information, the year 2000, it was right around 12 hours.
00:29:02.400 --> 00:29:04.559
And now we're in the decade of the 2020s.
00:29:04.559 --> 00:29:06.079
We're talking nanoseconds.
00:29:06.079 --> 00:29:12.000
And so this ongoing, always, you know, I have to always be more and more current and know more things.
00:29:12.000 --> 00:29:15.839
And, you know, within a just in moments, it's changes.
00:29:15.839 --> 00:29:20.720
I mean, everybody that's listening here has probably had a protocol last year that came out at the beginning of the year.
00:29:20.720 --> 00:29:23.839
Then a month later it was tweaked and changed, and now we're gonna do this.
00:29:23.839 --> 00:29:25.839
Oh, but now you can't dispose of that like that.
00:29:25.839 --> 00:29:32.079
So three weeks later, a new thing on how you dispose of the stuff that the IV things that you pull down, and then you have to label it like this.
00:29:32.079 --> 00:29:35.599
There have been like five changes in a protocol all in one year.
00:29:35.599 --> 00:29:37.599
So are you competent?
00:29:37.599 --> 00:29:39.519
Well, you know, where are you competent?
00:29:39.519 --> 00:29:42.000
If I ask somebody, are you competently doing it?
00:29:42.000 --> 00:29:44.720
Well, yeah, no, you're not because you didn't dispose of it correctly.
00:29:44.720 --> 00:29:45.759
You didn't document it right.
00:29:45.759 --> 00:29:47.279
This has changed, that has changed.
00:29:47.279 --> 00:29:49.920
So, right there, we're in a different world.
00:29:49.920 --> 00:29:53.440
So I think that's why it's so important now we get good at it.
00:29:53.440 --> 00:29:54.319
Yeah.
00:29:56.640 --> 00:30:09.039
Do you think that contributes to some of like the burnout and things that we see in our nursing workforce is kind of this half-life of information and the constant change and the constant need to, you know, look at competency.
00:30:11.039 --> 00:30:12.160
It could be.
00:30:12.160 --> 00:30:22.559
I I could be, but I I think for me, I and this is just my opinion, but I think it's helping people find the passion of their work.
00:30:22.559 --> 00:30:27.759
You know, I I really want people to there's a reason I I want to have curiosity with this.
00:30:27.759 --> 00:30:35.200
There's a reason people went into the profession that they did, you know, and frankly, I bet you and I probably have this as well, too.
00:30:35.200 --> 00:30:39.200
Didn't you have some things that you imagine in your head you'd do as a nurse?
00:30:39.200 --> 00:30:44.240
You know, that I thought um I would sit with a dying patient holding their hand.
00:30:44.240 --> 00:30:48.319
What was not part of that picture was somebody screaming from the hallway, hey, Dr.
00:30:48.319 --> 00:30:49.680
So-and-so is online four.
00:30:49.680 --> 00:30:51.279
You want to come and talk to them?
00:30:51.279 --> 00:31:02.000
You know, it's like just a minute, you know, like I to find those passions and then help people get those moments in the reality-based world we live in.
00:31:02.000 --> 00:31:11.839
I know that sometimes that wasn't always realistic, but I have now found as a nurse some of the things that are the most difficult to do are the things that bring me the most joy.
00:31:11.839 --> 00:31:20.960
You know, it's having that crucial conversation with a coworker and really finding common ground and finding out we have a lot more in common than we have differences.
00:31:20.960 --> 00:31:24.000
Oh my gosh, I can work with that and that's awesome.
00:31:24.000 --> 00:31:26.960
Using therapeutic relationship within our teams.
00:31:26.960 --> 00:31:29.200
Oh, I love that kind of stuff, you know.
00:31:29.200 --> 00:31:30.559
So I don't know.
00:31:30.559 --> 00:31:37.920
I think it's not so much the I think I don't want to get into you gotta work smarter, not harder, like we just gotta go faster.
00:31:37.920 --> 00:31:42.720
I think it's different because I don't think people get into healthcare because they knew it was gonna be easy.
00:31:42.720 --> 00:31:48.559
They got in because it was gonna be a challenge, but let's find the joy in the challenge or the passion.
00:31:48.559 --> 00:31:50.640
And that's what keeps my fire going.
00:31:50.640 --> 00:31:51.200
I don't know.
00:31:51.200 --> 00:31:52.400
How do you feel about that, Nicole?
00:31:52.400 --> 00:31:55.039
I mean, do you is that where'd you get your passion?
00:31:55.039 --> 00:31:56.640
Because you've been in this a long time too.
00:31:56.720 --> 00:32:07.359
So yeah, I mean, I think um well, I my next follow-up question to that was gonna be like, how does competency factor into helping you find that passion? Does it?
00:32:08.640 --> 00:32:09.119
Yeah.
00:32:11.039 --> 00:32:13.839
Okay, yeah, probably.
00:32:13.839 --> 00:32:21.680
Well, and I think too, I think even helping people find the right specialty.
00:32:21.680 --> 00:32:30.400
You know, I think when you come out of a your preparation school, your professional preparation, you don't know what you, you know, you want to do.
00:32:30.400 --> 00:32:31.759
You might think you do.
00:32:31.759 --> 00:32:35.599
I mean, I have so many people, I want to work in PEDs, and I go, Are you sure?
00:32:35.599 --> 00:32:36.720
Because that's hard.
00:32:36.720 --> 00:32:38.960
Labor and delivery, right?
00:32:38.960 --> 00:32:41.759
Like everybody it's hard, you know?
00:32:41.759 --> 00:32:46.559
Yeah, you f have your first stillbirth, and oh my gosh, this is a difficult place to be.
00:32:46.559 --> 00:32:52.319
So um, I just say, and I will tell you, my um my specialty that I found was my true love.
00:32:52.319 --> 00:32:55.440
I did not know it even existed in nursing school.
00:32:55.440 --> 00:32:59.200
And I'm a head and neck cancer nurse with laringectomies and trachs.
00:32:59.200 --> 00:33:15.680
And if someone along the way, a preceptor and educator, didn't help me understand that um my ability to, well, move into some surgical services with ARIMA management and things like that, if they didn't help lift that up for me, I would have never thought head and neck cancer is my love.
00:33:15.680 --> 00:33:17.599
Um, it's utums and trach.
00:33:17.599 --> 00:33:18.640
Who wants that?
00:33:18.640 --> 00:33:21.839
Oh, but I thrived in that specialty.
00:33:21.839 --> 00:33:23.599
So I'm grateful.
00:33:23.599 --> 00:33:36.240
And maybe we have to have systems that not only allow the person to know what they want, but the preceptors and educators to have things in place that help support um, you know, matching the person with the right situation.
00:33:37.119 --> 00:33:44.079
Um yeah, I mean, because I would say, you know, I initially thought I wanted to be a science teacher.
00:33:44.079 --> 00:33:48.400
Uh, I love sort of, you know, biology and some of those things.
00:33:48.400 --> 00:33:55.680
Uh I ended up down the nursing path and, you know, anytime like patient education.
00:33:55.680 --> 00:33:59.279
And then I was introduced to this world of nursing professional development.
00:33:59.279 --> 00:34:06.000
And I was like, oh wow, I didn't even know that this was an avenue that my career could could really go down.
00:34:06.000 --> 00:34:31.920
So um, yeah, I do think a lot of the things that you're exposed to, and then even, you know, when you first start in a profession like let's say, you know, education, practice-based education, uh, you know, you're kind of interested in it at first, and then you find out, like, oh, there are a whole set of, you know, competencies and practice models and all of these things that help me do my job uh better.
00:34:31.920 --> 00:34:39.840
And then with that, I think, you know, passion kind of continues to to develop and you continue to grow down this space.
00:34:39.840 --> 00:34:50.159
So I could see, you know, it's obviously a combination of a lot of different things, but it does feel a little bit like competency in an area, you know, does play a factor there for sure.
00:34:50.880 --> 00:34:58.320
Yeah, and I I can just share my own personal journey that uh early in my nursing career, I thought I wanted to work in the operating room, which I did try.
00:34:58.320 --> 00:35:02.719
I will tell you it was not a good fit for me, but I didn't realize, I mean, here's where I started.
00:35:02.719 --> 00:35:04.400
I thought, oh, I love surgical stuff.
00:35:04.400 --> 00:35:05.840
This is gonna be great.
00:35:05.840 --> 00:35:15.679
But I what I didn't plan on in the operating room, especially in the scrub position, you're next to the doctor, you can't move around, you got the mask over your face.
00:35:15.679 --> 00:35:17.679
And some of people know who I am.
00:35:17.679 --> 00:35:21.039
I'm very expressive with my whole body and my face and everything.
00:35:21.039 --> 00:35:22.719
I'm a very outgoing person.
00:35:22.719 --> 00:35:27.599
I would bump the table, I would hit and then they would complain about, oh, she's too fidgety and all that.
00:35:27.599 --> 00:35:39.199
Finally, my manager and the lead preceptor sat me down and they said, you know, this isn't probably the place for you because here's this, you know, they told me pretty, gave me some good feedback, and I was so devastated.
00:35:39.199 --> 00:35:40.800
Oh my God, I'm not a good nurse.
00:35:40.800 --> 00:35:42.719
They said, Oh my gosh, no, you're great.
00:35:42.719 --> 00:35:47.920
Circulator, you're moving around, work in the room, and you have high energy.
00:35:47.920 --> 00:35:49.280
We know where you should go.
00:35:49.280 --> 00:35:57.039
And they recommended to me um that I should go to PACU because I know all the surgical procedures and I'd be great to wake up the patients.
00:35:57.039 --> 00:36:04.559
Woo-hoo! You know, you need Donna to be in your recovery room, which then led me to airway management, which then led me to head and cancer.
00:36:04.559 --> 00:36:16.719
So you see how, and I'm not saying we have to be a career counselor for people, but I am so grateful that people early in my career saw what worked for my personality and what didn't.
00:36:16.719 --> 00:36:19.360
And it got me into the right place.
00:36:19.360 --> 00:36:22.320
Um, and I don't know even how they did it back then.
00:36:22.320 --> 00:36:28.800
I wish I kind of could see, did they map out, you know, is she a safe enough nurse, but surgery is just not her place.
00:36:28.800 --> 00:36:29.679
I don't know.
00:36:29.679 --> 00:36:35.760
So I'm trying to, you know, bring that to life in professional development of how can I help people be able to look at that?
00:36:36.000 --> 00:36:40.000
Well, I love the strength, sort of that strength-based approach, right?
00:36:40.000 --> 00:36:54.639
It wasn't like here's where your weaknesses are and we have to fix those, but instead let's look at, you know, what strengths you bring to the table and how we can really use those to help you down that path towards, you know, what you might find passionate.
00:36:54.880 --> 00:36:55.920
That's a great way to put it.
00:36:55.920 --> 00:37:01.119
Yeah, that strength assessment versus uh uh, you know, gap analysis of where you're falling short.
00:37:01.519 --> 00:37:07.599
Because we could have spent all the time in the world trying to get you to to be the person we wanted you to be in in surgery, right?
00:37:07.599 --> 00:37:11.039
But instead, we helped you find kind of where you could go.
00:37:11.280 --> 00:37:12.159
Yeah, exactly.
00:37:12.159 --> 00:37:12.719
You're right.
00:37:12.719 --> 00:37:14.639
And I don't think I would have loved it there.
00:37:14.639 --> 00:37:19.519
I mean, I go there now and I I look at it and I say, yeah, that's not my personality at all.
00:37:19.519 --> 00:37:20.639
But that's okay.
00:37:20.639 --> 00:37:22.159
You know, it fits for other people.
00:37:22.239 --> 00:37:22.719
That's fine.
00:37:22.719 --> 00:37:23.840
Yeah, for sure.
00:37:23.840 --> 00:37:31.599
So this this year we've been talking a lot about sort of nurse engagement and the things that influence nurse engagement.
00:37:31.599 --> 00:37:47.039
And so I'm just curious if you see any sort of connection between competency and ensuring our staff have competency, you know, in these, you know, certain areas, depending on our specialty, and the level at which they become sort of engaged in their work.
00:37:47.840 --> 00:37:52.960
Um, well, first of all, I'm gonna say this from a couple of different points where engagement really shines.
00:37:52.960 --> 00:38:15.280
I'm gonna actually start with the ongoing competency process where once you're in an organization, when you can start to be part of the assessment of what do we need for our comp to be uh to be successful in our job, if our job is expecting us to do this, what competencies do we need where we actually get to um own our practice, our service, and our competencies, it starts to change everything.
00:38:15.280 --> 00:38:16.880
I see a direct link.
00:38:16.880 --> 00:38:26.800
People are reporting time and time again when we made um the we had this the team be able to identify their own competencies as a group with their manager and their educator.
00:38:26.800 --> 00:38:28.320
I'm not saying they do it on their own.
00:38:28.320 --> 00:38:34.320
We come together and say, what's happening in our cardiac unit or our behavioral health area, whatever.
00:38:34.320 --> 00:38:39.760
And you say, This is really what we need in order to achieve the goals that our organization has set for us.
00:38:39.760 --> 00:38:44.000
So it's a beautiful gap analysis that we can then pick our own competencies.
00:38:44.000 --> 00:38:55.280
Uh, shared governance gets stronger, uh, staff satisfaction goes up, patient outcomes get better, and you have a longer retention of people, the people you want to keep.
00:38:55.280 --> 00:38:57.519
Those are all things that just excite me.
00:38:57.519 --> 00:39:05.039
You know, so you want to have people engaged in that so they can own their practice, their work, and their service, um, and therefore their competencies.
00:39:05.039 --> 00:39:06.960
So that's that's a part of it.
00:39:06.960 --> 00:39:10.400
Um, and so that that's one aspect of it.
00:39:10.400 --> 00:39:17.760
The other part is when we're looking at engagement, giving people choices and options with their verification means everything.
00:39:17.760 --> 00:39:26.960
And if you can make the competency verification methods matter and the competencies matter, then people just start to shine.
00:39:26.960 --> 00:39:29.119
Um, I can share another example.
00:39:29.119 --> 00:39:33.199
I was um recently in an OR, and I mean, this is now for my consulting job.
00:39:33.199 --> 00:39:38.239
I was working with an OR team, and we were uh gonna go into the surgery area and they were gonna show me some different things.
00:39:38.239 --> 00:39:41.840
So I'm changing into scrubs and I'm with another nurse that I've known for years.
00:39:41.840 --> 00:39:47.280
And we she opened up her locker and I saw in her locker um a verification method.
00:39:47.280 --> 00:39:52.719
It was actually an exemplar, a story that she had done a reflective thing on, and it was three years old.
00:39:52.719 --> 00:39:56.159
I recognized the form and I said, you know, you have that form still.
00:39:56.159 --> 00:39:57.119
And she said, Oh yeah.
00:39:57.119 --> 00:39:58.960
I said, you know, you don't have to keep it.
00:39:58.960 --> 00:40:00.800
We've uploaded that in the computer.
00:40:00.800 --> 00:40:03.119
You know, you've been checked off for your competency.
00:40:03.119 --> 00:40:04.719
You don't have to keep it anymore.
00:40:04.719 --> 00:40:06.880
And she said, I will never throw it away.
00:40:06.880 --> 00:40:13.119
She said, that exemplar that I did was one of the best things I uh the best moments of my professional career.
00:40:13.119 --> 00:40:18.800
It was a difficult day where I had to stand the ground and be an advocate for the patient in the operating room.
00:40:18.800 --> 00:40:22.079
And I reflected on that moment and I wrote my story down.
00:40:22.079 --> 00:40:24.880
It is like a thank you note I wrote to myself.
00:40:24.880 --> 00:40:32.719
I went, oh my gosh, you know, when somebody is keeping a competency verification method as a souvenir.
00:40:32.719 --> 00:40:34.239
Oh my gosh.
00:40:34.239 --> 00:40:41.679
But she was so proud of herself in a moment where no one really saw her do that, but she got credit for it through the competency process.
00:40:41.679 --> 00:40:44.079
I just love stuff like that.
00:40:44.400 --> 00:40:52.880
Well, and we're terrible about taking the, I mean, it, you know, we're working our shifts, we're getting to the next patient, we're rushing, rushing, rushing.
00:40:52.880 --> 00:40:58.480
Rarely do we take the time as nurses to sit down and probably reflect on some of those things.
00:40:58.719 --> 00:40:58.960
Yeah.
00:40:58.960 --> 00:41:11.199
And imagine if we had a competency that said, you know, um, you know, something about being an advocate in a different difficult moment or dealing with a difficult situation with a professional colleague or whatever the competency is.
00:41:11.199 --> 00:41:16.880
This is where we can get into some competencies other than skill, like uh the kind of technical skills.
00:41:16.880 --> 00:41:21.519
We're getting into critical thinking or interpersonal skills and stuff like that.
00:41:21.519 --> 00:41:26.800
And she chose to do a reflective story on that, which then her peers reviewed and all of that.
00:41:26.800 --> 00:41:32.960
So it was truly competency verification, but it was something that after it was all done, she kept it.
00:41:32.960 --> 00:41:36.559
And I go, wow, that's absolutely what we want to do.
00:41:36.559 --> 00:41:42.000
We have to have competencies that matter, where people say, This is why I got into this profession.
00:41:42.000 --> 00:41:44.159
This is why I do what I do every day.
00:41:44.480 --> 00:42:03.519
And I think sometimes when it doesn't feel like it matters, like when it feels like we're just checking the box, nurses are less likely to probably I don't want to use the term engage over and over again, but they're less likely to really put time and effort into it because they feel like it doesn't matter.
00:42:03.760 --> 00:42:06.960
Well, and we can use the word disengage or being disenfranchised.
00:42:06.960 --> 00:42:10.960
Here's a very common thing that happens in almost every organization I go to.
00:42:10.960 --> 00:42:19.760
Somewhere we have, you know, we got a problem with something like, oh, we have a problem with CADY, you know, catheter-associated urinary tract infections or something like that.
00:42:19.760 --> 00:42:23.440
80% of our clinical areas are having a problem with it.
00:42:23.440 --> 00:42:27.760
We're gonna make a mandatory competency this year on CADI.
00:42:27.760 --> 00:42:30.079
Everyone has to do the module and test.
00:42:30.079 --> 00:42:31.119
So we do this.
00:42:31.119 --> 00:42:33.280
We this is what's called spray and pray.
00:42:33.280 --> 00:42:36.719
We spray it on everybody and pray that it's gonna improve outcome.
00:42:36.719 --> 00:42:42.400
So now imagine if you and your team are not part of the 80%, you're part of the 20%.
00:42:42.400 --> 00:42:47.840
You guys have been working hard to bring your CADI rates down for two years.
00:42:47.840 --> 00:42:50.079
We've had zero CAUDIS.
00:42:50.079 --> 00:42:53.519
And now you got to do the module and test on CADI.
00:42:53.519 --> 00:42:55.360
You start to say, why do we even bother?
00:42:55.360 --> 00:42:58.480
Doesn't anybody see how great we are in the work we've done?
00:42:58.480 --> 00:43:03.920
So you don't you don't just keep that group average, you actually suck some life out of them.
00:43:03.920 --> 00:43:14.159
And that's the sad part about the approaches we take with competency is that we've actually kind of not increased engagement, not even increased competence.
00:43:14.159 --> 00:43:16.400
We kind of made people say, who cares anymore?
00:43:16.400 --> 00:43:18.079
Just do what you're told.
00:43:18.079 --> 00:43:19.760
That's a sad place to be.
00:43:20.000 --> 00:43:32.480
So what I hear you saying is not only is maybe competency, you know, important for engagement, but how how we are validating competency is going to be important for engagement as well.
00:43:32.480 --> 00:43:33.519
Absolutely.
00:43:33.760 --> 00:43:41.599
And I think too, it's about um allowing allowing the competency to take place where it needs to take place.
00:43:41.599 --> 00:43:46.719
Um, there's so many where again we spray and pray it on everybody and it just doesn't work.
00:43:46.719 --> 00:43:49.440
And we're creating beautiful mediocre organizations.
00:43:49.440 --> 00:43:53.840
I've never seen anybody yet put a banner in the lobby that says shooting for mediocracy.
00:43:53.840 --> 00:43:55.440
No, we're shooting for excellence.
00:43:55.440 --> 00:43:59.760
So your team that was doing great with our Ces was striving for excellence and was achieving.
00:43:59.760 --> 00:44:00.400
It.
00:44:00.400 --> 00:44:01.280
And now what do we do?
00:44:01.280 --> 00:44:02.880
Oh, who cares anymore?
00:44:02.880 --> 00:44:14.960
You've just dropped that engaged person down to mediocre in your efforts to bring up the people below the line and bringing them up to the level of where they need to be for safety.
00:44:14.960 --> 00:44:17.599
We we tend to not do well with those.
00:44:17.599 --> 00:44:22.400
I want to lift up our low performers and I want to lift up our high performers at the same time.
00:44:22.400 --> 00:44:27.199
And that takes a talent and that takes a different kind of system thinking.
00:44:27.199 --> 00:44:29.280
Uh, leaders have to think in a different way.
00:44:29.280 --> 00:44:32.400
Educators and managers have to think in a different way.
00:44:32.400 --> 00:44:34.639
Absolutely.
00:44:34.960 --> 00:44:36.320
Oh, do I have an amen?
00:44:36.320 --> 00:44:37.440
We'll go with an amen.
00:44:37.440 --> 00:44:42.320
I I I'm like sitting here, they can't see me, but I'm shaking my head.
00:44:42.320 --> 00:44:45.440
Like, you're pre you're preaching to the choir here for sure.
00:44:45.440 --> 00:44:54.400
I mean, there's nothing worse in any aspect of life than you know, getting the email that says, we have a problem, everybody needs to fix this, blah, blah, blah.
00:44:54.400 --> 00:44:56.000
And you're like, are they talking to me?
00:44:56.000 --> 00:44:57.599
Because I think I'm doing that right.
00:44:57.599 --> 00:45:11.679
But like, I mean, it makes you start to question sort of everything, sort of that, you know, we're just gonna put this blanket thing out there and make everybody do it because it's just easier to have everybody do it than to really focus on where the problems are.
00:45:11.920 --> 00:45:13.280
And then you feel invisible.
00:45:13.280 --> 00:45:15.840
And why would you want to be in a place where you feel invisible?
00:45:15.840 --> 00:45:18.480
So that's where the engagement comes right back around.
00:45:18.480 --> 00:45:25.280
If you feel seen, if you feel like you belong somewhere, you're more likely to contribute to that.
00:45:25.280 --> 00:45:28.239
It's a it's then that family of who we are.
00:45:28.239 --> 00:45:34.639
You know, it's it's back to what Brene Brown talks about in almost every one of her books, you know, is that belonging principle.
00:45:34.639 --> 00:45:41.440
So if we say when we look at competency or engagement and all that, you got to feel like you belong as part of a team.
00:45:41.440 --> 00:45:48.079
That when you say, this hospital, this organization is mine, I influence it every day and I'm proud of it.
00:45:48.079 --> 00:45:50.159
That to me is the essence of engagement.
00:45:50.159 --> 00:45:53.679
Not up above told me I've got to do this, this, and this.
00:45:53.679 --> 00:45:55.199
That's just an employee, then.
00:45:55.199 --> 00:45:56.239
I don't want that.
00:45:56.239 --> 00:45:56.880
Yeah.
00:45:56.960 --> 00:46:19.039
Well, and I think, you know, I guess I before this conversation, maybe I didn't understand the importance of it's not just, you know, the what, but it's the how and how how we validate competence, how we approach people on, you know, building their, you know, professional identity or their professional practice.
00:46:19.039 --> 00:46:23.840
How we do that is even more important to growing engagement.
00:46:24.079 --> 00:46:30.079
And actually, I think all day long, this is the the, I shouldn't say the humorous part of my job, but it entertains me every day.
00:46:30.079 --> 00:46:35.920
I go into organizations and we tell people two opposite messages all the time and in different categories.
00:46:35.920 --> 00:46:43.440
For example, we tell them, we want you to be a critical thinker, but yet we'll tell you what to do and how we're gonna be checking you off.
00:46:43.440 --> 00:46:45.440
You know, I think, well, that's kind of opposite.
00:46:45.440 --> 00:46:48.800
Or my favorite one is uh it's all about the patient.
00:46:48.800 --> 00:46:52.400
It's all it's patient-centered care, it's all about the patient.
00:46:52.400 --> 00:46:55.760
And then they'll say, Oh my goodness, the surveyors are here today.
00:46:55.760 --> 00:46:57.599
Quickly, everyone over here.
00:46:57.599 --> 00:46:59.440
Well, I'm with a patient.
00:46:59.440 --> 00:47:00.880
Leave them, leave them.
00:47:00.880 --> 00:47:04.800
I mean, it's like, uh what do you want from me?
00:47:04.800 --> 00:47:12.159
And I just sometimes I think we are telling people two different things, or our words say one thing and our actions say another.
00:47:12.159 --> 00:47:26.239
So frankly, a lot of what I think is related to competency has to do with how we as leaders, formal or informal, that could be managers, educators, everybody, how we come together to understand exactly what you're talking about here.
00:47:26.239 --> 00:47:29.119
Do we know what we're actually trying to accomplish here?
00:47:29.119 --> 00:47:32.400
This isn't just completing a list and checking people off.
00:47:32.719 --> 00:47:34.320
Yes, absolutely.
00:47:34.320 --> 00:47:36.559
So let's talk about that then.
00:47:36.559 --> 00:47:50.239
So let's say we're in an organization where the we might be telling them two messages, leaders, educators, they're they're trying to maybe take a different approach to competency.
00:47:50.239 --> 00:47:52.159
Where do you even begin?
00:47:52.159 --> 00:47:54.400
How do you begin to simplify this process?
00:47:54.400 --> 00:47:57.440
How do you begin to just look at this differently?
00:47:57.440 --> 00:47:59.440
What advice do you have?
00:47:59.920 --> 00:48:05.519
Well, if if anybody's ever cracked open any of my books, there's there's three words that seem to pop up all the time.
00:48:05.519 --> 00:48:09.679
They should for you um ownership, empowerment, and accountability.
00:48:09.679 --> 00:48:11.199
Those are the three words I keep.
00:48:11.199 --> 00:48:12.960
That's part of my model, everything.
00:48:12.960 --> 00:48:14.079
It's always there.
00:48:14.079 --> 00:48:22.480
So I want to then look at what are our systems that allow people to own their care, their work, their service, and their competencies.
00:48:22.480 --> 00:48:24.079
So we have to look at that.
00:48:24.079 --> 00:48:28.400
Um, and having the educator pick your competencies is not achieving that goal.
00:48:28.400 --> 00:48:31.679
They can help you facilitate that process, but not do it for you.
00:48:31.679 --> 00:48:33.280
How can we empower people?
00:48:33.280 --> 00:48:40.320
Where we have the employee at the center of the verification, and how can we empower them with choices and options so they have control over things?
00:48:40.320 --> 00:48:46.800
And then how can we create an accountability-based culture, uh, which is really about what we say we're gonna do, we do.
00:48:46.800 --> 00:48:49.760
So I usually have some discussion with leaders, even.
00:48:49.760 --> 00:48:53.119
Are we expecting everybody in this organization to be competent?
00:48:53.119 --> 00:48:55.039
And people say, Well, of course.
00:48:55.039 --> 00:49:01.519
Okay, then let's look at all of our actions to see if we really are doing uh, let's look at our own report card on that.
00:49:01.519 --> 00:49:09.119
And sometimes when you look at here's a scary one, but uh I've seen managers who write a disciplinary note.
00:49:09.119 --> 00:49:13.599
I'll just use this one a disciplinary note that says, I'm gonna follow up in a month.
00:49:13.599 --> 00:49:18.400
What percentage of managers actually follow up at the end of that month?
00:49:18.400 --> 00:49:21.840
And most organizations, that's 20 to 25% of the time.
00:49:21.840 --> 00:49:30.880
So I'm not saying it all comes down to disciplinary action, but if we say this is important enough, do we get distracted by the next shiny thing and we never kind of go around to that?
00:49:30.880 --> 00:49:37.679
Or do we ask people what was important to you or ask them, you know, what kind of competencies should we look at this year?
00:49:37.679 --> 00:49:46.480
And I like to give them forms and tools to be able to pull all these different pieces and then pull in the strategic plan and filter up to the surface the competencies.
00:49:46.480 --> 00:49:52.239
You can put ownership, empowerment, and accountability into everything you do if you just take a look at your systems.
00:49:52.239 --> 00:49:54.639
That's that's where I would start right there.
00:49:55.280 --> 00:50:05.199
I think another piece of, you know, sort of that disengagement too is the flavor of the month mentality of, oh, well, we were working on CAUDI last month.
00:50:05.199 --> 00:50:09.119
I I haven't heard anything about it in a while.
00:50:09.119 --> 00:50:10.639
Is that something we're still doing?
00:50:10.639 --> 00:50:15.760
You know, and you begin to question uh when you do have that flavor of the month happening.
00:50:16.000 --> 00:50:19.039
It just allows people to understand why we're doing what we're doing.
00:50:19.039 --> 00:50:33.280
When they are part of the selection of the process, and that's key to it, and they understand that, okay, we have a problem with this, or here's a new thing, and here's why we're doing it, then then people are much more um, I guess, you know, committed to it.
00:50:33.280 --> 00:50:35.199
They say, we understand why.
00:50:35.199 --> 00:50:38.320
Um, and they're part of the solution.
00:50:38.320 --> 00:50:42.719
Okay, so here's a story that really kind of exemplifies that.
00:50:42.719 --> 00:50:48.559
And this is a group um up in Montana that was using my competency model for about three or four years.
00:50:48.559 --> 00:50:50.880
They sat down to select their competencies.
00:50:50.880 --> 00:50:56.000
It was the shared governance council, the manager, and the educator all together in the cardiac area.
00:50:56.000 --> 00:50:59.920
And they were saying, okay, what's what's new, changing, high risk, and problematic?
00:50:59.920 --> 00:51:03.199
They were using a selection worksheet that I I recommend.
00:51:03.199 --> 00:51:07.599
And um, so they were, they saw that one of their problems they were having was with falls.
00:51:07.599 --> 00:51:11.599
They were having a lot of falls yet again this year, like last year and the year before.
00:51:11.599 --> 00:51:15.519
So somebody on the team says, Oh, we're gonna have to do the falls competency again.
00:51:15.519 --> 00:51:18.079
And so they said, Okay, yeah, we have to do that.
00:51:18.079 --> 00:51:19.280
And then somebody said, Why?
00:51:19.280 --> 00:51:21.039
Why would we do it again?
00:51:21.039 --> 00:51:23.199
We did it last year and the year before.
00:51:23.199 --> 00:51:26.559
We all passed, and it didn't, falls didn't get better.
00:51:26.559 --> 00:51:28.320
So why would we do it again?
00:51:28.320 --> 00:51:30.480
That's the definition of insanity.
00:51:30.480 --> 00:51:34.159
And they said, Yeah, and they said, but you know what, what are we gonna do?
00:51:34.159 --> 00:51:36.880
I mean, our falls are in the toilet, we gotta do something.
00:51:36.880 --> 00:51:39.119
And someone said, Well, let's just think a minute.
00:51:39.119 --> 00:51:41.280
I mean, we don't want our patients to fall.
00:51:41.280 --> 00:51:47.360
We put the red bracelets on them, we put the red socks on them, we put the thing over the bed that says false precaution.
00:51:47.360 --> 00:51:48.800
We talk about it in Huddle.
00:51:48.800 --> 00:51:51.760
Why is this still a problem?
00:51:51.760 --> 00:51:55.119
And then somebody said, Well, you know, when is it happening?
00:51:55.119 --> 00:51:56.000
Where is it happening?
00:51:56.000 --> 00:51:57.039
Well, who's involved?
00:51:57.039 --> 00:52:04.960
And they said, Let's pull all of our QA data, our quality data, and look at all of the data and figure out what's really happening in our backyard.
00:52:04.960 --> 00:52:11.039
And they noticed when, well, they had two falls on one day, and somebody said, Oh, I was working that shift.
00:52:11.039 --> 00:52:12.559
It was crazy and chaotic.
00:52:12.559 --> 00:52:16.639
And then somebody said, I was working on this day and we had a fall and it was crazy and chaotic.
00:52:16.639 --> 00:52:18.880
And then another person said, Me too here.
00:52:18.880 --> 00:52:24.960
And they realized that every day they had a fall, they had um, it felt like a crazy and chaotic day.
00:52:24.960 --> 00:52:27.760
And they said, Could it be that falls is not the problem?
00:52:27.760 --> 00:52:30.639
Falls is a symptom of something else.
00:52:30.639 --> 00:52:39.599
Could it be that us being able to manage a crazy and chaotic day is actually the skill we're missing, not the knowledge on falls?
00:52:39.599 --> 00:52:42.800
And they said, Well, maybe, but how would we even do that?
00:52:42.800 --> 00:52:46.239
I mean, would when we make it a competency, what would we do with that?
00:52:46.239 --> 00:52:50.480
And so they said, Well, who's good at de-escalating, you know, craziness?
00:52:50.480 --> 00:52:54.400
And they said, Well, maybe behavioral health can help us with de-escalating crazy.
00:52:54.400 --> 00:52:54.960
I don't know.
00:52:54.960 --> 00:53:01.840
They called over to behavioral health and they said, Oh, yeah, we got like three competencies we could show you and and behavior.
00:53:01.840 --> 00:53:07.440
The psych people helped the cardiac people come up with a competency on de-escalating craziness on your shift.
00:53:07.440 --> 00:53:17.280
And everybody on the cardiac unit that year did uh one of their five competencies that they selected was on de-escalating craziness in the day.
00:53:17.280 --> 00:53:19.360
Everyone had to show that they could do it.
00:53:19.360 --> 00:53:23.039
There were different ways they did the verification of that, very creative ways.
00:53:23.039 --> 00:53:26.880
And uh they did one of their five competencies for that.
00:53:26.880 --> 00:53:33.360
And what I love um was that at the end of the year, after everybody did that, they dropped their falls by 68%.
00:53:34.159 --> 00:53:35.119
That is incredible.
00:53:35.119 --> 00:53:38.000
And that is kind of that is what we need, right?
00:53:38.000 --> 00:53:45.119
Because when I think about competency, it feels like it's so much easier to just say falls is an issue.
00:53:45.119 --> 00:53:47.199
Let's do the false competency again.
00:53:47.199 --> 00:53:48.880
Let's not think beyond that.
00:53:48.880 --> 00:53:51.119
Let's check the box and move on.
00:53:51.119 --> 00:54:06.400
And that is why we I it seems to me anyway, that that is why we get stuck with continuing to not have the outcomes that we are trying to achieve because we keep doing the same things and it's clearly not working.
00:54:06.719 --> 00:54:08.719
And then what I love is this group called me.
00:54:08.719 --> 00:54:09.440
I wasn't even there.
00:54:09.440 --> 00:54:12.079
They called me to say, Donna, we're so proud of ourselves.
00:54:12.079 --> 00:54:13.440
Here's what we did.
00:54:13.440 --> 00:54:22.719
And they said to me this if we didn't own our competencies, if we didn't have the right to select our competencies based on data, they don't just get to pick anything they want.
00:54:22.719 --> 00:54:25.760
They said, we wouldn't have asked the second part of the question.
00:54:25.760 --> 00:54:28.320
They knew the data on falls was in the toilet.
00:54:28.320 --> 00:54:29.119
They knew that.
00:54:29.119 --> 00:54:30.880
But they said, what else is missing?
00:54:30.880 --> 00:54:33.760
And what was missing was their gut feeling of the day.
00:54:33.760 --> 00:54:37.199
There was more data than just what the quality department could give them.
00:54:37.199 --> 00:54:40.320
It was their own data to say, what did that shift feel like?
00:54:40.320 --> 00:54:43.440
What did that day feel like when we had the fall?
00:54:43.440 --> 00:54:48.960
And that was a second component of information that got to the real issue.
00:54:48.960 --> 00:54:50.960
And they made a difference in their patients.
00:54:50.960 --> 00:54:56.480
And they said to me, we made it safer here for our patients on this care area.
00:54:56.480 --> 00:54:58.559
And they were so proud of that.
00:54:58.559 --> 00:55:00.719
You know, that's what we want.
00:55:00.719 --> 00:55:05.199
And it's not about that from up above that we're not gonna, you know, focus on falls.
00:55:05.199 --> 00:55:06.960
Of course, everyone's focused on falls.
00:55:06.960 --> 00:55:11.599
So if your data falls below or above where you need it to be, you got to do something about it.
00:55:11.599 --> 00:55:15.360
And we gave permission to the team to do something about it.
00:55:15.760 --> 00:55:17.360
That is such a cool story.
00:55:17.360 --> 00:55:19.360
Thank you so much for sharing that.
00:55:19.360 --> 00:55:31.039
So much to learn, I think, um, about about competency, about that ownership, about empowerment, about account, you know, accountability uh from that story.
00:55:31.039 --> 00:55:32.719
So really cool.
00:55:32.719 --> 00:55:40.239
Okay, so looking ahead, I want to kind of switch switch roles here and and think into the future a little bit.
00:55:40.239 --> 00:55:50.320
You know, as our nursing workforce continues to evolve, as, you know, change probably continues at an even rapid, more rapid pace than it is already.
00:55:50.320 --> 00:55:55.119
How do you see competency evolving?
00:55:55.760 --> 00:55:57.199
Um, very good question.
00:55:57.199 --> 00:56:00.400
I think it's back to creating competencies that really matter.
00:56:00.400 --> 00:56:10.320
I've seen some shifts in the way people are actually looking at competencies rather than, again, the procedures and tasks and how to uh operate a machine and things like that.
00:56:10.320 --> 00:56:18.480
I've seen people that are looking at a competency like uh during orientation, the ability to learn on the fly.
00:56:18.480 --> 00:56:21.679
Show me not just, I'm not just gonna tell you you could look it up.
00:56:21.679 --> 00:56:31.760
I want you actually to prove to me, show, show to me four times that you can go get you that you can show that you know something or don't know something, and you can go look it up.
00:56:31.760 --> 00:56:39.679
You can call somebody that um during when I'm precepting somebody, I might say, um, if they ask me, well, how do I do this?
00:56:39.679 --> 00:56:45.679
And I say, okay, would you like to use this as one of your learning on the fly competency verifications?
00:56:45.679 --> 00:56:47.920
Or do you want me to just tell you what to do here?
00:56:47.920 --> 00:56:51.280
And then the new employee can, like, oh my god, I don't know if I'm ready yet.
00:56:51.280 --> 00:56:54.320
Okay, yeah, okay, I'm gonna give it a try, you know?
00:56:54.320 --> 00:57:06.000
And then you have to then show me uh what you don't know and where you would initiate your own education, look it up because I want you to demonstrate to me that you can use our resources, you can access stuff, you know who to call.
00:57:06.000 --> 00:57:08.159
It's not about knowing everything.
00:57:08.159 --> 00:57:09.039
We all know that.
00:57:09.039 --> 00:57:12.559
The scariest professional on the planet is someone who says they know everything.
00:57:12.559 --> 00:57:14.400
That's not realistic.
00:57:14.400 --> 00:57:17.519
The best professional is someone who's always curious.
00:57:17.519 --> 00:57:18.960
I think I'll look it up again.
00:57:18.960 --> 00:57:23.360
What other outcomes could we have with this that might impact what's going to happen?
00:57:23.360 --> 00:57:24.880
You know, all of that stuff.
00:57:24.880 --> 00:57:26.719
So that's an example of one.
00:57:26.719 --> 00:57:28.400
The ability to learn on the fly.
00:57:28.400 --> 00:57:31.039
Uh, I've done some other attitude competencies.
00:57:31.039 --> 00:57:39.920
I've done some things with some groups where we just finished one in an emergency room to distinguish between what's urgent and what's important.
00:57:39.920 --> 00:57:45.440
What you need to respond to right now and what's important, it could be high risk, but you have time.
00:57:45.440 --> 00:57:46.800
So you can slow the roll.
00:57:46.800 --> 00:57:49.679
They called it the slow the roll competency, you know?
00:57:49.679 --> 00:57:52.960
So you could distinguish is this an urgent thing or is it an important thing?
00:57:52.960 --> 00:57:58.559
Because that makes a difference in how we respond and our purposefulness on deciding the actions we take.
00:57:58.559 --> 00:58:03.039
It's not about running the machine, it's a different way of thinking in the emergency department.
00:58:03.039 --> 00:58:08.320
So I think our competencies are gonna look very different in the next five to 10 years.
00:58:09.519 --> 00:58:11.519
I think they're gonna need to too.
00:58:11.519 --> 00:58:24.079
Like I think that um we can't keep, you know, checking lists and checking boxes in these silos that we do really have to look at and how is it, how are all of these, the bigger picture of all of this being applied?
00:58:24.079 --> 00:58:35.199
Um, you know, when you talk about that learning on the fly, to me, this seems like something that is just innate for me that I'm always like, well, I don't know how to do that, but I can probably figure it out.
00:58:35.199 --> 00:58:46.880
It seems though, and I don't know if this is a generational thing, and this might be a tangent that we can cut later if we need to, but like, is this something that is missing in a lot of people?
00:58:46.880 --> 00:58:55.360
Um, that they they just expect that they a should know it, or if they don't know it, they just they don't know it.
00:58:55.360 --> 00:58:56.480
Big deal.
00:58:57.840 --> 00:58:58.880
Do you see that missing?
00:58:58.880 --> 00:59:06.320
Yeah, I think I mean, I will say I'm I'm going on my 40th anniversary as a nurse here pretty soon.
00:59:06.320 --> 00:59:09.280
Um, and I heard this back when I was a young person too.
00:59:09.280 --> 00:59:14.159
And I think sometimes we say it could it be that that that's the people have they changed?
00:59:14.159 --> 00:59:19.199
I think it I've seen different groups where some do well with us and some don't.
00:59:19.199 --> 00:59:21.440
You know, we've all probably experienced somewhere.
00:59:21.440 --> 00:59:24.480
Well, someone say, didn't they teach you that in school?
00:59:24.480 --> 00:59:29.679
Are you gonna be willing to ask more curiosity questions in the future when you get that kind of response?
00:59:29.679 --> 00:59:31.760
No, because that's your culture.
00:59:31.760 --> 00:59:50.880
I've also been a part of other cultures where the very experienced nurses would sit around and have some discussion amongst themselves, even during breaks or during report, and say things like, I'm just not getting the results I need from this situation or this these interventions I've been using.
00:59:50.880 --> 00:59:52.800
Does anybody have some other ideas?
00:59:52.800 --> 00:59:55.440
And they reflected with each other and with each other.
00:59:55.440 --> 01:00:00.000
And I thought, this is a nurse of 30 plus years of experience and they're still not certain.
01:00:00.000 --> 01:00:02.559
That was such a good thing for me to see.
01:00:02.559 --> 01:00:06.880
So I think, I think it's more about culture than it is about generation.
01:00:06.880 --> 01:00:09.440
I think, yes, there are differences with our generations.
01:00:09.440 --> 01:00:09.920
I get that.
01:00:09.920 --> 01:00:23.920
And that's not, I'm not wiping that out because there's different reasons we get motivated about things, but the connection, the passion we have for something, um, I think comes from the culture that allows this or that to happen within an organization.
01:00:24.320 --> 01:00:25.519
No, I think that's what it is.
01:00:25.519 --> 01:00:33.280
Like I, you know, I asked the question genuinely because I I wasn't putting that connection to culture there.
01:00:33.280 --> 01:00:35.199
But I do think that's what it is.
01:00:35.199 --> 01:00:46.239
You know, if you're if you're in a culture that encourages that type of behavior and models that type of behavior, you're gonna more likely develop those types of thinkers and those types of nurses.
01:00:46.559 --> 01:00:47.360
Absolutely.
01:00:47.360 --> 01:00:51.280
And I I rob from other industries uh blindly, I mean, just blatantly.
01:00:51.280 --> 01:00:51.760
I love it.
01:00:51.760 --> 01:00:52.719
So it's great.
01:00:52.719 --> 01:01:05.119
But uh in the airline industry, you'll see over the last decade or more, you know, they changed how um the you hear people talk about the door from the cockpit to the uh back of the plane.
01:01:05.119 --> 01:01:09.840
There was a hierarchy there that they purposely tried to dismantle.
01:01:09.840 --> 01:01:18.159
And now when you go on a plane, you can hear things like the pilot saying, Um, uh, welcome aboard this this plane today or our flight, blah, blah, blah.
01:01:18.159 --> 01:01:20.719
And you have we have an exceptional crew in the back.
01:01:20.719 --> 01:01:27.599
They give great respect to the crew versus before it wasn't, it was more I'm the captain, do what you're you're told.
01:01:27.599 --> 01:01:31.760
And they said that affected the ability for that team to function together.
01:01:31.760 --> 01:01:36.559
So I think uh a lot of times we have to examine what culture are we in?
01:01:36.559 --> 01:01:38.159
Is that the culture we want?
01:01:38.159 --> 01:01:40.880
What components do we want to keep or change?
01:01:40.880 --> 01:01:43.280
Um, it comes down to mostly culture.
01:01:43.280 --> 01:01:51.199
And it could be even culture within teams that are different from other teams in the same organization, or even shifts sometimes too.
01:01:51.360 --> 01:01:54.960
So, well, Donna, I have learned so much from you today.
01:01:54.960 --> 01:01:56.960
I'm so grateful for this conversation.
01:01:56.960 --> 01:02:05.920
You know, we've talked about competency, what it is, why it matters, what it's influencing, where to start, even thinking about into the future how things will evolve.
01:02:05.920 --> 01:02:08.639
Uh, before we go, though, I do have one last question.
01:02:08.639 --> 01:02:12.480
And I do ask this of pretty much every guest that comes on the podcast.
01:02:12.480 --> 01:02:28.639
Um, but when you think about competency and you think about the impact that competency has, what's one strategy that you see organizations using that you think makes the biggest difference and something you wish more organizations would adopt?
01:02:28.880 --> 01:02:31.199
Hmm, that's a very good question.
01:02:31.199 --> 01:02:42.480
I think just to have a reflective conversation to say what do we like or not like about our current um culture or process and put them into some categories.
01:02:42.480 --> 01:02:49.679
Because too many times organizations stay with the things they don't like just because it's familiar.
01:02:49.679 --> 01:02:54.800
So because they're comfortable there and they hate it, you know, the checklists, let's get rid of them.
01:02:54.800 --> 01:02:56.079
But oh, it's easy.
01:02:56.079 --> 01:03:00.400
I mean, we use that term several times during this podcast, you know, because it's easy.
01:03:00.400 --> 01:03:01.360
Easy for what?
01:03:01.360 --> 01:03:04.800
To not get to our goal, you know, that's not an excuse.
01:03:04.800 --> 01:03:09.039
So I think just I think awareness is so good to say what do we like about our process?
01:03:09.039 --> 01:03:11.360
Because you don't want to throw the baby out with a bathwater.
01:03:11.360 --> 01:03:17.440
But at the same time, let's not hold on to stuff we don't even like, and we've been whining about it for years.
01:03:17.440 --> 01:03:25.440
So to say we want to move to something that holds this to be true and keep it there, but get rid of the stuff that does not serve us well.
01:03:25.440 --> 01:03:27.119
Um, simple things like that.
01:03:27.119 --> 01:03:36.960
I even say with every policy that you have in your organization, I always ask the question you read a policy, does it serve you or does it control you?
01:03:36.960 --> 01:03:38.960
If it controls you, get rid of it.
01:03:38.960 --> 01:03:40.480
If it serves you, keep it.
01:03:40.480 --> 01:03:43.679
And that's where we go next because that will shape the culture.
01:03:43.920 --> 01:03:44.880
That is so great.
01:03:44.880 --> 01:03:50.320
I mean, thinking about, you know, um, being brave enough to try something new.
01:03:50.639 --> 01:03:53.440
And we don't have to change unless the change is warranted.
01:03:53.440 --> 01:03:58.239
I'm I don't want to take people to someplace completely new where they don't feel comfortable.
01:03:58.239 --> 01:04:02.559
But again, being aware of what you like and what you don't like.
01:04:02.559 --> 01:04:06.239
Um, you know, every everything in life is like that.
01:04:06.239 --> 01:04:12.639
You just change a job, don't jump off to a new job without saying, I really like this part of my job, I want to keep that.
01:04:12.639 --> 01:04:17.440
Or you even said to me earlier today, you really loved working with people and developing people.
01:04:17.440 --> 01:04:22.400
You didn't even know that for at, you know, when you first started in your nursing profession, but you love that.
01:04:22.400 --> 01:04:28.000
So as you move on to other things, you want to keep that part that you love, but you might want to get rid of this or that.
01:04:28.000 --> 01:04:29.840
I like to work indoors or outdoors.
01:04:29.840 --> 01:04:33.199
I want to travel more, I don't want to travel as much or whatever it might be.
01:04:33.199 --> 01:04:36.079
You need to know the pros and cons of everything that go with it.
01:04:36.079 --> 01:04:37.280
So excellent.
01:04:37.440 --> 01:04:41.920
Well, thank you, Donna, so much again for this conversation today.
01:04:41.920 --> 01:04:50.800
Um, I'm I'm really glad that you were able to join us, and I know that our listeners will walk away with just as much, if not more, uh, than I did.
01:04:50.800 --> 01:04:51.920
Thank you, Nicole.
01:04:51.920 --> 01:04:53.119
I appreciate it.
01:04:53.119 --> 01:05:03.119
Wait, before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses.
01:05:03.119 --> 01:05:13.599
This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program.
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This includes a comprehensive curriculum designed.
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