A Practical Framework For Building Engaged Nurses Beyond Residency ၏ စာသားမှတ်တမ်းအပြည့်အစုံ

this larger picture. 00:02:16.719 --> 00:02:20.319 So I began sharing the framework through presentations and webinars. 00:02:20.319 --> 00:02:25.360 And eventually, after a lot of writing and revising a published manuscript. 00:02:25.360 --> 00:02:32.400 Throughout this year on the podcast, I've been working or exploring different concepts of the framework with our guests. 00:02:32.400 --> 00:02:47.039 And today we'll explore the framework itself, the different parts, what initially connected with the two of us, reflect on what we learned through the writing process, and then consider how these ideas continue to show up in practice today. 00:02:47.039 --> 00:02:52.800 So to explore this framework, I have with me my co-author on the manuscript, Hannah Hayes. 00:02:52.800 --> 00:02:53.520 Welcome, Hannah. 00:02:53.520 --> 00:02:55.360 Thanks so much for joining me today. 00:02:55.680 --> 00:02:56.479 Thanks for having me. 00:02:56.479 --> 00:02:58.719 Excited to talk about it today with you. 00:02:59.439 --> 00:02:59.840 All right. 00:02:59.840 --> 00:03:07.039 So before we get too far into things, why don't we start off by having you tell our listeners a little bit more about yourself and the work that you do? 00:03:07.520 --> 00:03:07.840 Sure. 00:03:07.840 --> 00:03:11.919 So I am a nurse and public health professional by background. 00:03:11.919 --> 00:03:16.000 I have both my BSN and my Master of Public Health from UW Madison. 00:03:16.000 --> 00:03:21.120 And I've worked in many different environments throughout my career. 00:03:21.120 --> 00:03:29.840 So I worked in hospital-based settings, I've worked in public health and governmental public health, I've worked in nursing education. 00:03:29.840 --> 00:03:39.199 And currently I work for a federally qualified health center as a nurse, in addition to doing some work that centers lived experience and research. 00:03:39.199 --> 00:03:54.800 But a large majority of my work was for the New To Public Health Residency Program, which is a public health workforce development that was originally created through UW Madison's School of Nursing and is currently housed in a program of the de Beaumont Foundation. 00:03:55.520 --> 00:04:10.080 And the New To Public Health Residency Program is a workforce development program that is designed to support the competence and the confidence of public health professionals as they transition to governmental public health practice. 00:04:10.080 --> 00:04:16.160 And just like how you mentioned with your work, Nicole, it's really intended to be a retention effort. 00:04:16.160 --> 00:04:18.800 And we were seeing very similar things. 00:04:18.800 --> 00:04:34.160 So when I watched your webinar a couple of years ago, I reached out to you because our program was seeing the same things, we were hearing the same things that you're getting these, you know, outcomes of the program, but not necessarily seeing that reflected in retention. 00:04:34.160 --> 00:04:36.319 And I

wanted to explore that more. 00:04:36.319 --> 00:04:43.120 And your um the webinar that I watched and the model that you created was really resonating with me. 00:04:43.519 --> 00:04:44.160 Excellent. 00:04:44.160 --> 00:04:51.519 And so through the development of your New To Public Health transition to practice program, that's really where we first connected. 00:04:51.519 --> 00:04:55.759 And so that was kind of a fun project to kind of consult on with you. 00:04:55.759 --> 00:04:58.959 And and you guys have done uh great work with that. 00:04:58.959 --> 00:05:02.000 And I love uh continuing to see that grow. 00:05:02.000 --> 00:05:11.199 So kudos to you for um all the work that goes into that because I know how much um how much it takes to really get something like that up off the ground. 00:05:11.199 --> 00:05:14.399 So um good for you guys for that. 00:05:14.399 --> 00:05:27.279 Um, so let's so we started this year on the podcast talking about engagement to begin with, and then we talked about a lot of the different um pieces of this framework individually. 00:05:27.279 --> 00:05:37.120 And so I think starting this podcast, sort of kind of bringing it back to the beginning a little bit and talking again about what you know about engagement. 00:05:37.120 --> 00:05:44.480 So when you think about engagement and when you think about engaged nurses, what does that actually mean to you? 00:05:44.800 --> 00:05:46.079 Yeah, great question. 00:05:46.079 --> 00:05:53.439 So, first I'll just kind of start with uh what a definition of engagement is so everybody can have that, and then what it means to me. 00:05:53.439 --> 00:06:04.879 So engagement refers to the active participation and involvement of individuals from diverse backgrounds within their organization or within their community. 00:06:04.879 --> 00:06:07.120 And it encompasses a few things. 00:06:07.120 --> 00:06:20.000 It involves creating an environment where all people feel valued, they feel heard, they feel empowered to contribute to decision-making processes, and it really fosters a culture of collaboration and respect. 00:06:20.000 --> 00:06:22.240 And that's Oxford's definition. 00:06:22.240 --> 00:06:33.519 Um, and to me, what I think that really means in short is that it's a where people feel like they can thrive within their specific conditions, within their organization, within the environment that they're at. 00:06:33.519 --> 00:06:37.600 Um, whatever that might be that's individual and specific to them. 00:06:37.600 --> 00:06:57.759 Um, and I think that really aligns well with what we're kind of seeing, like what this model um reflects a little bit too is Mazell's hierarchy of needs, where at the top of the pyramid you have self-actualization, which is, you know, where people achieve their full realization of their potential, their creativity, and their growth. 00:06:57.759 --> 00:07:02.959 And I think that really reflects and aligns well with what engagement is. 00:07:02.959 -->

00:07:07.199 So being engaged at work means someone's excited to be at their work. 00:07:07.199 --> 00:07:19.199 They find joy and purpose in what they're doing, they have meaningful connections, they feel like they have autonomy, um, they can be creative, they can engage in problem solving. 00:07:19.199 --> 00:07:22.319 And I think all in all, they also feel resilient. 00:07:22.319 --> 00:07:29.920 Like if there's a period of adversity, they can bounce back from that, they can feel capable, they feel strong, and they believe in themselves. 00:07:30.160 --> 00:07:31.600 And I think that's what we want, right? 00:07:31.600 --> 00:07:38.480 Like when we really, at the end of the day, when we think about like what does healthcare need and what do we want? 00:07:38.480 --> 00:07:40.639 I mean, that is really what we want. 00:07:40.639 --> 00:07:45.439 If every single nurse showed up feeling that way, thinking that way, can you imagine? 00:07:45.680 --> 00:07:45.920 Yes. 00:07:45.920 --> 00:07:48.240 I think all nurses want to feel that way. 00:07:48.240 --> 00:07:57.600 And I think all supervisors and organizations want their staff members to feel that way because when you have engaged employees, people perform better too. 00:07:57.600 --> 00:08:00.240 And it supports the sex success of the organization. 00:08:00.560 --> 00:08:00.720 Yeah. 00:08:00.720 --> 00:08:04.879 And so I think, you know, the big question is, you know, how do we, how do we get there? 00:08:04.879 --> 00:08:05.279 Right. 00:08:05.279 --> 00:08:11.279 So hopefully we'll uncover maybe some of those things today throughout our conversation. 00:08:11.279 --> 00:08:21.519 But one of the ideas that we discussed in the manuscript is that engagement may actually be sort of this precursor or antecedent to retention. 00:08:21.519 --> 00:08:30.800 So, in other words, retention may be the outcome we're measuring, but engagement is really that experience that shapes that outcome, right? 00:08:30.800 --> 00:08:37.360 Because if I'm thinking and feeling all of those things that you just described there, chances are I'm gonna stay put. 00:08:37.360 --> 00:08:48.320 Why do you think sometimes organizations focus so heavily on retention and maybe pay a little bit less attention to this concept of engagement? 00:08:48.639 --> 00:08:51.759 I think there's many reasons why this could be. 00:08:51.759 --> 00:08:58.799 I think, first of all, thinking about retention, that is like a clear, focused, concrete goal. 00:08:58.799 --> 00:09:02.879 Like you have one clear outcome that you're trying to achieve. 00:09:02.879 --> 00:09:08.080 And if you're thinking more about engagement, that's like so variable. 00:09:08.080 --> 00:09:10.159 What does that mean for each person? 00:09:10.159 --> 00:09:12.399 It's very um, it's less focused. 00:09:12.399 --> 00:09:15.440 So it's maybe a little bit more ambiguous. 00:09:15.440 --> 00:09:22.559 Um, it also takes time, energy, capacity when we have all these other conflicting priorities. 00:09:22.559 --> 00:09:36.399 And, you know, really just to have your engage employees be engaged and as a supervisor, whoever that might be, to support that engagement as well, to do that authentically, it really does take time and intention. 00:09:36.399 --> 00:09:43.120 And I think everybody wants to do that, but we just have so many other things going on all the time in our lives, in our work. 00:09:43.120 --> 00:09:45.200 Um, and retention also matters. 00:09:45.200 --> 00:09:46.559 Why we want retention. 00:09:46.559 --> 00:09:49.039 All organizations want retention as well. 00:09:49.039 --> 00:09:57.200 It increases productivity, you know, it reduces turnover costs, it increases, you know, organizational knowledge. 00:09:57.200 --> 00:10:02.480 Um, and having retention really, you know, it improves morale as well. 00:10:02.480 --> 00:10:08.799 So, but I think that really focusing on engagement is the way to do that. 00:10:08.799 --> 00:10:18.000 Um, investing in engagement can help achieve those retention goals that we all want because we all want um, you know, to be happy in the work that we're doing. 00:10:18.000 --> 00:10:24.240 We want um employees and everybody to work hard, to be motivated, to be part of something that they believe in. 00:10:24.240 --> 00:10:36.720 And research also shows that having a highly engaged workforce can increase innovation, productivity, and reduce those costs associated with um, you know, hiring and turnover. 00:10:36.720 --> 00:10:43.519 So it's just a different way to maybe frame things that you're still going to achieve that same goal, but you're doing that in a different way. 00:10:43.840 --> 00:10:44.080 Right. 00:10:44.080 --> 00:10:49.200 Because when we, you know, retain uh, I mean, the things that we want, right? 00:10:49.200 --> 00:10:58.240 So we we want that financial impact, like you talked about, kind of retaining that knowledge and expertise because when staff leave, institutional knowledge walks out the door. 00:10:58.240 --> 00:11:02.240 We want that stability, we want that continuity of care for our patients. 00:11:02.240 --> 00:11:06.000 And if we want to grow strategically, we need people to stick around. 00:11:06.000 --> 00:11:23.919 And so I think you hit the nail on the head as far as retention is sort of that one sort of tangible, we can easily measure this um thing to kind of focus on, but we don't always take that time to focus on all the other pieces because it is just more difficult. 00:11:23.919 --> 00:11:30.639 And like you said, it is very individualized for each person that kind of walks through our door and works with us. 00:11:30.639 --> 00:11:37.679 So if engagement's the goal, then obviously our next logical question to explore is what creates engagement? 00:11:37.679 --> 00:11:47.919 And that's really, I think, where this framework comes in and what we're try what we were trying to describe and explore with the creation of this framework.

00:11:47.919 --> 00:11:59.360 So maybe now you can walk our listeners through kind of the major components of the framework that we identified and and shared in our manuscript and how they sort of fit together. 00:11:59.759 --> 00:12:03.840 Yeah, so there's three major components of this framework. 00:12:03.840 --> 00:12:14.320 There are the individual components, there are the foundational enablers, and there are also the organizational assets that are brought to the framework. 00:12:14.320 --> 00:12:30.559 So the individual components refer to really what is needed within and by the individual to achieve a successful transition within their role, whether they're new to practice or transitioning to their practice, and what is needed for them to be engaged. 00:12:30.559 --> 00:12:35.039 So those components, um, and Nicole, feel free to chime in anytime. 00:12:35.039 --> 00:12:49.360 So those components are competency, which is like the knowledge and skills that they bring to their work to support safe and high-quality care, um, physical and psychological and professional safety. 00:12:49.360 --> 00:12:56.879 Um, they need to have belonging, which is really feeling connected to the community or their unit, whatever that might be. 00:12:56.879 --> 00:13:09.039 Um, having esteem is feeling competent and accepted and being able to cope with the challenges that they may experience and know that they're worthy of happiness. 00:13:09.039 --> 00:13:19.200 And then um, last we have, and I forgot to say this is all, you know, presented as a pyramid, which I really like, thinking about that Maslow's hierarchy that I talked about earlier. 00:13:19.200 --> 00:13:27.039 Then at the top of the pyramid, um, we have engagement, which is that full investment and commitment with the work that they're doing. 00:13:27.360 --> 00:13:38.159 So we need nurses who know how to do their job, they feel safe doing their job, they feel like they belong to the group that's also working towards this goal of doing their job, and they need to feel good about it. 00:13:38.159 --> 00:13:44.799 And really kind of thinking of those as kind of the key ingredients to achieving engagement, I think. 00:13:44.799 --> 00:13:48.320 I I mean, clearly I feel like it makes a lot of sense. 00:13:48.320 --> 00:13:58.240 And I think one thing that really makes this framework feel a little bit different to me, anyway, was that it just didn't focus on what the nurses need individually. 00:13:58.240 --> 00:14:10.159 So, yes, those are the things that we've identified, but we've also recognized that organizations play a role in creating those conditions that make these sort of components possible. 00:14:10.159 --> 00:14:20.399 So, as we developed the framework, we really realized that identifying competency, safety, belonging, and esteem wasn't necessarily enough. 00:14:20.399 --> 00:14:25.679 That most leaders would look at those concepts and say, and maybe some of our listeners are doing that right

now. 00:14:25.679 --> 00:14:26.960 Yeah, this is great. 00:14:26.960 --> 00:14:28.480 Of course, those things matter. 00:14:28.480 --> 00:14:33.440 But the more important question is how do organizations contribute to that? 00:14:33.440 --> 00:14:45.600 Because uh, and I think one sort of caveat to this, and I think one of the things we were seeing in the residency program, and while this model was created, was we do a really good job focusing on competency. 00:14:45.600 --> 00:14:55.120 Like when we were reflecting on this as a team, it was like, yeah, we're hitting that nail on the head with our curriculum and all the things that we have doing through this residency program. 00:14:55.120 --> 00:15:12.399 Safety and belonging, like, yes, we were providing that within our program, but we had a little bit less control about how that was looking and showing up in the organization, even though we were coaching our leaders and our site coordinators with like, you know, we need you doing check-ins and we need you kind of focusing on these things. 00:15:12.399 --> 00:15:14.639 We just didn't have as much control there. 00:15:14.639 --> 00:15:19.759 And then, of course, like the esteem component, I think, is both kind of external. 00:15:19.759 --> 00:15:26.320 Like, are the organizations kind of recognizing the value of participation in this program? 00:15:26.320 --> 00:15:28.879 Are they celebrating the success of this program? 00:15:28.879 --> 00:15:36.320 But then also there's sort of this internal, I think, component to esteem as well, like our own feelings of worthiness. 00:15:36.320 --> 00:15:39.360 And I know we talked a little bit about that last month on the podcast. 00:15:39.360 --> 00:15:51.120 So we went back to the question of yes, our program is helping do some of these things, but it it really needs to go beyond what we're capable of doing within the walls of this nurse residency program. 00:15:51.120 --> 00:16:01.919 So when we think about how organizations create those conditions, that's where those foundational enablers that you mentioned come in, and then also the organizational assets. 00:16:01.919 --> 00:16:26.080 Um, if you're picturing this sort of Maslow's hierarchy of need for our listeners, so this pyramid shape, at the foundation, we identified things like healthy work environments, financial stability, not because those actually create engagement directly, but because they position organizations to support things like our residency program, right, more effectively. 00:16:26.080 --> 00:16:39.039 If nurses are working in unhealthy work environments or organizations lack the resources to create a transition to practice program, it becomes much harder to create some of those conditions that support engagement. 00:16:39.039 --> 00:16:41.679 So that's sort of those foundational enablers. 00:16:41.679 --> 00:16:51.519 And then from there, we started thinking about the different organizational conditions that cultivate the different

components of competency, safety, belonging, and esteem. 00:16:51.519 --> 00:16:57.279 Um, and for this, we actually identified what we called organizational assets. 00:16:57.279 --> 00:17:02.799 And we stated these in the terms of like forms of capital, right? 00:17:02.799 --> 00:17:06.000 So for example, we talk about human capital. 00:17:06.000 --> 00:17:10.319 Um, and that, yes, that's about having people in place, right? 00:17:10.319 --> 00:17:22.880 But it also includes how we support the development of that knowledge, those skills and abilities within our nursing workforce so that they can fulfill their role and do so safely. 00:17:22.880 --> 00:17:29.279 We also talk about social capital or those relationships, those connections that exist within the organization. 00:17:29.279 --> 00:17:32.960 Those relationships help nurses feel supported. 00:17:32.960 --> 00:17:35.599 They create opportunities to learn from one another. 00:17:35.599 --> 00:17:40.480 They foster both psychological safety and that sense of belonging. 00:17:40.480 --> 00:17:49.279 And we discussed this concept of psychological capital, which includes things like confidence, hope, resilience, optimism. 00:17:49.279 --> 00:17:58.559 These factors really influence how nurses perceive their own value and contributions within the organization and the healthcare team. 00:17:58.559 --> 00:18:11.759 So the idea is that by investing and strengthening in these different forms of capital, organizations can begin to cultivate the individual components that are needed for engagement. 00:18:11.759 --> 00:18:28.240 And so when we put that all together, the framework really suggests that nurses are more likely to become fully engaged when those foundational conditions are present and when organizations are intentionally building the assets that support those individual needs. 00:18:28.240 --> 00:18:41.200 I think another important sort of point I want to just make for our listeners, because you know, sometimes when we think of Maslow's hierarchy, it's like one thing builds off the next, and that is very, very true, right? 00:18:41.200 --> 00:18:47.200 But I think um these components don't operate independently. 00:18:47.200 --> 00:18:52.640 So in fact, one of the things we talked about in the manuscript was how interconnected they really are. 00:18:52.640 --> 00:19:00.000 So again, kind of going back to some of these examples, human capital can influence both competency but also safety, right? 00:19:00.000 --> 00:19:06.000 As nurses develop greater competence, they often feel more competent and secure in their practice. 00:19:06.000 --> 00:19:16.400 But at the same time, when organizations provide safe staffing, adequate support and resources, nurses have a greater capacity to continue to develop their skills, right? 00:19:16.400 --> 00:19:28.160 If we're constantly running short staffed, I don't even have the time to maybe ask the questions or really spend time developing my skills because we're just trying to get everything done as quickly as possible. 00:19:28.160 --> 00:19:30.640 Same thing is true for social capital. 00:19:30.640 --> 00:19:34.720 So social capital influences both belonging and safety. 00:19:34.720 --> 00:19:48.960 So having a trusted colleague and supportive relationships creates that sense of belonging while also making nurses more comfortable asking questions, speaking up when things feel unsafe, and seeking help when they need it. 00:19:48.960 --> 00:19:57.519 So while we describe these individual components, they're really constantly interacting with one another and reinforcing one another. 00:19:57.519 --> 00:20:04.319 And kind of a gap in one component can actually create gaps elsewhere as well. 00:20:04.319 --> 00:20:06.400 So just kind of keeping that in mind. 00:20:06.400 --> 00:20:10.960 And for anybody who's like, okay, I'm following along, this feels interesting. 00:20:10.960 --> 00:20:13.119 I'm having a hard time visualizing it. 00:20:13.119 --> 00:20:16.559 We will link the manuscript in the show notes of this episode. 00:20:16.559 --> 00:20:24.480 So you can go, you can take a look, the image is actually in the manuscript, uh, and then you can read about some of these things in a little bit more detail. 00:20:24.799 --> 00:20:38.960 And I think too, I just like would maybe conceptualize it as like, you know, those components are what you need, and then those organizational assets or those forms of capital or like how you really operationalize it, how you do it. 00:20:39.279 --> 00:20:39.839 I love that. 00:20:39.839 --> 00:20:41.519 Thanks for pointing that out. 00:20:41.519 --> 00:20:50.000 So now that hopefully our listeners have a little bit of a picture of this framework in their mind, let's go back to the webinar. 00:20:50.000 --> 00:21:13.440 So I had mentioned I started presenting this, I was using it as a tool to really explain to organizations that residency programs are a great tool to do some of these things, but here, but we sometimes have to go beyond nurse residency, which is really actually now that you think about it, where the title for this podcast sort of came came to be is this realization that it goes beyond residency. 00:21:13.440 --> 00:21:23.440 So talk a little bit now through your initial reactions when you first encountered the framework and why it resonated so much with you. 00:21:24.079 --> 00:21:32.000 I think why it really resonated with me is like I said, I was working for the New To Public Health Residency program at the time. 00:21:32.000 --> 00:21:34.559 And we had this great um program. 00:21:34.559 --> 00:21:41.359 And I I really do um firmly believe in nurse residency programs or public health residency programs. 00:21:41.359 --> 00:21:49.759 And we were hearing from some people who worked at public health departments, you know, that they got this program, but the person still left the organization. 00:21:49.759 --> 00:21:56.000 And I knew the

resident who participated, they were really passionate about the work that they were doing. 00:21:56.000 --> 00:21:59.119 And, you know, people were like, well, but they still left. 00:21:59.119 --> 00:22:00.640 So this isn't Effective. 00:22:00.640 --> 00:22:02.880 And I would disagree it is effective. 00:22:02.880 --> 00:22:05.200 But you just need those other pieces. 00:22:05.200 --> 00:22:25.920 So we started to be started to do more webinars or orientations with supervisors and more like broadly sharing information about what was needed to support employees as they transition to practice, or more broadly, what was needed to support the public health workforce. 00:22:25.920 --> 00:22:38.720 And something that resonated with me at the time was, you know, a lot of talk post-pandemic was about like resiliency that was needed from nurses, resiliency that was needed from public health workers. 00:22:38.720 --> 00:22:43.200 And I really resonated with the concept of collective moral resiliency. 00:22:43.200 --> 00:23:04.640 That yes, you need resiliency from an individual, but you also need the support from both society and from organizations, institutions, whatever that might be, which is something that can be called collective moral resiliency, that it's needed from all of us, that it's not just one or the other. 00:23:04.640 --> 00:23:07.920 It's not all just on the individual to be resilient. 00:23:07.920 --> 00:23:11.279 You need these conditions that support their resiliency. 00:23:11.279 --> 00:23:27.519 And I really started to take more of an upstream approach, if you will, about like what was needed from organizations to support like the resident, to support the training effectiveness, to really get that retained and engaged workforce that we're all looking for. 00:23:27.839 --> 00:23:29.920 I really appreciate that perspective. 00:23:29.920 --> 00:23:43.119 So kind of two things I I want to just comment on was one, what you just said about it takes more than just individual resilience, because coming out of the pandemic, like that was the focus, right? 00:23:43.119 --> 00:23:49.759 Of we need to make nurses more resilient or we need to help them better cope. 00:23:49.759 --> 00:23:51.759 And I think that's certainly true. 00:23:51.759 --> 00:24:04.240 Like there is a piece of building interpersonal skills that allow you to bounce back from adversity and cope with our completely imperfect healthcare system that we're working within. 00:24:04.240 --> 00:24:13.680 And I believe that to the point where we actually brought in more skills around well-being and interpersonal skills into our curriculum. 00:24:13.680 --> 00:24:15.440 So I think that that is definitely true. 00:24:15.440 --> 00:24:18.480 But I don't think it has to be an either-or, right? 00:24:18.480 --> 00:24:26.880 And I think this framework really does help you think about that a little bit differently, that nurses experience their work within the system. 00:24:26.880 --> 00:24:32.799 The work environment matters, leadership matters, workload matters, relationships matter. 00:24:32.799 --> 00:24:41.200 And so I think for me, it really does help kind of it can be a both and, right? 00:24:41.200 --> 00:24:43.119 It's not necessarily either or. 00:24:43.119 --> 00:24:54.480 And it's really kind of the interaction between that individual and the environment, the condition, the organizational conditions, the system that they're in that really are what we need to be focusing on. 00:24:54.480 --> 00:25:01.920 And then the other thing you talked about was about what organizations were saying after they used your program. 00:25:01.920 --> 00:25:08.400 And I think that is one of the lessons we kept learning too, over and over again in our residency work. 00:25:08.400 --> 00:25:20.559 A residency program can be incredibly valuable, transition to practice program, you know, whatever you want to call it, but it can't carry the entire burden of retention by itself. 00:25:20.559 --> 00:25:26.960 And I think that so many times organizations, you know, want that to be the case. 00:25:26.960 --> 00:25:32.160 They they want to say, well, they say, you know, residency programs, transition to practice programs help with this. 00:25:32.160 --> 00:25:38.480 And they they certainly do, but it can't be the magic bullet, it's not the magic bullet solution, right? 00:25:38.480 --> 00:25:42.480 The uh we need to create meaningful learning experiences. 00:25:42.480 --> 00:25:53.599 We we can build confidence, we can provide support and connection, but ultimately, nurses leave the residency classroom and go back to that environment that they're working in every day. 00:25:53.599 --> 00:26:02.240 And if what they're experiencing in practice isn't aligned with what we're building in the residency program, that can be really difficult to overcome. 00:26:02.240 --> 00:26:16.240 And I think that's one of one of the main driving forces with us even creating this framework was because it really helped us broaden the conversation beyond the nurse residency program itself. 00:26:16.240 --> 00:26:27.759 So one of the things that I really appreciated working with you, Hannah, on this manuscript was that it really pushed the framework beyond sort of my own experience and my own assumptions, right? 00:26:27.759 --> 00:26:34.000 And so as we worked together on this, what did you kind of come to appreciate most about the framework? 00:26:34.240 --> 00:26:39.200 I think what I really appreciated most about the framework were those forms of capital that were needed. 00:26:39.200 --> 00:26:45.440 So I'm speaking to like that collective moral resiliency that it's not just all on the individual. 00:26:45.440 --> 00:26:49.759 Um, and like you said, um, you know, it certainly is on the individual. 00:26:49.759 --> 00:26:59.119 Like the individual needs to achieve that engagement, but you need a supportive environment and conditions to allow that individual to grow

and to thrive. 00:26:59.119 --> 00:27:07.599 And I really liked how you conceptualize those forms of capital as what was needed to support those components along and up the pyramid. 00:27:07.599 --> 00:27:10.720 Um, so that's just really what stood out to me. 00:27:10.720 --> 00:27:18.799 Um, and there's so many things that organizations can do to support um raised residents as they transition to practice. 00:27:19.039 --> 00:27:22.960 Yeah, I mean, I think one of the things we know is leaders are incredibly busy. 00:27:22.960 --> 00:27:32.079 And if the framework only helps people understand what the problem is, but doesn't help them think about what to do next, it's not going to be all that useful, right? 00:27:32.079 --> 00:27:37.839 So um earlier this year, I actually had the opportunity to talk with nurses about this framework. 00:27:37.839 --> 00:27:44.160 And one of those consistent themes that came up was okay, this makes sense, but now what? 00:27:44.160 --> 00:27:56.880 Um, and so I really appreciated in the manuscript that we tried to move beyond simply kind of describing engagement and started identifying some practical strategies that leaders could use to support it. 00:27:56.880 --> 00:28:06.480 So if I remember correctly, that might not have been something we had originally written about, but after kind of getting feedback from the editor, we did include it. 00:28:06.480 --> 00:28:15.200 Um, so we it in the manuscript, there is a nice little table that talks about um for each of the different um components. 00:28:15.200 --> 00:28:20.400 So for competency, safety, belonging, and esteem, we have a list of different strategies that you can use. 00:28:20.400 --> 00:28:27.759 Some of which we have sort of put an asterisk by that indicate, and this fits really nicely into a residency program. 00:28:27.759 --> 00:28:42.960 So just about each one of these components, there are specific strategies that really tie in nicely to what you're doing in residency, but there's also a number of strategies that could be used sort of outside a residency program as well. 00:28:43.279 --> 00:28:49.759 Yeah, I think so many times that you have this literature, we know this information, and then it's like, what do you do about it? 00:28:49.759 --> 00:28:55.440 And I really appreciated that we, um, the editor, you know, encouraged us to like, what do you do about this? 00:28:55.440 --> 00:28:56.079 What can you do? 00:28:56.079 --> 00:29:00.960 It's so we do list um strategies to operationalize the framework. 00:29:00.960 --> 00:29:06.240 And then we also have different ways that you can evaluate um the strategies that you're doing. 00:29:06.240 --> 00:29:13.839 And something that we did within the manuscript too was we modeled this off a little bit off of something that's called the Kirkpatrick model. 00:29:13.839 --> 00:29:24.319 So um the Kirkpatrick model is an evaluation framework that has historically been used to assess the effectiveness and impact

of training and educational programs. 00:29:24.319 --> 00:29:27.759 It's something that the new to public health residency program uses. 00:29:27.759 --> 00:29:30.160 It's also a pyramid, ironically. 00:29:30.160 --> 00:29:32.400 So you have um four different levels. 00:29:32.400 --> 00:29:40.880 You have um reaction, you have learning, um, moving up, you have behavior, and then you have level four, which is results. 00:29:40.880 --> 00:29:50.079 So, you know, moving up the pyramid, it becomes a little bit harder to achieve like the evaluation, but it's more sometimes often viewed as more important. 00:29:50.079 --> 00:29:59.119 So we have um in our evaluation metrics of how you can really assess the strategies that you're using to operationalize the framework. 00:29:59.119 --> 00:30:11.519 We have what are different um strategies or evaluation metrics for participation and reaction, which is just like, did people find um what you did to be useful or relevant to what they're doing? 00:30:11.519 --> 00:30:19.119 We have learning, um, you know, did they gain the new skills and confidence that was required or desired of them? 00:30:19.119 --> 00:30:22.480 The behavior, are they applying it to their job? 00:30:22.480 --> 00:30:24.079 And then you have results. 00:30:24.079 --> 00:30:29.119 If you achieve the intended outcome of the program, um, what would that might be? 00:30:29.119 --> 00:30:36.400 Such as oftentimes um for, you know, programs such as this, it's retention, like the ultimate, ultimate um goal or result. 00:30:36.400 --> 00:30:50.799 And but we have that even broken down further within the different um strategies to build or achieve different forms of capital to afford um to um move along those components of the framework. 00:30:51.119 --> 00:30:57.759 Yeah, and I think that's like you said, really important because leaders are busy, NPDs are busy. 00:30:57.759 --> 00:31:02.079 If any guidance we can give people on, okay, so how do we actually use this? 00:31:02.079 --> 00:31:03.680 I think it's gonna be helpful. 00:31:03.680 --> 00:31:06.880 Um, and I've always been a big fan of Kirkpatrick's model as well. 00:31:06.880 --> 00:31:09.519 We use that in our residency program as well. 00:31:09.519 --> 00:31:17.440 Um, and it's so easy to focus on the smile, you know, what we call kind of like the smiley faces of like, did they like it on level one? 00:31:17.440 --> 00:31:21.680 And a little bit more difficult sometimes to focus on those higher levels of the model. 00:31:21.680 --> 00:31:27.039 So I guess I never put two and two together that they are both pyramids, but that's that's interesting. 00:31:27.039 --> 00:31:57.680 Another thing I've really come to appreciate is that while this framework was originally developed in context of nurse residency and to think about nurses transitioning into practice, the more I've thought about it and the more we've written about it and the more I've talked to people about it, I've really found myself seeing these things everywhere, whether we're talking about experienced nurses, educators, faculty, leaders, any professionals really in almost any field, people want a lot of these same things. 00:31:57.680 --> 00:32:05.039 They want to feel capable, they want to feel safe, they want to feel like they belong, they want to know that their contributions are valued. 00:32:05.039 --> 00:32:09.359 And and those don't just disappear after the first year of nursing. 00:32:09.759 --> 00:32:12.799 No, everybody wants to feel engaged in the work that you're doing. 00:32:12.799 --> 00:32:21.119 You know, if you're feeling engaged, you're taking pride in the work that you're doing, you're feeling committed and connected to the organization's mission and goals. 00:32:21.119 --> 00:32:22.559 It gives you a sense of purpose. 00:32:22.559 --> 00:32:23.599 You feel fulfilled. 00:32:23.599 --> 00:32:30.079 So everybody at whatever stage of their career wants to feel engaged in the work that you're doing. 00:32:30.079 --> 00:32:46.319 So while this was intended for people who are transitioning to practice or um who are new to practice, I think that this applies all the time, that you really want to focus on this engagement at all aspects and um stages of someone's career. 00:32:46.640 --> 00:32:53.359 And one of the interesting things that, so earlier this year, we actually did a focus group. 00:32:53.359 --> 00:32:59.200 So we got a couple groups of nurse leaders, MPDs, and then also frontline nurses. 00:32:59.200 --> 00:33:06.880 Um, and we had them take a look at this framework and we got their feedback in an effort to sort of verify this with active practicing nurses. 00:33:06.880 --> 00:33:13.680 And one of the frontline nurses had said, you know, I think all of these components are for sure important. 00:33:13.680 --> 00:33:24.799 She was somebody who was a little further into her practice, and she said, So for me, I could see where like competency and safety were really important to me as a new nurse when I was first starting. 00:33:24.799 --> 00:33:31.440 But now that I've been here for five years, seven years, I don't remember how long she had been in the profession. 00:33:31.440 --> 00:33:42.640 She said, you know, I'm kind of less worried about those things because I've already developed, you know, my competencies and I've been in sort of the same specialty for that duration of time. 00:33:42.640 --> 00:33:50.799 So now for me, it's more of sort of the esteem piece that is a little bit, you know, more of my priority, I guess. 00:33:50.799 --> 00:34:01.359 So it was interesting to hear her talk about how, yes, applicable across the continuum, but the emphasis or the importance of each of these might vary based on where you're at. 00:34:01.599 --> 00:34:09.840 And thinking about what you mentioned before to Nicole, is like this, you know, being in that pyramid form, it's intended to move up sequentially. 00:34:09.840 --> 00:34:20.000 It's not that

those other pieces don't reinforce um one another or like play in different directions, but really kind of thinking about how you move up that framework. 00:34:20.000 --> 00:34:21.360 So that makes a lot of sense. 00:34:21.679 --> 00:34:30.480 So since publication, where have you seen some of these concepts showing up in practice, either in your own work or in the experiences of others? 00:34:30.880 --> 00:34:32.159 Well, it's interesting. 00:34:32.159 --> 00:34:44.559 So um I currently work for a federally qualified health center and I kind of went back to clinical practice after being in a different type of work, which was public health workforce development. 00:34:44.559 --> 00:34:51.599 And I'm still engaged in um different, you know, um different public health work and initiatives. 00:34:51.599 --> 00:34:54.800 Um, but I'm working as a nurse now. 00:34:54.800 --> 00:34:56.400 Um, and that's been interesting. 00:34:56.400 --> 00:35:16.320 So even just thinking about like how I am developing or moving up these different, um, like engaging with these different forms of different components of the framework, that I need my own competency, that I need to feel safe and secure, and how those have played out um within the organization that I work for as well. 00:35:16.320 --> 00:35:18.960 Um, so I've had really supportive leaders. 00:35:18.960 --> 00:35:28.960 Um, I also have, you know, the organization that I work for, I do really feel like they want to support the full engagement of um, you know, the staff who work for them. 00:35:28.960 --> 00:35:32.800 So I've been seeing how it's been like, I think I take a different lens, right? 00:35:32.800 --> 00:35:37.119 Like I'm a quote unquote new nurse in this way to this role. 00:35:37.119 --> 00:35:40.239 I have, you know, been a nurse for many years now. 00:35:40.239 --> 00:36:00.239 Um, but I'm also just like seeing how like the strategies that the organization is using to maybe like achieve some of these forms of capital or like achieve like the components of the pyramid, um, you know, for me as a nurse or for like my colleagues that I work for. 00:36:00.480 --> 00:36:00.800 Yeah. 00:36:00.800 --> 00:36:12.400 Well, so um one of our program coordinators, Jess Osepka, actually just wrote a blog that we have on our website about um beyond the new grad, why belonging matters for every new nurse. 00:36:12.400 --> 00:36:16.960 So that was one of the components that we unpacked earlier this year. 00:36:16.960 --> 00:36:25.440 And she said, you know, when I was listening to that, I just thought, wow, this like this is so I feel so many of these things. 00:36:25.440 --> 00:36:26.960 And I'm not even new, right? 00:36:26.960 --> 00:36:30.960 I am the charge nurse or the supervisor on a shift. 00:36:30.960 --> 00:36:38.559 But sort of this idea of loneliness and belonging, I mean, it shows up for me when I walk in the doors there. 00:36:38.559 --> 00:36:44.559 So um I, I, I, she definitely sort of sees that

in her practice. 00:36:44.559 --> 00:36:55.679 Uh, another place where I've sort of found myself revisiting this framework is through some work that we're doing for organizational readiness. 00:36:55.679 --> 00:37:06.559 So historically, we've assessed readiness of a for a residency program with organizations that come to us and we focus on implementation questions like, you know, do you have the support? 00:37:06.559 --> 00:37:07.679 Do you have the preceptors? 00:37:07.679 --> 00:37:09.119 Do you have the resources? 00:37:09.119 --> 00:37:18.639 And more recently, I've actually started looking at that sort of readiness assessment more through this lens of this framework. 00:37:18.639 --> 00:37:26.320 So for each component, do organizations have sort of the ingredients they need to be prepared for this? 00:37:26.320 --> 00:37:35.599 So do they do they allow nurses the time and support to participate from like a financial stability piece? 00:37:35.599 --> 00:37:39.840 Is professional development a valued part of the organization? 00:37:39.840 --> 00:37:43.599 Sort of looking at sort of the idea of a healthy work environment. 00:37:43.599 --> 00:37:50.079 Do they have structures in place that are developing or helping to support that competency development? 00:37:50.079 --> 00:37:58.400 Um, do they, you know, so really kind of going up the pyramid and then asking organizations, where are we starting? 00:37:58.400 --> 00:38:08.400 Not that doesn't mean that we can't implement a residency program, but it really helps us have a pulse on, you know, again, do they have some of these key components in place? 00:38:08.400 --> 00:38:20.559 Because if we don't even have the key components in place for them to engage in the residency program, then we're not going to have the key components or we're not going to be able to work towards that ultimate goal of retention. 00:38:20.559 --> 00:38:23.440 And the program isn't going to do what's intended, right? 00:38:23.440 --> 00:38:33.119 Because if we from the very beginning are not allowing protected time for our nurses to work on this, it's not going to work for you, right? 00:38:33.119 --> 00:38:34.639 The program is not going to work. 00:38:34.639 --> 00:38:39.760 If we aren't helping build those connections, we're going to have a gap there, right? 00:38:39.760 --> 00:38:46.000 And we're going to be missing out on some of those important components of engagement. 00:38:46.000 --> 00:39:03.280 So for me, this framework has become um less of maybe a model, even and more of like this lens that helps me just ask better questions, whether we're talking about engagement in a specific program or engagement in an organization. 00:39:04.000 --> 00:39:04.719 Definitely. 00:39:04.719 --> 00:39:16.400 And just thinking about like how you are going to, you know, if you have these different um components right away, you're probably going to be much more effective. 00:39:16.400 --> 00:39:25.760 Like the success of the residency program and of the resident is just going to be so much more greater versus like if you're already starting behind. 00:39:25.760 --> 00:39:34.480 And I think that's where the framework really emphasizes to like those foundational enablers that are already like needed, like just at the bottom of the pyramid. 00:39:34.480 --> 00:39:40.079 What do you need in place to even just support this moving forward? 00:39:41.039 --> 00:39:48.880 So what's one or maybe more things you feel people still misunderstand about engagement? 00:39:49.920 --> 00:40:07.119 I think for me, engagement, um, if you're really trying to support the engagement of your nurses, it needs to be a very intentional um effort to be done authentically. 00:40:07.119 --> 00:40:12.880 And it needs to be unique and individualized to many different staff members. 00:40:12.880 --> 00:40:20.320 Um, so I think that there's different ways that you can do that, but it's not like a one-size, like catch-is-all approach. 00:40:20.320 --> 00:40:30.400 Like you really need to take the time to meet with each individual that you're working with, um, find out what's important to them. 00:40:30.400 --> 00:40:33.440 Um, you want to make sure that you can support them in their goals. 00:40:33.440 --> 00:40:35.920 So first you need to ask, like, what are your goals? 00:40:35.920 --> 00:40:38.239 Like, what do you need within the workplace? 00:40:38.239 --> 00:40:46.880 It might be nice to know like what are their personal circumstances and how you can support that because people are going to bring like where they're coming from to their work. 00:40:46.880 --> 00:40:50.639 Like that um creates a big impact. 00:40:50.639 --> 00:41:01.840 If they're having health problems or if they're having relationship problems outside of work, they're going to bring that to the work that they're doing and trying to like mitigate that as much as possible within work is important. 00:41:01.840 --> 00:41:07.519 Um, really being deliberate about creating a culture of belonging is so important. 00:41:07.519 --> 00:41:10.480 As you mentioned, like you're gonna have those gaps. 00:41:10.480 --> 00:41:23.360 Um, if people don't feel connected to like the people they're working with, you know, they're gonna have a hard time even feeling maybe safe to like ask questions, to make sure that they're being competent within this. 00:41:23.360 --> 00:41:25.599 So it all moves back and forth. 00:41:25.599 --> 00:41:32.480 Um, you know, people want to feel heard, they want to share their ideas, and they really want to feel valued in the work that they're doing. 00:41:32.480 --> 00:41:43.039 So I think it's important to recognize and value them as an individual versus just this um, you know, broad, all-encompassing approach. 00:41:43.039 --> 00:41:55.440 So, really, in short, I think that it needs to be a very individualized, unique, um, and intentional effort and when we're really thinking about how do we support engagement.

00:41:56.000 --> 00:41:57.199 That is really interesting. 00:41:57.199 --> 00:42:02.480 And I love that you you bring that up because I think, yes, it's it needs to be individualized. 00:42:02.480 --> 00:42:06.480 Another piece of that is it's definitely multifaceted, right? 00:42:06.480 --> 00:42:14.000 It's not one single intervention or one single pizza party or one single recognition program that's going to create engagement. 00:42:14.000 --> 00:42:16.159 Um, and I think the framework speaks to that, right? 00:42:16.159 --> 00:42:18.480 It's coming from multiple different components. 00:42:18.480 --> 00:42:29.280 Um, but along kind of the same lines of that, so I presented this framework um this year at the Association for Nursing Professional Development annual convention. 00:42:29.280 --> 00:42:33.280 And I had somebody come up to me afterwards and was like, okay, this is I really like this. 00:42:33.280 --> 00:42:34.159 This is great. 00:42:34.159 --> 00:42:37.679 So how are we, you know, measuring engagement? 00:42:37.679 --> 00:42:41.599 How do we decide that our nurses on our unit are engaged? 00:42:41.599 --> 00:42:45.679 And, you know, I it took me a minute to kind of think about that. 00:42:45.679 --> 00:42:50.480 And I'm like, well, you know, you can measure things like, are they, you know, going back to school? 00:42:50.480 --> 00:42:52.480 Are they continuing to develop professionally? 00:42:52.480 --> 00:42:54.960 Are they become a precept or charge nurse, etc.? 00:42:54.960 --> 00:42:56.800 Like monitor those things. 00:42:56.800 --> 00:43:02.480 And if if they're doing those things, I think part of that is showing that they are engaged. 00:43:02.480 --> 00:43:09.039 And then um, kind of that stuck in my brain for kind of a long time, that question. 00:43:09.039 --> 00:43:13.519 And I had the great opportunity to sit down with Donna Wright. 00:43:13.519 --> 00:43:20.320 I don't know if you know who Donna Wright is, but she's sort of the competency guru in the NPD world. 00:43:20.320 --> 00:43:31.039 Um, and she was on one of our earlier podcasts, and she has a really unique approach to competency where it you don't just verify competence through like a skills checklist, right? 00:43:31.039 --> 00:43:36.960 Or it's not always return demonstration, but there's a lot of different ways that you can show that you're competent. 00:43:36.960 --> 00:43:53.119 And that really sort of inspired me to kind of rethink this idea of what engagement looks like because I think we could really model a lot of that and and take a lot away from the way Donna talks about competency. 00:43:53.119 --> 00:44:02.000 To first of all, um, you know, somebody doesn't come in and say, uh, these are the These are the important competencies, right? 00:44:02.000 --> 00:44:09.440 But you talk to the people on the unit and they help identify what are the competencies that we need to be focusing on for our work. 00:44:09.440 --> 00:44:11.119 They're sort of the experts in it. 00:44:11.119 --> 00:44:16.639 So I think that was kind of my first aha was like talking to the people on the unit. 00:44:16.639 --> 00:44:19.360 What does engagement look like on this unit? 00:44:19.360 --> 00:44:26.800 What are the things that we want to see nurses doing to kind of contribute to you know improved patient care here, right? 00:44:26.800 --> 00:44:32.559 Like how do we want to see nurses showing up fully invested? 00:44:33.119 --> 00:44:43.679 And that's so funny you mentioned that too, because just this week at the organization that I work for, we actually had meetings as we're transitioning to the Donna Right competency assessment model. 00:44:43.679 --> 00:44:54.239 So like our I work for um like maternal child health, and we met as a team and identified like HR asked us, like, what are these competencies? 00:44:54.239 --> 00:44:56.400 How are we going to evaluate these competencies? 00:44:56.400 --> 00:45:02.559 So we're actively like initiating this model of practice in the work right now that we're doing. 00:45:03.039 --> 00:45:05.920 And I think this could be mirrored though around this engagement, right? 00:45:05.920 --> 00:45:07.280 So what does engagement look like? 00:45:07.280 --> 00:45:08.719 And then guess what? 00:45:08.719 --> 00:45:17.199 When when it comes time to like show that I'm competent, every single nurse gets to show they're competent in a different way, potentially, right? 00:45:17.199 --> 00:45:24.159 Or they have a group of, you know, you can select from these five um ways to show that you're competent. 00:45:24.159 --> 00:45:26.719 And I think we could apply this to engagement. 00:45:26.719 --> 00:45:31.519 Like, okay, so this is what we've decided as a unit, engagement is going to look like for us. 00:45:31.519 --> 00:45:36.880 And now you get to decide for yourself how am I going to engage? 00:45:36.880 --> 00:45:44.000 So I am really able to leverage my own strengths, the things that interest me, the things that I bring to the table. 00:45:44.000 --> 00:45:47.280 And I think that in itself is going to help, right? 00:45:47.280 --> 00:46:02.559 Like, not everybody has to be the preceptor, not everybody has to be the charge nurse, not everybody has to get involved in committees or, you know, work on evidence-based practice projects or or do whatever it is that we've identified as the thing that kind of marks them as engaged. 00:46:02.559 --> 00:46:05.679 But there are different ways for me to show that. 00:46:05.679 --> 00:46:13.440 And I think it takes really everybody's strength, sort of contributing in a positive way to really help us move the needle. 00:46:13.760 --> 00:46:14.159 Yes. 00:46:14.159 --> 00:46:32.000 And I also think that there are some valuable resources that exist too that are maybe adjacent to engagement, not necessarily using that term, but for example, the there's a surgeon general um document and framework for workplace mental health and well-being. 00:46:32.000

--> 00:46:40.719 And that has a lot of things too that are focusing on kind of like those aspects that are core to engagement, um, core to well-being. 00:46:40.719 --> 00:46:47.840 So there are different tools, resources, frameworks, um, evaluation, evaluation metrics that can be used as well. 00:46:47.840 --> 00:46:51.119 And that's a really good one that's from the government. 00:46:51.440 --> 00:46:51.840 Perfect. 00:46:51.840 --> 00:46:52.880 Thank you for sharing that. 00:46:52.880 --> 00:46:55.920 I don't think I was um aware of that one. 00:46:55.920 --> 00:46:59.039 Okay, Hannah, we have had a great conversation. 00:46:59.039 --> 00:47:02.480 Um, thank you so much for uh joining us. 00:47:02.480 --> 00:47:04.800 But before we go, I do have one more question. 00:47:04.800 --> 00:47:08.800 And I asked this of pretty much every guest, I think, that comes on the podcast. 00:47:08.800 --> 00:47:20.159 But if there was one thing that you wish more healthcare organizations understood about engagement, and one thing that you wish they were doing differently, what would that be? 00:47:20.719 --> 00:47:30.159 I think just really investing in the staff that you have in the ways that they need it. 00:47:30.159 --> 00:47:36.239 So asking them what they need and how you can support them goes a long way. 00:47:36.239 --> 00:47:37.920 Just meeting with those people. 00:47:37.920 --> 00:47:43.199 And we always talk about in nursing that you're supposed to meet the patient where they're at. 00:47:43.199 --> 00:47:51.519 And I think the same thing applies here, just meeting um your nurse, your staff member, whoever that might be, where they're at. 00:47:51.519 --> 00:47:57.119 And supporting engagement is going to support the goals of the workforce. 00:47:57.119 --> 00:48:04.960 It's going to be a more happy work environment, it's going to be more productive, it's going to support the success of the organization. 00:48:04.960 --> 00:48:10.079 Um, and it's also going to really support like the communities that we live in as well. 00:48:10.079 --> 00:48:20.800 If you have a happy, engaged staff members, like that's going to like even, you know, be reflected outside of work too in the community that we live in. 00:48:20.800 --> 00:48:32.400 And I really think that supporting that um supports the well-being of everybody of our community, and it's going to improve health outcomes and support equity in the long run. 00:48:32.960 --> 00:48:33.519 Excellent. 00:48:33.519 --> 00:48:36.880 Well, thank you, Hannah, so much for being here with me today. 00:48:36.880 --> 00:48:39.440 It's been a pleasure to talk about this. 00:48:39.440 --> 00:48:44.000 Thank you for all the work that you put into helping me write this manuscript. 00:48:44.000 --> 00:48:48.159 I don't know that it would have come to be without your encouragement. 00:48:48.159 --> 00:48:56.480 I think you said, you know, I think more organizations, more programs could benefit from sort of thinking about and seeing this model. 00:48:56.480 --> 00:49:02.800 So uh I'm not sure if I would have been uh published and put out into the world without your encouragement. 00:49:02.800 --> 00:49:04.320 So thank you so much for that. 00:49:04.559 --> 00:49:06.800 And thanks for letting me be a part of it, Nicole. 00:49:06.800 --> 00:49:13.599 I think you're doing really awesome work, and I'm really impressed that you're like sharing this more broadly because it is so important. 00:49:13.599 --> 00:49:15.280 So thank you so much. 00:49:16.880 --> 00:49:24.719 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. 00:49:24.719 --> 00:49:35.199 This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. 00:49:35.199 --> 00:49:41.679 Work one-on-one with residency program experts to make sure your organization is residency ready. 00:49:41.679 --> 00:49:55.760 Our Clinician Well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. 00:49:55.760 --> 00:50:05.039 Supporting nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. 00:50:05.039 --> 00:50:12.800 Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. 00:50:12.800 --> 00:50:18.639 And we can't forget about the program that started it all, the online nurse residency program. 00:50:18.639 --> 00:50:26.960 This includes a comprehensive curriculum designed to support new graduate nurses applying all the knowledge they learned in school to their practice. 00:50:26.960 --> 00:50:36.480 We focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. 00:50:36.480 --> 00:50:43.840 Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. 00:50:43.840 --> 00:50:49.840 You can learn more about all of these programs and more of what we offer using the links in the show notes below.