Welcome back. Last episode, we talked with Sal and Elaine about how all nurses are leaders and specifically about socializing nursing students to their value and impact. So, thank you for joining us again to continue this
conversation with Sal and Elaine. I was thinking as I as Sal was talking before Michelle and Rachel about all the work you're doing, you know, with learning science and constructivism and all and how that relates and this whole notion of thinking in context and activating prior knowledge is what S really just talked about, you know, and we talked about well tell me about your role,
you know, what does that look like? or if you're talking about delegation and how that fits with leadership, in what ways were you spoken to as a manager when you were in your staff nurse role that was helpful? In what ways were not helpful? And students can speak to that and they know that. And one of the great things about co there were some good things are the Zoom breakout rooms which really have fostered a great way for them.
They all can answer that question and then you can reach well let's think about what were the components of the more effective dialogue as you delegated and needed certain tasks done. The same way with this whole notion of thinking of problems first because that's who we are. We learned to think in terms of problems. That's what the nursing process is. We identified that
the bloody nursing diagnosis, right? So when you start with the problem, you only think in sort of a negative context of solving problems which is the right which is a good thing to do. But if you start with context and what are the issues involved here and are is it all problems or is there a way to reframe it then you reach a different point and thinking about how leaders can lead in context. Yeah. And I think the other one that always amazes me is when somebody says,
"Well, Sally, I don't like conflict." Oh, yeah. Like I get up in the morning and I say, "I can't wait to have 24 conflicts." You know, I mean, we separate these things from our humanity. Every situation, every organization has diverse, you know, situations which create what we refer to as conflict. You know, the conflict isn't the issue. It's the process of what do we how do we deal with this? How do we deal with diverse opinions? How do we make people feel like
what they have to offer makes a difference? How do we depersonalize and the key and Elaine and I talk about this all the time? It's naive. We put a group of people together who are total strangers and we say, "Okay, now go out and work together. Oh my god, they're having a conflict." Guess what? If you don't have rules of engagement, you have conflict that is unresolved. Conflict just means it's always going to be there because we're different. How do we manage those differences?
I agree. I could talk about this forever in the sense of sometimes as a leader we need to teach our leaders that they change. They can't change everyone around them. That was the hardest lesson for me to learn I must say in my leadership role. I think it comes from our nursing background and a psych nurse. You know, I was going to use the right the right communication, the right dialogue and get this person to really have insight and to see how they might be splitting their faculty team
for example. And with all my energy poured into it, the thought I put into it and I can't get them to change. So then I began to realize that I need to change and that concept was revolutionary to me to say I understand that this is your perspective. This is the way we need to move forward as we're moving on. If that's not a choice you can make then we can deal with the consequences. But right now that's the direction that we need to go. So all those skills are not known. They need to be
part of how I become a leader. It's communication. It's how one functions as a team and how one values yourself within the context of that team. I think that's really good. And an example of that I hear a lot from nurses who've been around a while. Oh, the millennials are difficult to teach. Oh, they are so difficult. Well, guess what? You've set yourself up. Okay. What do the millennials bring that's positive? And what do you have from your experience that they need to learn? That's
a dialogue. You know, I'm sure when Moses came down from the mountain, he said to Mrs. Moses, "Boy, I'm really worried about our teenagers." That's a fact of life. You know that people get hung up in stereotypes. One of the wonderful things I hear from the millennials is they want to have a purpose. They don't want to just have activities. They want to have different outcomes. That's a meaningful block. And Elaine's point,
I think, is so well taken. I've given up trying to use the magic wand to change other people. But I'll tell you that a lot of change within me has been very effective in creating much more positive outcomes. And you know, as we talk about these skills that can be built and developed and the change and the inner work we need to do as we lean into leadership, I think it even further reinforces the importance of scaffolding this across a curriculum. Not that there doesn't need
to be a leadership course. It's an and there's a leadership course and how do we sprinkle and scaffold these skills and opportunities for students to practice these skills, get feedback on these skills, develop these skills, get coached on them across the program and I see one of the pitfalls when we are siloing like you say Elaine is that in those leadership courses particularly in the pre-licensure courses what are the activities that they're doing the shadowing
risk management they're working with the charge nurse they're going to the bed coordinator they're doing case management and those are great for lateral integration of care and seeing system processes but that sends I think the wrong connotation that leadership lives in those roles and I think it undermines our intent for our nursing students who will soon become nurses to
see that they can lead from where they are. It is independent of the role that they're in and it's what they bring and their strengths they bring to the table in the situation. So well said. It's again that positional description of leadership rather than how they lead and activating the prior knowledge of students who come into nursing. They don't come in in a void. They've all been high achievers in high school or for the accelerator programs, right, Rachel? They've come, they've
led within their bachelor's programs. So they're not a they're not unleaders, if you will. And so activating how they have led, how they're going to take those skills forward. And I always tell them, especially the accelerated students, that they're the they're our hope for the future because they have had so many experiences and how we can apply them to nursing and have new ways to think about how nurses function within that
system. That's the group that's telling us you really need to think about some of the traditional ways that you're teaching nursing or teaching leadership or how you think of us as individuals and leaders. And the more we listen, the more we take it. A good example to me is with all the racial unrest in the tw 2020 and moving forward.
Every campus has had nursing students emerge as significant leaders to tell us where we need to integrate justice, equity, diversity, and inclusiveness in myriad ways throughout our curriculum. And what we need to do is honor that leadership rather than seeing it as something that's negative or that is not respecting the role we achieve as faculty. So that's a great example of how nursing has changed as a result
of student input and nursing education. Rachel, you just really outlined it beautifully when you just framed it in that way. One of the things that I have found with the DNP students is to ask them what challenges have you faced in your life. Not, you know, not put them on the sofa about their past life but it's amazing how people just inattend hurdles that they've already been over because once you realize that you have a history of success not always perfect but you made it. How
did you make it into a DNP program? There has to be some challenges if financial, cultural, environmental, what once people sense that they you're not saying to them you're perfect, but this isn't your first rodeo. You are a person with skills. You have purpose. You're here because you care. Now, let's start to cultivate that into more of a strategy than just activity.
You know, I use the same line of thinking and I'm going to go off on a small tangent though that a lot of nurse educators, you might hear these students or or practice partners too, the students and these nurses don't know how to think. They don't know how to critically think. And I disagree with that. I think like you said, our learners come to us with the ability to think, right? They probably drove a car and made a lot of critical thinking decisions to get to the
school. You know, they got dressed in the context of the weather. They build out that application. Oh my god. Exactly. You know how to critically think. It's just the our learners don't know how to think within the context of taking care of a patient with end-stage liver disease. Right. So about activating that prior knowledge and helping learners really lean on their already established thinking skills but within a new context. And how
do we do that? And I think you know it seems very parallel to me what you're saying about leadership that people come as leaders with leadership skills but how do we now develop that within the context of your role in socialization as a nurse and understanding your value? That's it. we have to lean in or activate them to think about their prior ways of leading. Interestingly enough, sometimes leading has been more aggressive or more
in your face than we need to. So that's one of the struggles that we're dealing with is we want to hear what your concerns are and your voice and how can we help you to bring that forward in a way that is collaborative, conciliatory and that we can move forward together. So there are pieces that need to be tweaked, if you will, to be in this context, but nevertheless, they come with
a skill. And when we honor that and value that, gets back to our initial discussion about value, then they see us and the context they're in in a whole different light. Very critical. And I love the fact that you think about teaching liver disease and leadership in the same context and or in the with the same frame. And that would make a great article, you know, because it's so true. You could take us through context, content, and course
and how one teaches leadership. Absolutely. You know, I think there's another big driver here is that health care is radically changing. You know, it's the train is moving faster than we. So, you don't want to throw out everything you've used in your curricula in the past, but you also have to look at this is a phenomenal time, but it's also a challenging time. And what do we want to keep with the way we teach students and what do we
need to delete? What do we need to add? Because you're you're preparing them for a different different world. Okay? You could teach anybody how to do, you know, an IV, but you can't just move away from the fact that these are they're going to be change agents and they're going to be involved in this revolution that's already happening. Okay. How do we prepare them for that? You know, you'd brought up about critical
thinking and how we identify ourselves. I'm thinking about a study that Dr. Pam Ironside and I did ages ago where it was part of the integration of gerontology and we asked students what was the main we asked graduating students all across the country what were what's the main thing you learned while you were in nursing school how would you describe yourself as you emerge and to a person almost they said I'm a critical thinker and so then we delve down some
and asked them what that meant And it was very hard for them to describe meaning to this verb of critical thinking. And I find the similarity with leadership. Once you get them to say, "I'm a leader." What does that mean? What does that mean for you? How do you describe that? So, it's getting to thinking in terms just like you two have helped us with all your learning science, think in context, what that means.
And so we developed an outcome for the gerontology project that students would say at the end, I can assess function as well as physical ability and client expectations to develop a plan of care that meets individual needs and builds quality and safe practice. Something like that. That's what critical thinking is. It has meaning in context. And so that's where we need to go with our students to say at the end how they define meaning in relation to themselves and see if Elaine just
hit the nail on the head though. You have to drive everything from outcome backwards. You know, we don't realize that outcome really drives behavior and behavior, you know, is it's wrapped up in in learning. But if you don't know what the outcome is, it's that whole wonderful thing in, you know, in the story of when the what's her name? She comes to the cross in the road in in the fable and she says to the rabbit, "Which way should I go?" And the rabbit says, "Where do you want to go?"
said, "I don't really know. It doesn't make said, well, it doesn't make any difference then." Once you know what outcome is, outcome forces decisions and behaviors. So I think critical thinking is nice but it has to have an outcome. You know what is it that we're trying because you can do that with students too. You do it in coaching or in mentoring. What do you want to have happen? What would be different in your life six months from now? those specific things are outcome oriented.
You know, Elaine, when you were talking about showing and what I heard was making really making leadership visible, making critical thinking visible. And so I guess why I'm hearing that is when you were talking about in the study, they had a really hard time articulating what critical thinking is. I'm going to share my thought process
how I got from A to B to C here. When I hear you say that, it makes me think perhaps us identifying and making leadership visible just like we make thinking visible can help our learners, our future nurses, our current nurses be able to identify opportunities for leading in the moment. And it makes me think about, you know, just a class I had yesterday where we're talking about service recovery for prelicensure.
They're bedside entry-level nurses and I see that if they saw an opportunity for service recovery in a patient that is in-the-moment leadership. They are displaying leadership if they're engaging in service recovery or they can recognize that there's challenges in handoff reporting at change of shift and engaging in shared governance of creating an evidence-based handoff report that helps the outcomes of the unit. And so I think that ties back to what Sal was talking about with
outcomes driving behaviors and actions. But I think identifying that, especially when we're role modeling and saying, "This is leadership. This is an example of it." So they can start to recognize it when it happens and recognize the opportunities for them to engage in it from where they are. And not just even I couldn't agree with you more. That's what I mean about integrating
leadership throughout. You're going to teach these skills of how you know of management of critical situations but how that looks like leadership and then asking them more how would you think what are the components that you need to have what are the abilities you need to have to lead in that situation well I would recognize the phenomena as it occurred and then I would communicate that and then communication is leadership that's how you would begin that process and break it down into
steps. I agree that's that whole idea of not siloing learning as we as we do too much I'm afraid in nursing education. One of the ways Rachel you get at that is driving all of this learning through stakeholders. One of the things that that we do a lot in the corporate world, we say who are the stakeholders in our business? Who has the most to gain or lose by our success or failure? When we do that, then we start to create the visual of what do we want our stakeholders to
say about us in six months. Okay? What would they say about us today? There's always, you know, you never get a mesh. And if they're not if we're not where we want to be, what do we have to do? See, it gets back to behavior. You know, all work, you know, learning without action is nice, but it has
no value. You have to do things. And you need to have a process that enables people to say, well, gee, you know, I'm always amazed and I tell Elaine this sometimes when you work with nurses, they ignore the fact that the faculty are stakeholders. So they have to create rules of engagement for themselves. How do they want to behave towards each other? You know, how do they want to handle gossip or conflict or all those things? That's what we need to do. We
need to drive this. And by the way, we really need to see the students as as stakeholders. I agree. And you know too, I wanted to circle back too about the Alice in Wonderland quote about the facing the cat in the woods and you know which direction where do you want to go? Well, it doesn't matter which path you take if you don't know. I think that just further emphasizes your comment earlier about the importance of coaching and how Michelle said, you know,
having these mentors to hold up a mirror. I can't tell you how much when I went through one of the NLM leadership programs and we had coaching, it was that mirror that was held up by my coach that helped me identify a tape that was running in my head of the train's going to come and if I don't get on it, I'm going to miss it and it's not going to come back again. So, this is why I say yes to everything. Just like you said, S that the problem with nurses sometimes or the challenge
is that they take on so much. They have so many activities that it's not focused, right? It's not driven by where you want to go. just like the path in the woods with Alice and Wonderland. And so it was through that coaching process that mirror came up that helped me recognize that train's going to come back around again. And I need to say not yes to everything by getting on every train, but saying yes to the right things. And that's only going to happen if I know where I'm trying
to go. And I think that's the importance of coaching and then seeing that connection with outcomes. It's also important. You know, you raised a great point. We have to find ways to provide coaching which is also economically sound. You know, it's it would be wonderful if you could have every person have three or four sessions every couple years. That would be terrific. You also though can teach group coaching. You
can teach how the process works. And then you may be able to cultivate students who themselves can become coaches for other students. And that's true of faculty. The big issue with it is that we have to find better ways to invest in people because your investment in people ultimately pays off. You can even show by the way you know people always say well that's a soft issue. No it's not a soft issue. You will find out that industries that lose people on a regular basis, it is not
cost- effective to lose good people. So if you're losing nurses, one of the things you have to look at is what's the economics of that. It can't be good and sound economics. So you have to find a better way to cultivate the environment and to enable people to withstand all the pressures that they face. So, we have to find a better
way to coach everybody. You know, we've spent I'm we're working now through the NLN archives and the Saga series on the curriculum revolution heroes, if you will, who back in the 80s and 90s, and certainly they introduced us to reflection as something that was not really inherent in the in nursing education. I don't know if we've really
gotten there yet, to be honest. You know, and then when you talk about coaching, Rachel, it was the only time when I thought, "Wow, someone's really focusing on me as an individual and my thinking and how that thinking guides so much of what I do." I spent all my time helping other people get directed, but focusing on me. And it gets back to our original conversation about valuing self and understanding self and how we really make that
visible. And until we integrate reflection about self into nursing curricula, I don't know how much we're going to really gain about having students leave our programs with an idea of how them as a valued member of the profession and as just as a valued person really makes a contribution defining the outcome for themselves and not be seeing it as soft and we don't have enough time to do it because they can't pass NCLEX because I think in the long run it negates their ability to really
make a significant contribution. Yeah. You know, one of my observations too is that it doesn't make you more selfish. It makes you more centered towards other people. It's incredible that, you know, it's that whole idea of when the oxygen mask comes down, put it on yourself first before you give it to somebody else. My observation is that I've seen tremendous growth in being outgoing
more once they realize their own value. You know, when a person senses that they have value, I mean, leadership without that doesn't exist, you know, it's false. But once they grasp that, they don't become by and large more selfish. They become more centered towards others. We have a lot to do to change nursing curricula. Good thing you're young. Well, I think that's a beautiful way to summarize
our entire conversation. And I do think we have a lot of work to do and I think Rachel and I are both very passionate about our work. So it's, you know, I think we're ready for the challenge. I know a lot of our colleagues are and there's, this time is full of a lot of change for obvious reasons, coming sort of out of a pandemic. I don't think we're out of it yet, but leaning that way and all the changes and the pivots that we've had to endure in real time just to respond to an
emergency. But I think we like going back to what Sal said, just deciding what what to keep, what's good, and then what what to change and what to move forward. Being so intentional about that and strategic, I think, can help us not get overwhelmed by that that charge and that challenge to make big change. I find it very exciting, but I don't know. Rachel, any last thought? My last thought is Elaine and Sal, I'm waiting for the day
you do a TED talk. I want that to happen. And the day that it happens, I'm going to be in the front seat of that dark room. Taking in every word you say. So, we have to make that day happen because you have so much wisdom and insight to share. It's so inspiring, beneficial, motivating. Every time I get a chance to absorb what you pour into everyone else. So, thank you so much. Thank you. Thank you. And you know, real quick, Elaine, we do have
rapidfire questions that we have asked of Sal. I would you be interested or willing to answer some of these fun questions? Yeah. Okay. So, if you were to write a memoir, what would you title the book? You know, I thought about that even before the question and I thought it's something about balancing. I'm a Libra and I'm always kind of looking to balance. So, finding a balanced life or something like that or I don't know if I found it yet, but it's the outcome I'm searching for. Okay,
wonderful. What is on the top of your reading list right now for fun? The fun answer has to be Louise Perry and her Three Pines. Do you know all those mystery series? Oh, no. You got to get into Three Pines and Louise Perry in south of Montreal. A lot of people die in that little town, but it's just a lot of fun. You really know the characters, talk about context and how their lives unfold. So, it's fun. That's great. And what is
your favorite quote? You know, I love Anai Nin's quote about we see the world, we don't see the world as it is, we see it as we are. And I think that's been the foundation of all this work about reflection and gathering and coming together to see it, you know, from our perspective, valuing self and then moving that perspective into the way the world is. So that's always been very close to me. Wonderful. That like fits with our, you know, the theme of this conversation
so well. Absolutely. If you could have dinner with one person, dead or alive, who would it be? And you are sitting next to your husband, so it might be I know. I've had during the pandemic, too many dinners. There you go. I have to say Michelle Obama. I so admire her. I probably would be so odd that I wouldn't know what to say or might not say anything, but what what a spirit, what an energy, and just a commitment to people.
She is just inspirational to me. Wonderful. Well, thank you very much both of you for joining us in this I think very important conversation. Very timely. And thank you very much. Thank you Michelle. Bye Rachel. Byebye. Bye. Thank you. Thank you for joining us on this episode of NLN Nursing EDge Unscripted Surface. We hope you join us next time. Until then remember, whether your water is calm or choppy, stay connected. Get vulnerable and dare to go beneath the surface.