February 24, 2020

Episode 1: Courtnay Caufield of Cedars-Sinai

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Description

On this episode of The Handoff, executive nurse leader Courtnay Caufield joins Dan to talk about her early experience as a travel nurse and how it informed her more recent experience hiring, managing and working with travel nurses. She offers useful insights on staffing plans, as well as best practices around onboarding, deploying and gathering feedback from flexible workers. 


Courtnay is the Executive Director of Women's and Children’s Services at Cedars Sinai, where she oversees Pediatrics, PICU, NICU, OBGYN, MFCU, and Postpartum. She started as a nurse in the Special Care Nursery at Trios Health and eventually worked her way up to become the director of the Surgical Services and Surgical Pediatrics unit. Today she is an executive nurse leader and recently finished the AONL executive nurse fellowship. You can find her on Twitter @pedinursegeek.

Podcast

Transcript

Dan:
Courtnay, thanks for joining.

Courtnay:
Thanks for having me, Dan. It's a pleasure to be here.

Dan:
We are talking about the gig economy and its impact on healthcare, or the flexible workforce that includes travelers per diem. All of the non full time employee options we have as we staff hospitals and health systems and clinics, and we're excited to hear your insights on that. But before we dive into those content areas, we'd love to learn more about you and your background, and your experience through nursing.

Courtnay:
I've been in nursing for over 15 years. I started as a bedside nurse, it started as an LPN. I would float anywhere they would take me just to get the experience of all the different departments, which really helped me see many aspects of different parts of nursing. It was a blessing in disguise when I didn't get hired into a whole department. And then after that my informatics background led me into helping with our EMR implementation, and into the world of nursing informatics. I loved that part of the job. It allowed me to meet all sorts of new people, and do different parts of nursing that you wouldn't think are a nurse role. And then I moved into leadership. And in leadership I've had the opportunity to work in a few different facilities, most recently Cedars. And I am over all of our women's and children's services and working with the operations team to do an expansion, which is also something new, but in nursing leadership, nothing is stagnant, so things change and I really like that part of my job.

Dan:
And you were recently an AONL executive nurse fellow, right?

Courtnay:
Yes,  It was great. I had the opportunity to join the inaugural class for the nursing executive fellowship, which was a wonderful experience. I highly recommend the fellowships to anybody who's contemplating it, or for some staff who are looking for development. A cohort of people who are in the same shoes as you, when you don't have that type of group to talk to, has been amazing. And they really looked at developing people, and developing leaders with different thoughts on how to approach the workforce for the future. So something I definitely appreciated.

Dan:
Yeah, and we'll dive into that in a little bit as well. I want to hear your insights on how that changed your viewpoint on the workforce. But you've talked about a lot of clinical roles that you've had across your career. It sounds like you floated to a lot of different units, which travel nurses as well do, do that and gain a ton of experience. So as you've risen up through the ranks of nursing, can you talk a little bit about how you've worked with travel nurses over the course of your career?

Courtnay:
I've had a lot of experience working with travel nurses, and also being the travel nurse. One of the things that was interesting to me is about how did you become a travel nurse? What do they do? What do they know? Immediately as a newer nurse, I just assumed that they were the most experienced and really knew everything. But one thing I've learned throughout my years working with travel nurses, has been that they just have the willingness to work with anything, and are flexible and easygoing. And so that was helpful for me to see a different opportunity in nursing, and a different way to provide income or work in different facilities.

Courtnay:
Later in my clinical career, I actually became a travel nurse myself. It was just on a case by case or per diem basis. But one of the reasons I started doing that was because I went into management, and I had a fear that I would lose my clinical skills. And one of the things I've talked to other leaders when they're contemplating going into leadership, or becoming exempt, is that they were fearful they would not be a real nurse. They would be not clinically sound. And it was something that I said this is something that maybe I can do on the side, and not even tell anybody, so that I can keep my clinical skills up, and at least be relevant, which I really value, and it was great. And going into a facility as a travel nurse, they saw me now as a kind of clinical expert and didn't even know my day job. So it was a fun, different type of world.

Dan:
Yeah, no it sounds like it. And that's something we're hearing a lot from our guests, and from the industry, is that there's something about a good travel nurse. They're sort of like a MacGyver. They are able to flex with anything, and use the resources around them, adapt quickly, but they're not always used in that way. So we've heard from some of our travel nurse guests we've had on about how they've been under utilized for their skill set, or given really the poor shifts. And not seen as an expert but more as like they're filling in this need, and they're just kind of there, and they're not really part of the team. So I wonder if you have any insights or experience on how you might fold the travel nurses into your team, and treat them as one of your own rather than maybe an outsider.

Courtnay:
Oh yeah, it's a great comment. And I think from both the leadership role, and from being the travel nurse role, I've seen it. And I've seen it both ways, where the leadership may have somebody going out on leave or have a need that they can't fill, and are looking to have a travel nurse come in to fill that need. And the leader, most often what I've seen, has seen this person as "Well, this is an expert, this is an experienced nurse. I'm going to have them come in. I'm going to expect to give them some resources and some location type training, but they know what the skills they have, the skills that they need to do to fill the job. And I'm going to have them fill in for me and help me out as a resource."

Courtnay:
From the staff perspective, and I'm sure I'm guilty of this as other people were, is "Here comes a travel nurse. They're making the big bucks, let's give them the difficult shifts or the hard patient. And I did experience that as well as a travel nurse, thinking, "What is this assignment? This doesn't seem right." And not knowing if I should speak up or just, "I'm here to help them out. I'm going to do my job." And I think it takes effort on both ends. Not only the introduction from the leadership to the staff about, "We have some travel nurses coming in to help us out. We want you to thank them, welcome them to our family, because we're all providing the excellent care, and we're working together as a team." Rather than here's somebody that you can jump on. And so it really does depend on the attitude of the leadership, the organization, and how they are introduced to the team, I feel to be successful on both ends.

Dan:
Yeah. And I think the economics is interesting to me, and I would love your perspective on this, since you're in the operations, you're leading operations there at Cedars. Sometimes the travel nurses, and the one making the big bucks, and it's the nurses, the staff nurses on double OT, that are taking shifts. So, is there a point where it makes sense to actually bring in travelers to supplement your core staff, as a more affordable option, than maybe trying to fill out all the FTE count that you have?

Courtnay:
Oh definitely. And one of the things that I think that nurse leaders, and especially new nurse leaders, and as I've hired leaders, I've found not only at the entry level of leadership management supervisors, or even experienced nurse leaders, it's been publicized recently, as well as what we hear, is that financial acumen understanding, honestly even anything outside of your position control or balance sheet, is the greatest need for nursing leaders. And really are looking for some financial stewardship classes and help where you know where you can save money on some of your budget, but understanding the longer term or perspective staffing, and how that impacts your budget. People are learning more and more, but if you really want to teach leaders, what I've found has been helpful is to say, "Let's look at the cost of onboarding a permanent employee. Let's look at having everybody work, stay over on overtime four hours on every shift. Versus giving them some extra overtime shifts, versus hiring a traveler."

Courtnay:
When you really put the numbers on paper, it stands out very clearly that for an anticipated need or an emergent need, hiring a traveling nurse with a set amount of shifts, a set amount of dollars, understanding what you need, definitely the cost is less than incurring over time, that is also unpredictable. So when you want to be able to say, "Hey, I an anticipated need." If you can get to the point where you're fully staffed, and you need to fill in for those holes, the travel nurse is actually not as expensive as most people think. It's just putting it on paper, and breaking down those misconceptions that teaches folks, "What works best for our budget, what's best for our patients, and also how do we utilize resources that are out there."

Dan:
Yeah, and also like you said, the financial acumen around, the added cost of benefits and all the added things that are on a full time core staff member, that aren't necessarily baked into the flexible workforce. So ...

Courtnay:
Right.

Dan:
Yeah, that's a great piece of advice is that just really looking at the numbers, and getting clarity and actually uncovering those numbers. Because what we've found is we've talked with several health systems, is that they don't look at those numbers. They look at simple holes in staffing and they try and fill them with whatever resource they can. Not making decisions based on number one skillset, or the cost of the labor for to fill that hole, or the most efficient way to do it. So I think the more and more we get data around that, nurse leaders will be able to make better informed decisions. So it's a great point.

Courtnay:
Absolutely. And one of the things about it is leaders hate my perspective, at least from what I hear, and I'm just assuming as well, but leaders hate the feeling of putting fingers in the dam, and plugging holes, and fires are coming at you from every angle. So having a prepared plan, that if you're going to have an absence, "What can I fill it with?", is always more calming. Lets you leave your day feeling that you have a strategy for your unit, and not that in the middle of the night you're going to have to figure out how to piece meal care for your patient.

Dan:
As you think about this and you're training your own, the leadership team on your own team, about how to think about staffing and be filling your full time FTEs, versus flexible work. How are you seeing some of those conversations change over time? I think there has been, and there still is a focus on, you wanting to have all of your own nurses in your own organization, and that's how you're going to be the most efficient and fully staffed, and everyone's going to be happy. But the reality is that's probably never going to happen. You always have leaves, you always have open positions. It's just, it's unrealistic to think that you're going to be ever really fully staffed 100%. So how are the conversations around using flexible workforce changing in your view?

Courtnay:
I've seen it different in different organizations. In a community hospital that I worked at, it was a given that we would have at least, be on a staff of about 120. We have at least four travelers on at any given time. And the understanding was that when somebody is going out for a leave, a maternity leave, a sickness that's longterm and predictable or scheduled, our action plan was set that you would put in for a traveler, and look for a great candidate, and set amount of time. And then have everybody with the understanding of what that's going to look like. In another organization that I've worked in, it was a responding to the fire, where assuming we are going to have our staff, our units fully staffed, and then when it doesn't happen, starting to get a little desperate, and then last course would be to call for travelers.

Courtnay:
I've worked at an organization as well that an incentive goal for leadership is zero travelers.

Dan:
Yeah. I've seen that too.

Courtnay:
And so when, and I was one of the people who I thought I turned in a sheet saying, "Look, I had six travelers, I've got to zero. Yay, look at me." But the reality is I was over staffing. So I had to over hire in order to plan for the what ifs. And in, I work in California, the leaves system is very rampant, and generous with time. And so understanding that I could have an employee out for two weeks or almost up to a year, not anticipating and having a controlled plan around what am I going to do. And then when you need a traveler tomorrow, you can't anticipate, especially highly specialized areas, getting somebody who meets the qualifications that you really need right away.

Courtnay:
So it is a little bit of anticipated chaos. So to your point, Dan, one of the things that has been helpful is knowing we are always going to have about a 3% vacancy rate. Let's understand that. And then when that is going to happen, what is the company's expectations of you as a leader to be able to staff your unit? Is it in dollars? Is it in FTEs? And if you have the opportunity to be able offer some over time to your staff, but have a core shift staffed with a plan like a travel agency, and do it with control and a budgeted amount of travelers, it works really well. And I've seen really great outcomes and even some recruiting, and people who find their medical home and decide "This is where I want to stay, at least for now." So having less chaos, more control, is what I see when I have anticipated plans for hiring travelers, and knowing what I can look forward to and to plan for what if.

Dan:
It's about seeing the system impact. Not just that dollar amount or that FTE count, but really seeing the possibilities of a flexible workforce. Like you said, you can, and we heard this from other hospitals as well, that you, travelers are actually a recruiting source for you. They come and they love it, they're treated well, they see the great care that's being delivered, and they end up staying and converting to full time employees, or extending contracts, or just trying to stay in the area in some way. So I think, one of the points you made for the nurse leaders is, and for healthcare leaders, is to think about the system, which we always teach in the fellowship, and in innovation programs and things. But once you zoom out and see the system, you can see all the benefits and the ripple effects of having that one, that person there. And maybe those are added business case points that you can make as you think about a more flexible workforce.

Courtnay:
Absolutely. And if you have the power to be able to influence your budget, like I said, if you add in the cost of, the average cost of maybe a highly specialized traveler for 3% of your workforce over the next year, and budget it in, you will have planned for your folks to be able to be out on leave. And it's less stressful for your staff as well, knowing that, "Hey, my company has a plan." Maybe some leaders think, "Well they don't care, they're just going to go." But from what I've heard, most staff and even from being staff, you feel bad about leaving your company short. So knowing that they do have a plan to take care of your patients and your team, is also helpful for staff, and their feeling of feeling taken care of, if that the organization is doing the right thing as well. So ...

Dan:
Yeah, that's a good point. It's all about those, it's all about the staff at the end of the day. They're the ones touching the patients.

Courtnay:
Yeah.

Dan:
We talked a little bit about best practices from a nurse, or a healthcare leader perspective around travelers. What other best practices have you seen on onboarding travelers, or using travelers, or things that we haven't talked about related to best practices?

Courtnay:
Well, actually that's a good point about onboarding, and training travelers. And like you said, if you have this great experienced nurse coming in that you've obviously hired because they have the skills, you want to court them a little bit. If your goal is to hire into your facility, this may be their test run in an interview of you as well. So if you treat them that like, "Hey, you're only here temporarily, I'm not going to invest in you as a human," they know it right away. And so I do feel that treating a traveler nurse is as you do all of your full time employees. Giving them an onboarding plan and letting them understand what you expect really does help them not only see your facility as, "Hey, maybe I want to be here a little bit longer," or "This is somewhere I want to refer my friends to," even if it's not to them.

Courtnay:
But also when you have patient, they shouldn't know the difference between a traveler and a permanent staff. They should be able to see the same nurse, and the same care regardless of the status of their FTE. And so I do think that we could do a lot better with investing in our onboarding training for our travelers. And not just assume that they know everything, "Let me give you a lay of the land," but letting them know a little bit more about the culture, and giving them also a buddy and somebody who is a resource to them. Because it is lonely when you're a traveler. You show up and you may be going back to a hotel by yourself, and not really know anybody.

Courtnay:
So at the end of the day, like you said, how we provide the best care is how we treat our employee. And I've seen differences from all four, three or four day onboarding, five days orientation to "Here's a binder. Here's two hours of your orientation. Good luck."

Dan:
Right.

Courtnay:
And unfortunately as a traveler nurse myself, I usually got a pamphlet that was left for me, because I did night shift, and a password, and that was it. So, you do have to be a different type of person and flexible, but also be able to speak up for yourself and say, "Hey, I need a little tour first. I need to walk through and tell me about what's important to you." So there's both ends.

Dan:
Yeah. Well, and that reminds me of the book chapter you and I wrote about toxic leadership. And I think you mentioned a few toxic leadership behaviors in that answer. And one of the issues we, and we talked about this earlier, I had said travel nurses are sometimes treated like second class citizens. They're given a binder and a password and the worst patients, and the poorest shifts. And they have to work every weekend or whatever in some cases. And you've talked some examples about that. And so if you were to give two or three nuggets of advice to leaders about how they could better be transformational leaders, rather than toxic leaders towards a more flexible workforce, what would be some of those points you'd give them?

Courtnay:
Oh, I could go on and on. Okay. Two or three nuggets. And I wonder where I had some of these examples from. I think again, what you put out is what you get back. And so from a leader, know who's onboarding your staff, and choose your preceptors, choose the people who onboard your people wisely, and make sure they value the same things that you do as well. People get bored being precepting, sometimes they despise it. Make sure that the people who are doing it, are enjoying it. And so like I said, invest in those who are investing in your team onboarding. And make sure that they understand that you work here to make sure that this person's experience at our facility, and the care that they're able to provide is the best, period. But as a leader, it's just to say, "Joe is going to onboard Susie when she comes on tonight. Here's a password."

Courtnay:
So making the conscious effort to say, "When I have a traveler, this is what I'm going to do as a leader. This is what I'm going to make sure my staff knows about. What I expect out of everybody, and the travelers and what I'd like back from them." And secondly, asking for open feedback. When we have travelers, they work through the agency mainly in our HR department. Allowing for an exit interview or a close out meeting has been some of the best feedback that I've received, because they're not quitting in anger. They're not leaving for a different job. They're traveling, and they're doing this lifestyle for a reason, and getting different experiences. And you get the freshest set of eyes of folks who've been at other facilities, and you can get some great feedback on what is something that we do differently that other facilities aren't, that you can carry on. Or is there something that we're not doing that you would recommend?

Dan:
Do you have a good example of that one? Do you have a good example of feedback you've gotten from a travel nurse that made you think, "Oh, I need to change something"?

Courtnay:
Oh, it happens almost every single time. Whether it's a product and they'll contact somebody, and say "Hey, we were using this little thing to hold the ET tubes. What was that?" And someone will send them a picture. Another person said, "We are using this program that you're, it sounds like you're implementing for scheduling and staffing. Here's some of the best practices that we've heard that we learned when we had our rollout." That was another thing. Another traveler had shared with me something about floating that the, " In my resume, I did let you know that I work in a neonatal ICU, but I also have labor and delivery experience and I never had the opportunity to float down there, and I would have been willing to float." Had no idea.

Courtnay:
And so being able to say, your resume says one thing about you, but talking to them and saying, "How would you have done that differently?" Well rather than just the checklist again, back to that about "Who are you? What skills can you do? Are you legally allowed to do X, Y, Z? What do you value?" We had a traveler recently that went into leadership, and then stepped back to the bedside to do some traveling. And one of the things that they shared was that they had arranged a whole new preceptorship program. And we were in the middle of trying to create a preceptorship program.

Dan:
Wow.

Courtnay:
So they said, "This, you don't have me here as a travel nurse to just provide clinical care. I'm also a human with a history, and some advice if you'd love to pick my brain I'd love to share it with you." And it was such a great opportunity, we just never asked.

Dan:
That's awesome. And that's I think one of the things that I found in being new to the travel nurse world, talking to them, just the wealth of experience from working in different places that they can bring, and actually be this really awesome source of performance improvement and innovation, but many times go untapped. It sounds like you've worked them into the culture of the leadership team, and the exit interviews and the HR side, it's really kind one of those best practices. Do you ever, from a nursing perspective, do you include them in things like shared governance, or quality meetings, or any of even just general staff meetings while they're on assignment?

Courtnay:
It depends. When I was at community hospital, they were union but they were not paid for staff meetings. It was optional for our staff. So we would invite the whole unit, and we would highly encourage them, and most of the time they actually came. And another facility, if people did come in for a shared governance or a staff meeting, they had to clock in. And a lot of the times they'd already worked their full shifts of the overtime. And so there was some concern with paying the travel nurses for the overtime. And the organization actually said to me, "Well, why are we investing in them? They're not going to be here longterm. Why are they coming to the staff meeting?" And so, and I thought to myself, "Well, are we just dumping about the future, or are we asking questions about today?

Dan:
Right.

Courtnay:
So the question came up, "Well I don't know, what does your staff meeting look like?" And then that became a whole other ball of wax.

Dan:
Again, even second party, the travel nurse is creating a conversation around what could be done differently. That's kind of funny.

Courtnay:
Exactly, exactly. And so we have had council meetings. We've had shared governance meetings. And we, and the only request is, if you are a travel nurse and you're on the floor and we're pulling everybody off the floor, and coming over to participate in something in a longterm project, and you're leaving, would you, we'd ask them to stay on the floor, care for the patients and help our nurses be able to come over when they wouldn't be able to before. And it wasn't a fight of who gets to attend the meeting or the event. If it's during a shift, we can cover for each other. But in other circumstances we've invited them to say, "We'd love to hear your voice, but please just speak up. Give us an opinion. Tell us what you think." The perception was, "Well, they're just going to come and listen and get paid and eat the food." I said "Really? Come to a meeting."

Dan:
That's right. Engage.

Courtnay:
Well this goes back to where we need to continue handing out ribbons for attending meetings that could have been an email, right? So if you have people come to something that you're trying to share with staff, whether it's your engagement results or a staff meeting, or like you said, a shared governance discussion, just having purpose for, not only your travelers, but all of your staff. Ask, they have opinions, voices. If you're just talking to them you're not going to get really anything but your voice and noise coming out of your mouth, coming out there. So setting up some sort of request to say, "Our rules of engagement in a meeting is whether you're a traveler, full time per diem, whatever it is, your opinion counts, but we would love you to participate."

Courtnay:
So that's been the a great take back and win from us. It's just really been a culture change, because the thought has always been, we're not investing in them if they're not going to be here longterm. To change it to, they've been all around the world, let's hear what they have heard and have said and have seen and can bring to us.

Dan:
Really good advice for nurse leaders. I mean this is, what's interesting is, there's definitely a cohort of people that think the same way you do, but there's also a cohort who think in this, a travel nurse is a commodity. And I think there's a balance between the two.

Dan:
So you mentioned earlier in your intro that you were in the inaugural class of the nurse executive fellowship for the American Organization of Nurse Leaders, which is super awesome. And I had a chance to present to that group last October, and it was just an amazing group of nurse leaders, and super exciting to see what you'll do. I know that experience probably helped you evolve your thinking around leadership, and I wonder did it change any of your views on the healthcare workforce? And maybe what are some of those key takeaways that changed for you?

Courtnay:
Oh yeah, like you said, it was so fabulous and more is needed. People are hungry for professional development, and honestly the executive fellowship, what I did learn is, there's a lot of people with the same thoughts that you're having in a similar role with no one to talk to you.

Dan:
Leadership is lonely.

Courtnay:
Leadership's lonely, so just go on listservs or you'll try to phone a friend, but sometimes giving out a secret thought, people don't like to share so much. It's kind of weird. But so sometimes you'll listen to podcasts.

Dan:
Yeah, yeah. Like this one.

Courtnay:
Like this one. One of the things about the fellowship that was wonderful, and in particularly like you said at your speeches, and the discussion we had around innovation is you have to think differently. If you open up the cookbook of the way you've always done it, you're going to get the same results. And something that hit home to me is talking about the workforce today.

Courtnay:
We always say, "Well, let's invest in that, and let's hope that we can get all of our staff to stay past the two year mark, because then we know we've got them." But if we start catering to the workforce that's going to be here about two years, what does that look like? And shared resources, helping people grow when they come back like a boomerang when they find out, "I've kind of traveled the world a little bit, and now I'm ready to come back and settle down." The generation of nurses today who are not establishing families, and they have a dog, and they want to go to Bali. And we can't give them the vacation time because it's only five days the first two years, so they quit. So thinking differently about what's most important to them, but how do we continue to remember that we are running a business?

Courtnay:
It's hard to get people to understand nowadays that this is work, we need you to work your life around your job. But how do we, as the leaders of our organizations understand, you spend your life here, you make a living here. Meaning you spend more time here living than you do outside of here.

Dan:
Yeah. Right.

Courtnay:
So how do we make it that it's a win-win for both of us. Where we get what we need, when you're working, you are here to work and be engaged and present and you show up. And when you're not here you take care of yourself. And one of the things that you talked about, thinking innovation and staffing is the word travel nurse is not a taboo word. When like I said, the incentive goes for a lot of people are still zero travelers. Well fine, you want this much over time, you want disengaged people, working burnout and making medical errors? Okay, but that on paper. I don't think that's anybody's goal.

Dan:
Yeah. The evidence says that. I mean it's like we can work our staff four twelves in a row, which, or even a 12 hour shift is shown to have impact. And it's like we're still thinking in this mindset of the, just the way it's always been done. And I think you're right, there's this mindset shift around what the new workforce is demanding, and it's not usually brand loyalty, it's work life balance. It's being able to do the things that they feel passionate about, being connected to a mission. Having people that respect and help them grow. And I think that it's going to shift the entire landscape of how we hire, fire and staff hospitals in the future.

Courtnay:
Absolutely. And one thing that I think people forget about also, is if you look at the travelers that you have coming now, versus maybe that you've had I'd say about five to 10 years ago, I previously used to get folks in their second career, or they have left the bedside because they didn't want to work for three days a week, 12 days out of the year. Or they wanted to go part time and there was no part time for them. I've seen people that are more towards the end of their career previously, as travel nurses. And now you see a mix of both people who are very seasoned, and people who are, "okay, how many years do I need to be a nurse to become a travel nurse? 12 months? One year? Great. That's me." And so it's understanding that you have different people coming in, but asking them, like I said, I go back to look beyond their resume.

Courtnay:
You have people come in doing travel nursing that have, could have been a director, could have been an educator, have other skills that are outside clinical to tap into them. There's no extra dollar charge to ask them those questions. So looking for professionals that can add value to the unit, and understanding what's really out there is amazing. And so like you said, it's just thinking differently and challenging the way that we've done things.

Courtnay:
I did see the look when I looked around the room when we brought up the thought of what about eight hour shifts coming back. How do you use travel nurses and staffing personnel to fill in your needs? The look around the room, and the feeling I got was, "Oh no, we're going to be in trouble. That's our highest dollar." But like I said, going back to let's put it on paper and let's make a budget for it. It actually is going to cost you a lot more to just include a lot of overtime, and burn out staff, and then they go on leave because they have to call in sick for their regular shift, than it would have been to anticipate and plan. So I think it is just understanding that let's think a little bit differently and be okay with that.

Dan:
Definitely a mind shift. And also the value equation for travel nurse or even per diem isn't to give them the worst shift. The value equation is you're paying a premium for these people, use their experience to help you change what you need to change in your system. So I think that's also just, that's a more simple mindset shift, but it's just don't think of them as more expensive nurses that you can treat worse.

Courtnay:
Right.

Dan:
Think of them as a special operative when you call on the SWAT team to come in and actually help fix something or get some new insights into something. I think you they're a catalyst for innovation. So I think that's something to nurse leaders to consider as well. I'm interested to learn more about how we can reach out to your, or some of our listeners can get ahold of you if they have questions. I know you're on LinkedIn. We have the book chapter together. You're out and about. So what's the best way to find you and connect with you Courtnay?

Courtnay:
Oh, thanks Dan. Yeah, absolutely. I'm on LinkedIn, Courtnay Coffield. Also, I'm involved with Association of California Nurse Leaders, ACNL. We are, I'm the membership committee, member chair on the LA coastal chapter. We have meetings. I'm part of AONL like you said, and I teach also our certification class for the service certification for nurse managers and leaders. So if you attend one of those, you might see me. And I just love to be able to get together with folks who have questions. I'm on Twitter as PDNurseGeek. I know that sounds weird, but I was a pediatric nurse, I was an informatics nurse, and so those are my two combo name.

Dan:
Love it.

Courtnay:
And like you said, the toxic leadership chapter, I can see that going a lot further, and maybe some larger discussions, because I've had a lot of people reach out to me about, "I think I'm going through this. I don't know what to do," and we just need to talk about it more. So hopefully more to come around that with you Dan, and talk to nurse leaders and I'm trying to help everybody be able to find a friend, get a network together, help each other out as leaders, and just like you said, think differently. If we're going to change healthcare, it's going to start from nursing. And we have the power of the future in our hands, and it's just, it's a bright future. Someday maybe I will be a traveling nurse leader, so I can live on the beach half the year. Who knows? But those kinds of thoughts and dreams, it's okay to say it. You just have to create your own future, and think differently about how we take care of our patients and we are leaders in healthcare.

Dan:
And that's a great point to end on. Courtnay, it was so great to have you on the show today. We'll put all of that information on how to contact you in the show notes, and we'll make sure our listeners have connection to that. And thank you again for just really thoughtful answers, and giving us the real deal on what we can do as nurse leaders to better incorporate a flexible workforce into our health system.

Courtnay:
Oh no, thank you so much for having me. I think it's so great that you're having these podcasts, and I'm sure it will continue. And I'm going to want to listen to all of the other speakers as well. So thanks again and have a wonderful 2020.

Dan:
The year of the nurse. Thank you so much for tuning in to The Handoff. If you like what you heard today, please consider writing us a review on iTunes, or wherever you listen to podcasts. This is doctor, nurse Dan. See you next time.

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