October 8, 2020

Episode 33: Leadership insights for nurses

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Description

Making the shift from the bedside to nurse manager or nurse leader is one of the biggest challenges that nurses face. 

Our guest for this episode is well versed on this issue because her current role is all about creating professional development programs for nurses. Crystal Lawson is the Education Director at the American Organization for Nursing Leadership, overseeing their fellowships for nurse managers and directors. 

In this conversation, Crystal lets Dr. Dan pepper her with questions on everything from how new nurse leaders can settle into their roles, the difference between accountability and availability, and tips on budgeting, time management and boundary setting. She also shares some great tips for listeners who are interested in applying for one of the AONL’s fellowships. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Crystal, welcome to the show.

Crystal:
Thank you for inviting me to chat with you. It truly is my pleasure.

Dan:
Awesome. We read your bio, we got the basics there. But what are you working on? What's top of mind for you?

Crystal:
Well, other than the transition to the virtual world, post pandemic, really the majority of my work is overseeing the early and mid careerist leadership development programs for AONL. That includes the online leadership lab, or webinars, all of our historically face to face programs. So the leadership institutes for both emerging nurses and nurse managers, and then really the heard and soul of what I love and will talk more about are the nurse manager and nurse director fellowships. And a heavy portion of the work that I've been doing lately surrounds the work on transitioning to practice for new nurse managers. So I have recently finished my DMP project, and we're going to be able to launch this program nationally in 2021, so lots of exciting work going on at AONL.

Dan:
That's great. So tell the listeners a little bit more about AONL. I know as a nurse, you kind of get exposed to it a little bit. But as a staff nurse, it's not so top of mind for you maybe. So can you tell us a little bit about the organization?

Crystal:
Yeah, absolutely. AONL is the professional organization for nursing leadership. We have over 10,000 members. And really, we're aiming to shape healthcare through innovative and expert nursing leadership. And we have three arms that we focus on as our core work, education, which is primarily what I'm involved in, it's promoting professional development for nurse leaders, and that includes some of the face to face programs and online programs that I talked about, as well as our annual conference that draws thousands every year, with national renowned keynote speakers.

Crystal:
Another arm of what we do is advocacy, so we're very active in supporting policy for nurse leaders to help drive positive change with a collective voice to influence healthcare transformation. So AONL is a subsidiary of the American Hospital Association, so we're about to collaborate to ensure that the perspective of nurse leaders are heard. And then the third arm really is the community. We're made up of a diverse membership organization. As I mentioned, it's more than 10,000 members. And these are leaders at all levels, so these are emerging nurse leaders to seasoned executives that span across the healthcare continuum. So just that network of group to support and advance nursing through one voice.

Dan:
Yeah. I love it. I think I get a lot of value out of AONL's national conference and resources. It's definitely a place to network with the who's who. And so listeners out there, if you're not a member, it's worth checking out, simply to make connections. And the benefit beyond that is all the things you talked about, the advocacy, the voice at the table, and a ton of resources to level up as a nurse leader.

Dan:
So one of the things that we see in healthcare is that leaders sometimes are chosen because they're really good clinicians, and then they're promoted into a charge nurse role, or a leader role, or manager role, or whatever it is. They're not always given tools or skillsets related specifically to leading. So what's your passion around that? I know you love up scaling the nurse managers. But what is the first step for a nurse leader to kind of jump in and level up their skill as they enter a new leadership role?

Crystal:
It's exactly what you said. Often, we identify those expert clinicians and promote them into these roles without any formal training. And it's not uncommon for them to be unclear about what their role is, or what is expected of them. They feel pressured, usually that's an internal pressure, to do it all right away. And it can be really difficult to shift from that exceptional clinical competencies to really focusing on developing those leadership competencies. And I often see that they mistake that 24/7 accountability with 24/7 availability. And it's definitely not one and the same, and it often leads to burnout very quickly.

Crystal:
Really, they have to change their mindset. And I think some of the critical things for that to be successful, or to really shift from a more reactive to a more proactive stance, think 18 months from now. What is the vision of this department? And how are we going to get there? Rather than just focusing on putting out the fires. You've got to shift from being that individual contributor to the leader for that team. You're the personal caregiver, and now you've become the advocate for your team. You were the employee, and now you're somewhat of a business owner. You've got the responsibility of this department. And to shift out of that transactional leadership mindset into more of a transformational.

Crystal:
Some of the identities of a nurse manager that with have used in the development of our transition to practice program is really helping those individuals become a caring advocate. But you're really advocating from the individual all the way up to the team and trying to build a culture of excellence. You've got to become a strategic thinker. Use the data to inform your decision. And you have to have a system thinking perspective. Being a courageous communicator is so important in that role. Innovation is important, being able to collaborate with various disciplines to help engage in the problem solving, and then being able to influence. You have that balance of having to communicate up to the top leaders as well as to the frontline, and help align toward those shared goals and inspire action.

Crystal:
That nurse manager really is the linchpin of your healthcare organization. Their leadership abilities impact patient outcomes and safety. They impact patient and staff satisfaction, finance, and really just the daily operations of a healthcare unit. So it truly is a very challenging role, but also very rewarding.

Dan:
Nurse managers have one of the toughest roles in all of healthcare I think. And it is because they're the nexus of all of the competing interests of all the most important parties, the patients, your frontline staff, the physicians, the rest of the care team on one side. And then on the other side, they have the priorities of the business, the finances, the staffing, all the other things that go into the business, and they're right there in the center of it. And so it's challenging to move from taking care of patients to now having the lens of the team, the business, and those type of things. You mentioned earlier the supporting early careers and mid careers. What do you think is the biggest difference between those two groups in developing their leadership skills?

Crystal:
Gosh. Those early careers are really more focused on getting into that, how I mentioned the shifting from being that expert clinician into developing those leadership competencies. The mid careers have really I think began to hone in on those. They've started to master the concepts of the science, the art, and developing the leader within. They've really figured out those business things, the financial pieces, their time management, and really shifting into more of a system thinking role for those mid level careerists that are aspiring to move into those executive level leadership roles. It's transitioning out of that operational department specific mindset into a more global picture.

Dan:
That makes a lot of sense. I think as my career has grown, it's definitely the longer you're in it, the more you can see the system. And I think that's a skillset that the sooner you can develop zooming out and not getting caught up in the fires of the day, and see the long-term impact, the more successful you'll be as a leader. One of the things that AONL does is put out nurse manager competencies and nurse executive competencies as well. How are those shaped? And how do you incorporate those into the fellowship program?

Crystal:
Well, the nurse manager competencies, we have various level competencies actually. But the two that I work most closely with are the nurse manager competencies and the nurse executive competencies. And those were developed by a key group of leadership experts. And they are actually currently being looked at again to make sure that they are staying relevant and current, especially as we shift into a more role with telehealth, and the world is evolving. So it is definitely time for an update. But there were groups of experts from across the country that helped to define what those are. And all of our programs are aligned with our leadership competencies. So the intent is that the program outcomes are specifically developed to hit on those competencies. And I would say one of the biggest ones that we focus on is developing the leader within, specifically within our fellowship programs, that reflect the practice and your own personal and professional development is really core. But the leadership competencies are core to everything that we do.

Dan:
In developing the leader within, what are some of the breakthroughs that you see with the fellows that go through? Do you see a light bulb pop on during a certain session, or a certain time that they just realize, oh, my God, I should've been doing this before? Or, oh my God, now I have this new insight. It's going to change my whole way of practice.

Crystal:
That's a really great question. And it's so difficult to articulate. You ask anyone who's been through it, and I personally was in the nurse manager fellowship. That's how I got so involved with the AONL. And something does shift inside of you. And we promote this as a program to help you grow and be a benefit to your organization. But the light bulb goes off for people at different phases. And if you speak to the leadership that supports the fellowship program and sends the individuals, all they can really voice is something has changed. This leader has changed. And it seems crazy, but often it happens in that very first session, that first week that we hold together for the managers, it usually happens in New Orleans in January.

Crystal:
And it's like a whole shift in their focus. And they've suddenly got this network of peers from all across the country. And they are speaking to just brilliant nursing thought leaders. And you watch them just change over the course of a year. It's pretty incredible.

Dan:
Yeah. I had a chance to be there this year at 2020 in January in New Orleans. And definitely, there's a different energy there. People are excited to learn new things. And you could definitely see how engaged they were. If I'm a nurse leader, and I want to get into the fellowship program, what's the process? Do I have to be nominated? Do I have to have some sort of super power behind me? What's the process there?

Crystal:
Right. So in order to apply for the program, there are several components. And I do know that many organizations that have participated in the fellowship for years have their own internal process because it's so competitive, so they want to put their best foot forward. Any individual can apply, and they have to submit a leadership story. And what we're looking for really is beyond the traditional career journey. It's not that we don't care about that, but we want to know who you are, and what experiences have defined you in being the leader that you are.

Crystal:
We also ask that individuals submit a capstone project proposal. And the original tenet of that goal is to benefit your sponsoring organization through a PI project, or a new service, or business line development. Also, the goal should help develop and enhance your leadership competencies as a participant. And the goal is that the ROI must hopefully exceed the program investment that the organization puts forth in you. And we've seen many projects that have resulted in millions of dollars of ROI. They get published in Nurse Leader, which is one of the AONL publications, and honestly, many other national publications.

Crystal:
A special hint to anybody that may be listening to this podcast, the selection committee, which is made up of AONL member volunteers, they use a rubric, but they really do love to see new ideas. Although it's not required, there are definitely bonus points for outside of the box thinking on these capstone projects.

Dan:
I love it, an insider tip to get into the fellowship. It's so great. And it really is an awesome program. So let's get a little bit tactical here. So there's several kind of topics that you go through throughout the fellowship. I was able to do innovation. You do finance, budgeting, communication, I mean, leadership in general, all kinds of things. But let's go through a couple of those and give me some of your top tips for leaders in these areas. So let's start with budgeting. What is the top tip for nurse managers related to budgeting?

Crystal:
I'm just going to keep it very simple because this is the most sodded weakness of nurse managers. And my advice would be just learn the basics. Find some trusted advisors within your organization, lean on them. You don't have to be the expert, but you do need to be able to speak the language. So be proactive in monitoring and analyzing, get a mentor, take a class. AONL offers many. Just get a book. Educate yourself on how to be informed of what the terminology is. And you can really impress your finance team if you partner with them and just seek out advice.

Dan:
Yeah. And I just a couple days ago finished interviewing KT Waxman, who I know has written a book on financing, and speaks at several AONL events and fellowships and things. And that's another great resource. First, listen to that podcast, and then also she has a ton of resources that way too. What about time management? I think this is probably the number one killer of a new leader. Just how do you spend time? Sometimes it's, well, I have an open door policy, and I want everyone to come in my office and talk to me. But that takes up your entire day, and you can't do the tasks you need to do. Or I'm taking so much time trying to learn a new system, or a new process, or budgeting, or whatever it is. It's hard for me to focus on the other things that need to get done in the day. So what's a top tip for time management?

Crystal:
I alluded to it earlier that 24/7 accountability piece does not mean availability. And so my number one piece of advice would be prioritize your goals. The work is never ending. And you really have an opportunity to empower others, and it's a win-win for both. One of the roles as a leader is to build others in leadership. And so that can help offload some of the pressure from you. Implement boundaries, communicate clear expectations, and then know what's important to you as a person, know what your supervisor expects and what your team expects. And just prioritize from there, and know that it will not all get finished.

Dan:
Yeah. It will never get finished. But what's a tip for setting your boundaries? Give an example that a nurse leader could take tomorrow and say, "I can go do that during my shift and make sure that I take time for myself."

Crystal:
There are a couple that are my personal favorites. Intentionally block out time for you to prioritize your day for the day before. What are your top three goals for the next day? And they may get hijacked, but at least you go in with a focus. I mentioned identifying those things that are really important to you, so for me personally, that was I never missed my kids' ball games. There were a few exceptions to that, but I knew that rule. And then empowering others and clear expectations, so there is a team that is there when you aren't there. So whether that's your charge nurses, or your team leaders, or the house supervisors, if you set clear expectations of when to contact me, when you're empowered to make that decision yourself and you're supported, I think those are key. And then also, take time off. It's so important.

Dan:
I think that's a key too is don't be afraid to leave for a while. The world's not going to end. Your hospital's not going to fall down from you taking two days off.

Crystal:
Absolutely. And don't look at the email, and don't check your text messages.

Dan:
Exactly.

Crystal:
[crosstalk 00:16:31].

Dan:
Stay off teams, messenger, and all those things because you've got to recharge, or it's on your mind all the time. You can't relax. And we all know stress is a big factor in people's wellness, so those are some really cool tips. One of the things I wanted to ask you about, as you move into a leadership role, you may have been an influencer as a staff nurse of frontline clinician with your peers, but now you're in this formal role, this formal influencer, this formal advocate. And all the eyes are on you every time you say something. You could mean one thing, but it comes out another way. And people interpret that, and because you have a leadership role, it's taken completely differently. So what's your guidance on how to be an influencer and advocate as you step into the leadership roles?

Crystal:
The thing that I want to use here, it may be a little cliché, but I love sports analogies. I grew up playing sports, and nothing gets me fired up more than a little competitive sporting event. And I really link this concept around the shared vision, and ability to inspire and engage people around that vision and mobilize them into action. I realize that this example is probably going to be tough, given that you're from San Francisco, but since the Superbowl was one of our biggest events before we went into quarantine, football seems like a simple analogy to me. And it's simple, right? The vision is let's become the Superbowl champs. And the leader in this case would've been Andy Reid. He's the head coach of the Kansas City Chiefs. And he was able to inspire his team toward that shared vision, and so he's the leader. And your goal as the leader is surround yourself with a team of people that have complementary strengths. And then give them the tools they need to get their jobs done.

Crystal:
If Patrick Mahomes is an ineffective quarterback, the coach doesn't jump in and attempt to play quarterback. His job is to get people into those positions and get them what they need to be successful, and then inspire them to lift on another up. So I think in that same way, nurse leaders can influence their team, capitalize on your team members' strengths, help them support one another and advocate on their behalf to win whatever it is that your Superbowl is.

Dan:
Yeah. That's great advice. I think the coach player analogy is good because you're right, I think a mistake a lot of leaders make is they want to jump in, and they want to do it for the team. And they'll solve a lot of problems for the team. And that feels good for the leader. You feel like you're moving something, you're putting out fires, and there's adrenaline that goes with that. But ultimately over time, you're actually removing the ability for your team to solve their own problems because they'll just keep coming to you. And the sports analogy is good because the coach can't go in and play quarterback. Maybe they were quarterback at some point, but they're not going to play in the league now. And so the coach has to get inside that player's head and say, "Okay. What do you need? How do I remove the barriers? How do I take stress of you? How do I help you and give you something?"

Dan:
And maybe it's a directive. Maybe it's like, "I'm going to call the plays for the next ... " Don't even think about it, just throw the ball. And as a leader within a clinical space, you can do the same thing. Okay, don't think about X, Y, Z. I'll take care of that. You just go start that IV. You go talk to that family. You go deal with that fire, and I'll take the rest off you. And I think having those relationships as a leader is something that allows you to gain influence and advocate for your team, but also not make them reliant on your solving the problems all the time.

Crystal:
Yeah, absolutely.

Dan:
Another thing that happens when you move up through the leadership ranks, and for me it was really hard because I loved working in the ER and in trauma. It is my lifeblood. I still dream about days of awesome, gory messes and overrun ERs. And as I moved up through the leadership ranks, even when I was at Ohio State, I really wanted to stay clinical, so I stayed per diem for a long time. And then even when I went to Ohio State, I stopped my formal clinical role. But I'd go and I'd hang out with the rapid response team every couple months. And I'd follow them around, and I'd be like, "I'm just making rounds and seeing what my team's doing." But I'd really just want to go and do codes and start IVs and play with pens and all kinds of stuff.

Crystal:
It feels so good.

Dan:
It feels so good, right? And finally, my leader, my director sat me down and was like, "Dan, you can't do that anymore. Your job is not to go play with the rapid response team. Your job is to manage the educators and build this system and whatever." So what's some advice for nurses to help them step away and make that choice to step away from the clinical work? And how can they still feel like a nurse, even though they're not touching or delivering patient care every day?

Crystal:
Yeah. You hit on something that is always a challenge to anybody that leaves the bedside. I think you feel like you're losing a piece of yourself. But I really think you just need to reframe that. As a bedside nurse, you have the ability to impact maybe a few patients in a day. And when you move into that leadership role, you really have the opportunity to impact countless patients in a day. And not only do you get to care for the patients and their families, but you're caring for the caregiver. And if you care for those nurses, they're going to be able to provide exceptional care. And so you really just have to reframe your work. I felt like that personally when this pandemic started, working at AONL. I thought, "Man, I should be out there. I should be in the hospital. I should be leading."

Crystal:
And I hadn't felt that way in years, and honestly, I was able to just reconnect back to my purpose. And what is it that I do? And look how many more lives that you're able to touch in this opportunity to be in leadership. It just truly is rewarding.

Dan:
What I would think about is that I have influence over more of the system now. And so where, as an ER nurse, I can make an impact on four patients at a time, or whatever. Now I'm making an impact on 50, to 100, to 1000, to 5000, ultimately at Kaiser, 60,000 nurses. And they all touch four patients each every couple hours. That impact is kind of cool to think about too. So it's not that you're not a nurse anymore. You still use your clinical brain all the time and the skills you built there, and you have an even more kind of widespread impact across the system.

Crystal:
Yeah.

Dan:
What about resilience? This is the topic of the day, pandemics, people being thrown in leadership positions, change, it's like the new constant is all this stuff bombarding our clinical leaders. How do you stay sane and build resilience so that you can be there for your team, and also be there for yourself?

Crystal:
You're right. It does, and it can come across as the flavor of the month. Right? Do yoga, do meditation. One of my favorite speakers on the topic of resilience is Dr. Brian Sexton out of Duke. And he says that resilience is the antidote to burnout. And it really does go back to as simple as put on your own oxygen mask first. You own the responsibility of knowing what fills your own bucket. And I think oftentimes, people view this as, oh, I'm burnt out. I need to practice these things. And really, you could reshape the way you think of that as practicing resiliency is a sign of strength. And it's not really building a way to endure more. But it's your personal way to survive and do it well.

Crystal:
So I don't believe that resilience is a one size fits all. I could tell you to do yoga, or meditate, or journal, and that wouldn't necessarily be effective for you, although those are great practices, and I personally use those. And perhaps my two favorites are gratitude and laughter. If I'm having a really stressful day, just stop and do something to make me laugh. That will make you feel better. But try not to bite off the whole thing at once. I'm going to drink my water and exercise and eat right. Just start with a few small things, and notice the positives in the day. And individuals that have greater resiliency truly have an increased sense of purpose.

Crystal:
And then most importantly, by you practicing that as a leader, you are role modeling it. So if you are asking your team to take time off, or do these practices, they need to see you role modeling that. You've got to walk the walk. Just as burnout is contagious, resilience is contagious. And I think as leaders, we've got to put in the work in ourselves, so that we can hold that space for our teams because it's so important every day in nursing, but especially in 2020.

Dan:
Yeah, that's for sure. And I've had some conversations with my colleagues we ... [inaudible 00:25:04] did a survey for frontline nurses about their mental health and resilience related to COVID. And what we found out of that is yoga and meditation and breathing and that kind of stuff are good tools. Sometimes those are presented as the solution to the burnout problem, and we know it's much more complex than that. What are a couple things that nurse leaders, specific things nurse leaders can do to help their teams build resilience beyond maybe some of the low hanging fruit in the yoga and the meditation side?

Crystal:
A lot of the work that we've been doing, and actually, we've been doing it with the fellowship group since we've not been able to meet face to face since early in the year, is holding resiliency coaching sessions. And that really looks like an expert just holding space. But I will say that is a unique skillset, and not everyone has the capability to allow that to go south. But sometimes people just need to get it out and have a space to share. And I think if the leader is role modeling their own resiliency practices, and if they can't hold the space themselves, find ways to hold that space for them. And shift, notice the positives, celebrate your successes. Not every day is great. Some day is terrible. And the only great thing you did for anyone is give someone their first Diet Coke in three weeks, and that's okay.

Crystal:
You can't change the world every day. But taking the moment to do that, and then also, I really find it effective connecting to: Why are you here in the first place? Why did you start doing this work? And reconnecting back to that often gives a little bit of a boost.

Dan:
Those are good points. And yeah, I think it can be something as simple as giving someone a Coke or whatnot, and then also just listening to people be able to kind of let out some of that energy and saying, "That's fine." You don't even have to do anything about it. Just listen and let that kind of release, and let people know that you're there and support them as well.

Crystal:
There doesn't always have to be a solution offered, just [inaudible 00:27:12].

Dan:
Right. And I think that's another thing that a lot of new leaders want to do, is they feel like they always have to have a solution to what's going on. And sometimes there is no solution, and it's really just about being there and being present, similar to what you do with your patients, and allowing space for your team to just reflect and get that energy dispersed. So we like to hand off that one nugget of information to our listeners that kind of sums up your thoughts on nursing leadership. Crystal, what would you like to hand off to our listeners?

Crystal:
It's funny because you asked me a question earlier, and I really alluded to this already. But I really wanted to say that nursing leadership truly is a rewarding career. An exceptional nursing leader can impact countless lives. Back to that point of when you're at the bedside, you can impact several patients and families every day, but the scope is you transition into a leadership role. And I think about it now, I was a pulmonary nurse and a labor and delivery nurse. And I may have impacted two to maybe six or eight lives a day. And now if I have the ability to influence one nurse leader to make an impact on their team, just think of the ripple effect. So I know I discussed some of the challenges today that are really unique to nurse managers. But it really is a rewarding role, and it has been one of the favorites that I ever served in.

Crystal:
And there are resources there to support nurse leaders, to help you impact healthcare outcomes, and the nursing profession as a whole. And so whether you're the leader for your shift, department, or system, you really do have the impact to influence change. And I would say having the privilege of working at AONL, it offers just this huge community to be able to shape healthcare and a wide array of leadership development resources. And I really wish that people would see nursing leadership as something that is worthy of aspiring to because I think often, we don't make it look so glamorous, but it truly is a great ... It's a great field.

Dan:
Yeah. It's a great field. And there's so much opportunity, and it does take a leap beyond the comfort zone and what you know as a frontline clinician and what you learned in nursing school. But there's so much variability and opportunity and roles out there that can really satisfy a lot of different tastes. You don't always have to go up through the charge nurse, the manager, chief nurse route. There's the quality leaders. There's the ambulatory leads. There's the innovation leaders. There's all kinds of things that are out there that fall into buckets that you may not have thought about, so I totally agree. Jump in, test it out, and have fun with it. It's a new skill.

Crystal:
You never know where the journey will lead you. And it's funny how the last one perfectly prepares you for where you are today. So I agree, it doesn't have to be traditional.

Dan:
Love it. Crystal, where can listeners find you personally? Are you on LinkedIn, Twitter, any of that kind of stuff?

Crystal:
I am on LinkedIn. You can find me there. You can find me on Twitter. I'm at RN Crystal Lawson. And you can also go to aonl.org to find out information about anything that we've talked about today. But my contact information is also found there on the staff web page.

Dan:
Awesome. And definitely go check out AONL. There's some amazing resources. I've been a member for a long time, and found value in the community, the resources, and even there's certifications to just legitimize all these skills that you learn. And that's definitely looked upon with a lot of value from hiring managers and executives in the healthcare system, so go check that out. Crystal, thank you so much for being on the show. Really appreciate your insights. We will be in touch soon, and maybe send some of these fellows your way.

Crystal:
That's great. Thank you, Dan, for inviting me to be on your podcast. It's always a lot of fun to chat with you.

Thank you and welcome to the Trusted Community!
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