September 29, 2021

Episode 60: How to become a culturally competent nurse leader

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Description

Tiffany Gibson likes to refer to herself as a troublemaker and a nurse agitator -- two labels that Dr. Nurse Dan can absolutely get behind! 

Tiffany is a pediatric nurse turned professional development specialist who helps nurses become more effective leaders. Her focus is on asking hard questions, disrupting old narratives and empowering a new generation of culturally competent nurses. 

In their conversation, Tiffany and Dan talk about why she thinks that DE&I can’t be separated from professional development and how she integrates the two in her consulting practice. She shares her thoughts on the intersection of belonging and patient safety, why managing your emotions is critical to becoming an effective leader and why equity is about more than just racial justice. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Tiffany, welcome to the show.

Tiffany:
Thank you, Dan, for having me.

Dan:
So Tiffany, we read the bio, but I would love to get a 30,000 foot view of how you ended up where you are and what you're currently working on.

Tiffany:
Yes, absolutely. So currently I am a professional development specialist, board certified, but started off as a staff nurse at a children's hospital. And for me the biggest thing about where I am and how I'm taking my career is to disrupt old narratives in nursing and to shake things up a little bit. I've always questioned everything, very stubborn as a child, it's followed me into my adulthood where I always want to know why do we do things the way we do and who said? Who taught you? And so when I was at the bedside that I came up with that all the time, why do we do things this way? Who taught you? When I became charged and a preceptor, and I would have the younger, newer nurses come to me, I would say the same thing, "Who taught you to do it that way? Why are you doing the things that way?"

Tiffany:
To me as an educator it's all about understanding the why and the behind the scenes. It helps with comprehension and critical thinking, but on a granular level, I just like to know how things work. And so I'm a perpetual student and then I turned around and share the things that I've learned. That's why I love being an educator, but where I am now as a consultant, coach and a mentor it's more about creating a new generation of nurses who are thinking beyond the bedside, thinking beyond the chart and asking the questions why. And one of the things that I am trying to revolutionize is the way we approach diversity, equity and inclusion, and how we can ask a little bit more of the deeper questions, the uncomfortable questions, and pair that with the clinical concepts of nursing.

Dan:
I love that. And I love the fact that you ask why and you challenge the narrative. Because similarly, that's been my goal. I call myself the chief provocation officer because I go around and ask what are you talking about? Just because we did that for 400 years in nursing, doesn't mean we have to keep going that way. Or where's the evidence that this actually works, that kind of thing. What are some of the narratives that you're most excited to disrupt?

Tiffany:
So for me, a lot of the work that we do with nursing regarding diversity, equity and inclusion is teaching nurses how to be equitable and inclusive to the patients. So we only talk about D, E and I, diversity, equity and inclusion, when it's patient facing. And usually those patients that we're referring to are the non-English speaking or immigrant patients. And that's where we leave it too. If you think about it, there probably was one chapter in our nursing textbook for that one message course that talks about diversity, equity and inclusion. And it was very generalized. All black people do this, all Muslim people do this, all Hispanic people do this. And then that was it. We moved on. So, there really wasn't a lot of good understanding and provocation. I love that title, by the way.

Dan:
You can have it.

Tiffany:
I love that. I call myself a professional troublemaker. For me, it's like we breeze through that really quickly in nursing school. And then these future nurses become nurses and they are met with so many different people who look, think, and act differently from them, but not just from the patient standpoint, from the nursing standpoint as well. So your colleagues are different and diverse and your leadership is different and diverse and not a lot of nurses know how to navigate that. So, that to me is my number one priority.

Dan:
Yeah. I think that's such an important thing. Last season we interviewed Dr. Ernest Grant, who's the president of the American Nurses Association, about something similar. And he has a big passion around this as well. And you're right, it's so generalized that you're like, "Okay, all XYZ religion don't like blood transfusions." And you just make these assumptions and then that's the foundation of your nursing practice and it's not always true. And then I think the other piece is you may have some of this knowledge, but what do you do about it? How does it inform how you deliver care? And one of the examples we talked about was colon care in the Hispanic population and one of my roles, had to change the entire way we thought about that and spoke to the community because we were pushing different values on people that just didn't resonate with. So I think the more we can dive in, the better. So I guess a question is where do we start to make it better? How do we educate the newer nurses and experienced nurses in this way?

Tiffany:
So, to me, I see it as a multi-pronged approach. And so if we can get into the school of nursing at all levels. So from the LPN, ADN, RN, BSN level, and just really include equity and inclusion with every single clinical concept. And so when we're talking about cardiac health, respiratory, pediatrics, everything that we're adding, the cultural competency piece into it. But not cultural competence in the sake of race, ethnicity, and religion, which I think a lot of people automatically think of when you think of diversity and cultural competency, but just more so in the lens of people want to be treated the way they want to be treated, which I call the platinum rule. So the golden rule is do wants to others the way you will want to be done unto you. And I'm like, "But I don't know how you was raised. And I don't know if I want to be treated the way you want to be treated."

Tiffany:
I don't know if that's what I want. I want to be treated the way I want to be treated. So I call that the platinum rule, but if we incorporate just equity and inclusion into the clinical concepts then it starts from there in nursing school and equity not being just racial justice. Equity meaning eliminating barriers and removing challenges. And so, for example, to say that African-Americans have a higher incidence of hypertension, which is true, we can't leave it just there as nurses. We need to go into the social determinants of health to talk about why is that true for African-Americans. So just because I'm a black woman, does not mean I have a high propensity for high blood pressure. It means everything surrounding my lifestyle and my being as a black woman, where I live, what I eat, stressors that I face, my education, all of that in turn makes me more susceptible to having hypertension, not just because I'm black. And one of the things that we miss in nursing school is the social determinants of health. We just stop at the health inequities.

Dan:
Yeah, I think that's important too. And there was a lot of conversation, when I was involved with the Kaiser Permanente School of Medicine, around this topic too. The curriculum is based in cases, and so every case had some pathophysiological thing that happened. But then we had to be really intentional about how we selected the race, the gender, the historical background, all the stuff that surround that case because what we found is it drove medical decision-making in a completely different direction, depending on how you change those factors in these hypothetical cases. It's exactly like what you said, you have to look at the whole person, which is a core of nursing values but I don't think we execute on it that well.

Tiffany:
No, we talk about holistic nursing care and patient centered care, but what does that actually look like? And how is that measured? What are the metrics behind patient centered care? So to me it's well, if the patient really is in the middle of everything that we do, then our communication should be on their level and how they want it, the consistency of how we communicate their wishes should be a part of it and that doesn't happen all the time, it sounds good to say that we are a patient centered facility, but what happens is because we have white coats and stethoscopes, we say, "This is what you should do, and you should listen to us because we have the degrees," but we're missing that cultural competence piece from it, which is I understand you want me to do all these things, but my goal really is just to be able to walk up the steps.

Tiffany:
And I know the other things are important, but I just want to walk up the steps and that's where I want to start now. And so we really need to just be open to incorporate what it is that the patients want and some of the care, but then also realizing that this conversation can be amongst nurses too. And so new nurses and experienced nurses and that dynamic, there's a generational dynamics too and then a cultural dynamic. Cultural within the unit, but then within the hospital, so ICU culture versus med surge culture and things of that nature. So there's so many different tiers to this that we could explore a little bit deeper.

Dan:
I think that it's really important to look at that, and nursing culture is really interesting. And each unit has its own personality and you get absorbed into that. And I'm an ER nurse, and so we'd always make fun of the ICU nurses, they couldn't manage more than one thing at a time and they would make fun of us that we didn't know anything, we just threw IVs at people and see if they land right. But those subcultures, microclimates also impact how we deal with our patients and how we interact with them. So I think being aware of all of that is really important. And culture work is hard. I think the evidence says three to five years to change a culture. For nursing, it's probably more seven to 10 years it feels like sometimes. So, that's really hard work.

Dan:
You mentioned the metric side of D, E and I. How do you look at measuring that? Because I feel like a lot of organizations just say, "Well, we hired X many people, and we have this diversity on our team or a leadership team and they check the box, but do you think there's other metrics that go deeper?

Tiffany:
Absolutely. So because we went back to school to get more degrees and more student loans, I don't know about you, but for me, one of the things that master's program talks about is statistics and metrics and evidence-based and things of that nature, and so qualitative and quantitative metrics and numbers and what they mean. So you can look in a room and count how many different people you have, and different as far as external features. And so I have two women, three men, I have one Asian, one black, white, you can check off the differences that you have, but what makes things equitable and inclusive is that my differences is respected and not even tolerated, it's welcomed. I'm not going to say tolerated, it's welcomed. And so if you're hiring me as a black woman, which is great, then accept all of me and all of my blackness. Meaning, the inclusion part comes in when I don't feel like I have to code switch when I'm at work.

Tiffany:
And so the Tiffany that you meet at work should also be the Tiffany that you see if you saw me in Target and it shouldn't be two completely different things and I shouldn't have to feel like I have to perform at work so that I can be accepted because of the standard of professionalism. And so that's where the quality comes into place. And those are some other metrics that we can measure by asking people how they feel about belonging at work, that sense of belonging, that sense of welcoming, because that adds to the psychological safety, which psychological safety spills over into so many other things. If I feel afraid, intimidated, less than, then I'm probably not going to ask for help. And if I don't ask for help then I'm probably going to have a negative or a bad outcome, and the patient is going to be affected.

Tiffany:
So, this is not even just a race thing, this could just be I'm a new nurse and I'm a novice nurse and the older, more experienced nurses make me feel like I don't belong or they make me feel unwelcomed, and so I'm so caught up in my emotions that my cognition took a backseat. And so instead of asking for help, because it's the safe thing to do, I'm going to pretend like I know what I'm doing and turn around and kill somebody. So, that psychological safety is really what is the outcome of the equity and inclusion. So doing surveys, asking people, stay interviews, why do you stay here? Why do you work here? What do you like about being here? Those are some ways that you can get metrics to see how people feel about where they work and if they feel psychologically safe there.

Dan:
Yeah. I think you bring up a lot of good points there. And one of the things that I think is missed in leadership school is the direct impact of culture and leadership behaviors on patient outcomes. And you articulated it really well. If you have a toxic leader and a toxic culture on your unit, then you don't feel safe to ask questions and you ultimately can really hurt people. And we worry about collapses and [inaudible 00:12:42] , all the acronym soup, but at the end of the day, leadership and culture should be at the top of our list of being accountable for fixing and having zero harm because of that. So what advice do you give nurse leaders on how do they even start to figure out if a culture is not great and go about creating a diverse and inclusive workforce?

Tiffany:
So I know most magnet hospitals, they have employee satisfaction surveys, which comes out every couple of years and everybody groans and moans about it because it's so long and you have to do it. But I think if managers really took the time to build relationships with their direct reports, you will see a change. And to me, relationship building is one of the biggest things that leaders can do. I am of the philosophy that not all managers are leaders and not all leaders have to be managers. However, those who are in the position, the role, the title to make decisions and have the authority to make impact a greater impact on a larger level, need to really build relationships with the people who they manage and they supervise.

Tiffany:
And so, yes, as a manager and as a leader for an organization, there are operational outcomes that you have to meet. We need to stay under budget. We need to make sure our NCNQI scores are down. There are certain things that need to be met and you are the person who handles that. However, to have a productive workforce and for people to drink the Kool-Aid and do what it is that you want them to do, even if they don't want to do it, is where the relationship building comes into place.

Dan:
Yeah. I agree with you. And I love that. Just to reiterate to the listeners, just because you have a manager title, doesn't make you a leader. It's two different skillsets. I feel like sometimes we don't put enough emphasis on developing leaders. Now, you're a certified professional development professional, how do you go about developing leaders and what are some of the core pieces that you help new leaders become aware of?

Tiffany:
I start with emotional intelligence. That to me is golden. Emotional intelligence is the key to life. And emotional intelligence comes in four components. So before I even go into the skills of leadership, different type of communication, the different types of ways, you can give feedback, the different types of way you can evaluate for productivity. We start with the internal, we start with the emotional intelligence. And so level one or step one first component is self-awareness. And that is really checking in with yourself and checking your own vitals. How do I feel about this? What are my triggers? What bothers me? I may not know why I'm bothered, but I know for sure when I talk to this person, it makes my toes curl and I don't like it. And I can't put my finger on it, it's energy, it's vibes, but I know that about myself.

Tiffany:
And so, because I'm aware of this, because I know this, but I have to do this because it's a part of my role, then you go into step two of emotional intelligence, which is self-management. So I know this is how I feel, what am I going to do to manage this and mitigate this? And what are my coping mechanisms and what are some ways that I can be proactive instead of reactive regarding my emotions? Maybe I'm not the one that goes and tell this person that their PTO is denied, because I know how they're going to react. Maybe I have a witness in the room with me, or my director is the one that does it or I do it via email and not face to face. So I'm still communicating, I'm still making sure that this is done because it's my responsibility that this gets done, but how I get it done, so that I can still protect my peace, is what I'm thinking about.

Tiffany:
So it's all about self-management and being able to get yourself together so that you can manage other people's emotions, which comes with leadership. Majority of the things that we do as leaders, whether you're in management or not, is taking out the fires. There's fires all around and it's making the chaos organized and putting them out and managing other people's emotions and problem solving. And so I can be more effective in my problem solving skills if I take myself out of it. And so emotional intelligence is one of the first tactics that I teach leaders. And then once we get that down and we go through that, then we can talk about the tangible things that comes with leadership.

Dan:
Yeah. I think that's great. And emotional intelligence is something you can control without permission from others, so if you can be aware of it. As you were talking, I was just remembering some of those really crucial conversations that I've had in my career. And two days before you know you're going to have this meeting, you're pacing and sweating and trying to talk it out with people and then what if they say this? And what if you say that? And how are you going to keep a straight face because you know they're going to try and gaslight you and all this stuff.

Dan:
And I think you really have to put a lot of energy into that because the opposite of being emotionally intelligent is horrible and it can really impact people's lives if you aren't aware of your impact and how you deliver messages and how you treat people. I've had the pleasure of having toxic bosses in the past as well. And it doesn't just impact your work life, it impacts your family and health and all of that together. And I don't think we put enough emphasis on that in leadership training, is let's show you the evidence of when things don't go good, how it actually impacts people's entire lives.

Tiffany:
Absolutely. I believe that your personal life and your professional life is not segregated at all. And how you manage things and how you are in your personal life shows up in your professional life at some way or another. So how you handle conflicts and crisis management, how you handle things that happen unexpectedly, how flexible and fluid you are, that comes up in your professional life if you don't have a handle on it in your personal life, and when you have these situations, they do lead to burnout. But I think sometimes we talk about burnout a lot in the nursing community, especially within the past 12 months. It's one of the topics that I don't like to talk about often, because with burnout, at least on social media, it's a lot of finger pointing and blaming of other people instead of us realizing you have the opportunity to protect your peace where there were red flags a long time ago.

Tiffany:
And so before this little spark turned into a huge flame and now you resent coming into work, you cry in the parking lot, you're showing up late, you're being unproductive, there were things that were popping up that told you to, hey, pay attention. And for whatever reason, for various reasons, we didn't pay attention or we didn't notice it. And so I think leaders, we need to be more cognizant about our role in other people's lives outside of just the fact that we are leading this one unit or this one hospital. People can get emotionally caught up in work and the people that they work for. And nurses are not leaving jobs because the jobs are bad, they're leaving jobs because of poor leadership. I left my job at the bedside because of management. It wasn't the unit. Now my unit was crazy, but I loved it because the work culture was amazing.

Tiffany:
I worked on an adolescent unit that was mixed with behavioral health and nephrology. So it was a six week old baby with a horseshoe kidney or a 21 year old who went on a bender all weekend. That could be my assignment. And it was hell in a hand basket. And I absolutely loved it, but my manager, I had a problem with her and went to her blatantly telling her that I wanted to grow in leadership and there was a assistant manager position and I wanted to be an heir. And I did all the things correct, charge nurse, preceptor, certified pediatric nurse, CPR/BLS instructor, head of a committee. I did all the things correctly. And when it was time for me to interview for the job, she told me to my face, "Well, I didn't think you were serious. I didn't think you were serious and you're not groomed enough for this job."

Tiffany:
And she said the word groomed enough. And that triggered me so bad because I'm like, "Well, if that's how you feel, then when were you going to groom me? Because you see that this is something that I want. And I have the support of my colleagues and my peers who want me in this assistant management job and you're not doing what I feel like you should be doing as a leader to get me ready for this assistant management job." And that's why I left, because another opportunity for leadership came and I took that because where I wanted to stay and grow, I wasn't getting the support I needed from the person that I needed it from the most. And so that's one of the things we have to be mindful about management and leaders is that outside of the actual task, we play a huge role in people's lives and influencing their decision-making.

Dan:
Yeah, we do. And there's not enough emphasis on it. I loved a couple of things that you said in that. One was that the culture in nursing right now is we go to social media and blast things without addressing the issue at hand, then we blame it on we're tired, or they should just know, or they only give us pizza parties or the nurses aren't showing up, they're not working hard, whatever side, quote unquote, you're on. And it's so unproductive. And it just causes so much drama that creates more stress and more anxiety around this.

Dan:
I was messaging with a nurse friend the other day, and just saying, "You want change, you have to go do it." And his response back was, "Well, nurses are tired." I'm like, "I get that, but you can't just expect and hope that someone's going to fix this for you. You got to own some piece of it." And I think that's the paradox and nursing's culture hasn't been great about allowing to address things in the moment and get the skill set to actually push change forward in ways that are productive.

Tiffany:
And I get it, we're so overwhelmed. And so it's almost like Maslow's hierarchy of needs. We cannot get to self actualization and things beyond ourselves if we're in survival mode. We can't think about thriving if we're stuck in surviving. And so if I'm literally taking it shift by shift, if I'm literally taking it hour by hour, I am not thinking about changing the world. That is a priority. I haven't even peed this shift. I'm eating old Graham cracker crumbs from my pocket. I can't even think about changing the world, changing the culture, having these productive conversations. I'm literally trying to keep my patient alive until 07:35. That's what I'm trying to do. So I get that. My thing is but we're continuing to do the same thing we do in healthcare, which is be reactive and not proactive. Because once the dust settles and once this pandemic is under control, and once we get back to rebuilding, because this is a tear down. What's happening right now in healthcare is destructive.

Tiffany:
And once all of this is over, we're going to have to do a lot of rebuilding, remodeling, rehauling. And so what does that look like when all of this is done? Why wait until we get to the part where we're like, "All right now, who has the drawing plans? How are we building this?" Why can't we start imagining what that looks like now while we're in the thick of it. And so that's where I come in with shaking things up in nursing and being a professional troublemaker because yes, we're going through a pandemic. Yes, nurses do not want to be on staff, they want to travel. Yes, nurses don't want to be nurses, they want to do something else. I would rather work at the Gap and fold sweaters and get my steady paycheck and come home call it a day. However, not everybody feels that way, and there's some people who love the industry and love the profession, and so how can I in my little corner of the world help them with that?

Dan:
Yeah. I think that's a good point, is you got to create the change. We are in a destructive, chaotic environment, but if you look at how markets innovate over time, they all have transformed themselves in a crisis situation where the cracks in the system are wider, where the services and the culture isn't meshed with what the value is and healthcare is 100% in the middle of that. I think nursing specifically is at a moment of we can double down on the past and we can go the way of blockbuster video or we can adopt a Netflix mindset, start changing the game right now with the eye to changing the system in the very near future and win the game.

Dan:
And then eventually we can do a documentary about how we changed the game, just like Netflix did a documentary about how they beat blockbuster. So I think there's just so much opportunity for nursing to change the game and we're the center of the healthcare system, and I keep worrying that we claim we're tired. I get it, we're tired, but this is our moment. This is our moment to change the game and build the nursing profession, the healthcare system of the future. I hope we can continue to do it.

Tiffany:
Yes. And that is my goal. And so I realized that well-behaved women seldom change history is the quote that I have on my refrigerator. And so that's me. And that's why I dubbed myself the nurse agitator. And so when I give my bio, people say, "Well, who are you?" I'm a professional troublemaker, nursing agitator. And it raises eyebrows, but I'm really serious about that because I feel like we're currently just going along to get along. As leaders, we don't want to rock the boat too much. We're already sailing over choppy waters and we don't want to rock the boat too much. And so it's a lot when you disrupt the system and you turn it upside on its head because a lot of things will fall out. And a lot of things will not go back to where we once had them, but that's the point. And so if we can get the conversation started, and even if we don't have all the answers, but we have sparked discussion and thought, then that's a start.

Dan:
So the question is where are you starting? Or where have you started to change the game in healthcare?

Tiffany:
So I created consultations. For me, it's just about going around and talking to different nurse leaders in the academic and hospital setting on how they can at least start the conversation. So, that's one thing that I do. I started off with doing diversity, equity and inclusion training, and education but then I realized why are we separating the two? Why is this segregated? We're talking about D, E and I over here, and then we're talking about clinical safety over here, but they really should be immeshed. And so doing speaking engagements, training and facilitating is one of the things that I do. Then the others is actually talking to the nurses who are in it, who are doing the work. So from novice nurses all the way up to the experienced competent nurses and showing them that they too can be leaders and they too can be nursing agitators, and this is how.

Tiffany:
So it's not demanding that leadership and admin do this for you, it's not demanding higher pay, it's not demanding more ratio, it's literally how do we come up with solutions that all parties can win and that is something that can happen? So one of the things that I used to tell nurses all the time is you want more nurses, you want there to be a hiring increase and you want more nurses on staff. All right, great. Where are we getting these nurses from? So your nurse manager wants more nurses on staff as well. Trust me, they are over these crazy ratios and they understand how short-staffed the unit is. They want quality nurses to come and work here as well. We all know. We're well aware. Where are we getting these people from? Because no one is applying to be a staff nurse right now.

Tiffany:
And there's so many competing priorities. And also, and this is the other thing that I don't think that bedside nurses are aware, the nurse manager is not the one who's pulling all the strings, there's a whole level of people above the nurse manager that the nurse manager has to answer to. And so the nurse manager really is caught in the middle and that's where the leadership is going to be displayed. Because we can spend so much of our energy and effort advocating for our staff, but if we understand that admin is not prioritizing the same wants and needs, then we're stuck in the middle. And then how do we interpret and translate that on either ends? I have been teaching bedside nurses how to be leaders, effective leaders, right where they are.

Tiffany:
You are a staff nurse, you work at the bedside, great, this is how you can change culture when you're a unit, and it's not just policy and procedure because policy and procedure are just rules, those are things that don't change culture, individual behavior does. And so this is what you can do individually in your little world to start the ripple effect of change.

Tiffany:
Now for a management and leadership, their job is to sustain that change. When you see your bedside nurses actively amplifying their voices and advocating for things that they want to be productive, then your job is to help them sustain that and to try to remove any barriers that they have. And so what I'm doing now is helping management do that with removing of the barriers and what does that mean and sparking these conversations about psychological safety. And then for the bedside nurse is this is how you become a leader, because we don't get taught that in nursing school. So this is how you become a leader and this is what this looks like. And so we know how to advocate for our patients, we're taught that in nursing school. We're not taught how to advocate for ourselves. And right now what I'm seeing on social media is a lot of venting, griping, complaining, and people have the right to, but then there's no solutions. And so those are the conversations that I would like to have.

Dan:
Yes, we are on the same page, 100% there. So we could go in so many directions on that. Social media and nursing right now is the bane of my existence. And it's taken out of context and people are creating sides and I loved your approach. It's why are we continuing this narrative? One of the narratives in nursing is staff nurse versus traveler, staff nurse versus management. And we're all on the same team and it's easy to blame management for whatever woe you have because you have no visibility in there. So you're making assumptions and it's easy for management to make assumptions about this 80,000 nurses that work at their facility or whatever, and it's just not productive. Like you said, there's no solutioning in blame and we need to come into the table to figure out how we move forward.

Dan:
And I loved your example of the recruiting. Yes, you want more staff, well then the culture of the unit is 99% the staff nurses control. How they interact with each other is the culture. And if you want to attract people or have them stay, yes, pay and benefits, that's part of it. But if you make it awesome to show up to work and you're a team and there's no drama, I would work on a unit for less pay to do that, just to not be stressed at work. And I feel like the narrative, like you said, is just not there. And providing that perspective I think is one way to change it because it's just not productive.

Tiffany:
And that to me is where the change happens, is in that intersection of I know you have an issue and we all can identify that this is an issue. However, us as leaders are not the only ones who can come up with the answer. What I'm seeing now is that the bedside nurse, a staff nurse is looking at leadership, nurse managers, admins, for the solution, which looks like no more pizza parties, because everyone's over that, more pay, which I don't think people understand the finances behind that. I don't think people really understand budgeting and finances and how hospitals get paid, and then once they get paid, what that looks like trickling out.

Tiffany:
And then understanding organizational structure. So your nurse manager is probably not the one that's making these decisions, but they're the ones that's communicating the decision, and so you're upset with them and you're mad with them, but they're in the middle. It's a two-prong approach that I see that we need to get the leadership and management involved to understand the perception of those at the bedside, but then those at the bedside do not understand the business of healthcare and what that means, and so a lot of their finger pointing can hopefully stop once they really understand what this is and how the wheels work.

Dan:
And then also enable teams to come together and fix stuff and get those quick wins so that there's outcomes that are there too.

Tiffany:
The quick wins are really important, and that's where we can sustain the change and we can sustain the motivation to continue to do the hard work is with the quick wins.

Dan:
Well, Tiffany, this was awesome. We should have you back on and talk even more about all this stuff. You and I are on the same page. You're now part of my co-conspirator network or I'm part of yours, and so now we're obligated to work together to change the narrative on all kinds of silly, goofy things that nursing does. And I just really enjoyed it. Where can nurses and our listeners find out more about you, your services and get in touch?

Tiffany:
So I do most of my troublemaking on Instagram, so they can find me on New Nurse Academy on Instagram. So, that's @newnurseacademy, and that's where I do a lot of my tips, two cents in. And I go live very often to give my perspective about nursing. My more buttoned up approach is on LinkedIn. You can find me there on Tiffany E. Gibson over on LinkedIn, and then my website, newnurse-academy.com.

Dan:
Awesome. Check those out. We'll put the links in the show notes and Tiffany, this was amazing. I definitely want to stay in touch and if I can help in any way move the agenda forward, let's do it together.

Tiffany:
Absolutely. Thank you so much, Dan. I appreciate the conversation.

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