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Bill Klaproth: This is a special AONL podcast, as we speak with session presenters from the AONL 2022 conference. With me is Susan Sportsman, Managing Director for Collaborative Momentum Consulting, Karen Kowalski, President of Consulting, and a Professor at Texas Tech University Health Sciences Center, and Patricia S. Yoder-Wise, Vice-President of Nurses at Legacy Institute and a Professor and Dean Emeritus at Texas Tech Health Sciences Center.

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Susan, Karren, and Pat, thank you so much for your time. It is great to be with such an esteemed panel. I really appreciate your time. So Susan, let me start with you. In these complex times in healthcare, continued leadership development is critical for all nurses. And to leave a legacy, the leaders, the group, not one person have to commit to develop and lead. Talk to me about that. Why is that so important?

Susy Sportsman (Guest): We believe that to be able to be effective as a leader, you must have not just one person's ideas, you must have a whole group who have been invested in your legacy. If it is just one person, when that one person leaves, then the ideas, the initiatives that have been gotten seem to go away. That's why we believe that it is leadership, not just one person, but many. And part of the role of the leader is to bring those people together.

Host: Yeah, that makes sense. So you just made a great point, it can't just be one person, because if that one person leaves, then they take that all with them. So you really have to, as you said, permeate it through the group. It's kind of gotta be a standard across everyone that you're trying to achieve. So thank you for that. So, Pat, let me ask you, when it comes to working and permeating the group, in trying to leave a legacy, trying to raise the performance of everyone; what tactics or initiatives have you used to address this issue?

Patricia S. Yoder-Wise (Guest): Well, thanks so much for that question because this really, came to be, the book that was published last year, the Leadership Trajectory. And the Subtitle is Developing Legacy Leaders-Ship. As Susy pointed out, it takes more than one person to perpetuate a legacy. And what we did was this, we went through the literature first using things like the usual literature searches, PubMed and CINAHL, et cetera. And we kept looking at keywords and came up with probably hundreds of words. There are two types of ways to look at concepts. Those two ways are called splitters and plumpers, and we are plumpers meaning we keep putting concepts together into bigger piles.

And part of that was deliberate because we thought of saying to people, here are things you need to know to be an effective leader. And we thought if we presented hundreds of ideas, people would be so overwhelmed. They would not want to do anything. As a result of that, we kept distilling down, if you will, to key concepts for leaders, attributes, personal characteristics, and then environmental characteristics and then a trajectory. And what we did was, we used seven people as our circle of advisers and we kept going through each one of those people saying, here's what we have now as ideas.

And what we came up with was 14 processes, if you will, on the trajectory of how you become a legacy leader. And then looking at that process, there were 18 personal characteristics and 14 environmental factors. And the point of this model is that you put those pieces together for yourself. In other words, in a different environment, you might look at different personal characteristics than you had in the prior environment. And then you also might, as you move into a different role, even within your own environment fall back down on the trajectory, because you need to learn more about this new environment that you're in. Whereas before you were further up in the process. But the whole time is you are focused on what is your purpose? Not just your purpose in the organization, but your whole purpose in life in terms of leading toward a legacy.

Host: So you've boiled it down to 14 processes on how to become a legacy leader. So then do you ask all nurses to work on developing these 14, as you mentioned, that way everyone collectively is working on the same thing and that brings up basically everyone's performance leading to leaving a legacy. Is that fair? Is that how it works?

Patricia: Exactly how we see it. Every nurse has the potential to be a leader, and we believe that part of that is because if you think about it, leading from the bedside is a specific skill. It's different than leading in the board room or leading in the community or leading in a different role. But every position has the opportunity to lead as an individual, but where it becomes really effective is when all of us agree on here's something we need to do to make a difference.

Host: Well, I could see how this book would be very valuable in basically teaching these processes of leadership. Karren, let me ask you, as times change, as we know, they often do and things evolve. How do you keep these ideas current?

Karren Kowalski (Guest): That's a really good question. I just want to make a sidebar comment and that, can you imagine Pat and I sitting at her dining room table with all of these papers around it, trying to figure out this model? I mean, it was indeed a phenomenal process and we're very grateful for all of those who contributed to that process. But I think in fact, the model probably is fluid enough that you can change things as the atmosphere or the environment around us change. So, one of the things that we feel so strongly about is that we need to look at how we increase the number of diverse nurses in leadership. And so, we thought about a couple of things.

Obviously, you think of the future of nursing 2020 to 2030, but also things, documents like National Commission on Racism In Nursing. We really need to look at how we begin to use this model to forward coach, mentor, and create growth and learning in all of the people who have potential to be leaders at a more executive level. It's not that they don't lead at the bedside.

Pat made a really good point about that. It's that they also have a very specific skillset that changes as they move up the ladder in any facility or organization. So I think that it's very, very important. One of the things I know is I happen to be a magnet appraiser and believe it or not, we've done virtual magnet visits to hospitals across the country during COVID.

And so one of the questions I always ask the nursing leadership was what happened during COVID? How did it work? What did you do with it? And what I noticed as I talked to staff was that those organizations, which were truly successful had nurses who were, nurse leaders who were what I call in the trenches.

In other words, they were right with the staff on an ongoing basis. And the staff knew them. They expected to see them. They had no reticence at all in terms of bringing issues to those nurse leaders. So it's important to look at how do we adapt in terms of various crises that go on. We're always having something go on. So, it really is important for us to look at how we might do that. I guess the second point I'd like to make about that is, we stress very clearly how important it is to learn from what didn't work. So for example, I coined this in a very different way.

I always talk about the importance of MLEs. Now for all of the obstetrical nurses out there, that's not midline episiotomy, actually, what it is, is major learning experience. So when something doesn't work. The critical aspect is what did we learn from that? What would we do differently next time? That's a whole skillset that in terms of mentoring, in terms of bringing the team together, the whole team needs to be able to practice that skill set. What would we do differently? And how would we learn from things that didn't work from mistakes essentially?

Patricia: And a great example of that Karren right now is what we learned when we took students out of the clinical area when COVID hit. We know that so many places quickly figured out that was not a good decision because what we did was cut off the supply line. And now we know that students who came out were not as well prepared for as new graduates because they hadn't had the same kind of quality clinical experience. That's a great example. One that's right in our face right now. Great, point that Karren just made.

Karren: Let me just add to that, that what I saw in very successful facilities, were what they had done is they took students on as quote unquote "interns", and they let them work with staff during COVID. It wasn't a clinical as we traditionally see clinical, but they had the experience of working through that emergency and watching the problem solving that went on in terms of what the nurses did, how they related to other parts of the organization, like supply and all the rest of that. And so they really learned, those who actually had internships in these hospitals learned an awful lot. And I think probably they're more successful than those who did not have clinical of any kind and just did simulation for example.

Patricia: And that's an example of something that now other organizations are really buying into. They've developed that same kind of internship approach.

Susy: And I would say that it was probably particularly helpful for those students to see nurses struggle with problems and probably not succeed in some cases and all those things, as stressful as it might have been; it's a wonderful opportunity to practice what Karren was talking about. It doesn't always work well. And what do you do when that happens and not be afraid of failing?

Host: Right. That's where Karren mentioned learning from what didn't work, right? One of the keys. And also you said having the nurse leaders in the trenches, and it sounds like if a nurse leader possesses these leadership skills, when the other nurses see that, you kind of set the example and you can spread those leadership skills to everybody with the nurse leader being right there with you in the heat of the moment, is that fair to say?

Susy: That's exactly right. You've said it well.

Host: Really interesting. So Susy, tell us about measurable successes. What are the differences that you see? What are the results so far?

Susy: Well example here is we did a survey, verbally, with leaders from the AONL and there were some interesting results. The first thing we asked was, what is your greatest concern in developing leaders in this environment? And the large majority of the respondents said that choosing the right person was the greatest difficulty about if you want someone to, you know, help people move up the chain of command, how do you decide what the right person is?

And we think we hope that the model can be helpful in that approach. In other words, in looking to see or helping people to gain the various personal characteristics and respond to the environment is one way to do that. We also asked them, what were some obstacles for developing frontline managers, or leaders?

And, this is comes as no surprise to anyone, but they said the difficulty was managing to do that in these times where everybody is so busy and stressed and all those things. So finding time to develop leaders within your organization is a real challenge for people. And again, we hope that our model will help in that regard to point out the importance.

The last question we asked them, which had some interesting results was we asked them the extent to which you as a nurse leader in an organization would partner with the school of nursing, to help in developing leaders? And obviously we asked these questions cause all three of us, in addition to a variety of leadership roles in organizations, have also been teachers. We felt somewhat disconcerted that for the most part, they said they depended upon their own organizations to develop leaders rather than partnering with schools of nursing. And for the last 20 years or so, we have been talking about the need to partner with both schools of nursing and nursing organizations as a way to really generate much more forward movement, than we might do alone.

It's reasonable to assume that at this point in time, that's a response you would expect because of COVID, know, we can only talk by Zoom. So, certainly understand that response, but I think what it says to those of us who know both education and in leadership, we should have a continued emphasis on working with others in our environment. Again, what our, the model talked about.

Host: Yeah, I think that's really important. So you said the three main points; you've got to choose the right person, that's critical and then making the time to develop those leaders. You said that is a big obstacle. So making the necessary time available is really, really crucial. And then you said partnering with a school as well, so that speaks right to you, Patricia and Karren being that you're with Texas Tech University Health Sciences Center. Is that right?

Patricia: Yes. And I think that the real key is whether or not you partner with the school or you, the healthcare organization are providing this development, the real key is this is a personal leadership development journey. And the individual is the one who needs to decide which of those characteristics, personal characteristics apply to them in this particular situation, whether they learn that from the organization, from some external continuing education opportunities, through a mentorship. It depends on what is valuable to that person. And that might be through mentoring. It might be through some kind of reading. It might be through something that's totally unrelated from a traditional viewpoint, but the point is it is lifelong learning that makes the difference in terms of a commitment to being a better leader.

Host: That is such a great point, Pat, lifelong learning for any of us in any profession is really crucial, but especially in the nursing profession. Pat, let me stay with you. And I'd like to get all of your viewpoints on this as a nurse leader listening to this podcast, what is the key takeaway for you? What should we all remember about this? Pat, let me start with you.

Patricia: Well, I'm going to go back to Karren's key point, which is some of our best learning comes from our failures. Why we don't capitalize on that is because we often fail to reflect on our failures. Reflection, according to Kouzes and Posner's is how we learn leadership. And so, as an example, in the book, we put a reflection as the final element in each of the chapters. You have to think about what does this idea mean to me? What does it have as a learning experience for me? And if we think about the failures that we have, rather than just going, oh, cripe, that was really awful. I'll never do that again. What did we learn from it? What can we do differently? What big lesson? Karren's MLE what is the big lesson. That's the big life lesson that we learn that makes the big difference. So that's one of the key takeaways.

Karren: And I guess I would add to that. When we built this model, we looked not just the personal characteristics and the environmental processes. We also looked at this trajectory that goes up to the legacy. And one of the keys of that is coaching. And the fact that one of the purposes, one of the underlying foundational pieces of this model is the fact that leaders ought to be coaching their people. That's how you help them or support them in growing is you have you meet with them on a regular basis and you talk to them about what their goals are and how they're going to get there. And what is it going to take? So if they want to increase, for example, if they want to shift their attitude about something.

Then you look at how do I go about doing that? What are the things that have to happen in order for me to be successful in accomplishing that goal? That's how we work with people. That's how you increase the leadership abilities of all of the team that you have around you. And that's how you, develop this group. So that there's a whole series of you moving things forward, not just one person moving things forward.

Susy: And I would jump in here and say that I think the development of a leader comes both from the person who is wanting to increase their skills and the coach or the mentor who is there helping them. And I think one of the, to go back to the point about what we learned when we don't necessarily succeed in the way we want it to, I think, from the point of view of a mentor, we are often uncomfortable with talking about our failures.

And I think the way to be a really good mentor or coach is to be vulnerable enough to say when I was in this situation, this happened and it didn't go well, and what I learned from that was. And moving forward, I always appreciate when I listen to leadership talks, when people say I tried this, it didn't work. It was awful. I have now moved on. That seems to me to be much more interesting then when it's all I did all these things and I was just wonderful.

Karren: Although we are wonderful. It's not wonderful all the time.

Patricia: And, as Karren was talking, I'm sure there are some leaders who are listening to this podcast who are going, oh my gosh, I'm so busy. I don't have time to talk to somebody and help them develop some little component. And what I would say is one, you the leader don't have to do it personally. You can enlist the help of everybody on the team to do this. If the person is willing, you get the team to talk about whatever the person wants to talk about. And so you all agree that we're all going to help support Susy in being more vulnerable as an example. So, it is the team who is saying to Susy, hey, go ahead and tell us more about the time that this happened and we'll support you in it. It doesn't have to be just the leader saying that, but the official leader so that it really is capitalizing on everybody who has the ability to influence everybody else.

Host: So well said. I have taken a bunch of notes and hopefully our listeners have as well. I think you three are wonderful, from my point of view. So just to recap what you said, because I think it was so valuable, you talked about how reflection, right, is the key to learning leadership. We don't reflect enough. I think that is such a great point. And then again, talking about the MLEs, major learning experiences, the importance of coaching, then, Susy, you talked about a person wanting to increase their skills, but you got to have a coach ready to be there, that's willing to help that person improve their skills and, and the importance of being vulnerable, which is really so important.

And then enlisting the help of everybody, so key. So I want to thank you all for your time today, as we wrap up, if I could just get one final thought from each of you and Susy, let's start with you. When it comes to leaving a legacy, could you just leave us with a sentence? What is most important that we should remember?

Susy: I think the most important thing from my perspective is that we are all in the learning mode, regardless of where we are on the trajectory or where we are in the, whatever position you have. And so it is a continual process to develop skills that are necessary, not just in our work environment, but in the environment, wherever we are, our families, our friends, those sorts of things as well.

Host: Yeah, so true. Karren, how about you? Final thoughts? What is it most important we should remember about this conversation?

Karren: Well, I think, if you're not learning, you better change jobs. And so the emphasis, you know, at talked about lifelong learning, but I can't re-emphasize that enough. And we built the model looking at where are people apt to learn and where are the areas that could be problematic for some people, and that they would have to spend time in terms of working on that.

And so, the fact that we're, I mean, that must be because all educators. But at any rate we really feel strongly. I know when I graduated from Indiana University, I said, I would never go back to school again. Well, that didn't quite ring true because at that time I thought I knew everything and it took me about six months to figure out they didn't know hardly anything.

Going back to school was a big deal. Because of that, I think the focus on learning and how do we, adapt to various situations is critical, both in terms of the model, but also in terms of our lives.

Host: Excellent points. I love all these thoughts and Pat, let's wrap it up with you. Your final thoughts on this. What is most important to you that we should remember?

Patricia: There's a lot of disgruntlement in nursing today. And part of it is because each of us has core values and we have a purpose in life and we've interpreted that into nursing and we probably see what we want to do within the profession. And we don't see how we are making that difference. We want to leave a legacy. Maybe we don't describe it as a legacy. And yet if we really got down to what people want to do, it is really about leaving a legacy. We've got a lot of wisdom that we haven't tapped into. So I think that our challenge right now is to help people see that the core values that they have, lead to the wisdom that they can leave as a legacy that makes nursing better. That makes the profession consistently, the one that is the most trusted among the professions out there for the public. And that therefore makes it one of society's greatest assets.

Karren: Bill, if I could just add to that. I haven't met a nurse who wasn't able to say to me that she wanted to make a difference for the patients and their families. And one of the ways we do that is to continue to learn and grow, but making a difference; that's the legacy. In terms of working with patients and their families, and that's sort of during COVID because, they came up with iPads and various ways for families to be able to interact with their loved one who was sick and isolated. I mean, they did all kinds of creative things because they wanted to make a difference. And that's kind of the foundation, if you will, for how we go forward in the profession and for the model too, because that's what you leave in terms of your legacy is were you able to make a difference. Even for this one family or patient.

Host: Yeah, that's so true. As you said, making a difference, that's the legacy. So one last question, sorry that you guys are so good. I just have to follow up on your point, Pat, and thank you for saying that. Do you think nurses because the jobs are so hectic and there's so much to do, and there's so many stressors, so many pressures, do you think they lose sight of the fact that they are making a difference, but because they are so busy with everything else, they don't realize the impact that they are making and in fact that they are leaving a legacy. Is that a fair point?

Susy: Bill. I think you're absolutely right. And I think part of what we all ought to do for those that we work with is help to remind each other that we are making a difference, despite all the stuff that is going on and the chaos that they find. I think it's interesting that we see young people who are deciding on what they're going to be when they grow up, often choose nursing.

And you would think in this time when there's been so much emphasis, rightly so, on the stresses of healthcare workers and nursing specifically, but young people still want to be a nurse. Which, makes me feel really good about what we've got to look forward too. So, I think we just back to the reflection, we just have to stop every so often and reflect despite all the chaos. What have I done today that makes a difference?

Patricia: And I think this is a really exciting time because there are so many opportunities to make differences in terms of the employment conditions, the research that we've been able to generate during COVID, the new ways of delivering care. I mean, there's so many potentials. This next few years will make a huge difference in terms of the profession.

Host: Well with people like you leading the way with your wisdom and your research and your book; I think our next generation of nurses and nurse leaders are going to be in good hands. So we thank you for your service and everything you've done. Susy, Karren and Pat, it's really been a joy and a pleasure to talk with each of you. Thank you so much for your time today.

Susy: It's been our pleasure.

Patricia: Thank you, Bill

Karren: Thanks Bill.

Host: And once again, that Susan Sportsman, Karen Kowalski and Patricia S. Yoder-Wise. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.