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Bill Klaproth (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2022 conference. With me is Dr. Lee Galuska, Director Nursing Practice, Education and Research at UCLA Health System. And Dr. Judith Hann, Director of Nursing Professional Practice at Yale New Haven Hospital, as we talk about meaning and joy in nurse manager practice. And share some keys to leader fulfillment

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Lee and Judith thank you so much for your time. It is a pleasure to talk with you. Lee, let me start with you, when it comes to joy and meaning in nurse manager practice how did we get here? What led you to research this?

Dr. Lee Galuska (Guest): Well Bill over the last seven or eight years, then there's been a lot of recognition of the importance of clinician wellbeing and our ability to deliver excellent care and produce positive patient outcomes. So, first came about with Lucian Leape and the National Patient Safety Foundation, talking about meaning and joy in healthcare worker practice. So Judy and I started to think about this and we thought, well, what does that look like for nurses? And in answering that question, we decided to conduct a study. And so our first study, we talked to nurses all over the country, nurses in different roles and practice settings with lots of levels of experience. And in interviewing them, we came up with some themes and what we found was when nurses were able to practice in a way that allowed them to fulfill their purpose, make meaningful connections with patients and families and their colleagues, and to see the difference they're able to make, they found their practice to be meaningful, and they found joy in their work.

And one of the factors that contributed to that was their nurse managers and feeling like they had a nurse manager who role modeled, finding meaning and joy in their own work and who could create positive practice environments for them as nurses. So then we got to thinking about nurse managers and that's often described as the toughest job in the hospital. Nurse managers are at this critical intersection, you know, with patients and families and with their staff and interprofessional team members and senior managers and organizational initiatives. So they're sort of at that crossroad and they're so integral to us achieving great care and lots of other organizational goals.

So we wanted to understand this high pressure position and how do we help nurse managers to find meaning and joy in their work. How do we understand that better? And so we specifically, started a study, looking at nurse manager joy and meaning, and came up with some themes there as well. And I think, you know, maybe Judy wants to share some of our findings from that study.

Host: Absolutely. So Judith, tell us about your research, your findings. What did you learn about nurse manager, joy and meaning?

Dr. Judith Hann (Guest): Thanks Bill. This was a study that focused only on the nurse manager. And it was a qualitative study, which meant we asked a very open-ended question. We focused on the positive. We really researched a lot of the literature, which was focused on what does it look like and feel like to be burnt out. And we, we didn't take that approach. We took more of an appreciative approach and we wanted them to describe to us, when you were feeling meaning and joy, what did that look like and feel like? And what were the times that that was happening in your practice as a nurse manager? Of course our thoughts were, if we could identify what that environment was like, that hopefully we could springboard off of this new knowledge and create that environment for our nurse managers.

After we analyzed all of our data, we came up with five themes. And the first theme was to mentor and be mentored. And this theme was really focused on the primary role that they had to mentor others in their clinical growth and academic learning. And also to have a mentor themselves. They focused on the times that they felt the most fulfilled is when they were helping other nurses. And they really also expressed that they needed support from other mentors. So, mentorship came through as one of the themes. Another theme that nurse managers talked about was focusing on the patient. They really wanted to stay close to the patient, but have a broader influence. And they felt as though when they took these manager jobs that they could impact more patients and influence better outcomes for patients in their new roles as managers. And they really just wanted to stay connected to patients.

Part of their leadership was leading others, but also folks still very focused on the patient. The next theme was to create and cultivate environments. It felt a huge responsibility for other people that reported to them as nurses. And they felt the responsibility to build teams that could engage as professionals and that they were responsible for that space. They really wanted to create happy people in healthy work environments. And they reflected that when this was happening, that made them feel fulfilled and joy and meaning. Another theme was to be optimistic. One nurse said that we've got this attitude was really important to have a glass half full and the value and fun and humor at work.

And sometimes how critical and important that is, especially during times when you may be surrounded by many sick people and challenging life events for patients, that optimism was really, really important. They also felt, this theme was to be empowered by leaders. They didn't like to be micromanaged quite frankly, and wanted leaders that gave them the freedom and the autonomy to make the best decisions for their own units.

And they also believed in a healthy work environment for staff engagement and decision-making. So, that really meant engaging their staff and understanding how they knew how to improve patient outcomes and run their units that, that transformational leadership was important to them. So those are the five things that came through in our nurse manager study. I think there's, as we presented this at AONL, we saw so many head nods and so many people that this resonated with, as something that really is very important to nurse managers.

Bill Klaproth (Host): Yeah, those are five excellent keys. Number one to mentor, and to be mentored, two focusing on the patient, three cultivating a healthy work environment, four being optimistic is always important. And five nurse managers want to be empowered by their leaders, not micromanaged. Good stuff. Judith, thank you for sharing that with us. So Lee, now that we have these five things, what do we do now with this info? Help us out?

Dr. Galuska: Well, that's a great question, Bill. And from our study, we came up with some implications for leaders and managers themselves, and we wanted to offer those, but as we thought about the bigger picture and all that we had been through, with the pandemic, we thought, well, let's look out to the literature as well and see how do our recommendations align with other studies or in papers that have been published.

And what we found was there has been a lot of interest in this and a lot more that has been published, including some great work by the National Academies of Science, Medicine and Engineering that really looks at a kind of a multimodal approach and systems approach, really. So there's lots of things that we can do at the individual level that the nurse manager can do for themselves.

And that's where a lot of focus has been. And we'll, I'll talk about that in a second. But then there's also interventions that can happen at the team level, kind of a leader with her nurse managers, his or her team of nurse managers, and then at the organization and system level. So we really need to take a full, comprehensive look at this.

So as I mentioned, there's a lot of emphasis on self-care these days, and there's no doubt that every one of us at the individual level needs to take responsibility for our own wellbeing. There's all kinds of resources and apps and programs that have been designed to help us do that. Everything from mindfulness to yoga, to massage, et cetera.

And what we've realized is that that's really important and everybody knows we need those things as human beings to be healthy physically and psychologically and emotionally. But, we also know that there's some other things that we need to help nurse managers do as individuals around, kind of setting some boundaries and having in their schedules to allow for that important work-life balance, to allow time in the schedules to connect with patients as it relates to our themes and to be able to collaborate with colleagues. So all of that time sort of needs to be built in for the individual to be able to continuously kind of fill their own cup, reconnect to their own passions, why they became a nurse and why they became a nurse manager.

What we found in the evidence is that individual nurses and nurse managers know they should be doing all of those things. And there, the challenge is finding the time and the multiple competing demands in these very tough jobs to find the time and the energy to be able to engage in those. And that's where we need to make some improvements at the team and the organization level to help nurse managers do the right things for themselves.

So we created a crosswalk that we shared at AONL with some recommendations, that nurse leaders can take to help their nurse managers, not only to mentor them and empower them, but to really understand who they are as people, and to help them connect to their own purpose and, help to create the conditions where they can find more meaning and joy in their work. So, it means working on schedules so that managers can be encouraged to take the time off, have somebody cover them. There are lots of things that leaders can do to support their managers and having a more manageable schedule, so that they can engage in the meaningful work that provides some joy for them.

I think also, having conditions that support healthy teamwork. So there's work to be done on healthy practice environments in healthcare. There's work to be done on providing meaningful recognition. And also to allow people to take risks and be creative and innovate, not just be kind of bogged down in maybe a psychologically unsafe environment where they don't have the ability to take those risks safely.

So there's work to be done in organizations at the team level. We know that the most impactful interventions are going to be big picture organizational and system level improvements, across the United States. Safe staffing is an issue all across the country and nurse managers are spending an inordinate amount of time just trying to staff their units. So this needs national attention and we need to work on it together. We also need to work on span of control. Sometimes our nurse managers had hundreds of staff that they were responsible for. So how do you get to connect with your staff as a mentor, if you can't even get to see them?

So we've got to create manageable spans of control, and that's going to take some changes at the big picture level. We need to compensate them fairly. It's another thing in nursing that we're finding that we don't have fair and equitable compensation systems, particularly for these very difficult roles.

And, people are starting to walk away from them. We're seeing the great resignation in all professions, but right now in nursing were really struggling with this. we need to make sure that we are providing resources like AONL attendance, for instance, so that people can get additional training and education and coaching to be able to, grow in their nurse manager roles and as leaders.

So we've got to create those opportunities and we need to do that to kind of, system-wide not just one nurse manager at a time. And there needs to be a lot of work done in the national picture. There's a lot of focus on psychological wellbeing and creating environments where people who have no tolerance for bullying, there's no tolerance for humiliation and other kinds of things like that.

So we need to create those just cultures where people are free from psychological harm. As well, as provide the wellness programs that, that are needed. But those are not the only answer. And oftentimes that is our focus these days of providing access to massage and mindfulness and those kinds of things. We need to do the big picture changes that'll create environments that are healthier for our healthcare workers at all levels, including the manager level. These are important changes and we need to paint that picture, that there is no easy fix. It's going to take us all to work very hard together to make changes in the healthcare system that'll transform it to be healthier healing place.

Host: Well, your research has certainly helped prepare a roadmap on how to achieve that, those big picture results as you were saying. You also mentioned part of the challenge is finding the time to get this done. So, Judith, what is your takeaway? How do we get started? We can't do all of these at once. Where do we get started? What's most important to think about first?

Dr. Hann: Right. I think, we need to start with the simple things. The first thing is administrators need to get to know their nurse managers as individuals, and really help them connect to their purpose as a person and a professional. There needs to be time for open discussions about their hopes and dreams and what lights them up. In addition to some of the things that Lee talked about, there's a lot of data in healthcare that drives what we do, and we should really start tracking things like when's the last time our nurse manager had a day off. And how many of our nurse managers are spending their lunch break in front of a computer monitor when they could be out talking to staff and families like they want to. We need to look and see how many of our nurse managers actually have mentors.

And do we have an opportunity for them to share their stories and for us to share our stories with them. And, more time and more open conversations with formal and informal structures. We found that nurse managers like each other and they need each other as nurse managers. So are we creating forums for them to talk about their challenges and prioritize what they would need first.

But I think we're off to a start by just opening up this discussion and we've gotten such great response. And it's resonating with so many people. So we're thrilled that we can even do that at the very least in this time during the pandemic.

Host: Yeah, those are good first steps in helping our nurse managers achieve more meaning and joy. So as we wrap up Lee and Judith, I just want to ask your final thoughts on this whole subject of meaning and joy in nurse managers. Lee, let me start with you anything you want to add?

Dr. Galuska: Well, think it is critical. It's not a luxury for us to consider this, but it is essential because as I mentioned, that integral role that nurse managers play in the success of our healthcare organizations, being able to deliver great care to patients and families. So it's something that we must pay attention to now. And it's, something we need to start focusing on. As Judy said, there are things we can start right away without a lot of effort. Then there are big things that we can get involved in. The National Academy is offering an opportunity for people to get involved in the national plan, to make some health system changes in the United States.

So I think it's a matter of kind of exploring that landscape and seeing what we can do to create the conditions that are healthier for all healthcare workers, including our nurse managers.

Host: I like how you put that. It is critical. It is not a luxury. So this is something yeah, we all have to do. And Judith, if we could wrap up with you, your final thoughts on this as well.

Dr. Hann: Sure. The time is right for us to try some new models and to do things differently. It's a new day. It's a complex healthcare environment and the nurse manager can't be expected to do it all. And I think the competencies for nurse managers have grown from managing the business of the small unit to far reaching other responsibilities and to think about how could we do that differently with their work-life balance and this value that all nurses have for team and, being able to really help patients. Perhaps we could add some additional folks to that leadership team that have other competencies in running the business, that could be a big help to nurse managers like finance folks and quality experts and other, team members to help lead the team in a new model.

Host: Yeah, as you said, the time is right to try new things. So your research will help us to do that. And hopefully we can all move in the same direction to provide more meaning and joy in nurse managers. Well Lee and Judith, thank you so much for your time. This has really been informative. Thank you again.

Dr. Galuska: Well Thank you Bill. We enjoyed the opportunity.

Dr. Hann: Thank you Bill.

Bill Klaproth (Host): And once again that's Dr. Lee Galuska and Dr. Judith Hann 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.