Bill Klaproth (host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth, and with me is Nicole Stuart Pesevic and Suzi Talarico as we talk about reshaping the perception of nursing leadership and ambulatory care. Nicole, welcome.

Nicole Stuart Pesevic, MSN, RN, AMB-BC: Thank you, Bill. It's so nice to be here.

Host: Yeah. Nice to, for you to stop by. And Suzi, welcome.

Suzi Talarico, MSN, FNP, RN: Hi, welcome. Thanks for having us.

Host: Of course. Yes. Looking forward to talking with you both about this. So, when we talk about reshaping the perception of nursing leadership and ambulatory care, what is the perception that's out there right now that we need to reshape? What is the problem? What's happening out there?

Suzi Talarico, MSN, FNP, RN: So, as more care is transitioning from the acute to the ambulatory setting, increasingly we know that we need nurse leaders and nursing support in the ambulatory setting. And really the problem is that there are really, isn't really a perception of nurse leaders in the ambulatory setting because it's such a new role, and so it's not really well-defined.

And so what's happened is that nurses are just plunked in the ambulatory setting without really understanding the why. No change management and not really understanding what the role is. Don't you agree, Nicole?

Nicole Stuart Pesevic, MSN, RN, AMB-BC: Yeah, I agree. And when we're looking at it too, we took some of our personal experiences and wanted to say, are these really what's happening across the organization or across the board?

And, and we found that that's to be pretty true. So we have nurses who are great nurses, they're plopped in this position that is not just a nursing position, it is an operational position, meaning I need to understand finances. I need to understand HR. I need to understand how to lead in an organization where half of the people that work with me or for me, are not even clinical.

Host: So that's part of the perception issue is you're plopping dropping people into a, a position that they might not quite know all the different moving pieces and levers that they need to know. Would that be correct? Yeah.

Suzi Talarico, MSN, FNP, RN: Exactly. And, and it's true for the rest of the team. So the operators, physician leaders don't understand either why this role exists and why this person's here really.

And so it's really trying to figure out how to support that nurse leader and support the organizational change to really support the role because it is desperately needed.

Host: Okay. So we'll talk about, so now that we understand what the problem is, what have you put in place? Nicole, let's start with you to address this issue and solve this problem.

Nicole Stuart Pesevic, MSN, RN, AMB-BC: Absolutely. So what's really interesting is we kind of said, Hey, let's be trailblazers, and put together a group of leaders. And originally when I heard about it, I wasn't quite working with Suzi yet, but we put together this group of nurse leaders and we said, Hey, let's all come together and if we're coming together, maybe we're a bigger voice and we're able to learn from each other.

And also I think part of it is being intentional about it. So the intentionality of leading with influence and inspiration. As nurses, were really good at human connection. And so we took that and used that as a larger voice, within our organization, and really found, oh, okay, well we do fit in, and a lot of our operational leaders are starting to see this.

So when we're looking at our research that we put together qualitative research just to say, what are your experiences like now? What have you done to be very intentional to overcome that perception of your role?

Host: Yeah. Suzi, thoughts?

Suzi Talarico, MSN, FNP, RN: Yeah. We brought together the nurse leader council, and so that collective voice, it's been a journey over six years, and really defining, shaping, and when I, I really started this group six years ago.

I had people within the organization scratching their heads saying, why are you doing this? We don't need to bring nurses together. And in some markets we had no nurse leaders at all. And so I'm going in and I'm having conversations with these operational leaders like, you need a nurse leader.

Well. No, we don't. Yes, you do. So we brought them, I know it was just silly, but brought the nurse leaders together. Um, and the six year journey has really helped define the role. We've supported best practice, change management. And now we're a very valued voice that the local teams and, and I'm on the system team, we don't make decisions without our CNOs. Yeah. They have a seat at the table.

Host: So understanding their, challenges, the things they've been successful at their core competencies, really defining this position really has helped them in their roles and will help future nurse leaders in the same situation. Is that right?

Suzi Talarico, MSN, FNP, RN: Exactly.

Host: Yeah. Very interesting. So, tell us about the process then, if we could, for somebody listening to this podcast, how would they get started to roll out the same kind of program that you've rolled out? What steps do they need to take in order to deploy the same type of a mission, if you will?

Suzi, we'll start with you.

Suzi Talarico, MSN, FNP, RN: Yeah, I mean, I think if, if they're looking to really shape ambulatory nurse leadership and, create sort of depends on the size of the organization. I think it's really talking about the why. You start with the change management, develop that burning platform. Why do we need nurse leaders?

Why is it important? I mean, because we've got infection prevention issues. You've got safe, patient safety issues, quality issues, making sure that our staff is trained because the purview of the ambulatory nurse leader isn't just nurses. I mean, that's about 10% of our workforce in the ambulatory setting.

It's really our back office, non-licensed clinical staff that we have support over that we have to lead and support. So it's, we need to train our staff better. We need to do core competencies for them. So, it's really defining that why, that burning platform. And then it's repeat, repeat, repeat.

Going through that change management, bringing people together, and then start forming groups. We've got subcommittees under our nurse leader council, so I would suggest that they form a nurse leader council, and then you could have sub work groups to really start bringing the nurses together, sharing best practice, and creating that common collective voice.

Host: Yeah, that makes sense. Thoughts Nicole?

Nicole Stuart Pesevic, MSN, RN, AMB-BC: I agree. And I think the other thing is when you have this group of nurses, your, your top tier nurses, it also creates kind of a wonderful organic mentorship. And so you're able to learn from each other. And I found that every nurse that I talk to are, they're incredibly intentional about the education that they seek.

 The training that they are doing. I was once told that I was the least annoying, nursing manager. And I, I was like, oh, I'm gonna take that as a compliment because that means I must be doing something right. So I think that being intentional and being able to build relationships to influence change is so important.

Host: Yeah, absolutely. I mean, it ultimately is a relationship business when it comes right down to it. So understanding that is really important. Suzi, you said six years now you've been doing this, so what have the results been?

Suzi Talarico, MSN, FNP, RN: We've really elevated, like I said earlier, the nurse voice, and so our nurses, our CNOs, our nurse leaders in the markets, they have a proper seat at the table that they are involved in the key decision making of the medical group. They are valued. They are a trusted partner with physicians and operations. And that's a huge win. It was not that way before because again, no one really understood the role on both sides, and really couldn't define what the value was. So that's been the huge win, is that like everyone really trusts our nurse leaders.

Host: Yeah. Having a seat at the table is Important. So your voice is heard. Mm-hmm. Yeah. Really important. So, any key takeaways, important things that you really learned that maybe you thought you wouldn't have learned kind of in Oh wow moments from each of you? Nicole, what has stood out to you?

Nicole Stuart Pesevic, MSN, RN, AMB-BC: I think the first thing was, we went through this qualitative study analysis to see, what it looks like and what the landscape looks like, and found that we're not alone. And sometimes I think you can feel very alone in the role as a nurse leader, until people start seeking you out, you are alone.

You feel like a man of one or a woman of one or a person of one. You're like, this is it. I'm trying really hard to influence change and it's just me. And it was nice to know that we weren't alone and there are mentors across the organization and across the nation. I mean, we're here at AONL.

Talk about a mentorship pool. And I think the other thing is just the intentionality that I mentioned earlier is be intentional. Seek educational and training opportunities, and also make friends with the right people. My CFO, once I learned how to talk Excel, we are great friends now, because I said, oh, I'm taking a class. Let me figure out how to do this balance sheet. And we're good friends and I can say, Hey, this is what I'm trying to do. Can you help me build a business case for this? Or Can you help me with this? So I think those are my two main ones. I'm sure Suzi has more.

Bill Klaproth (host): Yeah, no, that's really important. Finding your own mentors, your own support staff, your own support team around you as well is really important as well. Yeah. So thanks for sharing that. Suzi, how about you?

Suzi Talarico: You know, because this been a six year journey, my advice or my takeaways are just be patient. Rome wasn't built in a day, can't boil the ocean.

So just, slowly, make incremental steps towards really finding your voice and finding your seat at the table. And then also grant people grace, like, assume good intent. Because again, this is new and so some of your physician partners or your operations leaders, they're not coming from a bad place, so assume positive intent, they just don't understand.

So it's grant people grace, take a deep breath and just stay the course.

Host: Stay the course. I think that's really important. And I think also for me listening to both of you is when you see a need or find a need, fill it. And that's what you've both done. You realized nurses needed a seat at the table, especially in the ambulatory care setting, and you decided to do something about it.

So I think that's right. You stood up and you said something, you're trying to affect change. Would that be correct, Suzi? Yeah.

Suzi Talarico, MSN, FNP, RN: Exactly. That's right. Yeah. And stay the course and. Just keep at it. Don't give up.

Host: Yeah, absolutely. Well, thank you both for your time today. This has really been great. Thank you both.

Nicole Stuart Pesevic, MSN, RN, AMB-BC: Thank you, Bill. Thank you. It has been really fun. This has been an experience for sure.

Host: See, not painful. See. Made it through. I know. Yeah.

Suzi Talarico, MSN, FNP, RN: Thanks Bill. My first podcast ever.

Host: Well, you know, I, I love it. So, maybe the first of many. You're both so good. Maybe this is a new road show, the Nicole and Suzi Roadshow Nursing Roadshow there we just created a podcast for you.

This is awesome. I love it. Well, thank you so much again. I really appreciate it. And once again, that's Nicole Stuart Pesevic and Suzi Talarico. 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.