Diana Harter: it's absolutely pivotal in healthcare because our communication drive interactions with our employees, with our patients and their families. Healthcare outcomes are relying on, appropriate communication and relationship center. Communication is really a communication approach that prioritizes meaningful interactions between people.

it emphasizes empathy, shared trust, decision making, and respect for others. So nursing leaders. It's imperative that we develop these relationships with our staff members because they are going to be responsible for our frontline. And when you think about those that touch our patients, we need them to have meaningful relationships.

So it's, it's so important in healthcare.

Bill Klaproth (host): So I like how you said meaningful. This isn't just shallow conversation. How's it going today? Right. No. What'd you do last night? Exactly. Yeah. What's happening this weekend? Meaningful conversations

Nikashia Franklin: and the thing that makes that meaningful, if I could, because yes, Diana, talked about that a little bit, but is honoring the humanity in each of those interactions, right?

That's the relationship centered part of it. Seeing the people as people, not just employees, not just patients, but as people. And so that's what makes the difference.

Diana Harter: Absolutely. Thank you Nisha. I, just wanted to add in one of the things that's really key is creating a dialogue with your employees and not a monologue.

So frequently in nursing leadership, we talk to. Our employees. We have a specific message perhaps that we're trying to relay, and this type of communication approach really, really emphasizes creating a dialogue where our employees, our patients and families, whoever you're speaking to, is a part of that conversation.

We're not just talking at you, we're talking with you.

Bill Klaproth (host): I love that line. It's a dialogue, not a monologue. Yes. Yeah. That really Encapsulate it right there, right? Absolutely. Yeah. Really good. I love it. Okay, so how do we start these meaningful conversations, Steven? what did you put in place?

how did this start? You've gotta have a, a framework or a structure. How did you do this?

Nikashia Franklin: Yeah. So several years ago, back in 2016, Texas Children's developed this five and a half hour course that we affectionately call breakthrough Communication. Which is this relationship center, communication.

it's a small group, you know, you go through you, we do a little bit of role play where we learn the conversation, we learn what the structure is, and then we put that into practice. And so we knew coming out of the pandemic, we needed something that nurse leaders, bedside nurses, physicians. Ancillary team members, we needed to prioritize communication because that was a key strategy for, turnover for quality metrics.

it's impactful. So we developed a five and a half hour course that goes through, different, what we call skill sets. So we have multiple skill sets that we work through, where we begin the encounter. We start the dialogue, not the monologue. We hear what the person who you're speaking with, we hear what they want from the conversation.

We have something that we want from the conversation. We make sure that we elicit all of the things that we wanna talk about today, and then we prioritize what it is in that conversation. So that's that skillset one.

Bill Klaproth (host): So you actually put a course together. So, yeah. So all nurses have gone through this or you put them through this, or at new orientation, when they come on board, you put them through this?

Is that how it works? Yes. No.

Diana Harter: So right now it's, it's a very elective course. So right now the participants, it's sometimes it's required because perhaps there was a communication opportunity, or. Perhaps some of our leaders have just adopted it because they recognize the true benefit that this course has.

So they require every new hire in their department to go through this training, knowing how key it is for their staff members to be able to deliver an effective conversation with people. and so our goal is to get it. For every new hire at Texas Children's to go through this course, being that it is almost six hours of dedicated time, it's a bit challenging, but that is something we are working towards, with HR and everything like that.

So that's the ultimate goal.

Bill Klaproth (host): Yeah. So do you have monthly check-ins or how I, I'm just curious. I mean, you want to have these conversations. Do you have monthly check-ins where you can really develop these deeper relationships or these deeper connections?

Nikashia Franklin: so the curriculum itself, we, to Steven's Point, it's a five and a half hour course post course we are available. PRN, right? If anybody has any questions that they wanna practice or, you know, put it into practice with us before having a conversation, if they've had a conversation that they're wanting to think through, post conversation, they can call, email us, pop up in our offices, or whatever the case may be, so that we can help figure out where the opportunities were and what they did well, which is the most important piece of it, right?

Because ultimately we want to instill that confidence in them to know that you can do this. It's difficult and you can do it. But personally with my employees. I know we talk about transformational leadership, we talk about servant leadership. I have calendared once a month meetings with my employees to build those meaningful relationships, and I'm also available as needed.

I think in order for you to be an impactful leader and to have those meaningful relationships, it can't just be confined to what's on your Outlook calendar. Yeah, and I'm not naive in saying that I should be available 24 7, right. For my personal wellbeing and my professional responsibilities. Right.

That's not, feasible. What I'm also saying is that in order for us to truly prioritize who our people are, we have to know that life happens, and it's usually not Monday through Friday, eight to five. Mm-hmm. Right, right. It's usually Saturday night, well into Sunday morning when they will need you and your expertise in how to navigate the thing that's happening to them.

Right. So being open to them reaching out is a pleasure for me because it means that they feel safe. And that's our ultimate goal, right? Is that psychological safety. So for them to feel safe enough with me to reach out in whatever moment of crisis or confusion or whatever the case may be, is very affirming to me as their leader.

Bill Klaproth (host): Yeah. So how have you measured this? Can you share some results? Yeah. And tell us

Nikashia Franklin: what Steven mentioned. when we developed this curriculum specifically for our nurse managers, and they were nurse managers that had less than two years of tenure in their role. And they were onboarded during the pandemic, which meant not only did they have the least amount of training as everyone else, it was the most important that they had more than everybody else had had.

Mm-hmm. Right? Because you're not just, and I don't say that to minimize what you would typically have done, you're not only responding to the usual air quote things that you would be responding to as a nurse leader. Everything is heightened. Everybody's on edge, including you, yourself. Right? You're bringing that into those conversations, and so we were intentional about that nurse manager population with less than two years of experience. And we did self-efficacy surveys at the beginning of their course, immediately before begin, immediately after it was over and three months after. And one of the things that they mentioned to us via self-efficacy survey is that they were least comfortable with having difficult conversations with their direct reports.

Mm-hmm. Mm-hmm. And through this course, both immediately after and three months post. We saw exponential increase in their confidence and not just having those difficult conversations with their employees, also with each other, also with families. And that's why I mentioned that confidence piece, because it's integral.

If you think you won't do it well, you won't, In spite your best efforts, you won't be able to. Yeah, because you're already in your head before you start the conversation.

Bill Klaproth (host): So that's a direct result of these meaningful conversations, people Feeling more confident to have difficult conversations, whether it be with a nurse leader or a patient or a family.

Absolutely. Would that be right?

Nikashia Franklin: I think so.

Bill Klaproth (host): So how did you uncover that need that people were Oh, 'cause you, you, did you do a survey to find out the need? That I'm kind of uncomfortable having a difficult conversation with my manager or my nurse leader.

Nikashia Franklin: Yeah. We started,

Bill Klaproth (host): yeah,

Nikashia Franklin: years ago, what do we need to do for leadership development?

And many years ago they said. High impact communication was one of the most challenging things. And so that's where we came together, developed this curriculum. And then what Isha was mentioning is they did a self-efficacy immediately before rating on, five different topics, one of them being meaningful conversations, challenging conversations.

It was the lowest scoring on their self-efficacy rating directly after we saw an increase. And then three months post, we saw a continued increase Yeah. In, every category. So we were confident that what the nurse leaders learned, they were able to put into practice. The more they put into practice, the more comfortable they got with the skills and the tools to be able to have those conversations.

So that increase. Immediately after three months later, it was really important to validate that this is actually what we need to be doing in leadership.

Diana Harter: Yeah, absolutely. And I would just chime in, bill, like driving this point, home communication is our most common procedure in medicine. Mm-hmm. And it's the one that most of us have received the least amount of training with.

And so when you think about that, when you put it into perspective. We have these brand new nurse leaders. They were hired during the pandemic. All of the courses were shut down because there was nothing in person. Everything was Zoom. We had a huge opportunity. We needed to catch them back up to speed with where they needed to be, and we owed that to them.

Mm-hmm. To develop them, to spend time with them to make sure that they were comfortable having these crucial conversations with their employees, with our upset family members. Now more than ever. People are heightened emotions, challenges, difficult times, and so it was really, really important for us to be able to teach our nurse managers how to effectively navigate that.

We owed that to them. Yeah,

Bill Klaproth (host): that's a great point. We really don't teach communication. Right, right. And you're

Nikashia Franklin: expected to be able to do it effectively day one,

Bill Klaproth (host): right? Yeah. Well that's why this, what you're doing is so important. You're teaching people those valuable communication skills. Right. And as I'm hearing you all talk, I'm thinking about any employee, no matter what, business always performs better when they feel heard.

Yes, absolutely. Or seen. And you valued. Valued. Yeah. By you giving them the tools to be able to communicate where they're not holding things in allows them to feel heard. Because I feel safe in Right. Talking to you about something that might be uncomfortable, something that might be bothering me that I'm not gonna bring it up.

They're gonna think this of me. Mm-hmm. So I'm just gonna hold it inside. I'm just. You're opening the door to say, no, we want to hear that. We wanna make sure we hear you and acknowledge your issues or problems and, and value you. So

Nikashia Franklin: yeah, that's the idea behind the dialogue instead of a monologue. Mm-hmm.

So that everybody's voices is heard. Yeah. So that you can get to what you need to do.

Bill Klaproth (host): I love it. You just, you just brought it around, Steven. I love, see how you did that. You're a pro. Did you see you, bill, how you did that? I'm

Nikashia Franklin: sorry, where do I sign? Just see how I did that, because it's not just an allowance, right.

For people to have that bi-directional feedback. It's encouragement.

Bill Klaproth (host): I like it. Yeah. Yeah. That's good. This has really been a great discussion. Thank you for sharing with me what you've done at Texas Children's. Really interesting. I'd love to go around the table and get final thoughts and key takeaways from each of you.

So Nikisha, if we could start with you key takeaways from your point of view or final thoughts, anything you want to add.

Nikashia Franklin: Um, I'll share one of my key takeaways and then if I could, I'll share a quote. One of my key takeaways that I like to share with everybody who's even interested in learning more about this work and trying to put it into practice is that I know that we've been taught before that practice makes perfect perfection, doesn't exist.

And if you allow it, perfection will absolutely steal the shine from progress. So pursue progress. It might feel clunky at first, and that's okay. It's the intentionality behind it. Embrace the progress and knowing that this conversation went better than the last and the next one will go better than that one.

Right? and allow that to give you the confidence. There's that word again. to be able to move into those spaces and navigate those conversations and. we say this quote often, we actually use it in, many of our talks. it's from Dr. Maya Angelou and she says, I've learned that people will forget what you said.

People forget what you did, but people will never forget how you make them feel. So putting them first in those conversations is a way to show them to your point Bill, that you're there. You see them, you hear them, they have a seat at the table, and you value them.

Bill Klaproth (host): That's amazing. By the way, that's my favorite quote.

Nikashia Franklin: I love it. By the way, if you

Bill Klaproth (host): go on your app, if you go on your A ONL app mm-hmm. And you look me up right now, I'm not kidding you.

Nikashia Franklin: Seriously, that

Bill Klaproth (host): quote is under my name.

Nikashia Franklin: That's awesome. You know where

Bill Klaproth (host): you, so I dunno if you've gone through the app. Yeah. So tell us something about yourself or give us your favorite quote.

Nikashia Franklin: Yes.

Bill Klaproth (host): I'm telling you. Look me up. You're gonna see that quote. Oh my gosh. Under my name.

Nikashia Franklin: That's, I love it. That's great.

Bill Klaproth (host): How is that? We were meant to be here. That's, that's serendipity. Serendipity. Yes. That's right. Steven's wrapping it all up. Nisha's dropping quotes that I love. I love it. This is just fantastic.

Diana, you're on the hot seat So give us your, key takeaways.

Diana Harter: My key takeaways. I saw this quote two days ago and I shared it with Nikisha and Steven and it's show your people, they matter. It's the least expensive part of leadership. But delivers the highest return.

Bill Klaproth (host): Wow. That is a great quote too. Yeah, that is, that sums up what y'all are doing. Yes.

Diana Harter: It resonated with me so deeply because all we have to do is recognize humans as humans, and. Listen with empathy, that's all they want, you know? Not for us to brush over something major, how stressed they are. Saying something like, I can see that it's been really challenging for you.

I would probably feel the same way, legitimizing those feelings and making it human. I think it's it. All the difference in the world.

Bill Klaproth (host): Absolutely. Yeah. The world operates better when we recognize the humanity, right? Absolutely. In each other. Absolutely. Yeah. That's my quote. Write that down. That's my quote.

Somebody write. Write that down. Real. We're putting Bill in the curriculum down. Yes, we bill. Bill, you're

Nikashia Franklin: going into the curriculum.

Bill Klaproth (host): We're gonna add a slide direct quote. The bill direct quote. The bill slide. The bill slide. I love it. Oh my gosh. Steven, wrap it up for us. Final thoughts or key takeaways from your point of view?

Yeah.

Nikashia Franklin: So as caregivers, we are interacting with people and we don't know what they're going through. It's a stressful time, and so being able to communicate effectively with empathy, recognizing people where they are, what they're doing, and with dignity. I think really changes, changes the, landscape of healthcare.

So I think being able to communicate well is the most important thing. We are facilitators of a, a communication course, and we don't get it right every time either. Right, right. So it's, it's not just about having the tools and, the skills and doing it all of the time there's a component of it that drives.

What you do every day. Yeah. And so I think to continue to do that to continue to bring forward that message changes our patients and families. It changes the caregivers that care for those teams. And as leaders, it's our duty and responsibility to treat people with the dignity they deserve.

Bill Klaproth (host): Absolutely. Yeah. Yeah. Very, very well said. Yeah. Thank you, Steven. And like you're saying, don't let perfection get in the way of Absolutely. Progress. Absolutely. Absolutely. Basically. This has been a great discussion. Thank you all and congrats on the great work you're doing. You're a model for what a lot of people can and should do, and uh, a lot of people will take something away from this podcast episode.

So thank you all for being here. I appreciate it. Appreciate you having us. For having us. Yeah, thank you. Absolutely. Once again, that is Nikisha Franklin, Diana Harder, and Steven Kibito. And for more information, please visit a l.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.