Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN | Cynda Rushton, PhD, RN, FAAN

 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 Cynda Rushton and Karen Doyle, as we talk about Raising the Voices of Nurse Leaders Using an Innovative Dialogue Platform. Cynda and Karen, welcome.

Cynda Rushton, PhD, RN, FAAN: Bill. Thank you so much for having us.

Host: Yeah, absolutely.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: Bill, we really appreciate being here. Thank you.

Host: Yeah, thank you. I'm interested to talk to you both and learn about a Dialogue Platform. So, Cynda, let me start with you. Why a Dialogue Platform? Why, why do we need this?

Cynda Rushton, PhD, RN, FAAN: Such a great question. And all of us who lived through COVID know that part of the long tale of COVID is this persistent narrative that nurses are saying, you know, nobody listens. Nobody cares. What I have to say doesn't matter. And that narrative was present before COVID, but it really intensified after COVID.

And part of it was understandable. You know, there were a lot of things we didn't know in terms of how to manage COVID. There was a lot of uncertainty. There was lots of risk that nurses were being asked to take and their concerns, they didn't feel were being understood and acknowledged. And at the same time, I think leaders, nurse leaders also felt that their concerns were not being heard and understood. And so part of the impetus for trying to find a solution was how do we bridge this gap? How do we close this chasm of nurses who are at the front lines saying, my leaders don't know what's happening here. They don't understand my concerns. They're not listening.

And at the other end of that continuum of nurse leaders feeling like I'm not getting the feedback I need to be able to make trustworthy decisions.

Host: Yeah.

Cynda Rushton, PhD, RN, FAAN: So that was really the context for this whole exploration of how we could address that gap.

Host: Yeah. Such good points, Cynda, when you talk about nobody listens, nobody cares. Nobody understands. That leads to burnout, that leads to stress. That leads to people not being satisfied in their jobs, that leads to nurses leaving the profession. So this is really important. What you're talking about is creating these Dialogue Platforms, right? Would that be correct?

Cynda Rushton, PhD, RN, FAAN: A hundred percent. And you know, when you don't feel heard, you don't feel that you can trust yourself, but you also don't feel like you can trust the people around you.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: And when you're in a constant environment where you don't feel safe and you don't feel heard and understood; it does erode our sense of who we are as nurses. It erodes our sense of why we're here, and it's a risk to our patients because it erodes our empathy. It erodes the safety environment because we're not talking to each other in ways that really are needed to provide the complexity of care that we're in.

Host: Yeah. So let's talk about the platform itself, the Dialogue Platform. Karen, let me ask you. So, what is it, how did you start it? Tell us more about it.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: So as the CNO, with thousands of people that report to CNOs, we were really looking for a platform to engage the frontline nurse leader, who's the linchpin to the point of care nurses. And in working with Cynda and her work regarding this platform; so, Cynda really employed the platform of Slow Talk so that we could create some authentic, honest dialogue with frontline nurse managers to tell me exactly what they're experiencing, what is going on in their work life. And more importantly, not just to listen and hear what is going on, but to begin to create action items around these issues.

And the platform itself, the Slow Talk platform creates a psychologically safe, trusting environment for their voices to be heard and for me to hear their voices so that we can act on the situations that they're managing day in and day out, that they feel nobody has a good understanding of what's happening on the front line.

Host: How does the platform work then? If I'm a nurse and I encounter something that I feel I want to talk to somebody about, how does the process work?

Cynda Rushton, PhD, RN, FAAN: So it's a very innovative platform from the point of view is, you know, it's an app that you have on your phone and one of the things that is central to Slow Talk is if you think about, the idea of fast and slow thinking.

Host: Okay.

Cynda Rushton, PhD, RN, FAAN: So fast thinking tends to be more reactive. It's sort of

Host: More emotionally driven.

Cynda Rushton, PhD, RN, FAAN: Exactly. Slowing down, the conversation means that we can be more fully present, but we can also be more flexible. We can listen. And get down below whatever the words are, to what's underneath this. Why is this issue important to people? So the idea of Slow Talk is to create a place where we can have honest conversations in a psychologically safe environment. And that's facilitated by an app that any nurse can touch into at their convenience. It's audio only. Which interestingly, there's actually data that it enhances our empathic connection with each other better than video like Zoom.

Host: Wow.

Cynda Rushton, PhD, RN, FAAN: And so what happens is, there's these nurses, six to eight of them come together like we were having a small group conversation using an app. And each of the sessions, Slow Talks, has a beginning,

recorded prompt. Welcome to our discussion today about what's the pebble in your shoe.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: And then you hear from each of the people in the Slow Talk. It's recorded and all the responses are anonymous, and then they are gone, put through a dialogue platform, an AI large language model to try to identify what were the themes in the responses of all the participants.

They can then take that information and come up with a report of what are the main themes that came out of this one question. So Karen, for example, might ask an operational question. In our first round of this, we ask nurses about their own narrative. What do you hear yourself and others saying about nursing? What we came up with in that whole series of questions was, the thing that was missing from our narrative was relationships.

Host: Hmm.

Cynda Rushton, PhD, RN, FAAN: Relationships with our leaders, with our patients and their families, with our peers and with ourselves. And so when you account for the fact that people were concerned about, yeah, compensation and workload; when you pull back, sort of the themes, it's about relationships. And so that gives us a clue about where should we be investing our attention. It's not on the numbers, it's on the people. And so that's why it's so great to have a partner like Karen to take it then into the hospital setting and say, okay, well let's see what we can learn in that environment.

Host: Yeah. Wow what a marriage of ah, from a podcast guy, analog and digital, you've got analog, a real human voice, real human hearing, but the technology you're using then to listen to what that nurse has to say and come up with bullet points or action items. Quite amazing. Yes. So does this work also in real time?

If I'm a nurse and say I was a patient just said something bad towards me or whatever. Can you use this app in real time like that to say, listen, this just happened to me. I just want to let you know this person just spit on me or, or tugged in on me or something. Does it work in that way too?

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: We haven't gotten,

Host: I'm just curious.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: We haven't gotten it to that point as of yet, but I would envision futuristically that we would be able to get it to that point. We're still in some pilot stages right now with nurse leaders and understanding them. And then the next pilot will be to getting it to the unit level, the point of care nurses.

Host: Amazing. But this is a great way for you to reach the whole staff. And ask a question and get feedback right away from all of them. Right? Is that right, Karen?

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: So every CNO struggles with the visibility of hearing the voice of all of their nurses, right? Because there's so many. And so for me, I have about 150, 160 nurse leaders. And I really wanted to connect with them, right? The span of control is huge in the nursing world, and it's nursing is probably one of the only industries that has the largest spans of controls that we do.

And so to try to get in front of so many people, I'll give you an example. We tried Zoom and WebEx and you have 150 people on, and they're typing in the chat box and you're trying to keep up and everybody's coming at you. Where this technology, as Cynda said, you know, it's voice activated, hearing the empathy in their voice and the tone of their voice, really is, inspiring and motivating and sometimes sad when you hear how disappointed or dejected people might feel in our current environment.

And so we can get six to eight nurse leaders on this app. Cynda asks a question, then I ask a question about, okay, of the last three policies that we've implemented, tell me what's been the most complicated. Okay. And they'll tell me that, then, the Slow Talk, digging in with deliberation, being very methodic about, alright, what action plans do we need to do to address this policy?

I get that right from them. And as Cynda said, it gets synthesized by this AI technology. And I'll, it would take me 10 months to come up with action items that I'm able to get through a few sessions of Slow Talk, and then the nurse leaders are telling me exactly what they think should occur.

Host: Wo wa way to, speed up to one, implement a new procedure or fix one that might not be running correctly.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: That's right. And so we came up with a number of policies and procedures. Hey, of the three, which one do we need to work on first?

Host: Mm-hmm.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: And what is causing the largest problems? Where do you need the most clarity? Where do we need the most change. And so they tell me, and we're able to figure it out in very short order and come up with very creative action plans to minimize the pebbles in their shoe.

Host: Yeah. This is amazing. Yeah. Cynda.

Cynda Rushton, PhD, RN, FAAN: You know what one of the pieces of this, some of my work in the past has really been around trust, and this is an incredible intervention to rebuild trust.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: Because when people don't feel heard and understood, there's a huge cost to that. So first of all, by being able to have clear expectations. And what I love about what Karen's doing is she gets the data, she can share it back to the group and say, I heard you and not all these things I can do, but here are some that we can do and here are some that we need to dig a little deeper into.

So that creates clear expectations. It also creates transparency because Karen can say, here's the report. Your words are here.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: And it also says, here's the boundaries of what we are able to actually do right now. And the other part that I love is what Karen was referring to in terms of getting the feedback from the people who will deliver the result.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: That builds trust because it honors their expertise. It makes them feel that my contribution actually makes a difference in what we do in this organization. So I'm really excited about how this can really bridge that chasm of nobody cares and nobody listens to actually look, here's your voice. And you're reflected in the solution here. So it's empowering people to be part of the solution.

Host: Yeah. We are listening. And here's the proof.

Cynda Rushton, PhD, RN, FAAN: Yeah.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: And one of the things that I think that has been really interesting is we didn't mandate that every manager participate in this because of concern for anonymity and all of those things. What I'm hearing from those who participated, which was over 40% of the leaders, is that, wow, this is really trustworthy. Thank you for giving us a platform. We appreciate this. You are interested in what we have to say because I don't know everything and I, I need you to help me lead this organization.

And as Cynda and I were speaking yesterday, it also says to those who didn't participate, look, I want to hear your voice and here's what we're doing, please. Does this resonate with you? Join in the voices to help shape our future environment. So that's also a good message that we're able to deliver.

Host: I'm sure some people that might be reticent when they see others participating in it, they're like, oh, wait a minute, maybe I should be doing that too. Let me get involved too.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: You know, there are always folks who want to wait and see, right? Yeah. Let me see what this is. Let me see what others have to say. And, every, with strong agreement or agreement, all of the leaders said this was helpful. Easy to use. My voice is heard and felt psychologically safe, creating that trusting relationship between senior leaders and the frontline managers.

Host: Yeah. This is really great. Well, thank you for stopping by and sharing this great information with us. I really appreciate it. I'd love to get final thoughts from each of you, or key takeaways. Cynda, let me start with you.

Cynda Rushton, PhD, RN, FAAN: I think one of the main things is that we all want to be heard and understood, and we know that when that happens, we're more likely to engage, we're more likely to be creative, we're more likely to be empathic.

Host: Mm-hmm. Yeah.

Cynda Rushton, PhD, RN, FAAN: So this is a platform that gives us a very structured, yet flexible way to create that kind of safety, to build the trust that's needed for us to design the future that we really want.

Host: Yeah. What a great use of technology. Really amazing for sure. Karen, how about you? Final thoughts or key takeaways?

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: What I would say as a CNO is one, be open to new ways of listening to your people. I mean, quite honestly, we have four generations of people in healthcare and I really needed to push myself to be open to new ways of listening, hearing, and I think more importantly is acting on what we've heard as well.

And so trust in the process. Try new things, be courageous. People are afraid to hear what they might hear, and it's actually pretty darn good.

Host: Pretty darn good. Yeah. And kudos for you to being open and accepting new technology. A lot of people might be like, that's not the way we did it. I don't want to even think about AI. But you said, you know what? Let's try this. Let's embrace it and at least understand what it can do for us. And you've done that. So that's really great. Well, thank you. Yeah. Yeah.

Cynda Rushton, PhD, RN, FAAN: I just want to say one more thing about, the process. You know that AI is an uncertain entity.

Host: Sure. A lot of unknowns at this point still.

Cynda Rushton, PhD, RN, FAAN: And one of the things I really appreciate about our partners in Slow Talk is they're very committed to confidentiality, to creating safe environments, to making sure that people feel that they can share what is important to them.

Host: Mm-hmm.

Cynda Rushton, PhD, RN, FAAN: And that is a really important key feature, I think.

Host: Yeah.

Cynda Rushton, PhD, RN, FAAN: In being able to really engage people and to then act on what the feedback that they're giving us.

Yeah. So I think that's a really important point as this is an enabling platform. This is not instead of humans.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: It's an enabling platform. It really does protect the confidentiality and anonymity of people speaking so that we can be genuine and authentic. And create that trusting environment.

Host: For sure. Wow. Well this has really been great. Cynda and Karen, thank you so much for stopping by. I appreciate it.

Cynda Rushton, PhD, RN, FAAN: Thank you so much for having us.

Bill Klaproth (host): Yeah, this has been great.

Karen Doyle, DNP, MBA, RN, NEA-BC, FAAN: Thank you, Bill. Thank you. Really appreciate it.

Host: Yeah, absolutely. Once again, that is Cynda Rushton and Karen Doyle. 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.