Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. With me is Felicia Sadler, Vice President, Quality Clinical Workforce Development at Relias, as we talk about how nurse leaders drive patient safety and organizational performance, sharing real-world lessons and practical strategies to enhance workforce resilience, engagement, and leadership capacity. Felicia, welcome.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Thank you so much, Bill. It's so wonderful to be here.

Host: Yeah, nice to talk with you. Thank you so much. So Felicia, let's start here. How do nurse leaders directly influence patient safety and organizational performance? And why is this connection more important than ever in today's healthcare environment?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: That's a great question and very relevant in today's time. Nurses are absolutely critical to patient safety and quality of care. They're critical to the success of any organization. You know, they have a lot of responsibilities when it comes to advocating for their teams, leading their teams, advocating for resources, policy development, and so forth. And so, when it comes to quality and safety, they're absolutely critical to ensuring that they're delivering safe patient care—safe, competent, and effective care.

Host: Absolutely. And then, from your experience, what are the most critical actions nurse managers can take to provide a culture of safety that consistently improves patient outcomes?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Another great question. They're on the front lines with the frontline staff. So, building trust is a key component. Ensuring that they've got a connection to their frontline staff, that their frontline staff can look to them to guide and advocate for them as it relates to safety culture, ensuring that there's psychological safety for their teams, hardwiring accountability into the process, as well as ensuring that they're strengthening the systems that exist and understanding where the gaps are relative to those systems to ensure that they can then mitigate any risk and close those gaps as needed.

Host: So, let's talk about resilience a little bit. That is a growing concern across healthcare. So, what practical strategies can nurse leaders use to strengthen resilience, boost morale, and sustain engagement on their teams?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: You know, according to Eleanor Brown, you cannot serve from an empty vessel. You can't serve from an empty cup. So, certainly being vigilant, it's important for nurse managers to understand the cues, pick up on the signs and symptoms of burnout, emotional exhaustion. If someone's calling in a lot sick, if there's cynicism that's growing among their team members, if there seems to be disengagement or depersonalization, these are all clear signs that something's not right. So, ensuring that nurse managers are well-versed on how to pick up on these cues and approach the individuals with that base or foundation of trust so that there's that sense of openness where they can share and hopefully mitigate and really address where the issues are.

Self-care is another component when we think about resolution to resilience, ensuring that they understand prioritization of self-care, but also provide visible avenues for self-care and being able to support that from a leader perspective, ensuring that staff understand where those resources are and that they're tapping into them as needed. Ensuring that they're addressing the personal aspects as well. There's a lot going on with their staff, with individuals. They are individuals and we're to be sure we are connecting them with them from a human perspective and a personalization perspective.

Fostering emotional wellbeing. Ensuring that, again, that psychological safety exists, that it's visible, it's evident. They feel safe to report concerns to their managers, to their leaders. And that their leaders are actually taking action, developing processes to address and close those gaps, if you will. And that really leads into the trust. When you're actually bringing action to the concerns, that helps to foster that sense of trust. But also, it builds in that accountability for both parties.

And I would say finally ensuring that there's a standardization, that there's an expectation of standardization in workflows. There can be a sense of stabilization. As much as possible in healthcare—it can be very difficult, especially as we think of the complexities that we have today—but as much as we can provide stability, that's critically important.

And then, also, I would want to mention competency and professional growth and development, that they're always tapping into that and growing and learning. The more competent professionals are, the more confident in practice they can be. So, ensuring that they have those structures that they can tap into to ensure that they're growing in their careers. They feel like they're moving or advancing in the organization, but also they're getting the emotional assistance they need.

Host: I love that phrase, you cannot serve from an empty cup.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Right. I mean, it's something that every nurse can relate to. We've all been there. When you're working three 12-hour shifts in a row and you're having to be off for one day coming back, you haven't seen your family, you know, in three days, essentially, if you've got young children, it can be difficult and draining because you've got to take care of your family and your personal space. But then, also, you know, you've got to come and you've got to deliver high quality care to vulnerable patients.

Host: Yeah. You said some really important things there. You said making sure that nurses feel seen and heard, that psychologically they feel safe. You also talked about standardization of workflows, so they know what to expect, which is really important. And then, you talked about competency and professional growth, which is really important, too. I really like that. So, can you then share some real-world examples that highlight effective nurse management in action and maybe some lessons that other nurse leaders can take from it?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Absolutely. So, we know that the patient experience is directly correlated to positive clinical outcomes or quality patient outcomes. And so, there was a case study that I worked partnered with a health system where they saw a tremendous decrease in their HCAHPS scores. But also, they saw a decrease in their quality outcomes for a particular unit. And what they wanted to address was really improving their patient experience scores, but also improving their quality outcomes.

So, what they did was they looked at their teams that were delivering care. And one of the specific components of the HCAHPS scoring was patient communication. It was the nurse communication component. And so, when it comes to the nurse communication component, that's how we communicate with patients, how they interact with us, their perception of care relative to that. And so, they needed to improve those scores.

And so, what they did was they looked at the interpersonal competence or soft skills of their staff, they wanted to see where they were from a current state perspective. And they were able to look at that plus the structures and processes that were in place, identify gaps by reaching out to the frontline. And, you know, through a shared governance approach, they were able to really see where the issues, the gaps were, but also look at where the soft skill gaps were. They developed mitigation, they developed interventions relative to that. And as a result, they were able to improve their HCAHPS scores. But also, as a result, they were able to improve all of their quality outcomes as well. So, it was a great success story and how that ended was the staff approached them and said, "Hey, what can we work on next? What can we improve next? So, that's the result of a transformational leader that's able to drive results, lead units, departments, and ultimately a health system to excellence.

Host: Yeah, that's a great example of understanding where a department may be deficient or what needs to be worked on and putting steps in place to correct those issues, and then seeing the results that follow.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: It's a wonderful thing. And then, when you can celebrate with your team and then share that story with the organization and ultimately at a conference, that's a great success story for any organization, for individuals. And they can take that throughout their career. They can always reflect back on that and hopefully take that wherever they go in their career.

Host: And it kind of becomes contagious, as you said

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: it.

does.

Host: You want to do more then?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Yes.

We love to improve care as clinicians.

Host: Right. So, Felicia, when you think about high performing nursing teams, in your opinion, what leadership practices or behaviors make the biggest difference in achieving clinical excellence? How do we get to be a high-performing team?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: It's a journey.

Host: Okay.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: So, we never get there, arrive, and just sit and plateau. That is not healthcare. It is a journey. It's a journey of excellence. And really, I would say one key fundamental component is high reliability. When you have structures and processes hardwired into the organization where you're always looking for zero harm, but you're always looking for areas and opportunities to improve, you're deferring to the frontline, much like our success story because they're closest to the process, they're closest to those gaps.

When you are able to bring all of those components in and you start refining and hardwiring that in the organization, that's where you can start maturing as an organization. Transformational leadership is absolutely fundamental. So, leading from a relational transformational leader perspective is critical to a high-reliability organization. That's how you can lead change. That's how you share the vision. That's how you get others to catch the vision. And then, you can bring the team with you, as you move toward high reliability. Hopefully, you can sustain zero harm, but it is healthcare. There's always going to be. But if you have those processes in place, you can always identify where are the risks, where are the variations, the unwanted variations. And then, use the team or have the team, engage the team to help to come up with the solutions.

Host: Catch the vision. I like it.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Yes.

Host: And it's a journey of excellence. Okay. So then, what are some of the common gaps you see in leadership development for nurse managers, and how can organizations close those gaps to create stronger, more confident leaders?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: I love this question because, you know, we're always about performance improvement. We're always looking for how can we get better. Purposeful leadership is being really intentional. We know that when you have ineffective leadership, you know, you can have the fear of reporting, you can get your misses, and those things never get addressed. You can have a lack of trust, which we've talked about, in the beginning is so fundamental.

But when we think about effective leaders, one of the biggest gaps today, I believe, is that we tend to promote nurses into leadership. And I think out of COVID, it was very evident. We promote them into leadership roles without fully preparing them for the role. And, you know, we need confident, we need competent, capable leaders to really lead in this dynamic environment that we have, this complex environment. It requires intentional progressive development.

Leaders need to be grounded in a systems thinking and think high reliability. They need to understand those principles and be able to engage even down to their units, departments. They need structured mentorships. Many times they don't have people they can go to, peers they can go to, to really bounce ideas off, really learn from their experiences and grow over time. So, ensuring that there's a strong mentorship. For nurse managers, the middle managers, they need the support to be able to be successful and strong. And so, they can grow and you're cultivating a pipeline of competent, confident leaders as a result. I do believe systems who invest in building leaders are building stronger systems. So, effective leadership does matter.

Host: So, that's awesome. Thank you for sharing that. Some of the gaps that are out there. So for someone listening to this, striving to elevate their leadership capacity. What skills or mindsets are essential to leading teams effectively and fostering a sustained culture of patient safety?

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Sustainability is always a challenge, because it's like, "Okay, we've gotten there, so how do we stay there?" Because there's elements that change on a continuum within a health system, and within the care environment. So, ensuring that you're hardwiring high reliability, hardwiring systems thinking, cultivating emotional intelligence, that's a key component when it comes to leadership. That's critical when it comes to an effective leader where they can focus on the human experience with every encounter, and they can pick up on those cues and they can act and react to them. It's important during leadership rounding, is another example. Skills and communication, conflict resolution, really hone and focus on those to enhance. Those particular skill sets can be absolutely essential for an effective leader.

I would also say that skills and data analysis today, you know, we're not trained necessarily as nurses to really analyze data, but it's absolutely necessary skillset in our day of technology and reporting that nurse managers see every day. So, I would say skills and data analysis, understanding where their units are from a quality, risk, and compliance perspective are absolutely critical skill sets that are needed. And then, securing support from senior leadership is important. Keeping them informed in the process, engaged, and so forth.

You know, the future of patient safety depends on the leaders we design today. So, it's critically important that we place focus at all levels from the preceptor to the charge nurse, to the nurse manager, and all the way up. That's how you cultivate a solid leadership pipeline.

Host: There it is. You wrapped it up for us. Perfect. That's it. That's the roadmap right there.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Yep.

Host: Yeah. Felicia, this has been great. Thank you so much for stopping by and sharing this information with us.

Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB: Thank you so much, Bill, for having me.

Host: Yeah, this has been great. Once again, that is Felicia Sadler. 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 at aonl.org/nursing-leadership-podcast. This is Today in Nursing Leadership. Thanks for listening.