Transcription:
Leading Advanced Practice Providers

Trisha Williams: Hi guys. Welcome to the third season of the Advanced Practice Perspectives Podcast. I'm Trisha William.

Tobie O’Brien: And I'm Tobie O'Brien. This is a podcast created by Advanced Practice Providers for advanced practice providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look at the various advanced practice roles at Children's Mercy.

Trisha Williams: Today, we have our very own Children's Mercy Senior Director of Advanced Practice, Sheri Shiddell. Sheri, welcome to the podcast.

Sheri Shiddell: Hi. Thanks for having me.

Trisha Williams: You are so welcome. Why don't you tell our listeners just a little bit about yourself.

Sheri Shiddell: Okay, awesome. I am thrilled to be here. So first of all, thanks for inviting me. Actually, I've spent my entire career at Children's Mercy. So, I was born and raised in Kansas City, and I have always desired to work at Children's Mercy because pediatrics is my first love. So, I've been here my entire career, which is going on, I hate to admit it, 30 years this year.

So, I started out as a new grad in the NICU, went on to become a nurse practitioner about 10 years into that career and was a surgical nurse practitioner. And then, I specialize in urology specifically for another, oh, I would say, five to seven years specifically in that role. And then, I became a director in the urgent care for another few years and then became senior director of the surgical specialties and then went on just in the last year to assume the role I'm in now, which is the Senior Director of Advanced Practice Providers. So, I kind of had an evolution of my career, but still keep that clinical basis as well.

Tobie O’Brien: I love that. Well, yes, we are so thrilled to have you on. So since you have been at Children's Mercy for so long, I bet you have been able to really see a growth in how advanced practice has grown in the time that you've been here. I wonder if you could elaborate a little bit about that.

Sheri Shiddell: I actually have. It's been amazing, honestly, to see it evolve over time. And I do feel like advanced practice has been nothing but seeing growth at Children's Mercy and we've been so fortunate that we've been embraced by the organization. So, I definitely think that there's a focus of our leadership in this organization to recognize and appreciate advanced practice providers. And from that, we have seen tremendous growth. So, I can't even tell you how many APPs were there when I first started, but it felt like far and few. And today, I can tell you we have over 400 advanced practice providers at Children's Mercy. And also what's exciting is they're really integrated into all subspecialties of the organization except for maybe one. And that's just by a fluke, not that we won't get there soon. I totally anticipate we will probably get there with that group as well. It just hasn't really been a need that's been, I guess, explored at this point.

What makes me really excited about it is we have nurse practitioners, of course, but we also have CRNAs. We have anesthesia assistants that are part of our advanced practice team. We have clinical nurse specialists. We don't have any midwives, but we do have a women's health practitioner and we also have pediatric mental health providers, which I think is pretty exciting with where we're going with all the needs that we're seeing in our community for pediatric and mental health. So, it's really exciting times here for advanced practice providers.

Trisha Williams: I think it's very exciting times for us indeed. Tell us what you think about how advanced practice providers can impact practice and patient care inside Children's Mercy and outside Children's Mercy as well.

Sheri Shiddell: So, I think that's huge. I mean honestly, I think advanced practice providers are really a valued and integral part of the healthcare team, no matter how you look at it. I mean, I think, APPs influence practice across the continuum. I mean, I think we know our history, where we kind of came from and that was probably kind of starting with serving more rural and underserved areas. While I think that's still incredibly important and we have to think about that, I think in the walls of a large organization like we have and it's outside the walls all the way to very rural areas because we can get that care to rural areas, we can provide care to disadvantaged population. Then at the same time, we influence the outcomes, and just make a difference in how patients are cared for. We integrate into the clinical and the operational parts of care and influence satisfaction and retention and capacity and quality of care, decreasing wait times, improving access, all of that we can influence as advanced practice providers, which I think is huge, and I love that. And that's basically where I think we are at Children's Mercy. I think our advanced practice providers are able to deliver care and collaborate with our physicians colleagues in a way that just makes it better for everybody. I mean, let's face it, we have plenty of patients and plenty of care to deliver. So, we get to rise to that occasion and that's how I see it as a privilege.

Trisha Williams: Yeah, I think it's important to know that within a huge institution in a metropolitan area, that we impact patient outcomes and patient access to care. But then our rural colleagues, they help alleviate that strain in those healthcare deserts out in rural Missouri and rural Kansas. And so, we all impact patient outcomes and access to care regardless if you're in a huge metropolitan institution or the healthcare deserts out in rural Missouri.

Sheri Shiddell: Absolutely. And I love that. And I think we have to be careful to think about that because I think, honestly, when you go to the profession of nursing, which, you know, we live within nursing also. And I think it's important for us to think about that. Like we have to have that global collaborative approach to thinking about as we advocate. Because I think also as APPs, I mean we are advocates. We're advocates for our patients, but we're also advocates for our profession and how we deliver care. And I think that's an important aspect that we have to keep forefront in our minds.

Tobie O’Brien: Absolutely. you said you've been in this leadership role as senior director for a year, right?

Sheri Shiddell: Yeah, just out of a year.

Tobie O’Brien: Just out of a year. Okay. Talk a little bit about your leadership style and your goals for advanced practice?

Sheri Shiddell: When I really think about my leadership style, honestly, I know the buzzword out there, a lot is transformational, transparent. There's so many buzzwords for leadership styles right now. And I think my leadership style is honestly to try to be very thoughtful and listen and come with a curious spirit, so I can hear what people are needing at that point. I don't think there's one leadership style that fits all. So, I hope that I integrate many styles into my leadership to then hopefully meet the needs of what's at hand and deliver. So, that's honestly how we would answer that, because I don't like to pin myself in a corner for my leadership style if I'm really honest about it.

But I do think how that influences then the goals for advanced practice, I think is being collaborative. When I think about the goals for advanced practice at Mercy, I think it's integration into the healthcare system. We're at a point at Children's Mercy now that's an exciting time because we're looking at integrating advanced practice providers into a practice plan. That's new and different for us, and it's a journey, so we're learning as we go. But what I love about that is it gives us the chance to come to the table, demonstrate the value of nurse practitioners, show how they make a difference, show how we know that they influence and improve patient outcomes. How do we find ways that nurse practitioners and advanced practice supervisors can work at the top of their scope in all areas and yet be autonomous? Like, that's the other thing that I think about. To credit Children's Mercy, we have a very engaging executive leadership group that embraces nurse practitioners in our practice. But we still have opportunities in our world, in our community. I mean, we live in Missouri, so we're still a restrictive state, that also influences how we lead and how we think about things and advocate for nurse practitioners, which I could go into that if you want.

Trisha Williams: I love everything about what you just said. I think you developed your own style of leadership that might come out into a textbook next year probably, thoughtful leadership or something, because there are so many avenues and like buzzwords around leadership that, you I have a hard time myself trying to figure out, okay, which one do I fall under? And really I want a little bit of all of them, right? what you had said about just being thoughtful and going in open-minded and collaborative, and let's be thoughtful and think of outcomes and, you know, and how we can things forward. So, we are very lucky to have you at the table as a representative for advanced practice at Children's Mercy.

What do you see as the biggest barriers for APPs? How do you see us working collaboratively with our institution to kind of move things forward?

Sheri Shiddell: So within Mercy, again, I think we have a lot of collaboration and a lot of support. But outside the walls, I do think, I mean, Missouri's Children's Mercy lives kind of on the state line of Missouri and Kansas, but are Adele Hall, our main campus is in Missouri, in case that people aren't aware of that. Missouri's still a restrictive state for advanced practice. So, I think that one of our biggest barriers is full practice authority. And I definitely would love to see us get there. I think there's a lot that's packaged into that conversation.

But I think just to make it very real, we also are a document of recognition. So, we don't have a separate license in Missouri. And Kansas just recently passed full practice authority with some provisional period last year. So, I think we're right on the state line. I think there's a lot of legislation going on and a lot of work going into that. So, I think, we definitely have governance relations teams and teams within Mercy that are actively advocating and listening, honestly listening and hearing the voices of APPs and how that influences and impacts.

And again, we talked about the rule in, you know, areas that aren't in an urban area. I guess, probably we don't even really recognize it or I don't know that in my career, because I've always been at Mercy, I've ever stopped to really think about it. But I mean, we have barriers to our practice. We have mileage barriers. We obviously have a collaborative practice agreement. We have things like that that we might not even think about when we work only within an organization such as where we work and I work, but other people do. And I think we have to think about that. So, that is definitely something that I think that I'm part of and trying to influence and thinking about in having conversations. I give credit, we have some amazing APPs here at Children's Mercy that are very actively engaged in that and working towards that and influencing for full practice authority within Missouri.

I mean, one of the other things is we all know that we have such a big, such a big need for how we can help our mental health teams and our psychiatric medicine teams and things like that. Nurse practitioners here, we can't prescribe ADHD meds. And that's a challenge for us. And there is such a gap that we could fill and help if we had that ability to help with the intake process for mental health. I mean, there's just so many ways that our restrictions inhibit us from delivering amazing care. I'm completely an advocate of the right education, the right competencies, making sure we can come to the table and deliver amazing care. I never want to compromise a patient, but I think we can do that, and those are the things that I advocate for.

Tobie O’Brien: Absolutely. I mean, just the access to the care that's so needed that we don't have, and we see a way to remedy that and it's just getting there.

Sheri Shiddell: Yeah, I completely agree.

Tobie O’Brien: So, I love everything that you said and that was one of the things that you try to do. So, you know, don't be pigeonholed down to any sort of style, but just be ready and open-minded and listening. And I think that's awesome. So, what is your hope for the future of the APPs within Children's Mercy? You've kind of answered that a little bit, but I'm just curious, like your own personal goals and hopes for us.

Sheri Shiddell: So, my goal is that APPs have joy in their workplace. And if we can establish and package up that word joy, that APPs truly have joy, then I think we're going to be amazing. Because we all know that happy providers, happy clinicians, whoever, if you are happy and feeling joy in your workplace, you're going to deliver, and that's going to reflect in our patient care. So, I think we all agree. You know, our true north is amazing care. We want our patients to walk out of here with the most amazing experience every time they come in. But we can't do that if our teams aren't doing well. And to me, that's that APPs feel that joy. And to me, when they feel that joy, it's because they feel grateful, they feel gratitude, they feel appreciated. They feel the partnership that we have. We have great partnerships. We have amazing physician providers and partners here and collaborators, but we also have opportunities to leverage the value of roles of both. There are things that APPs, in my opinion, do better than physicians. And there are things that physicians do better than APPs, but we can come together. And when we partnership, we're amazing. And that is absolutely my goal, is that respect, that teamwork.

I love that our COO has a sign on her wall that says, "Today we run as one." And that's what I want to see. I want to see APPs completely respect the other members of the healthcare care team because we all have to do it together. It doesn't matter who you are. I totally firmly believe in it's everybody as a united team that makes the magic happen, and that's where I want us to be. And then, if we're really joyful, we probably have a sense of wellbeing that we're focusing on. We have resiliency, we have all of those other things coming together too. So, that's where I hope we are.

Trisha Williams: I see a new T-shirt. You have a new book coming out and a new T-shirt, right? "Joy," a t-shirt that says "Joy."

Tobie O’Brien: I'll wear that T-shirt.

Trisha Williams: Yeah, I would too. I mean, you are so right. And I think that as advanced practice, we are in this unique role where we have a foot in on the medical side and a foot on the nursing side to where we have so much leverage and potential and we have to have that growth mindset and the ability to embrace both sides to embark greatness. I look forward to the future of what advanced practice has to hold in our institution and across the country.

Sheri Shiddell: Me too. I'm really excited. I think the future's going to be great. We just have to lean into it and really work on it. I mean, it's not going to come easy. We're going to have to intentionally go there to get there.

Trisha Williams: That's my wisdom for the day.

Sheri Shiddell: But worth it.

Trisha Williams: But worth it. Yes, absolutely. Well, Sheri, as you may know, Tobie and I reached out to a group of amazing humans prior to this interview. We reached out to our advanced practice council. And for those of you that don't know, our Advanced Practice Council is a group of advanced practice providers. We have representatives from our physician assistants group, our nurse practitioner group or CRNAs and anesthesia groups or CNSs, and they come together to help represent different groups, so everybody feels like a shared voice within our shared governance structure. And so, we asked the advanced practice council kind of some things that they wanted to learn about, so we have to give kudos for their collaboration, for their questions that we asked today.

Sheri Shiddell: That's awesome.

Tobie O’Brien: Yeah, absolutely. so, Sheri, one thing we do, we are just so thankful that you join us today. And one way we end our podcast each episode is we ask our guests the same question each season. We change it up with the new season. But our question this season is, in what way do you love to encourage your colleagues?

Sheri Shiddell: Oh, I love that. So, I love to encourage colleagues and I probably have three things, so I'm going to try to go quickly and share these with you and summarize it. But I think one of my favorite quotes, I think it's Robert Holden, and that is "There's no amount of self-improvement that can make up for a lack of self-acceptance." I totally live by that and I encourage everyone with that because that speaks to my heart that I have to be okay with me and I have to know my values and know what I stand for and what I fall for. So, I start there as far as how I encourage them in their daily walk and their daily grind. I think that's a foundation for me.

And then, the next level I go to is not to be afraid to fearlessly connect at the level of the heart. I have that as a quote on my wall, but I cannot find for the life of me who said it. So, I want to credit the right person, but I do not know who that is. So somebody out there deserves credit for that. But I've lived by that for many years.

And when I say that, I think it then takes me to the next level of my third quote that I love and it's kind of a spinoff. I think Theodore Roosevelt said it, which is, "Do what you can with what you have." And I think he said where you are. In my mind, it's do what you can with what you're given in the moment you're given. And I believe that, and I live by that. It's just how I think it all comes together. And I can demonstrate that, like my favorite story of probably my career started way back as a NICU nurse. And I'll never forget it. I had a neonatal baby years ago. And it's not me, it's just how it worked at the time, but I think every nurse can relate to this or advanced practice provider, that you go the extra mile because you know it's the right thing to do.

So, a long story short of this baby was I got the baby out for the mom to hold many times. The baby never left the hospital after about two and a half months and passed away eventually. But when I was on, I would get that baby out of its isolette, which was a hassle on a vent and all the tubes, et cetera.

It was a hassle, but it meant the world to the mom, and I knew that. So, I did it. The baby passed away. I didn't want to go to the funeral, but I did. I snuck into the funeral late after working a night, sat on the back row. I was a little late, walked in, thought I could sneak in. And the mom sitting on the front row, I'll never forget it, you guys, the funeral had already started. The mom got up, walked to the back, grabbed my hand in the funeral of this baby, walked me to the front row and set me on the pew in this church right by her and her husband, and their little boy. And I was like, "What is happening?" She then proceeds to go up to the casket, gets the baby girl out of the casket, and lays her baby girl in my arms and says, "You let me hold my baby. I want you to hold her in her funeral." I held the baby through the funeral and then walked up at the end of the funeral later back in the casket for them to close her casket. And I will never ever forget that because that was a risk, but it was worth it. And it has literally embraced and changed the way I live my life for the rest of my life. And that's probably the pearls that I would share that I will always used to encourage my colleagues to do the right thing and go the extra mile.

Tobie O’Brien: Oh, that story that is, ugh-- I mean, how sweet and amazing, and you made the difference to that mom. And it makes all the difference the fact that you just went the extra mile. I love it. It's so encouraging.

Sheri Shiddell: And it's crazy, Tobie, because it's not about what she got, but it's what I got. Like, you get so much in those moments, but you have to-- not to quote Brene Brown-- but you know, you have to go into the arena. You have to take the risk. And I love her books by the way. So, that would be another pearl I would say. I think that's where the sweet spot is. So, I love that.

Trisha Williams: The sweet spot indeed. Now that I have to dry my eyes. Holy cow, Sheri, that's a beautiful story. It's a beautiful story that I think everybody can take some away, take the risk, get in the arena, do the best you can with what you're given and do what's right. sometimes. The right things are hard, just like the best things in life. They're hard. Do the hard things. I have a quote that says, "Get better with the hard stuff," or something like that. I can't quote the thing, but it's part of my New Year's resolution. Is do better with hard. So, I think we all need to do better with hard. So, I really appreciate you spending time with us today, Sheri.

Sheri Shiddell: Thank you so much for having me. It is my pleasure. And thank you to you all for launching this podcast. It is great. And it is so exciting and it's such a gift to APPs across the nation. We're so excited. So, thank you for that.

Tobie O’Brien: Oh, thank you. We love doing it. We are the lucky ones. Getting to meet so many people. So, I will echo Trisha. We really appreciate your time.

Sheri Shiddell: Yeah, of course.

Tobie O’Brien: Well, listeners, if you have a topic that you would like to hear about or you are interested in being a guest, you can email us at tdobrien@cmh.edu or twilliams@cmh.edu. Once again, thanks so much for listening to the Advanced Practice Perspectives Podcast.