Dan:

Casey, welcome to the show.

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Casey:

Thanks for having me.

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Dan:

So Casey, you do a lot. You're an educator. You're a nurse. You have your EMT. You have all these things. You're going to enter a new job soon. What are you up to lately?

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Casey:

Right now, I just had surgery, so I've been on the recovery. Right now, I'm focusing on helping new grads get jobs and also educating, clinical instructing, and helping them get out of nursing school.

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Dan:

I love it, so let's dig into that a little bit, because there're some assumptions being thrown around there. Now there's, with the pandemic, the violence against nurses, the working conditions, all of those things. There's been kind of two camps that I've seen. One is there's not enough people entering school and graduating, and then the other side is we are seeing enrollments in things increase. From your vantage point where you're at, what are you seeing from the nurses entering the profession, getting ready to join as RNs?

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Casey:

I've seen, where I clinical instruct, we for the first time ever don't have a rating list, which is kind of incredible, because usually we're 150+ names on the list. I think a lot of the things in the profession over the last two years, the pandemic, I've met a lot of nursing students that have switched other careers to nursing because of the pandemic, and they kind of felt a calling and sense of purpose.

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Casey:

But with everything else going on with the profession, like we're talking about all the violence recently. A lot of nursing students are also really concerned about entering the profession and kind of worried about where it's headed, or they're going in at a time where picking up the pieces and sort of still trying to figure out things that they're worried about, where's the profession headed? And I've heard much more lately of a lot of the students that I've had in clinical up until they graduated.

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Casey:

Now they're a year out, two years out, and they're talking about leaving the profession, and that's a little scary for me because I haven't had that experience where nurses are at six months, talking about doing something else or going back to the career they had before nursing, so I think some places are seeing swells in enrollment, but I know here in Maryland we're seeing, overall throughout the state, is just decreased enrollment, especially where I am.

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Dan:

And that's scary, because there's already a gap of 170,000 nurses a year, not to mention any retirements, early retirements, people leaving the profession. What are they citing as sort of the biggest reason, or what are you hearing in the hallways as they talk about these things?

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Casey:

One of the biggest things is I've had a lot of new grads change specialties. They couldn't do share time, so they kind of took a job blindly because they were just getting information on it through interviewing and things, but they never really got to see the unit.

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Casey:

Then, working on it, they either didn't like the unit, or one of the big things that's emerging with the groups that are just about six months is that they're being precepted by nurses with the same amount of experience with them, or it's just them working once they get off orientation and they don't feel safe, and especially after the RaDonda Vaught case and others, they're very worried about the legal ramifications of working with people that have the same amount of experience, and seeing nurses with 20, 30 years choosing to retire, or seeing nurses at 7-10 years choosing to do something else in nursing, whether that's NP school, CRNA, and other things, instead of staying at the bedside.

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Dan:

That's sort of disheartening as well, that one case can shift an entire population of people to enter a profession or leave it, and that's scary. What do you think one of our pathways out is? How are you helping coach? One of your roles is helping nurses find jobs, graduate, and do great things as professionals. How are you sort of supporting them, or what are you saying to them as those conversations come up with your students?

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Casey:

I talk about my own experience as a new grad, where six months in I didn't really like my job until six months in. It's also new and just continuously keeping them motivated and, "You're doing great." It just takes time to kind of get the new grad funk off of you, if you will, so it takes time to feel comfortable in these roles, but also having them talk about their experience to see, "Are they burnt out already?", and linking them with other nurses who coach nurses through burnout, or they talk to new grads specifically and kind of coach them through that.

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Casey:

I think a lot of the other things, too, is finding other nurses, where they are, that can help support them and kind of mentor them where they are, because I'm one person. I try to link people that I've graduated with or someone that I might know that works at the same hospital or even on the same unit, that can kind of watch out for them and mentor them where they feel they have a sense of belonging a little bit more, and they feel like they're included. Sometimes that's enough, but also if it's something truly where they don't like the specialty they're in, how to have that professional conversation with their manager and how to move on from that experience if it's something where they're going to leave the profession or find a new specialty to work within.

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Dan:

Yeah. I think that's good. The extreme cases aren't always the true cases, and that there's plenty of safe practice and support that can happen. To have those conversations, I posted on LinkedIn recently about you protect yourself, your safety first, you protect your license, and you protect your patients. If you sort of think of it like that, there're ways that you can set up the support around you or advocate for yourself as well so that you're not put in situations where you might have your license impacted. A lot of our listeners on the show are also nurse leaders in some capacity, both formal and informal roles. What is your advice to nurse leaders on how they can support the next generation of nurses entering the workforce?

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Casey:

I think it's twofold. Here, at the community college, we have convocation in the spring and winter, and one thing that our new president kind of hit on, and something that we're going to have to start to realize, is we still in nursing school and even in the workforce talk about, we kind of stop at millennials and not going forward to the new generation of nurses who are very technical, but not the best with emailing, not the best with calling. They have to be taught professionalism. Even learning in a nursing school is not enough, and it has to be reinforced.

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Casey:

We're really not focused on retention at all currently, but as we start to talk about retention, we talk about older nurses who have been in the profession longer, but we don't really focus on the retention of nurses in the first year of nursing. So, how do we support new grads to stay A) at the hospital, but just B) in the profession? Because that first year is going to be the difference between people leaving the profession and continuing on for the career. I think support, mentorship, and looking and really doing more with staffing. I know that staffing's awful.

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Casey:

I've been a charge nurse when staffing wasn't awful, and now it's even worse, but linking people, really being purposeful with making assignments, and having senior nurses, at least one person there where it's not all new graduate nurses, because that was one of the big problems when I was a charge nurse was they would put nurses with less than a year of experience all together, and they don't know what they don't know yet, but even if they do know what they don't know, it's so frightening to them because they just oriented with people with tons of experience to then be essentially together, lost on the island.

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Dan:

Yeah. No, I think those are great tangible points, and it goes back to sort of the idea of staffing and skill mix. Forever in nursing, since the beginning of time, we have done this on paper, and we've done it on Excel spreadsheets, and there's no data. We continue to have these sort of, "Well, I know this person," or "They're my friend," or "That's the person that answers the phone," and so that's sort of how we've piecemealed together staffing forever, and now there's technology that can help us.

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Dan:

If we can understand the skills, competencies, career goals of our nurses at any level, 1 year in or to 50 years in, then we can help have some sort of augmented decision making related to who's going to be on that unit, not just who picks the phone that day. I think that's a huge step that our health systems are going to need to take in order to ensure safe practice. I think, and I'd love your opinion on this, we don't really assess competency that well. You do your new grad program. It's maybe a couple weeks to a couple months.

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Dan:

Then, after that, you're sort of, once a year you go see your poster board and sign off that you know how to do restraints, and that's about it. Are there better ways for us to understand kind of the growing skillset in more real time or even just more frequently so that we can actually match the skills of nurses, both new and experienced, together better?

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Casey:

One hospital that I worked at, we would look at metrics, like the charge nurses were all involved in looking at metrics, which I found kind of refreshing because I wasn't a permanent charge nurse. I still worked on the floor, I precepted people, but I was in charge, at least 50 percent of the time, on night shifts, so we got included in the metrics, and we looked at what mistakes are people making. So, what is the charge nurse's strongest thing, like that they could teach somebody and they never make mistakes? They're the person who's always scanning their meds or the person who never messes up a Heparin drip, which happens too frequently, but look at those people. What do they do, and how can they teach someone? Because looking at a poster board, that's literally the bottom. It might be underneath the lowest level.

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Dan:

Yeah. Whatever the bottom of Bloom's taxonomy is, like the basement, that's where that poster board lives, but it's still something we do. We check it off, because joint commission or whatever the excuse is that we have to do these things. I remember when I was the director of nursing education at Ohio State's Wexner Medical Center, it was similar. Before I got there, it was very much two weeks of lecture, and basically mini nursing school, and it wasn't helpful. It wasn't what these people needed to enter their jobs, and now we were able to cut that down, make it more interactive, meet people where they are, and that type of stuff.

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Dan:

I do think that's key, and that competency assessment, in some way, needs to happen more frequently. I don't think we leverage enough out of the EHR too. If we're taking care of a patient with ECMO, restraints, sedation, and whatever name your stuff on there, why can't we take some of that data from our charting and the outcomes of that patient, and say, "Hey, it looks like everything was done on time. Outcomes were great. Charting patient got better," whatever it was, and actually use some of that real time data to kind of create a competency framework or assessment of our nurses in real time. I don't know. What do you think about that idea?

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Casey:

Yeah. I love that, and I think, too, at Hopkins we do grand nursing rounds, and that is wonderful, but I every unit should do what the fellows and residents do. They have meetings where they go over recent patient events, and they teach people about a patient that nobody has ever seen before or, "We had this really bad outcome. Let's work together to see how we could do things differently," and I think to get into the future of nursing, there's a lot of technology that's being created that we don't use.

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Casey:

I'll use Epic for an example. In the ER, there's a whole narrator for intubation. There're whole narrators for stroke narrators, that some hospital systems are not using. MedStar in Maryland's the only place that links the Alaris pump to the chart, and it's a technology that any other hospital could use, but only MedStar uses it. There's a lot of things that can make our jobs easier, but also it encourages nurses to keep learning and seek out the new things that are happening instead of the same competencies, or you just get on a unit one day, you see a new technology, you have no clue how it works, and nobody taught you how to use it, or they just gave you a pamphlet and said like, "Here you go."

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Dan:

The three-ring binder.

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Casey:

Yeah, so I think one thing that I like to do was with the new grads, is we had a box of things, like the triple [inaudible 00:13:04] and other things that we used really frequently in the unit. We had a demo dose of our RSI kit, so you could open it up. We had a code cart that you could open up and show the new grads and people who were new to specialty, "What does this look like? Open it up, touch it." You know, we are very tactile.

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Casey:

I spend 80 percent of my time telling the nursing students that manual dexterity is an essential function of our job. You have to be able to feel and touch and do things, because just reading in a textbook won't actually give you the practice, or you are less confident in actually being able to pick up, touch, and do the skills, so that's one thing that I would really like to see us do better in nursing, or we'll do Escape Rooms and things, but people go out of the competencies and education, not really knowing or not feeling a pride of ownership in their skill and taking care of the patient on the unit.

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Dan:

Right, and I think you're a good example of this. You have a ton of certifications, a ton of continuing education. You've really just taken the profession by its head and just dominated it as far as just skilling up. How have you thought about it as you've done all of these different things and continue to learn as a professional? What's sort of that drive and that value that you get out of that?

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Casey:

I think a lot of people think that certifications are just letters. I respect the certification. You see a certification behind somebody's name, and you think immediately, "Expert. That person's an expert." Not only do they just take the test, because it takes a lot to know the knowledge, but it also is not just a letter. You can't just get the letters and then not take in the information.

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Casey:

I think, every time that I took a certification, if I want to know the most I can know about my specialties, which critical care is my specialty for all of my certifications, are critical care, but I want to know this is a craft that I've kind of honed over now seven years, and I really want to show that I've honed these skills, but also I want to know what's best for my patient. I want to know what the newest thing we're doing is, not just the textbook answer, but what's the research showing, and especially when you do the CE's to renew your certifications. You keep looking at what's new, what's happening now, and what's the trend in nursing. Through studying, I learned that we changed the names of several things, or what I always had thought was the rationale, I'll use magnesium as an example.

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Casey:

I always thought that we gave magnesium to pregnant patients because of the magnesium, and I didn't know that it was for neuroprotection and that's how the magnesium works. I never knew that magnesium drops because it binds to calcium, so there's a lot of things that I learned. We have this idea, like you go through nursing school. That's 50% of what you know. That's to get you out to practice, and then you have to continue to hone your skill. I kind of wish that more leaders in nursing were, not pushing people towards certification, but kind of showing it as, "You are honing your skill as a nurse."

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Dan:

Yeah. I think that's a great way to frame it, and you're exactly right. It puts personal accountability on the learning, but it also demonstrates to the world that you are the expert in that specialty, and I think it's so critical to do that. I, similarly, did, mine was emergency room nursing, and I started at UCLA Medical Center, and I remember the nurses saying, "Oh, you can't get certified until you've worked here for 2, 3, 4 years".

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Dan:

I remember saying, "Well, I can do that. This is what I do. I want to be an expert and demonstrate that I know what I'm doing as soon as possible." On my one year anniversary of getting my RN license, I passed the certified emergency nurse test, and I was really, really proud of that, and it did. It changed the way my professionals acted with me, the physicians, et cetera.

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Dan:

It just changes that dialogue, and it elevates you because now more, and there were questions on that test that I would've never thought about. It completely kind of flips what you think you know into different ways, so I would encourage everyone to get out there, do the certification because it's more than just letters. It really does demonstrate who you are and pushes you forward to learn the things that you may not have even thought of. You don't know what you don't know either.

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Casey:

Well, even if you're like, "Oh, I don't want to take a certification," I've inspired many people to get certified. Half of the nursing educators that I work with, after all that, all of the certs, they were like, "I want to get more certifications. I've never thought of it that way," so I inspired one of my managers at my transport nursing job to go and get her management certification, so it's kind of like you inspire people to do it, because if they see you doing it and you're so positive about it, then they want to as well.

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Casey:

But I also think, even if you're not ready for certification, there's nothing saying you can't study. You can get the test plan and go from there, self study, and find articles. The American Nurses Association has articles in every single journal that they have, and same with if you joined your professional organization; you can just learn by reading the journals that come out. What's the new emerging things in the profession, but also how are we treating things? You can read about things in five, ten minutes now that you used to have to sit down to read in a textbook.

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Dan:

Right, so even if you don't want to take the test, it allows you to just learn more about what you're up to, and then you can pull the trigger on the test another time. Casey, I want to switch gears a little bit. You're an educator. You're a critical care nurse. You're an expert. You're a charge nurse, and now you're going to be starting a new role as a nurse manager. One of the things I've noticed is it's a big leap just mentally shifting from direct patient care and education to more of a formalized sort of leadership management role. What kind of inspired you to take that leap, and what are you looking forward to?

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Casey:

I think, for me, I had been on the path for CRA school, and I started to see things. I love the nursing profession. I will encourage people to do it 10 times over, even with all the things that have happened in my career and happening in the profession currently, because it's a wonderful profession, and patients really do need us, and they need people who truly care for them. I kind of started to see my nursing students go out and be jaded by their experiences.

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Casey:

I started to think of all the leaders that were great and inspire me, but all the ones who have almost pushed me out of the profession, and kind of thought like, "Okay. I could be as good, if not better than them." You keep talking about creating a positive culture, but then we want to do that, create that, and I feel like there's a real need for more nurses with very strong, clinical leadership, but also with the leadership on the unit that they have, stepping into formal leadership from informal to formal, there's a lot of trepidation. I have a lot of nervousness about stepping into the role.

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Casey:

But I think that's going to be the thing that propels our profession forward, is having nurses who clinically are very strong, but also people strong and an informal leader on the unit that kind of reads the writing on the wall and thinks, "Maybe I should step into a formal leadership role and give this a go," because we need people who are authentic and leadership who understand the clinical side of the profession, but also understand the people part, and that remember that they know what it's like to be on the floor doing things, and they know the people that they're working with, but even if they don't, they love the area that they're in so much that they're willing to build a better culture than some units currently have.

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Dan:

I love that approach to it, that you can help shape this culture, and when I talk to people who are considering kind of the formal leadership roles, you nurse nurses now, and you have the opportunity to really address issues, to build up your teams to address issues, to support nurses in ways that you hoped your managers and leaders would've done in the past. It's sort of that next level of calling to nurse nurses, and so that's exciting to have you do that, and it's a great way to continue to shift and build our profession for the future, so kudos to you. What are you hoping to impact specifically? What's number one on your agenda as you take in this leadership role?

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Casey:

I am lucky the team that I'm joining is pretty awesome already. I'm going to have to learn all the metrics part of the job, but more just supporting people. It's a really rough time if you're a bedside nurse, whether you're traveling or not. The staff nurse, like the non-traveling staff nurse, it's a really rough time for new grad, bedside nurses, and staff, like core staff nurse, that didn't leave to travel. I didn't leave to travel.

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Casey:

I did travel nursing before, and I didn't leave the bedside in the first or the second wave to travel because I didn't want to. I didn't feel the need to go and travel. There was places that were surging that I almost felt a calling to go and help them. Less of money and more because it's horrible seeing other people drowning while waves are happening, and not necessarily where you are, but just because travel nursing exists, it doesn't mean that people want to do it.

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Casey:

So, I think really supporting the people who are not traveling and staying, and are probably very burnt out, and just being visible and there, I will never, ever, ever, no matter how high up in leadership I go, forget where I came from and forget the burnt out feelings that I had during the COVID surge, being a staff nurse surrounded by travelers. I still do love travelers, but I think that for staff nurses that stay behind, there is a little animosity and a feeling like they're not being supported, so I just kind of want to go in and be supportive to the staff that's there, and kind of find out what does that mean for them? How would they like me to support them, and not just assume that I know what that means to them?

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Dan:

Yeah. No, you're already on the right track from a leadership perspective, and it sounds like you've had good mentors, you're teaching, you have access to all the books and things. There's some really good ones out there by authors that you may or may not be speaking with at the moment as well around this stuff, so you've been a student of critical care, which you can continue, but now you need to be a student of leadership, and so it'll be exciting to watch your journey there. The last thing I want to hit on, so you're in LinkedIn Top Voice. How do you see using social media, specifically like a LinkedIn and other ways, to help influence and support nurses as we sort of evolve the profession coming out of the pandemic?

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Casey:

I think that really LinkedIn and other same with more non-formal social media platforms, like Instagram and Facebook as well, I think they give a glimpse into our profession that patients really never had before, and that's good and bad. I have a lot of feelings about the TikTok nurses. I'm a TikTok nurse, but I use it for education, and there're positive things because it gives us a voice. You can go and speak from your heart. I was humbled, honestly, to be in the same conversation, in the same category, as you and Bonnie.

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Casey:

I just kind of use LinkedIn to speak about my experience as a nurse, what I see every day when I work, and I work in several different places, so I really like to give people a glimpse of, "What is a day in the life of critical care Casey? What is a day in the life of Casey Green? What am I doing, and what things do I feel we could do better in the profession that we don't do, or what new gadgets are out there that we're not using?" Now there's LMAs that you can intubate through, but no hospitals have them, and those have been out for almost seven years. I like to highlight things that would make our jobs easier if people only took the time to either listen or see that.

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Dan:

Yeah. There is an opportunity for using the social media to good. I do, and Bonnie Clipper and I talked about this on the last show, about this sort of negative narrative that sort of spun up within mostly nurse TikTok and Instagram, where we make fun of ourselves. We make fun of other specialties that aren't our own. We make fun of management. We make fun of hospitals. We make fun of JCO, but we're not building each other up in that either. There's this sort of negative narrative that sort of spins people off into this frustration and creates assumptions based on a 13-second video.

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Dan:

Recently, people are reaching out on LinkedIn with this very negative narrative, that don't even have any clue who I am or have never talked to me and sort of make these assumptions. It's frustrating, but I do think you make a good point, which is if we can do it from an education standpoint, we can do it from being real and solving the problem to create a narrative about what the profession needs, then I think it can have lasting impact for us too. And that's why I was so excited that you're included on that, because in just speaking with you and having you on the show, you're a light for nurses across the country, and I think that's a big role to play, but also so needed in our profession, so thanks for doing that.

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Casey:

Yeah. Thank you so much.

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Dan:

Well, we've come to the end of our time, Casey. What we like to do at the end of the show is hand off that one nugget of information to the listeners, so what would you like to hand off to the Handoff listeners?

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Casey:

I think the big thing is looking at how we can keep nurses in the profession, and supporting them and making them feel seen, heard, and felt during this, and just remembering to support each other. It's hard for everybody from the top to the bottom right now, and just remembering that it's hard for everyone right now, so just even expressive eyes through your mask, a thumbs up, or a "Hey, how you doing?", is good for people right now.

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Dan:

I love it. That's a great message. Casey, where can we find you online? Where are you at?

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Casey:

I'm on everything. I am on Facebook, Casey Green. On Instagram, [inaudible 00:27:47]. On LinkedIn, Casey Green, and then alphabet suite behind it. Very easily searchable on LinkedIn, and also through Critical Care Casey. If you are nursing students listening, that's how you can find me to support you getting through nursing school.

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Dan:

Awesome, and you've got to connect with Casey. She's awesome. She shares amazing nuggets. She's humble. She's going to be an amazing leader in a formal way, and can really help you transition in your career, so Casey, thank you so much for being on the show today and sharing what you think about the future of our profession. I'm so excited to see where you go, and if we can be any help here at The Handoff in supporting you, please let us know.

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Casey:

Thank you so much for having me.

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