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Nursing Leadership

Episode 108: Nurturing Innovation: Nurses Leading Change in Healthcare

October 4, 2023

Episode 108: Nurturing Innovation: Nurses Leading Change in Healthcare

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October 4, 2023

Episode 108: Nurturing Innovation: Nurses Leading Change in Healthcare

October 4, 2023

Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie. Today, I speak with the founding clinicians of Trusted Health, Chelsea Rolfes and Sarah Gray. We discuss their transition from direct patient care to building and scaling a high growth company dedicated to solving the nurse staffing crisis. Together, we explore their transitions, learnings and successes, advice for nurses and perspective on the future of nursing. Here's my conversation with Chelsea Rolfes and Sarah Gray.

Welcome to the Handoff. I am so excited to speak with the founding clinicians of Trusted Health. I have Chelsea Rolfes and Sarah Gray. Welcome.

Chelsea:

Thanks for having us.

Sarah:

Excited to be here.

Dani:

Well, as you know, this season is a season about healthcare innovation and fearless leadership for change, and both of you have definitely gone down a path of innovation and being fearless in leading some unique changes for the industry. But before we start, I would love to center us back to our purpose, which is patients and the care we deliver. And it would be really meaningful if you could share a particular patient's story or experience that has had profound impacts on both of you during your career. Chelsea?

Chelsea:

I'd love to. I'll give a little context. As a new grad, I worked on a pulmonary step down unit, and we had high acuity patients and we started taking on end of life care. So they'd bring the patient down to the ICU, and then they'd put on one nurse for a continuation of care. And so I was on that team and one family in particular really stuck out to me. I had this patient who was in his late seventies and his family, it was a little sudden, so they were all there and you had three kids, and as an end of life care nurse, you're there through it all. You're also teaching them, right? They're going through this for the first time. It's like, how does this work? What do I expect? And the grieving process. And so for me, I was in this room for three days basically, and when it came down to it, the family wrote me a letter and they said, you'll always be that nurse. And I've never forgotten that. Even 10 years later, I recently lost a grandparent and we have that nurse with my family. You can't forget that bedside nursing and has its hard days, but those moments are why you do it. So definitely a moment that stood out in my career. For me,

Dani:

That's a profound call out of that nurse, right? Because those are, I would say, your birthing experience and then also death. I mean, those are profound moments in a human experience and being able to share that and impact our patients is so powerful. So thank you for sharing that and bringing us back to our center. Sarah, what about you?

Sarah:

Yeah, I love that Chelsea. I think the thing that's pretty incredible about nursing that that made me think about was for them you were that nurse and for you, they're that family or that patient, and it's like it can be such a symbiotic relationship.

Mine's a little bit more lighthearted. I'm throwing it all the way back to my first job as a nurse, which I often overlook a little bit because I think about my first job as a nurse, as my first inpatient acute care job, but I actually worked as a school nurse initially. But the way it worked in California, the public school system, was that I was actually assigned to a specific patient or student rather than being the fixed school nurse. And it was a posten year high school program for students with disabilities. I was assigned to my patient mostly for Central Line Care, G-tube meds, G-tube care, but the program was focused on employment skills, continuing education, like training and independent living skills.

And so much of the educational environment we were out and about. We did lots of field trips and I really became a part of this little community, but I did transition out of that program or that role when I started in the new grad program at UCSF. But my last day with my patient and those students, the way the teachers positioned it was that I was graduating because that's what made the most sense to the students. And so they actually threw me a graduation party and each student included a note about how I cared for them as a nurse thanking me for my care. And it really, I thought about my patient and the specific hands on care that I provided for him, but otherwise I was kind of just there with the group and made me realize the impact that nurses can have in non, non-direct and nonclinical ways. And then the way they had positioned and framed my departure, really the importance of meeting patients where they are and adapting care and situations to their needs and how they can best understand it. And I think that was a really profound experience because that was my first experience working as a nurse. And it made me realize so early in my career that impact can really span care settings. And when I moved inpatient, it really gave me the perspective to think about my patients more than just the human in the hospital bed.

Dani:

Absolutely. I did not know you were a school nurse, and I love that you had a graduation ceremony. That is a cool story, ed. You're right. The impact of nursing or delivering care transcending the environment that it is beyond the environment that we're in. Well, let's talk a little bit more about both of you, and I would love to understand you both had a unique path from direct patient care to the tech startup space. And can you please share with our listeners today that journey to Trusted and what you're doing today here at Trusted and maybe some pivotal moments or things that you thought during the journey that you'd like, I would've wished I would've known that, or just things that you can share with nurses or other healthcare clinicians, leaders that want to take a path, not so traveled, Sarah.

Sarah:

So as I mentioned, I had started as a new grad at UCSF and I pretty quickly, I was pretty eager to get all of the experience. I couldn't understand how it all worked. And so I think I became my unit's youngest charge nurse ever. I joined every committee I could. I became a clinical nurse three. And as I progressed through these roles and experiences, I found myself drawn to really the operational side of care delivery and specifically nursing care delivery. And I found myself very frustrated by the inefficiencies and really the lack of ability to deliver care at the top of my licensure. And I, of course wanted to do something about it. So I joined the Evidence-Based Practice Fellowship program and it gave me an opportunity to do some really, really cool things. I implemented a standardized handoff tool. I measured the impact of aspects of team patient rounding on nurse satisfaction.

But throughout these projects, I was constantly told that I needed to focus on small tests of change and I needed to scale down what I was hoping to measure. And I think I ultimately realized that I needed to step outside of the walls of the hospital, so to speak, to make the change and impact I knew was possible. That left me with the question of like, okay, so what do I do? And at the time, I didn't know many nurses or had many role models who had pursued non-traditional career paths. And so I thought, okay, maybe I need to go get my MBA. And so I started applying for programs and that's when I had a mentor who said, Sarah, you live in San Francisco, you're in Silicon Valley, there are health tech startups out there. They would love to have you. And my initial thought was, I just didn't believe it because at least at that point in my career, I had really felt like people don't truly understand what nurses do and the competencies they have.

And I wasn't convinced that someone would understand how those competencies would translate outside of direct patient care, but I am not one to turn down advice. So I did a little bit of homework and that's when I connected with my co-founders here at Trusted. And it very quickly became clear to me that the problems that we were focused on were ones that I really wanted to spend my time and energy on. And so this was four of us in a shared space with no product, really just a vision. And over what's been nearly six years now, I've had the opportunity to stand up our marketplace, build and scale internal operations, manage a handful of teams, hire a ton of amazing nurses internally here at Trusted and more recently have been working now on our workforce management platform Works. And throughout that all I will say I was not qualified to be doing any of what I was doing, but that was the beauty of it.

And that's what nurses in general I think are incredibly resourceful, adaptable, and were problem solvers. And really that's what building a company and early stage company, that's what it's about, is really solving problems. And before we had any product, any jobs to offer, my initial challenge or job to be done was finding nurses who would be interested in working for us when we eventually had those jobs. So building up the supply side of our marketplace. And that's when I went to Instagram and ended up in many nurses DMs, and one of them was Chelsea and that was love. And so I'll let Chelsea kind of take it from there with her journey. But I will say that was probably one of the most fruitful actions or efforts that I've done here at Trusted.

Dani:

I love it. What a great story to you, Sarah. You wanted to solve change in a big way and you weren't in the environment that allowed you to do it, and you were able to get into an environment that allowed you to embrace that burning passion inside of you to bring change to healthcare and bring it to life. So what a wonderful story and testimony to what is possible. Chelsea, let's hear from you, your experience and how you have been transforming healthcare here at Trusted Health.

Chelsea:

Awesome. And Sarah, thanks for teaming up. I was going to say if I had a one-liner of how I landed here, it's like Sarah Gray sl it to my up.

Dani:

She said it,

Chelsea:

But so I'll give a little background too on myself. In college we had, I heard a trust or travel nursing, and at the time, social media wasn't nearly like it is now. So I said to myself, I'm going to put in my year, year and a half as a new grad and I'm going to be a travel nurse. And sure enough, that time came and I started exploring different recruiters and agencies and just learning. And I really took the angle of I want to travel the country and go to these different cities. And so I traveled with two friends and at this time I had traveled for almost two years and personally a little different from Sarah, but I was starting to get this itch of like, man, okay, I'm nursing. I'm still excited and energized by traveling, but also I am working three 12. What can I do on my other four days off that can continue to develop me in my career?

At the time, I was actually really into functional medicine and pivoting into this, how can nutrition help us all live more optimally? So I actually started down that pathway and then yeah, to Sarah's point, we connected. I had just moved, had my last travel time in San Francisco. I'd moved to Austin and she's like, Hey, let's connect. I'm trying to meet more nurses and I want to tell you about we're doing. And basically it was like, would you want to come be a travel nurse for Trusted in California? That's the only place we're licensed. And I'm like, hold on. Whatcha doing behind the seeds here? And ultimately as a traveler, I was really frustrated with the model myself. It is pretty nuanced. You have no control over what jobs are out there. For me, I had sort of found some of these jobs myself and found it frustrating that I to negotiate my pay with the recruiter, the incentives a little bit misaligned.

And I also lacked community as a nurse at that time. And so this light bulb was just going off and I was so energized by my conversation with Sarah. I'm like, I actually don't want to be a traveler. I'm energized by what you're doing here in building. And so one thing led to the next, and I mean literally the next week I flew back out and to Sarah's point, I met the small team of six sitting at a table. And I think to Sarah's point, you really have a hard time envisioning how are my skills really going to, am I really qualified for this? Do they want me here? And my thought there is just take the leap and especially as a clinician and the need for nurses, you can go right back to it. And so for me, I was like, all right, this feels like a risk, but the bedsides right there and here I am five and a half years later and haven't looked back.

So I think in speaking a little bit to my time here as well, I think when I started it was to Sarah's point, we were doing it all right, how can we as clinicians come in and help shape the strategy and the product but also be there for our clinicians on our platform? And that meant getting 'em a profile all the way through onboarding 'em and supporting through benefits and all the rest. And so my role and journey at Trusted is actually really stuck with our nurse advocate org and scaling that team of clinicians, which to Sarah's point, one of the favorite things about my time here is hiring and leading a team of nurses. I mean, I often pinch myself, there's no one else doing this kind of work out there with a team of 20 nurses. And so our org is really focused on how do we support our fellow clinicians in their search for a job, support them in their career at Trusted, make sure they're qualified, set us apart from what everyone else is doing.

Yeah, it's been an incredible journey in that sense and in wearing a lot of hats. I've always been very energized, similar to Sarah by the operations, give me the problems, let's solve. And so more recently I moved into a new role in business enablement where essentially we sit within marketplace operations. And number one, it's how can we tee up our internal teams to have quality knowledge and external content resources for our clinicians as well? And then how can we help tackle problems and come up with creative solutions for these problems that span across multiple domains and that may be operations, ensuring our teams are working as efficiently as possible, and then also informing our product. How do we just keep doing this better with our clinician experience top of mind? And that's one thing I've loved about Trusted. To Sarah's point, we just ingrained and everything we do, our nurses kind of boots on the ground feedback that is just so valuable in how we've built this company.

Dani:

First of all, the DNA of Trusted Health is exactly the reason I this company. You guys led a path of let's develop something that is serving to the clinician, giving them flexibility choice. But the DNA kept growing because we were hiring and allowing clinicians to continue to operate, build and design the way that we serve our clinicians and serve the health systems that we're serving as well. I love that that was the beginning of the DNA of the company and has continued to mature into something so magical and wonderful today. Additionally, one thing that I heard from both of you that I think is an important call out for our listeners, which we've often talked about, it's a little bit of imposter syndrome. Both of you're like, yeah, I wasn't really sure if I was qualified to do that, but look at who you are today and where you've come.

And I'm so glad you didn't let that stop you from taking the leap and doing the work. And so I just want to encourage our listeners, if you have that sense of, I don't know if I'm qualified, hey, get that out of your head and if there's a passion, if there's a dream, if there's something you want to solve, there's a reason that's there, and look at how you can do that. You have the skills and you can learn along the way to really make the impact when you talk about your journey. This is amazing. Hey, were there any surprises or successes or things that you're like, I wish I could do that over, or maybe not. Hey, I want to replicate that and do it again somewhere else. Not that you're leaving Trusted, right? But Sarah, anything from your perspective

Sarah:

Things I would do over? I don't think so. I think this kind of feels like the butterfly effect situation where if I were to choose to do anything over, then maybe things wouldn't, each and every subsequent thing wouldn't have unfolded the way it did. And so I don't think there's anything else, anything I would do over something I was a bit worried about in making the transition away from direct patient care, especially working in pediatrics, which I truly loved was I worried whether I would still feel the same sense of gratification and impact that I did being hands-on with patients and families. And I will say since joining Trusted from day one, that was actually only amplified. And I think that was due to the ability to think about our nurses as our patients. And so we weren't providing hands-on care, but we were designing product and policies and community and content for nurses. And for that work was just as important. And the way I always thought about it too was that just I could, in California, in pediatrics, in acute care, I was taking care of four patients at a time. And really if I had the mindset that if I could invest in the nurses who are thousands of nurses who are then taking care of multiples of patients, that has been incredibly gratifying. And the opportunity to be the voice of the nurse in building a product and at a tech company has been the opportunity of a lifetime.

Dani:

Lovely and wonderful. Hey, Chelsea, what about you?

Chelsea:

Yeah, before I jump into mine, I just have to touch on what Sarah said too. I think it brings me back to my story being that nurse and when you do make that jump, it's like how could I ever feel that kind of emotion? And maybe it's heavy, but in this space, and to Sarah's point, it is wild how you can still feel that sense word. It's different, but I think as we continue to evolve and tap into how much we can disrupt this industry, it's that much more exciting knowing that to Sarah's point, you can make an impact on such a bigger level. And at the end of the day, we're still focused on patient care. It's just different. And so I have to agree that it is hard to imagine finding that, but it's here. And I think again, having clinicians within our company helps. I was very surprised, your bedside nurse, you've been doing it for four years and you start working sitting next to an engineer, learning about code, learning about, I mean there's stories of me, I didn't even know how to use Excel. I'm like, do you hire me?

I'll figure it out. It's like, alright, you figured out, but you have those soft skills and I think that that is what is just the message I want to get across. Those translate incredibly. One of the biggest learnings for me was you're at the bedside. Patients are first, you are worried about your patients before you're going to the bathroom, before you're eating your lunch. Maybe you're getting off late and you're missing something, it doesn't matter. You put them first. Personally for me, I think one of the biggest transitions was that can be dangerous almost coming into a startup where especially when it's a small team, there's work to be done 24 7, there's never enough time and you really have to create those boundaries for you and life outside of work. And everyone says you show up better when you put that time into yourself. And I think it's obviously way easier said than done, but for me as a leader and hiring nurses from tech, I made that very clear, this is not going to be an easy transition, but you can do it. In fact, you make an incredible employee and you have the skills here, but let's keep top of mind those boundaries and you'll show up better. You can thrive in this environment if you can figure that out. But bringing in a nurse with that mentality to a startup, you can easily get burnout. So I think that's one thing that I've learned and definitely translated into my leadership to be sure that clinicians could be successful and staying with trusted.

Dani:

You mentioned something that kind of triggered in my mind when you said the soft skills. So last season, season seven, we were talking about workforce flexibility. I had a guest, Dr. Lisa Summers, she was leading this new organization, a campaign for nurses to run for office. So she was like, nurses are actually wonderful politicians and it touches on the same point that you spoke on the soft skills. She was like, they're really good at negotiation. They establish trust right away. They can cross the aisle and get things done. And so it just kind amplifies the soft skills that you learn as caring for patients as a nurse sets you up for business endeavors. If you want to be a politician, go for it, run for it. We need more nurses in the office, starting companies and nonprofits, whatever the sky's the limit, but those soft skills of establishing trust, creating compromise in the way that it can be a win-win for the objectives you're trying to accomplish, your assessment skills, all those things are just really powerful skills that can be translated in just so many environments.

As we're talking about how you guys have grown your careers and what do you think as you think about nurses at the bedside and they need to grow their skills and careers if they want to grow at the bedside or even beyond. So is there any advice that you would give to those nurses to think about the skills and career growth opportunities that have helped either of you. Sarah?

Sarah:

I mean, I think first and foremost goes back to what you had mentioned about imposter syndrome. And so don't underestimate yourself and how applicable your competencies are and to the point you just made. I think nurses have a great foundation for being really great at whatever energizes them and you can fill in the hard skills, the things that you can learn. I get questions and inquiries all the time from nurses about I am interested, what's the first step? And I think the first being a part of the change you want to see even in the smallest ways, and you can do it without completely changing your career from the get-go. If there's something that's frustrating you is inefficient, is making your job delivering high quality and safe care difficult, it's most likely something that someone else is experiencing too. And so don't underestimate your ability to do something about it.

It's a matter of getting started and that's leaning into the discomfort. Chelsea and I have had several conversations about this, but when you first get started doing something that you haven't done before, it could be really uncomfortable. And when we had first started at Trusted, I don't think we had felt such discomfort as when since were new grad nurses, it was hard to see draw the line between how am I going to get there? But you get there. And so even if you're years into a nursing or clinical career, it's never too late to be a beginner in something else in knowledge or skill wise. And everyone started as a beginner. And so really embracing being a beginner with a growth mindset, but to that point, you've got to have your eyes and ears open for opportunities that spark your interest and that requires putting yourself out there, whether it's networking or being part of the conversation on LinkedIn, even having a LinkedIn where people can find you and sharing your thoughts and ideas so others can connect with you on that. Or in this case, slide into their DMs.

Dani:

Yeah. Chelsea, what about you?

Chelsea:

Yeah, so I mean the first thing that came to mind here for me was it's like keeping your head on a swivel for these opportunities that create challenge. When you're a new grad, you're forced into that challenge. You don't have a choice. You chose this career, you graduate, you have to show up and learn it on the fly. And that mentality, again, at that point you don't have a choice, but finding opportunities that give you that feeling again is how you're going to grow. And you have to seek those out as your career goes on. And so I think it can be very uncomfortable, but I think that is really how you grow. And especially as it relates to being a nurse in a hospital setting or a health system, it can be really intimidating to think, oh my gosh, to grow and challenge myself, I need to go be a manager.

How would I ever move to tech or a corporate world or I have to be a charge nurse. It's like I think there's also something to be said about challenging yourself in your day-to-day and just constantly having that mindset of you can grow and excel in your own role and keep stacking your resume and those skills. It doesn't mean you have to climb a ladder, move to a new industry, but if you start to get comfortable with being uncomfortable, that is how you're going to keep figuring out what lights your fire. And I think just constantly being mindful of that, it really does keep you engaged and excited about what you're doing and uplevel you as a professional,

Dani:

The power of discomfort. Sarah, you said it pressing, lean into it. And then Chelsea, I like your mention of, and then where you are today, I think it's a good call out. People sometimes think, well, I need to get another job in order to grow skills. It's like a no, you actually can grow within the job that you have, and oftentimes it is seeking out new opportunities within that job, whether, as Sarah mentioned when you were a nurse, you're like, I did everything I could. I was on committees, I was a charge nurse. So it's looking to the new opportunities that can help you understand your gifts, your talents, and more importantly your passions and following those passions. When I started my career in the staffing scheduling space, so I was a nurse manager and I transitioned into this system director role over eight hospitals and I was brought in to redesign their workforce and I had no experience. I had never done that before and I was like, well, I've got the energy, so we're going to figure this one out. It

Chelsea:

Goes a long way.

Dani:

It does, but that's again, a point of encouragement. I wasn't an expert in this space. I had no idea, but I was willing to be like, I'm going to learn the technology, I'm going to dive into this. Of course there was failure along the way, but there sure was a lot of growth and learning and something that transformed my life to who I am today. And so I think just in terms of the thing that we're hearing here is like press into this discomfort, see how you can grow. And even if you don't have the skills, if you have the desire, you can develop 'em. So let's talk a little bit more about flexibility and the power of choice, specifically a frontline nurse, but even for health systems in general. And as you're working with health systems, how has this transformed your own career and what do you think the healthcare industry needs to do to keep innovating around the concept of flexibility?

Sarah:

I think flexibility and the power of choice for nurses is so important. It's something I am incredibly passionate about and I joined Trusted because I wanted to be part of fundamentally changing the way nurses work who aligned with their need for flexibility and choice and a traditional nursing career. Working inpatient can come with a lot of limitations and restrictions on one's personal life and the choice to become a nurse. The choice one makes to work. That job means scheduling your life four to six weeks at a time, learning how to function in a family in social circles while working nights, weekends, holidays. Nurses are often told when they work what they must wear to work when they can eat their lunch, if they get that at all what they work on being a patient assignment. And I think we know nurses know what they sign up for.

And so none of that comes as a surprise. It comes with a lot of limits on choice and flexibility all while choice and flexibility has expanded for many in other professions. I think I'd like to see the healthcare industry rethink the 12 hour shift, the focus on retention. I see a lot of headlines and I hear a lot about stabilizing and core staff and maybe those two together are stabilizing core staff, but I don't think we're living in a reality anymore where nurses want to go and work on a unit for five plus years. And even that is maybe a long time, and I very much understand the economics of nurse turnover, but at some point, I think the conversation needs to shift to acknowledge nurse preferences and values and that health systems need to adapt their expectations and systems to form a symbiotic relationship.

And I believe that if you know and respect that nurses want greater flexibility, variety, control, choice, support, you'll understand that that doesn't always translate to working a traditional three 12 hour shift on a unit for five plus years. And it feels a little bit like we're trying to fit a square peg in a round hole. And if we don't really lean into the flexibility and understanding what that means and giving nurses the power of choice, I mean they have that power of choice and they're voting with their feet. And if we don't change, we're going to continue to have a hard time getting people to choose and continue to choose nursing. And so the things that are crafted and designed for us, even by nurses, but often those who no longer work on the front lines or haven't in a while, what if when we talk about flexibility and the power of choice, what if we let the frontline nurses design that blueprint and then dedicate our energy and focus and resources on bringing whatever that blueprint looks like to life? And so I think it's exciting to hear a lot about flexibility and the power of choice that I think I would like to kind of see it come to life a little bit differently.

Dani:

I think the power of the frontline and designing is fundamentally an absolute foundation of what you should be doing for any health system. But what I'm hearing you say is let's take it a step further, whole design and then the support of the leaders or maybe the administrative to bring it to life. And that gets me excited. Like imagine the buy-in from that, right? This was your solution, it is yours, we're bringing it to life. This wasn't forced on you, and I like how you brought up, we understood what we were signed up for with these terms and conditions and transactions of our job, but does it have to be that way?

Sarah:

Even if it's an initial choice, is it sustainable? And that's what we have to really narrow in on.

Dani:

Yeah, absolutely. Jesse, what about you?

Chelsea:

Yeah, I guess on a personal note for me, that's why I jumped into travel and nursing, and I think there's something sexy about that in today's environment of the word flexible when you talk about balancing your life. And so for me it was like, man, let me go work 13 weeks, take a couple off, move around, and everyone gets something out of that. But I think ultimately you're able to fill your personal cup when you feel like your professional life is flexible. And as a traditional staff nurse at the bedside in the hours, that hasn't changed and it can be very hard to be living that environment, especially I'll just say too, in post covid world, your friends are working remote, they can travel, get a job shift around jobs much more easily. I think outside of our industry, it's much hopped on LinkedIn, apply to a bunch of roles, move into a new opportunity.

And as a nurse, I think you can tend to feel stuck because within the hospital systems, a lot of this is the same theme, your hours, your unpredictable shifts. And so I think when we talk about flexible, it is, and what we're seeing now is nurses are leaving. They don't know how to find that within the health systems and the industry has to follow suit. We're historically always a little behind in how we can have change. And to Sarah's point, the frontline nurses, they want change. They're asking for change. But I think to keep nurses and keep future generations excited that we really have to tap into what flexibility means and make it sustainable. For me, being a travel nurse wasn't sustainable. I had to find a career that let me be planted in one city. And so how do we allow bedside nurses to feel that too and stay excited and engaged by evolving like these other industries have?

Dani:

Yeah, that was the beginning of your career was the choice of you feel like you didn't have the choice even in what was deemed a flexible role. Travel nursing is historically known to be flexible, and so you're like, it's not, and I'm going to take it a step further and keep pushing the limits there. I think one component of flexibility and it's key too, is our leaders. And something that I try and remind myself is how can I myself have a flexible mind about how I'm viewing, how I'm leading, how I see the workforce, the lens of practice that I've had, and that may not be the right lens in which I create solutions. And so being willing and open to listen and hear and flexible in the solutions that are proposed. And so it's a journey from within as well as the transformation around us. Let's talk about the future of nursing, and we've had lots of conversations with just different leaders across the country, but I would love to hear from both of you, what worries or excites you about the future of nursing and where we're heading?

Chelsea:

I mean, I think what excites me when you ask that question is we're here talking about this, right? I think what's excited me is really especially leading a team of clinicians that we've constantly integrated their value and perspective within as we've grown, trusted, right? It helps us influence change decisions we're making about our strategy, our product. And what excites me is we're starting to talk about that outside the walls of a startup. I think trusted is unique in that, but in a hospital system, and me as a bedside nurse when I was there, I did not feel that. I did not feel that my chain or my voice was heard, nor was change being made to have an impact on the things that the bedside nurses were asking for. And so I think what's exciting me is we're starting to talk about that there's the nursing shortage, the demand, the burnout, mental health, it's being discussed.

But I think what worries me is when are we going to see these big swings and big shifts to actually start to bring that change to life and really listen to the boots on the ground, feedback from our bedside nurses to help evolve our hospital systems in this profession to pour back into the people that are giving patient care at the bedside. And I think that's what worries me, and I hope to see that we continue to move in that direction. And obviously that does take leadership and just continuing to figure out how we can integrate that mindset into decisions that are being made across the industry and health systems.

Dani:

We don't want to circle 'em out in again and again and again. The same conversations that I know I've been having in my career since I've started. So that's a huge call out. We're having the conversations, but let's put it into action. Sarah, what about you?

Sarah:

We at Trusted, when we got started six years ago, we were quite differentiated in our leveraging of technology in our what we call nurse first mindset. And after some time and others in the space realized how impactful both of those things were. And so there's been handfuls of other innovations and companies who have done or deployed technology and this modern branding, but nurse first or nurse focus in what they're building and what they're doing. And I think that's great. What excites me is that there people focusing on this and people, Chelsea's point, the point I made earlier, outside of the walls of the hospital. And so we've got some of the best engineers, designers, marketers, business people in the world, laser focused on solving the nursing shortage and fundamentally willing to rethink how nurses work and how they're engaged as employees. I think the other thing that excites me is that it feels like we're at a point where healthcare can't not adapt.

And I'm not sure I'm convinced it's prepared to in the big bold way that it needs to, but things are looking fairly dire. The risk is much too high to not be courageous in trying new things or kind of rethinking the systems and how they're set up. And I feel optimistic because in my role every day I have an opportunity to interact and engage nursing leaders. And it's not limited to just nursing leaders, but healthcare leaders who want to be part of leading that change. And so they're out there and I think it's just continuing to push forward. And to your point, not circling them out and continuing to move forward even if that feels uncomfortable.

Dani:

So we talked about you and Chelsea connected via DMs, but where can our listeners find you? Is there a way that you want them to connect with you so that they too can have a conversation that would be life-changing?

Sarah:

I welcome anyone interested to please do reach out. I am very responsive on LinkedIn, so that's probably the best place to find me. I'm no longer on Instagram connecting with nurses, but LinkedIn is the best place to do that. Or you can find me at sarah@trustedhealth.com.

Dani:

Perfect. Chelsea?

Chelsea:

Hey, I'm laughing at that LinkedIn, also agree with Sarah. You can find me there and I'd be energized to hear from anyone who's interested in connecting. Always am. And I'm chelsea@trustedhealth.com.

Dani:

Well, this has been really insightful, impactful. I love talking with pioneers Trailblazers is what I would describe to you as both having accomplished and achieved over the last six years. What would you like to hand off to our listeners today?

Sarah:

I'd like to go back to kind of underlining maybe a point I made a few times, but I think what I hand off and encourage listeners to consider what we ask and expect of nurses in order to deliver care today and whether that's necessary and how even in the role that they're in now without big swings, how they can chip away at that.

Chelsea:

Exactly. Yeah, in line with that too, I think something that came to mind for me was really passion. I think if you're a nurse at heart and you went through nursing school and were a new grad, you know what that feels like. That's why you're here and have gotten here. And I think on a personal note and professional note, keep checking in with that and what you're energized. Are you energized by what you're doing? And to Sarah's point, what are you not energized by and how can you lean into your passion to help make that change or advocate? And I think you can so easily be paralyzed whether it's passion for a move in your career or a change or passion for change within your hospital. But I think just listen to that and tap into that. And I think the more you can feel passion and create those frictions, the more doors open and it can help be a part of this change we've been talking about today.

Dani:

Anything's possible. Thank you so much, Sarah, Chelsea, for sharing your stories and also bringing a lens and perspective that's desperately needed for change to healthcare. And so thank you. I love working with both of you. It's been inspiring just listening to this story and I feel energized and who knows what I'm going to go out and solve next from this conversation. Hopefully just a daily task. But thank you so much. I appreciate it and I can't wait to have this air soon.

Chelsea:

Thanks for having us and for the forum to have this discussion.

Sarah:

I agree. Thanks so much Dani.

Description

Dr. Dani speaks with Chelsea Rolfes & Sarah Gray, Founding Clinicians of Trusted Health, transitioned from direct patient care to building and scaling a high-growth company tackling the nursing shortage and enabling health systems to transform their workforces. Together, they discuss their transition, learnings and successes, advice for nurses, and perspectives on the future of nursing.

Transcript

Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie. Today, I speak with the founding clinicians of Trusted Health, Chelsea Rolfes and Sarah Gray. We discuss their transition from direct patient care to building and scaling a high growth company dedicated to solving the nurse staffing crisis. Together, we explore their transitions, learnings and successes, advice for nurses and perspective on the future of nursing. Here's my conversation with Chelsea Rolfes and Sarah Gray.

Welcome to the Handoff. I am so excited to speak with the founding clinicians of Trusted Health. I have Chelsea Rolfes and Sarah Gray. Welcome.

Chelsea:

Thanks for having us.

Sarah:

Excited to be here.

Dani:

Well, as you know, this season is a season about healthcare innovation and fearless leadership for change, and both of you have definitely gone down a path of innovation and being fearless in leading some unique changes for the industry. But before we start, I would love to center us back to our purpose, which is patients and the care we deliver. And it would be really meaningful if you could share a particular patient's story or experience that has had profound impacts on both of you during your career. Chelsea?

Chelsea:

I'd love to. I'll give a little context. As a new grad, I worked on a pulmonary step down unit, and we had high acuity patients and we started taking on end of life care. So they'd bring the patient down to the ICU, and then they'd put on one nurse for a continuation of care. And so I was on that team and one family in particular really stuck out to me. I had this patient who was in his late seventies and his family, it was a little sudden, so they were all there and you had three kids, and as an end of life care nurse, you're there through it all. You're also teaching them, right? They're going through this for the first time. It's like, how does this work? What do I expect? And the grieving process. And so for me, I was in this room for three days basically, and when it came down to it, the family wrote me a letter and they said, you'll always be that nurse. And I've never forgotten that. Even 10 years later, I recently lost a grandparent and we have that nurse with my family. You can't forget that bedside nursing and has its hard days, but those moments are why you do it. So definitely a moment that stood out in my career. For me,

Dani:

That's a profound call out of that nurse, right? Because those are, I would say, your birthing experience and then also death. I mean, those are profound moments in a human experience and being able to share that and impact our patients is so powerful. So thank you for sharing that and bringing us back to our center. Sarah, what about you?

Sarah:

Yeah, I love that Chelsea. I think the thing that's pretty incredible about nursing that that made me think about was for them you were that nurse and for you, they're that family or that patient, and it's like it can be such a symbiotic relationship.

Mine's a little bit more lighthearted. I'm throwing it all the way back to my first job as a nurse, which I often overlook a little bit because I think about my first job as a nurse, as my first inpatient acute care job, but I actually worked as a school nurse initially. But the way it worked in California, the public school system, was that I was actually assigned to a specific patient or student rather than being the fixed school nurse. And it was a posten year high school program for students with disabilities. I was assigned to my patient mostly for Central Line Care, G-tube meds, G-tube care, but the program was focused on employment skills, continuing education, like training and independent living skills.

And so much of the educational environment we were out and about. We did lots of field trips and I really became a part of this little community, but I did transition out of that program or that role when I started in the new grad program at UCSF. But my last day with my patient and those students, the way the teachers positioned it was that I was graduating because that's what made the most sense to the students. And so they actually threw me a graduation party and each student included a note about how I cared for them as a nurse thanking me for my care. And it really, I thought about my patient and the specific hands on care that I provided for him, but otherwise I was kind of just there with the group and made me realize the impact that nurses can have in non, non-direct and nonclinical ways. And then the way they had positioned and framed my departure, really the importance of meeting patients where they are and adapting care and situations to their needs and how they can best understand it. And I think that was a really profound experience because that was my first experience working as a nurse. And it made me realize so early in my career that impact can really span care settings. And when I moved inpatient, it really gave me the perspective to think about my patients more than just the human in the hospital bed.

Dani:

Absolutely. I did not know you were a school nurse, and I love that you had a graduation ceremony. That is a cool story, ed. You're right. The impact of nursing or delivering care transcending the environment that it is beyond the environment that we're in. Well, let's talk a little bit more about both of you, and I would love to understand you both had a unique path from direct patient care to the tech startup space. And can you please share with our listeners today that journey to Trusted and what you're doing today here at Trusted and maybe some pivotal moments or things that you thought during the journey that you'd like, I would've wished I would've known that, or just things that you can share with nurses or other healthcare clinicians, leaders that want to take a path, not so traveled, Sarah.

Sarah:

So as I mentioned, I had started as a new grad at UCSF and I pretty quickly, I was pretty eager to get all of the experience. I couldn't understand how it all worked. And so I think I became my unit's youngest charge nurse ever. I joined every committee I could. I became a clinical nurse three. And as I progressed through these roles and experiences, I found myself drawn to really the operational side of care delivery and specifically nursing care delivery. And I found myself very frustrated by the inefficiencies and really the lack of ability to deliver care at the top of my licensure. And I, of course wanted to do something about it. So I joined the Evidence-Based Practice Fellowship program and it gave me an opportunity to do some really, really cool things. I implemented a standardized handoff tool. I measured the impact of aspects of team patient rounding on nurse satisfaction.

But throughout these projects, I was constantly told that I needed to focus on small tests of change and I needed to scale down what I was hoping to measure. And I think I ultimately realized that I needed to step outside of the walls of the hospital, so to speak, to make the change and impact I knew was possible. That left me with the question of like, okay, so what do I do? And at the time, I didn't know many nurses or had many role models who had pursued non-traditional career paths. And so I thought, okay, maybe I need to go get my MBA. And so I started applying for programs and that's when I had a mentor who said, Sarah, you live in San Francisco, you're in Silicon Valley, there are health tech startups out there. They would love to have you. And my initial thought was, I just didn't believe it because at least at that point in my career, I had really felt like people don't truly understand what nurses do and the competencies they have.

And I wasn't convinced that someone would understand how those competencies would translate outside of direct patient care, but I am not one to turn down advice. So I did a little bit of homework and that's when I connected with my co-founders here at Trusted. And it very quickly became clear to me that the problems that we were focused on were ones that I really wanted to spend my time and energy on. And so this was four of us in a shared space with no product, really just a vision. And over what's been nearly six years now, I've had the opportunity to stand up our marketplace, build and scale internal operations, manage a handful of teams, hire a ton of amazing nurses internally here at Trusted and more recently have been working now on our workforce management platform Works. And throughout that all I will say I was not qualified to be doing any of what I was doing, but that was the beauty of it.

And that's what nurses in general I think are incredibly resourceful, adaptable, and were problem solvers. And really that's what building a company and early stage company, that's what it's about, is really solving problems. And before we had any product, any jobs to offer, my initial challenge or job to be done was finding nurses who would be interested in working for us when we eventually had those jobs. So building up the supply side of our marketplace. And that's when I went to Instagram and ended up in many nurses DMs, and one of them was Chelsea and that was love. And so I'll let Chelsea kind of take it from there with her journey. But I will say that was probably one of the most fruitful actions or efforts that I've done here at Trusted.

Dani:

I love it. What a great story to you, Sarah. You wanted to solve change in a big way and you weren't in the environment that allowed you to do it, and you were able to get into an environment that allowed you to embrace that burning passion inside of you to bring change to healthcare and bring it to life. So what a wonderful story and testimony to what is possible. Chelsea, let's hear from you, your experience and how you have been transforming healthcare here at Trusted Health.

Chelsea:

Awesome. And Sarah, thanks for teaming up. I was going to say if I had a one-liner of how I landed here, it's like Sarah Gray sl it to my up.

Dani:

She said it,

Chelsea:

But so I'll give a little background too on myself. In college we had, I heard a trust or travel nursing, and at the time, social media wasn't nearly like it is now. So I said to myself, I'm going to put in my year, year and a half as a new grad and I'm going to be a travel nurse. And sure enough, that time came and I started exploring different recruiters and agencies and just learning. And I really took the angle of I want to travel the country and go to these different cities. And so I traveled with two friends and at this time I had traveled for almost two years and personally a little different from Sarah, but I was starting to get this itch of like, man, okay, I'm nursing. I'm still excited and energized by traveling, but also I am working three 12. What can I do on my other four days off that can continue to develop me in my career?

At the time, I was actually really into functional medicine and pivoting into this, how can nutrition help us all live more optimally? So I actually started down that pathway and then yeah, to Sarah's point, we connected. I had just moved, had my last travel time in San Francisco. I'd moved to Austin and she's like, Hey, let's connect. I'm trying to meet more nurses and I want to tell you about we're doing. And basically it was like, would you want to come be a travel nurse for Trusted in California? That's the only place we're licensed. And I'm like, hold on. Whatcha doing behind the seeds here? And ultimately as a traveler, I was really frustrated with the model myself. It is pretty nuanced. You have no control over what jobs are out there. For me, I had sort of found some of these jobs myself and found it frustrating that I to negotiate my pay with the recruiter, the incentives a little bit misaligned.

And I also lacked community as a nurse at that time. And so this light bulb was just going off and I was so energized by my conversation with Sarah. I'm like, I actually don't want to be a traveler. I'm energized by what you're doing here in building. And so one thing led to the next, and I mean literally the next week I flew back out and to Sarah's point, I met the small team of six sitting at a table. And I think to Sarah's point, you really have a hard time envisioning how are my skills really going to, am I really qualified for this? Do they want me here? And my thought there is just take the leap and especially as a clinician and the need for nurses, you can go right back to it. And so for me, I was like, all right, this feels like a risk, but the bedsides right there and here I am five and a half years later and haven't looked back.

So I think in speaking a little bit to my time here as well, I think when I started it was to Sarah's point, we were doing it all right, how can we as clinicians come in and help shape the strategy and the product but also be there for our clinicians on our platform? And that meant getting 'em a profile all the way through onboarding 'em and supporting through benefits and all the rest. And so my role and journey at Trusted is actually really stuck with our nurse advocate org and scaling that team of clinicians, which to Sarah's point, one of the favorite things about my time here is hiring and leading a team of nurses. I mean, I often pinch myself, there's no one else doing this kind of work out there with a team of 20 nurses. And so our org is really focused on how do we support our fellow clinicians in their search for a job, support them in their career at Trusted, make sure they're qualified, set us apart from what everyone else is doing.

Yeah, it's been an incredible journey in that sense and in wearing a lot of hats. I've always been very energized, similar to Sarah by the operations, give me the problems, let's solve. And so more recently I moved into a new role in business enablement where essentially we sit within marketplace operations. And number one, it's how can we tee up our internal teams to have quality knowledge and external content resources for our clinicians as well? And then how can we help tackle problems and come up with creative solutions for these problems that span across multiple domains and that may be operations, ensuring our teams are working as efficiently as possible, and then also informing our product. How do we just keep doing this better with our clinician experience top of mind? And that's one thing I've loved about Trusted. To Sarah's point, we just ingrained and everything we do, our nurses kind of boots on the ground feedback that is just so valuable in how we've built this company.

Dani:

First of all, the DNA of Trusted Health is exactly the reason I this company. You guys led a path of let's develop something that is serving to the clinician, giving them flexibility choice. But the DNA kept growing because we were hiring and allowing clinicians to continue to operate, build and design the way that we serve our clinicians and serve the health systems that we're serving as well. I love that that was the beginning of the DNA of the company and has continued to mature into something so magical and wonderful today. Additionally, one thing that I heard from both of you that I think is an important call out for our listeners, which we've often talked about, it's a little bit of imposter syndrome. Both of you're like, yeah, I wasn't really sure if I was qualified to do that, but look at who you are today and where you've come.

And I'm so glad you didn't let that stop you from taking the leap and doing the work. And so I just want to encourage our listeners, if you have that sense of, I don't know if I'm qualified, hey, get that out of your head and if there's a passion, if there's a dream, if there's something you want to solve, there's a reason that's there, and look at how you can do that. You have the skills and you can learn along the way to really make the impact when you talk about your journey. This is amazing. Hey, were there any surprises or successes or things that you're like, I wish I could do that over, or maybe not. Hey, I want to replicate that and do it again somewhere else. Not that you're leaving Trusted, right? But Sarah, anything from your perspective

Sarah:

Things I would do over? I don't think so. I think this kind of feels like the butterfly effect situation where if I were to choose to do anything over, then maybe things wouldn't, each and every subsequent thing wouldn't have unfolded the way it did. And so I don't think there's anything else, anything I would do over something I was a bit worried about in making the transition away from direct patient care, especially working in pediatrics, which I truly loved was I worried whether I would still feel the same sense of gratification and impact that I did being hands-on with patients and families. And I will say since joining Trusted from day one, that was actually only amplified. And I think that was due to the ability to think about our nurses as our patients. And so we weren't providing hands-on care, but we were designing product and policies and community and content for nurses. And for that work was just as important. And the way I always thought about it too was that just I could, in California, in pediatrics, in acute care, I was taking care of four patients at a time. And really if I had the mindset that if I could invest in the nurses who are thousands of nurses who are then taking care of multiples of patients, that has been incredibly gratifying. And the opportunity to be the voice of the nurse in building a product and at a tech company has been the opportunity of a lifetime.

Dani:

Lovely and wonderful. Hey, Chelsea, what about you?

Chelsea:

Yeah, before I jump into mine, I just have to touch on what Sarah said too. I think it brings me back to my story being that nurse and when you do make that jump, it's like how could I ever feel that kind of emotion? And maybe it's heavy, but in this space, and to Sarah's point, it is wild how you can still feel that sense word. It's different, but I think as we continue to evolve and tap into how much we can disrupt this industry, it's that much more exciting knowing that to Sarah's point, you can make an impact on such a bigger level. And at the end of the day, we're still focused on patient care. It's just different. And so I have to agree that it is hard to imagine finding that, but it's here. And I think again, having clinicians within our company helps. I was very surprised, your bedside nurse, you've been doing it for four years and you start working sitting next to an engineer, learning about code, learning about, I mean there's stories of me, I didn't even know how to use Excel. I'm like, do you hire me?

I'll figure it out. It's like, alright, you figured out, but you have those soft skills and I think that that is what is just the message I want to get across. Those translate incredibly. One of the biggest learnings for me was you're at the bedside. Patients are first, you are worried about your patients before you're going to the bathroom, before you're eating your lunch. Maybe you're getting off late and you're missing something, it doesn't matter. You put them first. Personally for me, I think one of the biggest transitions was that can be dangerous almost coming into a startup where especially when it's a small team, there's work to be done 24 7, there's never enough time and you really have to create those boundaries for you and life outside of work. And everyone says you show up better when you put that time into yourself. And I think it's obviously way easier said than done, but for me as a leader and hiring nurses from tech, I made that very clear, this is not going to be an easy transition, but you can do it. In fact, you make an incredible employee and you have the skills here, but let's keep top of mind those boundaries and you'll show up better. You can thrive in this environment if you can figure that out. But bringing in a nurse with that mentality to a startup, you can easily get burnout. So I think that's one thing that I've learned and definitely translated into my leadership to be sure that clinicians could be successful and staying with trusted.

Dani:

You mentioned something that kind of triggered in my mind when you said the soft skills. So last season, season seven, we were talking about workforce flexibility. I had a guest, Dr. Lisa Summers, she was leading this new organization, a campaign for nurses to run for office. So she was like, nurses are actually wonderful politicians and it touches on the same point that you spoke on the soft skills. She was like, they're really good at negotiation. They establish trust right away. They can cross the aisle and get things done. And so it just kind amplifies the soft skills that you learn as caring for patients as a nurse sets you up for business endeavors. If you want to be a politician, go for it, run for it. We need more nurses in the office, starting companies and nonprofits, whatever the sky's the limit, but those soft skills of establishing trust, creating compromise in the way that it can be a win-win for the objectives you're trying to accomplish, your assessment skills, all those things are just really powerful skills that can be translated in just so many environments.

As we're talking about how you guys have grown your careers and what do you think as you think about nurses at the bedside and they need to grow their skills and careers if they want to grow at the bedside or even beyond. So is there any advice that you would give to those nurses to think about the skills and career growth opportunities that have helped either of you. Sarah?

Sarah:

I mean, I think first and foremost goes back to what you had mentioned about imposter syndrome. And so don't underestimate yourself and how applicable your competencies are and to the point you just made. I think nurses have a great foundation for being really great at whatever energizes them and you can fill in the hard skills, the things that you can learn. I get questions and inquiries all the time from nurses about I am interested, what's the first step? And I think the first being a part of the change you want to see even in the smallest ways, and you can do it without completely changing your career from the get-go. If there's something that's frustrating you is inefficient, is making your job delivering high quality and safe care difficult, it's most likely something that someone else is experiencing too. And so don't underestimate your ability to do something about it.

It's a matter of getting started and that's leaning into the discomfort. Chelsea and I have had several conversations about this, but when you first get started doing something that you haven't done before, it could be really uncomfortable. And when we had first started at Trusted, I don't think we had felt such discomfort as when since were new grad nurses, it was hard to see draw the line between how am I going to get there? But you get there. And so even if you're years into a nursing or clinical career, it's never too late to be a beginner in something else in knowledge or skill wise. And everyone started as a beginner. And so really embracing being a beginner with a growth mindset, but to that point, you've got to have your eyes and ears open for opportunities that spark your interest and that requires putting yourself out there, whether it's networking or being part of the conversation on LinkedIn, even having a LinkedIn where people can find you and sharing your thoughts and ideas so others can connect with you on that. Or in this case, slide into their DMs.

Dani:

Yeah. Chelsea, what about you?

Chelsea:

Yeah, so I mean the first thing that came to mind here for me was it's like keeping your head on a swivel for these opportunities that create challenge. When you're a new grad, you're forced into that challenge. You don't have a choice. You chose this career, you graduate, you have to show up and learn it on the fly. And that mentality, again, at that point you don't have a choice, but finding opportunities that give you that feeling again is how you're going to grow. And you have to seek those out as your career goes on. And so I think it can be very uncomfortable, but I think that is really how you grow. And especially as it relates to being a nurse in a hospital setting or a health system, it can be really intimidating to think, oh my gosh, to grow and challenge myself, I need to go be a manager.

How would I ever move to tech or a corporate world or I have to be a charge nurse. It's like I think there's also something to be said about challenging yourself in your day-to-day and just constantly having that mindset of you can grow and excel in your own role and keep stacking your resume and those skills. It doesn't mean you have to climb a ladder, move to a new industry, but if you start to get comfortable with being uncomfortable, that is how you're going to keep figuring out what lights your fire. And I think just constantly being mindful of that, it really does keep you engaged and excited about what you're doing and uplevel you as a professional,

Dani:

The power of discomfort. Sarah, you said it pressing, lean into it. And then Chelsea, I like your mention of, and then where you are today, I think it's a good call out. People sometimes think, well, I need to get another job in order to grow skills. It's like a no, you actually can grow within the job that you have, and oftentimes it is seeking out new opportunities within that job, whether, as Sarah mentioned when you were a nurse, you're like, I did everything I could. I was on committees, I was a charge nurse. So it's looking to the new opportunities that can help you understand your gifts, your talents, and more importantly your passions and following those passions. When I started my career in the staffing scheduling space, so I was a nurse manager and I transitioned into this system director role over eight hospitals and I was brought in to redesign their workforce and I had no experience. I had never done that before and I was like, well, I've got the energy, so we're going to figure this one out. It

Chelsea:

Goes a long way.

Dani:

It does, but that's again, a point of encouragement. I wasn't an expert in this space. I had no idea, but I was willing to be like, I'm going to learn the technology, I'm going to dive into this. Of course there was failure along the way, but there sure was a lot of growth and learning and something that transformed my life to who I am today. And so I think just in terms of the thing that we're hearing here is like press into this discomfort, see how you can grow. And even if you don't have the skills, if you have the desire, you can develop 'em. So let's talk a little bit more about flexibility and the power of choice, specifically a frontline nurse, but even for health systems in general. And as you're working with health systems, how has this transformed your own career and what do you think the healthcare industry needs to do to keep innovating around the concept of flexibility?

Sarah:

I think flexibility and the power of choice for nurses is so important. It's something I am incredibly passionate about and I joined Trusted because I wanted to be part of fundamentally changing the way nurses work who aligned with their need for flexibility and choice and a traditional nursing career. Working inpatient can come with a lot of limitations and restrictions on one's personal life and the choice to become a nurse. The choice one makes to work. That job means scheduling your life four to six weeks at a time, learning how to function in a family in social circles while working nights, weekends, holidays. Nurses are often told when they work what they must wear to work when they can eat their lunch, if they get that at all what they work on being a patient assignment. And I think we know nurses know what they sign up for.

And so none of that comes as a surprise. It comes with a lot of limits on choice and flexibility all while choice and flexibility has expanded for many in other professions. I think I'd like to see the healthcare industry rethink the 12 hour shift, the focus on retention. I see a lot of headlines and I hear a lot about stabilizing and core staff and maybe those two together are stabilizing core staff, but I don't think we're living in a reality anymore where nurses want to go and work on a unit for five plus years. And even that is maybe a long time, and I very much understand the economics of nurse turnover, but at some point, I think the conversation needs to shift to acknowledge nurse preferences and values and that health systems need to adapt their expectations and systems to form a symbiotic relationship.

And I believe that if you know and respect that nurses want greater flexibility, variety, control, choice, support, you'll understand that that doesn't always translate to working a traditional three 12 hour shift on a unit for five plus years. And it feels a little bit like we're trying to fit a square peg in a round hole. And if we don't really lean into the flexibility and understanding what that means and giving nurses the power of choice, I mean they have that power of choice and they're voting with their feet. And if we don't change, we're going to continue to have a hard time getting people to choose and continue to choose nursing. And so the things that are crafted and designed for us, even by nurses, but often those who no longer work on the front lines or haven't in a while, what if when we talk about flexibility and the power of choice, what if we let the frontline nurses design that blueprint and then dedicate our energy and focus and resources on bringing whatever that blueprint looks like to life? And so I think it's exciting to hear a lot about flexibility and the power of choice that I think I would like to kind of see it come to life a little bit differently.

Dani:

I think the power of the frontline and designing is fundamentally an absolute foundation of what you should be doing for any health system. But what I'm hearing you say is let's take it a step further, whole design and then the support of the leaders or maybe the administrative to bring it to life. And that gets me excited. Like imagine the buy-in from that, right? This was your solution, it is yours, we're bringing it to life. This wasn't forced on you, and I like how you brought up, we understood what we were signed up for with these terms and conditions and transactions of our job, but does it have to be that way?

Sarah:

Even if it's an initial choice, is it sustainable? And that's what we have to really narrow in on.

Dani:

Yeah, absolutely. Jesse, what about you?

Chelsea:

Yeah, I guess on a personal note for me, that's why I jumped into travel and nursing, and I think there's something sexy about that in today's environment of the word flexible when you talk about balancing your life. And so for me it was like, man, let me go work 13 weeks, take a couple off, move around, and everyone gets something out of that. But I think ultimately you're able to fill your personal cup when you feel like your professional life is flexible. And as a traditional staff nurse at the bedside in the hours, that hasn't changed and it can be very hard to be living that environment, especially I'll just say too, in post covid world, your friends are working remote, they can travel, get a job shift around jobs much more easily. I think outside of our industry, it's much hopped on LinkedIn, apply to a bunch of roles, move into a new opportunity.

And as a nurse, I think you can tend to feel stuck because within the hospital systems, a lot of this is the same theme, your hours, your unpredictable shifts. And so I think when we talk about flexible, it is, and what we're seeing now is nurses are leaving. They don't know how to find that within the health systems and the industry has to follow suit. We're historically always a little behind in how we can have change. And to Sarah's point, the frontline nurses, they want change. They're asking for change. But I think to keep nurses and keep future generations excited that we really have to tap into what flexibility means and make it sustainable. For me, being a travel nurse wasn't sustainable. I had to find a career that let me be planted in one city. And so how do we allow bedside nurses to feel that too and stay excited and engaged by evolving like these other industries have?

Dani:

Yeah, that was the beginning of your career was the choice of you feel like you didn't have the choice even in what was deemed a flexible role. Travel nursing is historically known to be flexible, and so you're like, it's not, and I'm going to take it a step further and keep pushing the limits there. I think one component of flexibility and it's key too, is our leaders. And something that I try and remind myself is how can I myself have a flexible mind about how I'm viewing, how I'm leading, how I see the workforce, the lens of practice that I've had, and that may not be the right lens in which I create solutions. And so being willing and open to listen and hear and flexible in the solutions that are proposed. And so it's a journey from within as well as the transformation around us. Let's talk about the future of nursing, and we've had lots of conversations with just different leaders across the country, but I would love to hear from both of you, what worries or excites you about the future of nursing and where we're heading?

Chelsea:

I mean, I think what excites me when you ask that question is we're here talking about this, right? I think what's excited me is really especially leading a team of clinicians that we've constantly integrated their value and perspective within as we've grown, trusted, right? It helps us influence change decisions we're making about our strategy, our product. And what excites me is we're starting to talk about that outside the walls of a startup. I think trusted is unique in that, but in a hospital system, and me as a bedside nurse when I was there, I did not feel that. I did not feel that my chain or my voice was heard, nor was change being made to have an impact on the things that the bedside nurses were asking for. And so I think what's exciting me is we're starting to talk about that there's the nursing shortage, the demand, the burnout, mental health, it's being discussed.

But I think what worries me is when are we going to see these big swings and big shifts to actually start to bring that change to life and really listen to the boots on the ground, feedback from our bedside nurses to help evolve our hospital systems in this profession to pour back into the people that are giving patient care at the bedside. And I think that's what worries me, and I hope to see that we continue to move in that direction. And obviously that does take leadership and just continuing to figure out how we can integrate that mindset into decisions that are being made across the industry and health systems.

Dani:

We don't want to circle 'em out in again and again and again. The same conversations that I know I've been having in my career since I've started. So that's a huge call out. We're having the conversations, but let's put it into action. Sarah, what about you?

Sarah:

We at Trusted, when we got started six years ago, we were quite differentiated in our leveraging of technology in our what we call nurse first mindset. And after some time and others in the space realized how impactful both of those things were. And so there's been handfuls of other innovations and companies who have done or deployed technology and this modern branding, but nurse first or nurse focus in what they're building and what they're doing. And I think that's great. What excites me is that there people focusing on this and people, Chelsea's point, the point I made earlier, outside of the walls of the hospital. And so we've got some of the best engineers, designers, marketers, business people in the world, laser focused on solving the nursing shortage and fundamentally willing to rethink how nurses work and how they're engaged as employees. I think the other thing that excites me is that it feels like we're at a point where healthcare can't not adapt.

And I'm not sure I'm convinced it's prepared to in the big bold way that it needs to, but things are looking fairly dire. The risk is much too high to not be courageous in trying new things or kind of rethinking the systems and how they're set up. And I feel optimistic because in my role every day I have an opportunity to interact and engage nursing leaders. And it's not limited to just nursing leaders, but healthcare leaders who want to be part of leading that change. And so they're out there and I think it's just continuing to push forward. And to your point, not circling them out and continuing to move forward even if that feels uncomfortable.

Dani:

So we talked about you and Chelsea connected via DMs, but where can our listeners find you? Is there a way that you want them to connect with you so that they too can have a conversation that would be life-changing?

Sarah:

I welcome anyone interested to please do reach out. I am very responsive on LinkedIn, so that's probably the best place to find me. I'm no longer on Instagram connecting with nurses, but LinkedIn is the best place to do that. Or you can find me at sarah@trustedhealth.com.

Dani:

Perfect. Chelsea?

Chelsea:

Hey, I'm laughing at that LinkedIn, also agree with Sarah. You can find me there and I'd be energized to hear from anyone who's interested in connecting. Always am. And I'm chelsea@trustedhealth.com.

Dani:

Well, this has been really insightful, impactful. I love talking with pioneers Trailblazers is what I would describe to you as both having accomplished and achieved over the last six years. What would you like to hand off to our listeners today?

Sarah:

I'd like to go back to kind of underlining maybe a point I made a few times, but I think what I hand off and encourage listeners to consider what we ask and expect of nurses in order to deliver care today and whether that's necessary and how even in the role that they're in now without big swings, how they can chip away at that.

Chelsea:

Exactly. Yeah, in line with that too, I think something that came to mind for me was really passion. I think if you're a nurse at heart and you went through nursing school and were a new grad, you know what that feels like. That's why you're here and have gotten here. And I think on a personal note and professional note, keep checking in with that and what you're energized. Are you energized by what you're doing? And to Sarah's point, what are you not energized by and how can you lean into your passion to help make that change or advocate? And I think you can so easily be paralyzed whether it's passion for a move in your career or a change or passion for change within your hospital. But I think just listen to that and tap into that. And I think the more you can feel passion and create those frictions, the more doors open and it can help be a part of this change we've been talking about today.

Dani:

Anything's possible. Thank you so much, Sarah, Chelsea, for sharing your stories and also bringing a lens and perspective that's desperately needed for change to healthcare. And so thank you. I love working with both of you. It's been inspiring just listening to this story and I feel energized and who knows what I'm going to go out and solve next from this conversation. Hopefully just a daily task. But thank you so much. I appreciate it and I can't wait to have this air soon.

Chelsea:

Thanks for having us and for the forum to have this discussion.

Sarah:

I agree. Thanks so much Dani.

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