Dani:

Welcome back to the Handoff from Trusted Health. I'm Dr. Dani Bowie, Chief Nursing Officer of Trusted Health. This season we're covering healthcare innovation and the importance of fearless leadership for change. In this episode, I have the pleasure of speaking with Dr. Desi McCue, Senior Director of Operations at the Center for Women's Health at Oregon Health and Science University and current President of Northwest Organization of Nurse Leaders. Today, we discuss workplace violence and the impact of tailored programs to improved outcomes. We also cover her thoughts on nurse staffing laws, her pathway to leadership, and how professional organizations shaped her as a nurse leader. Here's my conversation with Dr. Desi McCue. Welcome to the Handoff. I am excited to be speaking with Dr. Desi McCue. Desi, welcome to the Handoff.

Desi:

Thank you, Dani. Thank you for having me. It's a pleasure to be here.

Dani:

Yeah, I can't wait to start. And first of all, we've been starting the podcast off with how can we center back to the patient and the experience of the patient and the work that we do as clinicians and caregivers and healthcare. And so Desi, I would love it if you could share a story or a patient experience that has had a particular impact on you and your career that you can share with our listeners today.

Desi:

There's so many patient stories, and so I picked the one that resonates with me still 20 years later, which is odd because I think that people probably most often think of something that happened to them recently. But I recall being a newer ICU nurse on a cardiac surgical ICU. And I had a patient who was a medical ICU overflow patient and was very sick. He'd had cancer for a really long time and was septic. And we started out doing a lot of really intensive care for him, multiple drips. He was on a ventilator doing lots of proning because he had ARDS and he was a really, really sick man. And at some point his family finally decided to put him on comfort care. I recall in that moment feeling sort of mixed about that we'd been trying so hard to keep this man alive and now we're sort of withdrawing everything.

And I think for sometimes, especially for an ICU nurse that can feel like, well, this is now below my level, right? They don't need me anymore. I'm the intensive care girl. I'm the who's doing the lifesaving interventions and multiple drips and you don't really need me to shut off things. That's not my thing. They could probably go to med-surg. And I remember connecting with the patient's mother and just having this moment with her where she was afraid to leave the bedside. And I said, don't worry, I will not let your son be alone. If you're going to leave, I will be here and I'll be holding his hand and I will let him know that I'm here. And I remember covering all the monitors with sheets and making the room as non-medical as possible and feeling that rather than being disappointed that I wasn't being "an ICU nurse," feeling empowered in giving this man dignity and death and giving his family the opportunity for closure and really making a sense of explaining everything we were doing and what did it mean as we withdrew things.

What did it mean as we made him more comfortable? And as he finally passed, and it turned out it was a community-based hospital and the woman, the mother, I did not realize, went to church with my grandmother. And so I actually attended services with my grandmother later on and ran into this woman. And I actually didn't recognize her. It was years later, but she remembered me and the impact I had for her and her family, and she saw me and just started crying. And she said, you took care of my son when he needed you the most, and I will never ever forget you and you are my angel. And I was embarrassed that she was calling me out, but at the same time, how many patients would I ever have had that impact on them and their family? And that was so meaningful to know that years later I still had such a profound positive impact on that family's experience, which was a very sad thing to go through. And so I think it also taught me this lesson that in nursing, nothing's beneath me or beyond me, and that all care that I provide or all of the nurses now as a leader that I support to provide care is important from the littlest act to the biggest. And there's not one type of nursing that's more important than another. We're all doing something really valuable and the people we touch, it's even more valuable to them.

Dani:

Desi, you bring up a good point. As I was listening to your story, often in healthcare there are specialty based clinicians, ICU, med surg, step down, pediatrics, you name it. And I think it's an important call out that you had of the mindset shift of this is how I'm trained is to save lives and it's really important. But the point of care that was needed for this gentleman was transitioning to end of life and how impactful that was for his family and how nursing is holistic in the services we provide. It's a valid recognition of the mindset that we have as we're doing our jobs that you were trained to save lives and it's not as often that you help with the transitioning to death and passing. So thank you for sharing and kind of calling out, I think some uniqueness to our profession and also the specialty and the learning of rising above to service our patients and meet them exactly where they're at. Desi, you have a really interesting career and it would be awesome if you could share one or two pivotal moments that helped shaped your career and where you are today.

Desi:

I think the most pivotal thing for me is probably a series of events because my first jobs in healthcare were around the support roles for nursing. So being a unit clerk, being a transporter in the hospital, working as an or secretary and scheduling surgical cases, working back when we developed films, being a radiology assistant and developing mammograms and chest x-rays and being a cardiac monitor tech all before I became a nurse. So I had a really healthy respect for my colleagues and for being a team player and understanding the value of everyone's roles when I became a nurse. And I think that that helped me not only be a better nurse, but once I entered leadership, being a better nurse leader because I valued everyone on the team and I didn't believe that certain people were more important than others. I understood the individual contributions.

So I think that part has really shaped me. And then of course there's a's always leaders that we would follow to the ends of the earth because we respect them so much. And I certainly had leaders who stepped in and helped us on the floor when we needed it. And then I had leaders that I shaped me the other way too that I said, oh gosh, I really hope I never do that and I never want to do what that leader did. Looking back on those experiences, I wouldn't either being led by a strong leader or maybe someone who was not meant for leadership. And I learned those lessons on how I don't want to be as a leader, and those were just as strong and wonderful in shaping me to be a better person and a better leader.

Dani:

That's a really important call out being led by both types of leaders to understand you yourself as a leader and who you want to be and the characteristics and the qualities that you want to emulate and those that you're like, I would like to do that better. I also didn't realize that you had had an extensive career in healthcare outside of nursing, building your way into the career, you've been in the trenches from all angles. And then using that experience then to go into leadership, I'm sure has created some really powerful impact for the teams that you lead and the initiatives that you take on. Speaking of initiatives, I know that workplace violence is top of mind for many clinicians and as well as for you as a leader. What programs have you created to support physical and psychological safety for your frontline staff?

Desi:

Yeah, thank you for asking. It's something I'm really passionate about having led in the emergency environment for 15 years and seeing the progression of violence in healthcare not only before the pandemic, but during really made it a critical initiative for me. And over the years, I taught a lot of what I call box programs of workplace violence prevention and deescalation training and personal safety. And they're all really great. They have really great aspects. They teach people valuable lessons on how to deal with the public, but what they don't take into account is the individual environment that person's working in the legalities of the state law or local initiatives that might impact how a person practices as well as the decisions that a nurse might have to make when they are dealing with someone in a violent setting. And so we really at our hospital, looked at all the research and all the programs we had taught before and customized them to each environment.

So when I went to teach emergency department nurses how to deescalate, I thought about where are some of the real patient scenarios that they are dealing with? How much of their population is under the influence of drugs and alcohol, and how might that approach be different than someone who's very angry about something else? And then a completely different tactic with the same basic principles. But for our sitters who worked on the floor with adolescent psychiatric patients, we would change the focus to their environment and their clinical needs and some of the concerns that they had. And by tailoring it, not only do I think the people paid more attention and got more out of it, but I also feel like we answered their real worries, fears and questions about what they could do and when they could do it. And I think the most important thing that we did was shift people's mindsets.

This sort of goes back to almost my patient's story a little bit where we want to do things we want to fix. We're nurses and we want to fix things, and sometimes in violent situations, the exact thing we need is for nurses not to fix it. We need for them to step back to know when to disengage, when to give people more space, when not to push a treatment. I think a lot of times we feel like, oh, this is ordered. This is what's best for the patient, and we really push it on people instead of stepping back and going, huh, they don't want this. I wonder why And giving that space, and a lot of that's just because we're busy and we're all well-intentioned, but teaching nurses when to back off and disengage was a very valuable lesson. And just that in itself decreased physical injuries. Serious physical injuries by 75% in one of our departments, which was pretty profound. Does violence still happen? Of course, but the number of actual injuries to our nurses significantly decreased because they knew when to disengage from that patient.

Dani:

Amazing results. Amazing. And you're absolutely right, learning how to disengage. We are trained to heal. We want to help. We want to make sure that patients get the best. And so helping us shift our mindset and your team shift their mindset that the best is meeting 'em where they're at. And if they're not wanting to do something to know when to support that and disengage. It is a matter of choice. I also really liked how you mentioned you took the box programs and you made them out of the box in the sense of tailor made, custom made to the specialty areas. And as I was listening to that, I think that's a really awesome approach for any leader because we don't have to reinvent everything, right? There is lots of programs and philosophies and things out there that we can take learn from and then implement into practice with minor modifications for customization to make it very effective. I love that example, and thank you for sharing that. I want to switch gears. I know you're practicing in the state of Oregon and the state of Oregon recently passed and are staffing. What's your perspective on this upcoming nurse staffing law and the impact that it will have on nursing in the state?

Desi:

I would say my feelings are a little bit mixed at this point. I know that we certainly can survive ratios. California did. We certainly can. I think I grieve a little bit for the lack of innovation that applying a strict number creates for people. When I say this type of patient needs one nurse or these five patients need one nurse, I'm not taking into account a lot of things that need to happen for that patient as far as they're shifting acuity, people possibly getting sicker, people getting better. The nurse's ability to drive the plan of care and decide what resources they need for those patients, especially the charge nurses at the unit, it doesn't eliminate innovation. In fact, the law does say that a nursing staffing council could vote for an innovative model. Most nurse leaders I talk to though don't believe that any of the nurses are going to want to vote for an innovative model.

They're not going to want to try something new. And so for a lot of hospitals, especially in rural areas, it's really going to tie their hands as to how creative and innovative they can be. One of my biggest dissatisfiers at the bedside and what I hear from most nurses when I'm rounding is when they're not working at the top of their license when they feel like the work that they're doing is something that some other discipline could be doing, or they don't feel like they're using all their years of education and their critical thinking to drive care. And in some cases, I do think this is going to drive a primary nursing model where the nurse is doing everything and it's going to limit the ability to, for instance, have dedicated case managers and social workers on units to have people to do your ADLs and hygiene for you to have people who knows there could be a patient care role that we could invent in the future. That takes off a lot of stress for nurses and for physicians that we just don't know about. And I also worry about as we have a physician shortage on top of the nursing shortage, more and more is going to get pushed to nurses because of the lack of physicians and other apps and those nurses not being able to do the things they love because there's going to get more pushed onto them and then there will be a lack of flexibility from the ratios.

Dani:

You know what you're touching on all the key components of, I think we both agree well-intentioned, we want nurse staffing to be at the best possible level that it can be because we know that a healthy work environment promotes joy in the workplace. It gives the nurses a sense of meaning and safety even in that, but it's not just a numbers game, it's more than that. It's acuity that changes, but sometimes hour by hour for a patient discharge transfers that we need to take into consideration and top of licensure work and a number doesn't address top of licensure work. And if you shift numbers one way, what will be also removed if you build up one number? And then is there another number of, as you mentioned, support staff, et cetera, that is reduced to account for this change? I think it's complex and I'm hopeful as I hear in the law, there's opportunity for innovative models to be approved that maybe there will be some in the state of Oregon where out of necessity and need it comes to life. I agree. You're hitting on all the key components of let's get staffing where it needs to be, but not forget about flexibility and choice of the nurses and top of licensure work. I also know that you are the president of Northwest Organization for nurse leaders. How did you get involved professionally and what brought you into the Northwest organization and what are some unique focuses that you have as top of mind as you're helping lead that organization?

Desi:

I had an incredibly supportive chief nursing executive when I got into my first Oregon leadership role and she actually purchased this membership for us, but she said, I only purchase it once unless you're engaged and so you have to tell me that you've gone to association meetings or chapter meetings and that you're actually engaged in the organization for me to pay for this next year. And so I started going to these chapter meetings for N W O and L and I was so in awe at how many leaders from other organizations were going through the exact same struggles I was. And to be able to be vulnerable with them and share ideas and them to be willing to share innovations that they had that I hadn't even thought of was so rewarding that I ended up becoming a local chapter and really, really loved doing that.

I got to set the agenda for some of the speakers that we had. I got to engage with a lot of chief nurses from our region and find out what was important to people and try to bring in new offerings and then was encouraged to apply for office secretary treasurer and then eventually president. And I can say it's been one of the most valuable experiences I've had to network with other nursing leaders, especially during covid, to have people to go to and have them understand completely what you're going through. And I think Covid was hard on everyone, but particularly leaders because we were worried about our staff after hours. We were concerned about what the next rule was and how we were communicating and just that camaraderie of having someone else that also was worried about their staff and also didn't know what the answer was going to be tomorrow about what P P E to wear or whether to be vaccinated or all these things that were so controversial. Those are moments that I think made me a better leader because I could draw on those other leaders and made me a better mentor because I could also share the things that I was doing and help build others up

Dani:

This sense of community and belonging that I'm hearing Northwest Organization for Nurse Leaders. It used to be Northwest one, but I know it's changed, so I keep wanting to reference it that way. It's near and dear to my heart. I mean, that was a pivotal experience in my career as well. Now I live in Ohio and I love the activity that was happening in the state of Oregon and Washington and that professional community and am just delighted to hear the thriving elements of it and that you're leading with such a sense of inclusivity and belonging and creating a safe space. What I was hearing, Desi is like a safe space to share the vulnerabilities as well as the opportunities to improve practice to grow together, and that is invaluable. So well done. I wish I could come attend a chapter meeting if I'm ever in Oregon or Washington when it's happening. I'll reach out and see if I can attend. Yes,

Desi:

Come on over.

Dani:

Would you give any advice to our listeners about how they could get involved professionally? What would you encourage our listeners today as they think about their career? And also I know a lot of new nurses are like, how do I get involved and what should I do and where should I look? So do you have any advice for them?

Desi:

Absolutely. I think one of the best lessons I got is that leadership is a specialty. And when I was a critical care nurse, I belonged to the American Organization of Critical Care Nurses when I was an ER nurse, the Emergency Nurses Association. And as a leader, I think it's great to still be involved in those things and to know the practice components for your group of nurses that you're leading, but I think at some point you have to recognize that leadership is its own specialty. And so you start looking for organizations that will bring that to you. And there's many professional organizations that you could join or local ones such as N W O and L. And what they really help you do is understand beyond what I needed to be a good clinician and a good individual performer. What are the skills and tactics I need now to lead those individual performers to beat their best?

And while a lot of organizations have a leadership track, a lot of them aren't completely just dedicated to leadership. And so having that sense of community where you are embracing leadership as a specialty, you're challenging yourself to lead in new ways and you're staying on top of all of the information that's coming out as far as healthcare trends and innovations and different staffing models and learning about how to run healthcare as a business as opposed to participating as a employee in the business is very valuable. And I cannot recommend enough that once you decide that leadership is a pathway you want to explore that You also consider joining a leadership organization.

Dani:

I actually haven't heard of it mentioned that way, and it's kind of like how we started the conversation. You were an ICU nurse and you were thinking broader through this patient experience of you were delivering care one way and you're shifting into a new point of care. And the same goes for as your career shifts, how do you continue to build those special skills to be effective and to be the right type of contributor where you're at? And so leadership as a specialty and investing into the learnings, the skills and the community to bolster that and help you be the best that you can be is a really great call out and something that I actually haven't heard before. This has been a really delightful conversation. Desi, where can our listeners find you if they do want to reach out and have a question for you?

Desi:

Sure. I'm on LinkedIn and I believe my LinkedIn handle will be in the notes of the podcast. Yes, I am also at Desi McCue@gmail.com. That's my email.

Dani:

Love it.

Desi:

It's not vain, it's just because it's hard to remember other things.

Dani:

No, I'm all about that. I have emails with my names as well, and it's some of the best. I love it. As I mentioned, this been really a great conversation and as I said, delightful. It's been a joy listening to your passion. Also. I see optimism though our listeners can't see it. Desi actually has a smile on her face through most of the conversation. I mean, it is just she's got an essence of joy and delight in the work that she's doing. But what would you like to hand off to our listeners today?

Desi:

I think that I would love to hand off that healthcare is changing rapidly and we've all lived through a lot of rapid change lately, and you can do it and never ever let the fear of being seen differently or the fear of failure or the worry that maybe you're not ready or you can't do something, hold you back from going after what you really want and from challenging yourself to do new things. It's okay to try and it is inspiring to others when you do so don't hold yourself back from doing what you really want to do. And from advancing healthcare leadership, we need new ideas and we're not going to get that by doing the same thing over and over.

Dani:

You hit on a point, which is our podcast is about fearless leadership this season, and then we don't even talk about it. You mentioned the essence of leaning into the uncomfortableness and don't let fear hold you back so you hear at listeners, don't let fear hold you back. Explore the new horizon and opportunities because we need you. Desi, thank you so much for your time today and your insights. This has been a really great conversation and thank you for sharing everything that you have.

Desi:

That was my pleasure, and it was such an honor. Dani, thank you for having me.

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