Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works, the technology empowering next generation health system workforce management. Today we're honored to have a distinguished guest with us, Dr. April Tinsley, National Vice President of Clinical Performance at Kaiser Permanente. 

April is a healthcare executive with over 25 years of experience in various staff consulting and leadership roles at both the hospital and corporate levels. Throughout her illustrious career, she has developed and implemented numerous financial, operational, quality and experience initiatives that have driven positive operational efficiencies and generated growth opportunities for multiple organizations. Colleagues describe April as a motivated, energetic and insightful leader who possesses a deep understanding of both clinical and operational perspectives. April's journey began at the University of Missouri at Barnes College of Nursing, where she graduated as a registered nurse, and her career started at the bedside on med-surg and cardiology units.

But her passion for emergency medicine soon led her to spend over 15 years in various roles with emergency medicine and critical care. This experience ignited her dedication to improving clinical operations and the professional practice environment for nurses to further enhance her business acumen and leadership skills. April earned a master's degree in business administration from the University of Lindenwood. Recently, she completed her doctorate of nursing practice, executive Nurse Leadership at Baylor University. 

Today, April joins us to discuss the value of ensuring that nurses work at the top of their licenses and how to achieve this goal. Her insights will undoubtedly shed light on the importance of empowering nurses and optimizing their contributions within the healthcare system. Welcome, Dr. April Tinsley to The Handoff.

April: 

Good morning.

Joni: 

Hello, April. It's so great to have you today. Thanks for joining us.

April:

Yeah, thanks. I'm excited to be here.

Joni: 

Yeah, absolutely. So I'm going to jump right into it. I agree with everything your bio says. You're absolutely energetic, insightful. I always appreciate the way that you think, April, especially about nurses working at the top of their licenses. You've challenged me a couple of ways over the course of my career in this area, which I particularly appreciate and enjoy. And so from your perspective, April, what does it mean for nurses to work to the full scope of their licensure and why is this really important for patient care?

April: 

Yeah, thanks, Joni. I think it's a great question. We hear about it all the time. Everyone's saying nurses need to work to the top of their scope. But really that is the question. What does that mean? Well, really, nurses should be doing what they've been trained to do and unfortunately what has happened in my opinion is that we have gotten a little lost around what that means. So nurses, frankly, are the leaders of the care team. To work at the top of your scope is doing exactly what you've been trained to do: assess, interpret, prepare, and then make recommendations so that we are contributing to the decisions that our physician colleagues will give us. So that it's not simply “A, B and C.” So, I would like to avoid nurses just simply calling a physician to just regurgitate something. We should be able to say, we are licensed professionals. This is what I'm seeing, this is what I'm interpreting, and this is the recommendation. And so really using that full scope and not minimizing what it is that the role of the professional nurse should do.

Joni: 

Wow. So you mentioned the role of the professional nurse, and it's interesting because you and I, we've both been in nursing for the better part of two decades now. It's hard to believe that.

April: 

Wow. Right. I know. 

Joni: 

Right? We've seen a lot of changes in nursing just in the span of our careers and particularly in terms of transactional encounters in nursing. And so from your perspective, how has the transactional nature of nursing impacted the ability of nurses to apply their critical thinking skills?

April: 

So Joni, I'd like to give you a real life story where I personally watched it in action from a family member perspective. So I have med-surg, emergency medicine, and critical care experience, as you know. I felt my role as a nurse was to work to my full scope, which is to assess, make some recommendations and anticipate what is coming next. So, I had a family member recently who was an inpatient in a med-surg unit. And when I arrived, she had a drastic change in her condition from the day before. So much so that I was alarmed. So I called the nurse and I said, I'm here at the bedside. There's been a change in her condition and I'm concerned. And the nurse's response was, well, “I'm passing meds. I have three other patients to pass meds too.” And I said, I think you must have not heard me. There's been a change in her condition and I'm concerned, right? Joni, for me as a nurse, these are keywords that are being dropped. And she said, yes, I have three other meds to pass before I'm there.

Joni: 

That's so transactional. The passing of medications is so transactional. And I do think that we get lost in that, which is we need to pass our meds, we're missing the key components. We don't pass meds until we've assessed and determined that we should still be giving those prescribed medications. 

April: 

And in my example, the transaction of simply passing meds has now taken over that you have another patient who somebody is saying there's a change in the condition. Now, please know, Joni, I'm also not so foolish that I didn't realize everyone on that unit knew I was a nurse because they would say, “Now you're the one that's a nurse, right?” Yep. Red flags. We as nurses are always like, “Oh, great, there's a nurse in the family.” But the reality of it is so that even more should have, in my opinion, probably should have heightened that nurse’s just prioritization. And again, stop that transaction of passing a med and quickly come and do an assessment because no one else on the care team, there is not a physician on the unit that has that within their scope of practice to do that assessment and make the recommendation of what we should be doing differently.

Joni: 

So true. And it's really interesting because I know that was a personal experience, but I think that that experience is in most hospitals around the United States today, there are so many things for nurses to do these days in a shift trying to fit everything together. It can be easy to lose sight, like you said, of the things that only the professional nurse can do to care and safeguard the patient's entrusted to us. So, in what ways has the focus on tasks and checking boxes detracted from patient education or overall care? Because April, we have a lot of tasks and there are a lot of check boxes these days.

April: 

Absolutely. Joni and not all of them are the role of the registered nurse to actually be doing some of those tasks. And as I sit back and I think…how did we evolve? How did we evolve to where the registered professional nurse is doing tasks that do not require a license to do and instead of delegating those? And when I think about it, and I even think back as a new nurse, and I remember questioning that, I remember saying, so I actually have patients to see, but part of my role is going to be to do quality control on the AccuCheck. We don't have unlicensed professionals who should or could be doing that. And I think back to that, Joni, and I think that was an effort really to try and build the team, but in an effort of trying to build the team, we have registered nurses who are doing things that don't require a nurse to do.

I also think, and that certainly impacts when we think of, let's face it, stress. I think fear impacts that. Again, I think we'd be remiss if we didn't say the staffing challenges have added to that because we get in that mentality of checkboxes and do things that don't require a license to do, but we've asked, we've assigned that to the registered nurse. Sometimes that has also happened out of necessity, perhaps, right? We've had some reductions. Somebody's got to check the crash cart, somebody has to check that. And historically the answer has kind of always fallen too. Well, nursing can do that. I think as nurse leaders, we have to challenge that and we have to say, why does the nurse have to do that? Why does the nurse have to check the crash cart? Well, there's meds in it. Let's partner with our pharmacy. Then it doesn't have to always fall to the nurse.

And then we wonder why they feel like they're doing all of these pieces or checking to make sure all the equipment's in the room. We're a care team for a reason, we're a team. So if we can have unlicensed professionals doing those transactional pieces, it does free up the time for the nurse to be able to spend quality time with their patients. Patient teaching, again, the only member of the care team who can do patient teaching and patient education, and it's so rushed these days. It's a stack of papers that we say here, kind of go ahead and read through this at your leisure, that when we're sending patients home from whatever care setting, whether it's inpatient emergency department, an outpatient procedure, do we really think they're going to go home and read their 14 pages? And then we wonder why they're either calling back their physician, they're showing back up in the emergency room, and they're like, well, didn't you see this was to be expected?

No. How could they see that we didn't have the capacity to provide them with that moment of education and to help them or their family member? Again, we also have to evaluate where our patients are in that comprehension of this education piece as well? And Joni, again, I've been doing this a long time, as we both said, decades. Now, there are three things I've never heard us say. Never. As nurses rewind almost 30 years ago, we have never said we have too much staff. We have never said, I spend too much time with my patients and we have never said, I make entirely too much money. Those are three things we have never ever said. So as leaders, we have to say, okay, this has been decades that the same thing has been occurring. So we need, as leaders, to be doing things differently so that our nurses do have the time to spend with the patients, and that in fact, maybe we remove some of those transactional pieces that we've asked them to do because either we're trying to make the team feel cohesive. And again, I would say every member as a team does have a part. Nursing. When you look around at other professions, even outside of healthcare, not many roles would do that. Not many professionals would say, I'm going to do the job of every member of this care team. We just don't do it. And so as nurses, we do need to be able to say, let's put the right resources to do the right tasks. As you can see, I could go on about that one. Joni,

Joni:

That's fabulous. April, that's fabulous. You're right. I have never had my team members come and tell me, I think I'm spending too much time with my patients,

April: 

Right? Yeah. I've just got entirely too much time with my patients. I couldn't possibly do any more patient education. It was too much time. 

Joni: 

That's fabulous. That's a great way of getting to know them, right?

April: 

Yes. That's a great way. That's where I think nursing really is. We've been the most trusted profession for 22 years straight for a reason. And it's the nurse who comes in and is able to connect with the patient… What's important to you? Let's go over where you want to be. When we're looking at, and we've given them all the tools, they've got their boards like, let's walk through who your nurses are. And even sometimes that has become so transactional, which is they simply come in, write their name on the board. Let's talk about what are your goals for today, not my goals as your nurse. I do have some goals to get you through this admission, but what are your goals? Is it to get out of bed today? Because if it is, we need to get you out of bed today.

Joni:

Right? Absolutely. That's great. Another, I will always remember you just repeatedly asking questions in conversations we've had historically over the course of our career. Does the nurse really need to do this? I could hear Dr. April Tinsley in my ears. Is this something that the nurse actually needs to do? Does it require a nurse to do this? A great example is the nurse checking all of the patient's items and security measures at admission, right? Things that we have just historically said, like you said, “Oh, the nurse is there. The nurse can do that part. The nurse can do it.”

‍April:

Yeah, Joni, it's a great example. And it's funny, I just told that story. I like to tease. I'm the leader who's somewhat of a five-year-old as well, right? I'm always saying, why, but why? 

Joni: 

I love that. 

April: 

Why are we doing it this way? And I just gave this example, and for the listeners, the reality of it was I did ask, why does the nurse have to check the belongings? And it was actually some of the nurses at the point of care who were saying, “No, we've got to do this.” And when I said, please help me understand why the nurse? And they said, well, if the dentures or the hearing aids are lost, we're going to have to pay for them. And I said, “Yes, if they're lost, we probably are. But that has no bearing on why a nurse had to say, there were dentures or hearing aids upon admission.”

It doesn't matter who's inventorying the belongings. Do they need to, again, you're not hearing me say “stop inventorying belongings.” What my question would be is why are we adding that to the nurse when we look at the requirements, and again, this is very acute-care focused, but for a nurse to admit a patient to the unit, when we were looking at time studies, and it's in some cases over an hour– over an hour– and when you looked at what they were doing, the assessment took the least amount of time. The only person on the care team who can do that assessment on admission, and that's the least amount of where they were spending their time. We should challenge that as nurse leaders.

Joni: 

That's beautiful. That's great. Great leadership. April. So you've mentioned the role of the nurse leader, and my goodness, nurse leaders have a role in helping nurses work to the top of their licenses. How do you see the transactional aspects of nursing management contributing to staff dissatisfaction?

April: 

Yeah, Joni, so this one I really could jump on my soapbox about, right? Because I am passionate about this. Being a nurse leader is not easy. Now, I would say I think from nurse manager, nurse directors, chief executive, it doesn't really matter what role. I think for the most part, we make it look really easy. People don't realize what's happening behind the scenes. And I've historically equated it to– it’s kind of like figure skating– like, “boy, that triple salchow looks super simple.” But if I put on ice skates, I doubt I could do it. I mean, it looks pretty easy. I feel like that's the role of that nurse leader. We make it look easy. Unfortunately, we have moved into transactional tasks, and I say that because I'll say, when you ask nurse leaders what they spend the majority of their time doing, they're going to tell you scheduling and payroll, staffing, scheduling, payroll.

When you ask them what they would like to spend less time doing, it's staffing, scheduling and payroll. But when you attempt to pull that back from them, it is really the nurse leader who's like, “Whoa, wait, wait, wait. No, I have to do the staffing. I have to do the scheduling.” I would challenge that. And I would say actually, it doesn't require a nurse. It doesn't require a degree actually even to do staffing, scheduling and payroll, especially when we have the technology to support staffing, scheduling and payroll. They are the definition of transactional. And I think that has led to a wellbeing issue from the nurse leader as well because, and I'm not sure how we evolved into that, but I do think that all of a sudden, particularly at that nurse manager role, there's that feeling of 24/365 day accountability. And that isn't necessary. 

Of course, in some of our acute care spaces, outpatient is somewhat different. Procedural areas are somewhat different, but somebody does have to be responsible when you're in 24/7 operations, but it doesn't necessarily have to be that unit nurse every single time. And then we wonder why our nurse leaders are getting a little burnt out, and we also wonder why our staff are getting frustrated. 

We need to minimize that transactional role of the nurse leader. When somebody says, “Well, what would the nurse leader do then if they weren't doing staffing, scheduling payroll?” Well, I would say creating the culture of their unit and working with ensuring that the nursing staff are engaged, that their wellbeing is being addressed, which we know contributes directly to the experience of our patients, the quality of care, and every other metric you have.  

We look at our nurse-sensitive indicators for all of our quality and safety. We look at all of those pieces. Nurse leaders aren't really held accountable to your staffing and scheduling metrics. Nobody's really looking at those. They're asking you about what's going on with your CLABSI. What's going on with all these pieces? And when nurse leaders are spending so much time trying to work on scheduling and staffing, they really can't get out there to educate their team on things to build that culture of the unit. More importantly, I would say, to even ensure that the wellbeing of their staff are being addressed. 

That’s what I would say that we have. I don't want to call it a buzzword, but it's coming up a lot. And so people would say, well, “What does that mean?” I might have a different view of what that looks like from that nurse leader role, especially at that nurse manager role. I do think it looks different, but as a nurse manager, if you have a nurse who's been on the unit, this is their seventh day in a row…not only for their wellbeing, but for the safety of our patients. When I started pulling back from 12 hour shifts, as in my career, I wasn't as sharp on my third 12 hour in a row as I once was. So, I'd have to space those days, but it also was for my rest and renewal, but also led to the quality of care I was providing. And I do think at that nurse, that nurse manager level, he or she should be asking those questions, which is, “Hey, I see this is your seventh shift in a row. What can we do to get you some rest and renewal?” 

But instead, what we do is create staffing guidelines that will tell them, “you can't work any more than seven shifts in a row.” Well, that's such a disconnect then. Now the staff are angry. Now you're telling me what I can work. It really is we're trying to force wellbeing instead of really engaging with our associates to have that conversation instead of this broad stroke of we'll create a staffing policy for it, we're missing the mark. That again, is very transactional versus having that conversation and being present when and where your staff needs you to be.

Joni: 

Yeah, that's so true. And so nurse managers, I feel like that is the hardest role in healthcare. I mean, you're really sandwiched between a couple of different layers and you're trying to engage with frontline team members and then also with directors and above. Even the c-suite will connect directly with nurse managers at times. So how can nurse managers balance the expectations and demands from both staff, team members and executives while maintaining a healthy work environment? How do they do that?

April: 

Joni, again, I think that often we're asking that question, which is, how are we balancing that? I think it goes back to elevating our role as professionals. And so as that nurse manager, remembering what their level within that organization is. And again, if we're asking our nurse managers to fill in staffing every single day or even half of the time, well then they're not doing their role as a nurse manager. And I do think to balance that with the staff, because I think if you ask a lot of clinical frontline nurses, what makes a good nurse manager? A lot of times you'll hear them say, they jump in when they need to help us when we're short staffed. I do think there has to be a balance to that. And so yes, jumping in maybe playing air traffic controller during a time of a crisis.

Joni: 

Absolutely. 

April: 

Well, when I say crisis, I don't mean true crisis, but things are a little hectic wherever you're at, kind of doing a little air traffic controlling. But if the expectation is that's what you think makes you a great nurse leader is that you jump in and take an assignment every single day, you're actually not functioning at the nurse manager level. And so I would say elevate your practice as well, which is you've been put in a position of leadership. And so it's not to manage the unit or manage a patient assignment, it's to lead the unit. And it's to be able to have those conversations with the staff to let them know you will jump in when it's necessary, but if you’re staffing, if you are in staffing every single day, there's no way you can do all the other jobs that need to be done to improve the conditions on the unit.

If you're staffing four days out of the week, how are you interviewing potential new associates? So, that's all delayed and that's just foundational, because, well, we're so short staffed. If the leader is constantly staffing, there's no opportunity to even bring on new team members.

From the executive level, I would say that, again, if you're constantly in staffing, you're not able to really dig into your unit financials to be able to have those articulate conversations with either the Director, the Chief Nurse Executive or your CFO, to be able to prove your case of why you are asking for what you're asking for because you're really too busy just trying to maintain a patient load. I also think too, that being able from that nurse manager level, when we're given initiatives, so let's just say bedside shift report, so that crosses all of those examples that you've given.

Where does that nurse manager play? It's leading by example. It's being able to have those crucial conversations knowing that when we're receiving resistance from our staff, that we're able to coach and mentor why it's important, the impact it's going to have, and then crossing that level to the C-suite, which is being able to articulate our results and having that ability to say, here's my data that supports it's working, or here's my data. Thank you very much, right?

And again, if the nurse leader is not able to really be grounded in the data and the evidence-based practices, the literature is there, it supports it. And I look back, and change is hard. Change is so hard. And I used to say, right, if we didn't change, we'd be coming to work in our horse and buggies. We'd be grinding up our own pills. Look at all the advances we have made. And so change is hard, but when we look at it and we say, okay, so the evidence supports the bedside shift report works. Hey, why are we so resistant to it? We can name all the excuses, right, all the excuses, but we know it works not only for our patients, it improves the team collaboration. So we have all of those examples. It's the nurse leader who has to be able to show the literature, work through the barriers, coach the team, and then again, work from the director level up to explain the results and the metrics.

Joni: 

Yeah, absolutely. You mentioned that we build policies and procedures with broad strokes in order sometimes to correct things, protect things, but that in and of itself becomes transactional and almost to a point of micromanaging the professionals. So why is it important to recognize and really utilize the professional skills of nurses rather than micromanaging their tasks.

‍April: 

Yeah, so Joni, yeah, it's a great question. I think when we look at some of the policies and procedures that we've done, a lot of times people will say, well, it's a regulatory issue or it's a safety issue. And when you really peel that back, it's not a regulatory issue. It's something maybe we had a finding on a regulatory issue at one point 17 years ago. So what we have done then is we basically are micromanaging how we want the professional nurse instead of really saying, okay, let's learn from what happened, let's educate and let's let the registered professional nurse elevate their practice so it doesn't happen again. 

When we micromanage and we build these policies and procedures, excuse my transparency when I say this, we're dumbing it down. We are dumbing it down instead of allowing the nurse to pull themselves up and be able to work at that highest level and ensuring that we're saying that it won't happen again, but instead, we haven't allowed them to even critically think to give us ideas that would have impacted that. And instead we make this broad sweeping policy change that will micromanage how they're going to do it. And now we're not even asking them that. We're not even asking them to elevate their practice.

Joni:

Yeah, that's great, April. I totally agree. When we tell nurses what to do, we lose the brain trust of incredibly diverse and educated professionals who actually do the work and know how to make the work better. 

April: 

Absolutely. I agree. I've said before, the answers are always in the room. And do I think I'll use myself as an example, do I think maybe I could come up with some solutions? Yeah, I think I could, but really I'm not the one doing the work anymore. So what I'd really like to ensure as a nurse leader is that what we're implementing makes sense to those that are doing the work. Because what do nurses do when we give them something without their input? If it doesn't work, they create a workaround. I was the queen of workarounds. I really was, because if this doesn't make sense, nobody asked my opinion, but I'm going to do it how I think it's going to work, I would create a workaround. And then a lot of times it was decreasing efficiency, and maybe it wasn't within the best quality standard that we would want because it wasn't working for the flow of how the registered nurse should be doing what it was that they needed to be doing.

The answers are in the room. 

Now, do I think I have to ask the nurse to come up with the idea? No, bring a half-baked process that they would say, will this work? And you get the right nurses that we have asked to elevate that we've asked, “Hey, we want you to work at your top of scope.” Again, I should add that to my other thing that I haven't heard nurses say, which is “I don't really want to work to do what I went to school to do.” I should ask that. I should now add that to my list of things. Because if you ask them, “Hey, will this work? We want you at the top of your license, we want you to be the professional that you are.” They'll give you the feedback, “This won't work. Here's a better idea.” And then they will tweak it so that when it is rolled out, it has had the voice of the nurse, not anyone else.

Joni, it is interesting, in our profession, I'll use nursing documentation as an example, right? I've spent a lot of time in my career trying to reduce the amount that nurses document, right? Because again, somewhat transactional because a lot of it isn't something that the registered nurse needs to be doing. But I've spent some time focusing on reducing how much nurses are documenting. And it's amazing to me how many people within the care team have something to say about what the nurse should be documenting. 

None of them are nurses, but a lot of members within our care team think they should have a voice in what nurses should be documenting. And the reality of it is, it's the nurse who should be driving what the nurse is documenting. Now, certainly, obviously I know there are certain pieces that we know the nurse has to document, but again, to have dietary pointing in on what we think the nurse should be documenting, no, thank you. The nurse will document what is within the nurse's scope and licensure. That's what nurses should be documenting.

Joni: 

Yes. I love your perspective. The answers are always in the room. That is the truth. So if the answers are always in the room, April, why is it crucial for nurse leaders to move past traditional ways of leading and think creatively or differently about staffing and work environments? Do you have any examples of innovative leadership in nursing?

April: 

Yeah. Great. So Joni, I think the reason why it's important is because it's not working. Our nurse leaders are feeling stressed, our teams are stressed. The landscape of healthcare has shifted so much, but we have not shifted. So we do have to look at leading differently, empowering our staff, empowering our nurse leaders, our chief nurse executives have to be courageous. For example, take the role of staffing and scheduling away from your nurse leaders. That's such an easy fix. I say that, right? Such an easy fix. It's that Triple Salchow, right? 

Joni: 

Exactly. 

April: 

But our chief nurse executive should be saying, “why are my nurse leaders spending between 60 and 80%-- that’s what the data shows–60 and 80% of their time doing staffing, scheduling and payroll. Goodness, get that away from them. Having non-licensed, doesn't need to be a nurse, doesn't need to have a master's degree or higher doing staffing, scheduling and payroll.

I'm not saying not having a relationship with the team in order to make sure that that balance is met, but then that nurse leader really can be looking at creative ways to be doing different things. We don't have enough nursing research going on in a lot of facilities because there's just not the capacity. So imagine you remove some of that transactional piece of the nurse leader, and that nurse leader is really able to spend some quality time asking the team, “Hey, what could we be doing differently here?” Maybe it isn't a full on IRB approved research, but maybe it's just a QI process that we can really say, look, this has impacted whatever metric it is that we're trying to solve. And I do think that if we continue to lead the way we historically have led, nothing is going to change, right? Absolutely nothing is going to change.

I've been reading a lot of articles where a lot of different organizations are looking at Fridays off for nurse leaders or no meeting Mondays, those types of pieces. I kind of chuckle because in 24 hour operations, there are nurse leaders who are thinking that's never going to work. I ask, why wouldn't it work? 

So Joni, you and I are nurse leaders in the same facility. I trust you. Our boss has said, you are a qualified nurse leader. They hired you, so why wouldn't I trust you to cover my unit while I'm off? Or here's another thing. We ask all of our nurse leaders to sit in the exact same meetings all the time, same meetings. Why aren't we trusting that one nurse leader disseminates the information? Let's face it, we ask that of our nurses, we send you to a conference, we expect you to come back and disseminate the information. And they do, right? It's amazing. They present somehow or maybe they do a poster presentation, but we don't challenge our nurse leaders to do that. 

Do we all need to be sitting at the exact same meeting? If we as chief nurse executives or directors and above can really challenge that to say, let's free up our leaders. Let's build our trust among each other that I trust Dr. Joni Watson to give me the updates of the meeting, to cover my unit, and make decisions and trust those decisions. Will they always work? Maybe not. So let's say, you know what? Maybe you made a decision that impacted the staffing of my unit. Okay, am I never going to trust you again or am I not human? I might make the same mistake given the information that I had.

So I do think we have to look at doing things differently that will support those that are at the sharp end regardless of your care setting. But our decisions that we need to be making for the wellbeing of our staff, the nurse manager's wellbeing has to be as well. And frankly, I don't see right now where there's a lot of nurses raising their hand to say, you know what? I want to be a nurse manager because the role looks so difficult. And again, I would also say though, Joni, and I'm sure you've heard me say this before in some of our historical conversations, we have to change the narrative. We have to change the narrative that we as nurses are sharing. When I look on social media or you hear nurses talk, we are not the biggest cheerleaders for our profession. We have to change that narrative.

I am not saying people shouldn't be saying, “Hey, we need to make improvements.” But it's how we share that message. And again, I remember as an ER nurse, I remember driving home after a midnight shift and thinking, I know I didn't eat, but did I urinate last night? And I was like, but that was the greatest shift I worked. I remember driving home with my biscuits and gravy on my passenger side. I was going to have breakfast when I got home. I distinctly remember it is one of those moments. And I was like, the entire team came together, but I wasn't doing the woe is me. I didn't get to eat, I didn't urinate. And we almost wear that like a badge of honor. No other member of our profession does that, right? You don't hear our physician colleagues doing that. So why, as nurses, if we want to be treated as the professionals that we are, we have to change our narrative.

We need to be able to be the cheerleaders for our profession, for our teams. I do think that it really does start with our nurse manager role because that balance of managing your relationship with your team as well as the role of the nurse manager is somewhat dicey in that part, right? 

But again, because you want to relate to your team as well, but being the leader is not always being the friend. It's the leader. And so changing that narrative that will change our profession. We want to make sure that we are preparing for succession planning. And when you are a nurse leader at any role who's like, this is the worst job ever. I have terrible work-life balance, all the things, and you're sharing that with your team, none of them are going to raise their hand to say, this sounds like a good gig. Let me do it. And so I do think that's part of being a professional, which is elevating ourselves and being able to be the cheerleader for the profession, which is– let’s tell the great stuff, but the challenging stuff too. We do need to bring that to the surface. Please hear me say that. But the way we deliver that message is what will create the difference of are we professionals or is this just a job?

Joni:

Yeah, that's a great point. April, teams and beautiful memories are usually forged in challenging moments. That's usually when teams come together. As I think about my own experiences, just like you shared, it is those kinds of moments that I think, “Oh my goodness, I'm so glad that I got to work alongside you during that shift. It was a difficult shift. It was the people and my colleagues that made the difference.” And so you're right. I love the way that you ask questions, April, and I know that you joke about being a five-year-old asking why and why not? I'm the same way. And I think as leaders, we need to ask more questions to help spur nurse managers ourselves, our team members, our colleagues to practice at the top of their licenses. That's a great challenge and spurring April. So like I said, I've always loved the way that you think and ask questions. So I'm curious because we have worked together in the past with one another. We don't work together in the same healthcare system right now. And so I'm curious, what are you reading or experiencing right now to sharpen your skills? How are you pulling yourself up? I mean, you have a master's in business, you have a doctorate of nursing practice, executive nurse leadership. How are you spurring yourself on and nourishing your mind and your soul these days?

April: 

So I like to think I have a great balance. So from what I listen to on podcasts versus when I'm buckling down for the profession, it shouldn't surprise you based on our call today. The funny thing is the book that I go to most often, sits on my desk, and then I had to look down on the floor to be like, what was the second one? And so it shouldn't surprise you Lead Like a Nurse by Dr. Adams, right? I mean, it's earmarked. There's pieces because leading like a nurse, that's what we want. So I would say I like to refer to that frequently. And then the other one would be Work Better Together, which is by Jen Fisher. And it really is on how to cultivate strong relationships to maximize wellbeing and to boost bottom lines. And so how do we do that? So those are my two professional ones. I would say I'm also a true crime junkie, so that's what I do when I need to just kind of decompress. But from a professional standpoint, I would say Lead Like a Nurse and then Work Better Together.

Joni: 

Great recommendations. We've covered a lot today. April, ultimately, what would you like to handoff to nurse leaders at all levels and in every setting?

April: 

Yeah, that's a great question. I feel like I would have so many, right? And the opinion of one, but I think if I had to hand one off, it really would be let's challenge ourselves, right? Let's just not say we need to be elevating the profession. We need to be working at the top of our license. Let's challenge ourselves and not only ask my five-year-old question of “why,” but follow up with, how are we going to do that? And where do I think it starts? I think it starts by asking those questions, asking how we can elevate the role of the professional nurse and have them work at the top of their licensure and their scope? Ask the nurses what that looks like. And for nurses who don't know what that actually means, we need to be able to articulate what is the role of the professional nurse, and what did you learn in nursing school, right?

You learned you were going to be the leader of the care team. You learned that you were going to be the one who were going to be the eyes and ears to be able to assess, to intervene, to look at all of the, in this example, let's say you've got a patient who's got some blood pressure issues. You've got a plethora of information to look at and make your informed decision for a nurse-driven protocol. I do love some nursing protocols, but in the event you don't have that to be able to call your physician colleague and be able to paint the picture for them so they can make the informed decision. I'd love to make a recommendation. So I would recommend we do blah, blah, blah, blah, blah. That is raising our profession up. Instead of simply saying, here, my patient's blood pressure is high, low, what have you. And I want us to be able to ensure that our teams are equipped with the right resources, doing the right tasks to allow for that nurse to have that time to do their assessment, their interventions, make the recommendations, and elevate the role.

‍Joni: 

Excellent. April, where can people follow or connect with you to find more of your work?

April: 

So I would say LinkedIn would be the best place. So that is my professional social media place, I guess I would say. So LinkedIn would be a great way to connect.

Joni: 

Excellent, beautiful. Everyone, be sure to find Dr. April Tinsley on LinkedIn and continue the conversation and the questions. April, thank you for sharing time, energy, expertise, passion and spurring questions with us today to help us move nurses and nurse leaders to the top of our licenses. Thanks so much for your time today.

‍April: 

Thank you, Joni. 

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