Joni:

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders from Works. I'm happy to introduce this episode's guest. Our guest today, Dr. Nick Escobedo, is more than just a leader in healthcare. He's a visionary whose passion for innovation and compassionate care has left an indelible mark on the industry. Currently serving as the Associate Chief Nursing Officer at Houston Methodist, Nick embodies the essence of a human-centric leader, constantly advocating for the well-being of both patients and health care professionals. With a multifaceted background as a nurse, techie, and innovator, Dr. Escobedo's expertise extends far beyond the traditional boundaries of health care. He's a driving force behind initiatives aimed at promoting a healthy workforce and fostering a culture of inclusivity and empowerment within the nursing community. In addition to his role at Houston Methodist, Dr. Escobedo serves as a strategic thinker and change agent on the board of the American Organization for Nursing Leadership, where he continues to influence policy and drive positive transformation across the healthcare landscape. 

Dr. Escobedo has a highly accomplished nursing leadership career with a strong background in healthcare management, clinical operations, and patient care. He holds a Doctor of Nursing Practice degree from the University of Texas Health Science Center at Houston, a Master of Science in Nursing in Educational Leadership from Texas Tech University Health Sciences Center, and an Associate of Science in Nursing from San Jacinto College Central. With over a decade of experience in the healthcare industry, he has demonstrated expertise in various nursing roles, from direct patient care to executive leadership positions. He currently serves as the Associate Chief of Nursing for Houston Methodist Cypress Hospital. Throughout his career, he's been recognized for his exceptional leadership skills and dedication to improving patient outcomes. He has led numerous initiatives aimed at enhancing patient care quality, reducing hospital readmissions, and implementing innovative technologies to optimize healthcare delivery. So without further ado, let's dive into the world of developing the leader within you and leaders around you with Dr. Nick Escobedo. Nick, it is so fabulous sharing time with you today. 

Nick:

Yeah, thank you, Joni. I'm so, so excited. I'm a listener to the podcast and I'm so glad to be a part of its legacy with you as you take this on. So thank you for the invite. I'm so excited for our chat today.

Joni:

Excellent. I'm so glad. I always love it when there are listeners that get to be guests. I mean, it's just like an added layer of fun. It really is.

Nick:

It's going to be fun.

Joni:

Yeah. So, Nick, in watching your career, and we've been colleagues for a while through the Oncology Nursing Society, which is where we originally met. I've been astounded at all the things you've accomplished. You have such a vibrant perspective on leadership, in my opinion. And while we talk a good game in nursing and healthcare about this topic, you truly emphasize the importance of developing leaders at all levels within healthcare.

Joni:

So can you share your approach to fostering a leadership mindset across diverse roles and specialties with us today? 

Nick:

Oh, my gosh, yes. Great question. You know, definitely, I think it kind of starts with a little bit of a framework and just my feelings about leadership. And when we talk about leadership and we look for the definition of a leader, really focus on those very formalized leadership roles, you know, Manager, Charge Nurse, CNO. But I take the framework of really and truly everybody is a leader, right? You don't need to be a boss to be a leader. That misconception that you need the fancy credentials, the formal titles, the role in the office of manager, director, chief emergency officer, I really don't believe that. I think leadership really, you know, at its foundation is about how you are able to motivate, how you are able to influence, and how you work very collaboratively in an environment of respect. So again, it's not about the title, it's not about, you know, a role, but it's more so of those behaviors that we see leaders do.

It's about doing. So there's an interesting quote from Brené Brown that I really, really like to refer to a lot. She says, leadership is not about title, stance, and wielding power. A leader is anyone who takes responsibility to recognize the potential in people and ideas and has the courage to develop that potential. I've just leaned into that mindset and mentality that in our very collaborative world of healthcare and working within very multidisciplinary teams, we just have this inherent opportunity to provide, you know, avenues and venues for people to really drive and change, you know, the whole mindset of leadership, right? So my work really has been to focus on how we personalize that strategy and how we can work with our teams to really hone in on these flexible developmental activities that help build a skill set to really change the way that we deliver health care. 

I've got an example of a nurse that I've seen kind of grow in her trajectory as a frontline nurse and now very much of informal and in some cases, formal leader, right? So she came to us with big dreams. She said, I know that I'm in a Masters of Education program and one day I want to be an educator.

And I want to focus on quality. So it was like, great, we've identified a new area of interest for you. So let's see what we can do to help kind of push you along on that. And very quickly, she came on and joined our team, she identified that there was a need for a little bit more of a formalized program in our cancer population and really, really honing in on all the things that we were looking at from a quality perspective, like length of stay and a few other quality indicators she honed in on. We see that there is an increase in the amount of patients who are developing erectile abscess while they are in our care. And so, giving her that opportunity to say, okay, you've identified the problem. Now here's what I think you need to do. Go go seek your physicians, get a little input from them, go talk to your clinical pharmacy to see what we're doing when it comes to some of the protocols that are in place. Go talk to your frontline staff to get a sense of what they're really doing in practice. Go meet with our neuroscientists to help you start looking at the evidence that's out there. And as we built down that journey, right, to be able to help her put the pieces together, we met very routinely and frequently to kind of help and navigate her journey to say, I've identified an issue, I have a passion for this, I want to eventually put some sort of process improvement in place. And then as she started that work, it delved into a little bit more of, well, how do I expand this across, you know, other areas in our health system? How can I get this out to the professional nursing community? So then it kind of changed our model of looking at it from the perspective of, well, how do you submit an abstract? How do you go through and publish, which she just did, which is great. How do you kind of look at this from a system level and get this out to our other community sites? To know where she's like, okay, I can see this and she's got a slant in quality now where she's considering, okay, if I like doing that, what is my next step? As she's moved along the clinical career ladder, she's at the point now where she's like, I want to go into more formalized leadership roles because I kind of like this work. And what opportunities can I get to help, you know, one day be there, right? She's like, one day I would love to sit in your role in my previous role as a director, like what are the steps that I'm gonna be doing? And so even in my transition, we're still meeting and talking to say, here's some guidance, here's a little bit of feedback, go do, go break a system and see what you come up with. And then we're gonna come back to you, think about it and we're gonna talk about the next steps and things like that. So it definitely just one example of just a little bit of my style of, you know, helping to guide people along, helping to push their way of thinking a little bit so that they get out of their comfort zone and help them explore things where maybe they didn't consider, you know, at the onset of their career.

Joni:

Yeah, wow, Nick, that's beautiful. You've mentioned so many things in that answer. You mentioned a topic that I haven't heard anybody call it, but I wrote it down, flexible leadership development activities. I love that concept. That is so succinct.

What we tend to do often is just, you know, meeting people where they are to develop them in the moment for that leadership competency. And what a great example for that nurse. I have seen that manuscript, by the way. It's absolutely beautiful. I mean, for a nurse to identify that there's an increase in rectal abscesses that are impacting patient care. I mean, you don't see that every single day in healthcare, but for someone to identify that and then work on it, but then to have other leaders come around to in the moment, help with the very next steps. That is beautiful, Nick.

Nick:

And one thing to add, I mean, those activities that we talked about, right, was her not knowing exactly what kind of thinking was behind this. A lot of this was to help her start navigating and building some of these key relationships with a lot of our key stakeholders in all that we do with the operational piece of care delivery. So, you know, it was getting her into a different perspective from the physicians of, you know, as a vet, a clinician, yes, you may know me, but now as a leader, an educator, a person with interest in quality, you're going to view, they would hopefully have viewed her a little differently. When we had her reach out to key folks in pharmacy to talk about some of these regimens, it was again, building some of that foundational relationship piece. So now that she starts having her little co-conspirators and folks who are gonna help her along as she navigates her leadership journey, because those relationships are so important.

Joni:

I love it, Nick. That's great. I love that you've helped her reframe, I guess, a dimension of who she is with stakeholders that she continuously works with so that they can see her in a leadership, maybe a more formal leadership role. Let me say that because I wholeheartedly agree with your perspective of leadership is a behavior; It's not a role. I love that quote that you brought from Brene Brown. I mean, goodness, Brene Brown all day.

Nick:

Oh, yes.

Joni:

Right? Adam Grant has a very similar perspective that I really appreciate. So, yes, I'm right there with you. So, Nick, as we think about developing the leaders around us, leading oneself is a leadership competency. Even AONL has this as part of leadership competencies. And it's so easy to overlook leading ourselves, especially when we have, you know, just a million different ways that we're running and we're thinking. Regardless of one's role in healthcare, what strategies do you recommend for individuals to build and strengthen their inner leader? How do we lead ourselves?

Nick:

You're 100% correct. And I wholeheartedly believe that, that it is very much an activity that people forget about. The whole idea of self-reflection in our leadership practice. And how do we take the things that we know that we are inherently good at and our strengths, but also do that reflection to realize that we have opportunities and there are things that we could learn from one another. I've talked about those partnerships and trying to build up those partnerships. And so my mindset and what I try to communicate to leaders who are seeking out mentorship or opportunities for me is very much that.

I'm not an expert. I don't intend to be an expert in everything, but I do want to leverage the things that I feel are my strengths. But knowing that and knowing what those are, knowing where I have gaps and where I have opportunities, then my job as a leader is to build up those partnerships to ensure myself that I am surrounding myself with people who are way smarter than I am, way better operationally than I am, and give them that opportunity with a fair amount of space and accountability to say, you've got this strength that I need and how are we going to work together to achieve our outcomes, right? And it's in that to really kind of develop that relationship so that it is mutually beneficial, right? We're going to have things that we're going to be working on collaboratively to come through. And they may have a skill set that I need, but there is something that I may have that they're going to want out of me. And so if we kind of level set with that relationship at the very beginning, it really just will help build up that foundation so that it becomes one of very transparent communication, one with openness of knowledge sharing and seeking and just ultimately, you know, that place where you have a little bit of vulnerability to come through as a sounding board, a good vent session if you need to, or a little bit of that space to come in and challenge when you need to based off of, you know, the individual areas of expertise and strengths and things like that. That mindset of really kind of looking and starting from within first and then how you can kind of build that collaborative team around you, I think is so important.

Joni:

Yeah, I definitely agree with you, Nick. You know, you said a couple of things there that make me think about just, you know, career trajectories. You talked about how you tell people that you mentor that you're not an expert in everything. And it's so easy sometimes as being a leader and a mentor to other people to fall into a trap to feel like you have to know everything and do everything. But it's interesting too that once you start kind of leaning into them. And that leads me to a thought that when I've talked with you previously about your career, you've said things like that you've leaned into opportunities that weren't initially in your plan. And so how has that approach contributed to your personal skill set and leadership capabilities?

Nick
I think even as a clinician, right, I was always looking for those opportunities that I saw as challenges, right? So, you know, as a frontline staff nurse, when I hear in handoff, “oh, gosh, that's a difficult patient” or “oh, that's a very difficult case.” I just kind of ran towards it. And I said, you know what? If you're telling me that the typical patient by the end of my shift, I'm going to show you that we developed a report and we were able to make it work. So as a baby nurse, I think definitely that was something that I tried to just run towards to say, I'm gonna learn about it, I'm gonna throw myself into it, and I'm gonna turn this around in whatever way that I can, right? And I think that's kind of come with me as I've progressed through leadership roles that I've always been one when they're looking for somebody to take on the challenge or come in as an interim leader in a certain area or lead projects and things that are not my area of expertise. When I see that there's an opportunity, I'm going to raise my hand and offer to say, “I'm here to help.”

And even if it may not be something that is one of my strengths or an area that I have a good, solid foundation in, I'm going to make it so that at some point it will become a good solid foundation for me.

Joni:

Yeah.

Nick:

And what I think that has done for me in just developing a little bit more of an enhanced leadership skill set is that that's doubled up a little bit of resiliency.

Joni: 

Yeah.

Nick:

And that it also shows for anybody kind of looking at me and my brand of leadership that I am one who's going to role model the most positive kind of shared vision of, you know, we can do this. It may be difficult, but we're going to be here to work collaboratively along the way. Um, and that's a part of it. And I think another strength that I like to inherently lean into with some of this stuff is that I am very much a curious type of person. I'm a learner by nature. And so when I, when I can lean in and provide that outside perspective in whatever area it might be, that excites me. And I want to kind of put myself into that learner mode of, you know, if it's learning a little bit more about some new innovative therapies or new innovative technologies, or I'm going to learn all about it so that I can speak that language.

Or if it's a new service that I'm taking on to really kind of get a sense of what that practice might be like and where I can put my own stamp of leadership in an area like that. That learner mentality to really own it and to seek out those resources and start building those relationships to help again build my core group of people who are going to help and be better and smarter than I am in all of this to really help us figure out, okay, well, how are we going to move this forward? And how are we going to achieve the outcomes that we're looking at? What it's also done again is I think I really just set myself apart as a very much of a can-do leader and Somebody who's willing to take on some of these challenging things, which I tried to role model, right? You know being able to kind of come in and say this may be difficult This is going to be hard work, but we're gonna do this together and we're going to I would still people we're gonna stumble We're gonna fall we're gonna Have to gather ourselves together and we're going to have to get back on track.

But that's part of the fun of this journey, right? And so being able to do that and, you know, help us achieve even the smallest little incremental steps and progress that we can make, to do that with a little bit of energy and a lot of excitement around it, it's just what I try to deliver.

Joni:

Nick, I am like smiling from ear to ear because you're saying so many things that I think that, you know, it sounds easy, like we can do this and we're going to stumble and we're going to fall. But when I step back, I just think that sounds terrifying if you've never had somebody role you and someone who has sort of failed forward or stumbled forward. And you have done that. And so, you know, you talk about running towards things and raising your hand. The first time you kind of do that, it's a little bit difficult, I think, but I'm very similar in that it just kind of gets easier the more that you do it. It sounds a little weird. But I love how you describe your path and really program development and people development as stumbling forward. I feel the same way. I have felt like my career has been very significantly non-linear. It has kind of felt like I have just stumbled my way forward. Tell me more about why you feel this way, too.

And can you tell me a time when you faced challenges or made maybe some mistakes and lessons you learned from these experiences? I know that's a little vulnerable moment, but can you pull back the curtain for us a little bit and let us see inside some of those mistakes and lessons that have helped you stumble forward?

Nick:

Oh gosh, of course. One sticks out because, and we'll touch on it a little bit, because you mentioned having somebody allow you to be vulnerable in that moment. And so as a new director, I was ready and I said, I got this, I can do it. And quickly as I transitioned into the role,I immediately had those feelings of imposter syndrome and feeling like, oh gosh, did they make a mistake? Why did they choose me? Now I've got to deliver here. And I was really trying my best to just prove myself and show that I was a competent leader and that my boss at the time had made the best decision to put me in this role. And so one of the things I was charged with was an expansion of our services in our inpatient area. And we were moving into a brand new building. And this was going to be a pretty decent bed expansion. And, you know, I thought I was doing all the right things. And I thought I was getting things set up. It was very much at that point, a lot of like task oriented things without a lot of strategy and a lot of just operational foresight into like, a little bit of future thinking. And, you know, I'm giving the boss the updates I think I should be giving. And she comes to me one day and she says, okay, well, now we're going to talk a little bit about some of these operational things like your FTE extension. And here's the goal and here's what we need to do as we open up these vents. And, you know, essentially, this needs to happen. And where are you at with all this? And I remember like deer in the headlight, like, what do you mean?

What do you mean I need to ask staff at this point? You know, this is my first time hearing of this. And to like take a step back and have that moment of vulnerability with her and for her to realize very quickly that, oh, okay, this was an opportunity for both of us to really come together, me as a novice leader and her coming through with many, many years of experience behind this for her to take a step back and say, okay, let's pause. And she had to come and tell me, you know what, I have to realize that you are new at this and that you're basically you're not on my level. So then it was her taking me aside to say, this is okay. And now let's work this through. And for her to take the time to walk through this with me, and then for her to give her guidance to say, you need to meet with this person, you need to set up time with this person and come with your plan. And that's what we will present to figure out, you know, what additional requests we need to put through and then where we can actually realistically get with any possible event expansion at this point while we move into this new space. So, you know, it was definitely helping to guide me a little bit more. And then our conversations really did kind of flip into a little bit more of that direct kind of leadership that I needed at that point in my career. Always very much in that positive light of, you know, you are gonna learn this, you will eventually be proficient in this, eventually you won't be helping any of this, but we're gonna do this again together and we will slowly start, you know, taking off the training wheels as you do this. And she instills in me that she's like, I am confident that you will make this work. I am confident that you will get us towards this outcome of being able to move into this new building and open these new beds successfully. And reassuring me so that I was losing some of that imposter syndrome. 

But her being able to kind of set that out for me to look at any of the setbacks or things that I deemed as failures at that point and really just, again, building up that skill set to say, well, I'm going to do my best to prove myself and be proficient and get what I need to do out of this by building those relationships and making those connections to eventually get to the point where, you know, a couple of years later, once we'd been working with each other, it was like, I got this and now how am I going to teach this to others who are also going to stumble and have to go through this as we expanded across services over the next two years after that.

Joni:

That's great, Nick. Thank goodness for mentors who have let us stumble and who have been right there to be with us, to help pick us up and role model the way. I mean, that's been so important in my career, I know. And then to have a leader be vulnerable and share their learning opportunities with you, especially, I think, Nick, once you get into a role like, you know, you're a director, you're in a senior executive position, like an ACNO, more formal positions, you, at least I, do this. I look at people and I think, oh my gosh, they have it all together.

You know, they know exactly what they're doing. I'm sure that they're perfect. And of course, you know, they're not, but there's just something really encouraging in growth. Even I feel at this stage in my career as an executive leader, hearing from other leaders that they're still kind of stumbling forward in ways. So thank you so much for being vulnerable and sharing that with us. That was great. 

Nick: 

Oh, yeah. I have to think about that moment. And I'm like, look, look what it brought me. That's so great. So you are a natural future thinker.

Joni:

I think, Nick, you tend to, like you said, you raise your hand, you tend to go first in a lot of different ways, which has pushed you forward in your career. But I really think of you as a future and forward thinker in our profession. And so, I mean, right now you're working on building a brand new hospital, you know, a hospital of the future and building it with the right people to think about the future of healthcare. So as you think about the future of healthcare, what's your vision for creating a more inclusive and innovative and patient-centered system? And how can every member of the healthcare team contribute to that vision?

Nick: 

No, great question. I think healthcare is at this really great place, I think, where it is just prime for a total redesign, right? And I think every single person, regardless of your role, you know, but I'm a nurse, so I lean into the nursing aspect of it, that, you know, we've got nurses at every single level. We've got folks who are part of this interdisciplinary team that we get to work in in healthcare that I think really truly does have to embrace the ownership and their leadership at all levels. We really have to ensure that everybody has a voice and a seat at the table as we are really in this place of care redesign and driving what this new model of care delivery is going to look like as we as we kind of progress forward.

So you know with that I think people have to have the mindset to really just kind of think outside of the box and really break the system. And I think leaders need to allow for a little bit of that work to happen. Give people the space to do that with a you know a level of accountability to come in and bring those ideas that could you know really ensure that all of our roles have the right structures in place to remove any barriers to full practice, right? How can they provide us insight into how we thoughtfully integrate all of this technology that's come in the last few years so that it becomes a really best practice for patient care and for the people who are serving these patients. 

As I mentioned, I think really very much ensuring that we've got all key stakeholders represented, including our patients in that process. That diverse level of thinking to really help understand the complex nature of health care, I think it's going to be very, very important to ensure that we've got all voices and all perspectives counted. And I think again very much specific to what we need to look at for nursing, I think nursing leaders are poised to really drive a lot of this work. You know we spend the most time with our patients. We see patients in a very holistic view when it comes to their care delivery. So I think it's going to be up to nurses and nursing leaders to really help drive a lot of this. And really, really set the tone for some of the other disciplines that are out there. Really, really working to lead this, these efforts with our partners in, you know, respiratory pharmacy, academia, especially as we kind of try to build up this workforce. But again, voice and perspective is going to be very important to really just help us drive this vision. We've got really good integration of technology. We're delivering care as efficiently as we can and we're driving this towards the ultimate value in the care that we give.

Joni:

That's great, Nick. I wrote it down, “break the system.” Yeah. I love it. Break the system, create the future. A little creative destruction there. So that's really beautiful. You mentioned earlier that you're a curious thinker, a curious person. You're naturally drawn to curiosity. I am too, and I'm always wondering what other leaders are reading or doing or sharpening their skills right now. So I'm curious, what are you reading or learning about these days, Nick?

Nick:

Oh, yeah. So, again, I am curious. And there's usually a book that's along with me. And audio books have been a new thing. My commute has changed a little bit. So audio books have been a good one. So I actually have two that I'm focusing on right now. So in my new role, it definitely is a little bit of a thing. I feel very much that I am such an introvert and I need that ability to kind of recharge. And I think the thing that I continuously try to focus on is my ability to network and put myself out there in situations where I'm not the most comfortable. And in my new role where there's a little bit of an expectation to really kind of increase my presence in the community we're serving and start building up some of these relationships as we're building this hospital, right? So what I've been listening to on my commute is the Harvard Business Review Guide to Smarter Networking. So, I listen to it, it's more tips and tricks and things that I'm trying to integrate into my practice. One, so that I'm a better, you know, networker and communicator. And I think for me, that I can learn those things and maybe take away some of that apprehension about doing that type of work when it's something that is out of my comfort zone. 

So that's one that I'm listening to. And then this is a fun one that I just picked it up and so I just started this last weekend and so I'm very early into it but during 2023 I was doing some binge television watching and so I became a fan of Ted Lasso and I happened to stumble across this book, Lead It Like Lasso, and so it is interesting. It's written by a person who's got a PhD in education, and this other gentleman is a tech startup guy, and they've taken some of the key leadership components and things and lessons that you would've learned from watching Ted Lasso, and how they've put their slant on it for things and tips and tricks that you can learn from that leadership journey that Ted went through, and how you can apply it to everyday leadership. So far, I have a few pages I've been able to read. It's fun stuff. And of course, because I'm a fan of the show, it's nice because there's little tidbits and connections and things like that to the show, which is kind of fun.

Joni:

That is great, Nick. Thanks for sharing. I love those little Harvard Business Review compilation books. Those are super resources. Oh yeah. So yeah. Nick, what would you like to hand off to nurse leaders at all levels and in every setting in closing today?

Nick:

I think in a handoff, I think really and truly, as I mentioned, this is very much an exciting time for care delivery. And I'm just very super excited for what we're going to be able to achieve. It is definitely a pivotal time for innovative care delivery models that need to be integrated into the work we do, a really cool time for all this technology that we're trying to integrate into the work. And because of that, we really do need input and voice from every single member of our profession and the interdisciplinary team, right? If we're going to really try to innovate care delivery and make the most impactful positive change for our professions and for the communities we serve, you know, we need input. We have to have everybody along for this journey. We've got to get the different perspectives on board. Otherwise, you know, we're going to be doomed to repeat some of these failures that we've seen. So I'm excited for what's coming down the line and excited for some of these folks who are going to help us break the system, as you said.

Joni:

Those are your words, not mine, Nick. I just repeated them. So I'm going to quote you from now on, “break the system” dash Dr. Nick Esamino. Nick, you are an incredible leader. Where can people follow or connect with you or find more of your work after the handoff if they'd like to do so?

Nick:

Yeah, so you can definitely find me on LinkedIn. So you can find me, Dr. Nick Escobedo, on LinkedIn. I'm open to email as well. Email address is nescobedo@houstonmethodist.org. 

Joni:

I love it. Excellent. Everyone, find Dr. Nick Escobedo on LinkedIn or send him an email. I can personally testify he's an incredible colleague to have in your network, a beautiful leader. So continue conversations with him after the handoff. Nick, I sincerely love sharing time with you. Nick, I sincerely love sharing time with you. Thank you for handing off beautiful wisdom and encouragement today. 

Nick:

Thank you, Joni. It was a pleasure.