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 have a very special guest joining us, Dr. Janice Walker, the Senior Vice President and Chief Nursing Officer for the Southeast Region of Advocate Health. 

In her role, Janice provides strategic leadership for all nursing and other designated patient care functions and services across Atrium Health, a critical component of Advocate Health's southeast region. Dr. Walker brings a wealth of experience from her previous leadership roles at renowned institutions such as Baylor Scott and White Health, Texas Health Presbyterian, Freeman Health System, Slyde Memorial Hospital, and National Park Medical Center. 

Her extensive background in clinical recruitment, transformational nursing leadership and patient care strategies has made her a national speaker and published expert on topics like patient satisfaction, zero patient harm initiatives, and nursing recruitment and retention. Today, Janice will be sharing her insights on ensuring the voice of the nurse is heard at all decision making tables within a healthcare system. We'll discuss how nurses can be effective participants in healthcare system decision making and explore the vital role of nurse managers. So without further ado, Dr. Janice Walker, welcome to The Handoff.

Janice:

Thank you, Dr. Watson, and thanks for the invite.

Joni: 

Absolutely. It's so great to have you today. Now you have had the opportunity to lead many nurses in several large organizations. I know you are particularly passionate about the voice of the nurse. From your perspective, why is it crucial to ensure that nurses have a voice at decision-making tables in our healthcare organizations?

Janice:

I would say it's because nursing is the only profession that can provide nursing. So think about it and take it maybe in a different realm. We don't make decisions for teachers as nurses because we're not teachers in educational systems. We don't make decisions for accountants because we're not accountants. We are professional nurses. And although we work in environments that are full of other professions because it takes a team to provide patient-centric care, we don't make decisions for each other's discipline out of mutual respect and professionalism. And we are the only ones that are licensed to provide nursing care. So therefore, we must have a voice in all of our practice and anything that affects our practice.

Joni: 

Yes. And so, can you share some of your experiences with involving nurses in processes and how it has impacted patient safety, workforce engagement, or nursing quality?

Janice:

So, I would say that in my career, that list is endless. We cannot make decisions for nursing practice inside of ivory executive towers. We have to go to the bedside. I can think of example after example of how to prevent patient harm. One that comes to mind is the care plans that might be created inside of an electronic health record give you nuggets of success that are based upon evidence-based protocols of high risk or moderate risk fall patients. But to execute on those details of the care plan, it takes the input of the bedside nurse. 

Another thing that comes to mind is sepsis. And we know that sepsis is a high risk mortality type situation, and to execute on timely infusions of fluid boluses that come when our patients come in that are highly septic, we have to have the voice of the nurse on how they receive that sepsis alert, how they execute to that fluid bolus, how they document that fluid bolus and what happens before and after that fluid bolus. 

So, I would say that at times we must train ourselves to go slow to go fast because if we don't have the input of bedside nursing leaders, we cannot execute on any process and we create workarounds or flow diagrams that don't work because we didn't pause to go slow and get the voice of the clinician at the bedside before. Then we can hardwire something that goes faster.

Joni: 

Yes, absolutely. Those are great examples. We've been talking about the voice of the nurse forever and rightly so. It's vital to healthcare and as you've mentioned, it's often overlooked, which is shocking and surprising and frustrating, all of those things. What practical steps can healthcare organizations take to ensure that nurses, one of the largest end user groups in healthcare, are effectively included in decision making processes?

Janice:

So I think it starts with the title and the role that a chief nursing officer plays in a healthcare system. There must be mutual respect at the table, at the executive table that we can't make a decision about nursing without the CNO at the table. Then the CNO can define, who is my next stakeholder I must call? Who's the friend that I have on speed dial that's going to know how to execute on a challenging topic or to close a gap with an outcome. But without the CNO at the executive tables where it starts and then it starts to diffuse throughout the organization all the way to bedside, professional governance, and every step in between, whether it's a director's council, a nurse manager's council, the supervisor, the voice of the admin soup that we know runs hospitals when we all go home in the afternoon and on weekends. 

So it's that seasonality that a chief nurse brings to the table for him and her to say, “I can't make this decision in isolation. I have to pause and get back to you after some input.”

An example might be, let's say we've got a gap in care where we know that something negative has happened, but we need to rewire something or rework a process. The chief nurse can't do that in isolation until they know what the gap was and how the bedside nurse made the decision he or she made in order to close the gap. That creates another smooth transition for the next patient that we touch. So, I think it starts at the very tip of the spear with the executive at the table, but then the seasonality and maturity of years of experience or mentoring that comes with our chief nurses to know they must make decisions in a group consensus effort in order to get buy-in. 

Joni: 

Yeah, and when you bring nurses to this decision making table this season on The Handoff, we are starting to focus on workforce engagement solutions to help with the workforce. I'm curious, what feedback are you hearing from frontline nurses about scheduling shift preferences or workforce readiness? What is the workforce asking for from your perspective? I love to hear what you're hearing from them and how it's changing the way you think about workforce management going forward.

Janice:

So I think for years we've always heard something called work-life balance. I don't know that it's a balance anymore and that it's more of a workplace harmony that they must have those two, work and home must interlock. So what I've heard from the bedside, especially after the exhaustion times of the pandemic, is that you've got to meet me where I am with creative scheduling and creative work, life, harmony. Life is harder than before we knew the word COVID, and I don't think it's going back to something more simple tomorrow. And so work peers that might share a shift or, an example, work nurse managers that might share a unit is an example, and both work part-time, we'd never heard of that before in our lives, before life became so hard. Job sharing is certainly an option. I think we got very creative during the pandemic of looking at models, and I think that creativity still exists and we enjoy the piloting of different work models in order to meet the needs of our communities. So I would say Joni, that it's still here to stay. I don't know if any of us have reached utopia about work and work life harmony, but I think our eyes are wide open to doing something a little more creative.

Joni: 

Yeah, that's great. So as healthcare organizations are readying executive leaders and nurse leaders at all levels to share the voice of the nurse at all of those different tables, how can we prepare our nurses who are doing the work, they know the problems, they often know the solutions. How can we prepare our nurses to be effective participants at decision making tables starting maybe from more intimate tables and needs and progressing to larger and more complex issues?

Janice:

I think there's a magic of engaging the nurses that this is a profession. This is not a task-based profession. This is a profession of your expertise that you worked so hard for that you probably could help us solve a lot more than we could do ourselves. But maybe there's a fear of you raising your hand and that no one is going to listen. Or, I raised my hand years ago and they didn't listen. I'm just going to say to you that this is a profession that we never can give up on, and we must always be leaning in to remove barriers. The barriers today are different from the barriers of yesterday, and they are different from our future barriers, but we have the discipline, we have the knowledge, we have the professional title to make a difference, and we own our own destiny. So it is challenging at times to get every bedside or clinic nurse, ambulatory, for example, to realize they have a voice. But I think as hospitals are maturing in their magnet journeys or their pathways to excellence journeys or just overall professional image of nursing, it is our time to keep our hand raised high, never let it down, never let our passion down because we own our own destiny with our profession. If we don't take charge of that profession and our practice, someone else will, and that's unacceptable.

Joni: 

Oh, heartedly agree. You talked before in a previous question about different councils. So unit- based councils, manager councils, director councils, those can be great ways for nurses to hone their decision making skills. I know just speaking for myself as a nurse, I would sometimes look at these big tables and think, oh, I can't make a decision at some of these tables. It was my unit-based councils that really helped prepare me. Can you talk more about how nurses can hone their decision making skills and grow in those skills over time?

Janice: 

Right. So I work in an organization now that brought a best practice to my portfolio that I'd never heard of in any of my other systems that you rattled off when you introduced me. And it's the president of nursing. So lemme tell you, this is a published white paper on how to take bedside nurses and give them the experience of leading unit-based councils. Then elevating them to some type of council that is just particularly related to research or particularly related to leadership. You keep growing them with the next project. So then they may step it up a notch and not just be a unit based chair, but maybe the hospital chair. Okay, then let's go to more of a regional chair and then let's be voted on a two-year term of the president of the nursing council chair that sits at the C-suite table with the regional chief nurses.

So we have presidents of nursing at Advocate Health System that are really our ears and our voices of many different bedside nurses all the way up through the chain of command through our councils. And they sit at the table, they sit at the table and they are part-time president of nursing, and they are part-time providing care. So executive leaders learn from them so much of what the front lines' hot points are. At the same time, because they're at the executive table and meeting with us weekly, they know our hottest challenges as chief nurse execs and they can create that conduit of communication straight back to the bedside. 

So I've never had a president of nursing until I arrived in this role, but it is a blessing. It is a blessing. Her name is Katie. To have Katie on the phone and bouncing ideas off of, just met with her this morning on a topic and you say, “Katie, what do you think? And she probably hits the nail on the head every time with what the voice of the patient and the caregiver nurse is really thinking at the same time. 

So she does a President of Nursing Newsletter and a President of Nursing monthly report out with the shared governance and it's a sought after position, and it's two-year term. Then we'll move to the next president of nursing. At times the president of nursing then has gotten a really good exposure to leadership and they may decide futuristically to enter leadership. Not always, but a lot of the time that's what happens.

Joni: 

That is a great example. Janice and I have never heard of that either. So you said that is already a white paper or It's about to be a white paper?

Janice: 

It's already a white paper as well as published as a magnet exemplar to have presidents of nursing, which it's just an expense of their time, but it's value added of getting the voice of the nurse at the executive table.  

Joni: 

That's beautiful. 

Janice: 

And many of our entities have their own president of nursing. I have more exposure to the regional one, but it's great, great, great best practice that I now have in my toolkit.

Joni: 

Thanks for sharing that. That is a great way. And I love the concept of growing those nurses in lots of different ways to get to that ultimate role because by then you've probably encountered quite a few different scenarios, had to make decisions in a lot of different ways so that you're prepared to sit at the C-suite table. That's great. 

During the COVID-19 pandemic, we saw dramatic turnover in nurse manager positions with an influx of novice nurse managers. Now anyone who's ever held the nurse manager role knows it is one of the hardest, if not the hardest role in nursing, which is saying something because nursing is difficult at all levels. From your perspective, what are the key challenges nurse managers face today and how can healthcare organizations provide the necessary support to these leaders to ensure effective management and mentorship?

Janice: 

I'm so glad that we had to cancel this podcast recording more than once in order to do it today. Because as of this weekend, there is a new workforce committee, 2024 Span of Control Subcommittee report from the American Organization of Nurse Leaders or AONL. So Joni, I took a moment this weekend to read this great great paper. I knew it was being worked on. I was on a subcommittee that was helping do this. And it's taking the problem of the span of control of the nurse manager. And it's taking it at a national research level to see what everyone is experiencing across the US. And when documents are published, you'll notice this particular one has multiple sub references where they pulled literature forward to help publish it. But I would say after my reading of it, it has a calculator in it where you can take the direct report span of control of nurse managers and everything that they have to do every single day to drive outcomes with strong retention and safe staffing. And the calculator will tell you that one of our number one challenges in healthcare is the number of direct reports they have.

So I have found myself speaking about this a lot, not only in the role I'm in now, but the previous role I was in, that we have to do something about the span of control. Without that burnout is going to continue. Burnout, exhaustion, losing their joy for work. And we don't want that. 

We need our nurse managers to be resilient, to be patient-centric and employee-centric. It's next to impossible to do sometimes with these spans of control. So I'm so proud that the paper is now out, but we know the mountain is there to climb on how to appropriately fund this and put it into operational metrics. But the research presents itself extremely well. It's all about that huge span of control. Sometimes 80 to a hundred FTEs need their own work-life harmony, and they need their own relationship with their boss, which is their nurse manager. And you can't do that when you have that many direct reports. 

So, is the future model something that swaddles that nurse manager with a cabinet per se? So, that they have some supervisors, they have some educators, they have some clinical nurse specialists? What does that cabinet look like that relieves that enormous burden right now that exists across the whole in the United States with the nurse manager's role?

So the Healthcare Academy also published some things. AONL references that subgroup. It's an amazing publication, and it was well overdue. It's been two decades since we really understood the burden of the nurse manager. And that is not the day of today in 2024 where we know exactly that, what a nurse manager has to drive for value-based purchasing penalties or recruitment and retention that they must hit. It's a different world than the last time this was studied.

Joni: 

It absolutely is. Those are both great resources that we can lean into. I mean, that's where we start, with the evidence and then we can develop interventions to help support and transform our work environments. Absolutely. Well, Janice, we have covered quite a bit today, and you have always been a curious thinker. That's a compliment. So I've had the pleasure of serving with you for many years and you ask great questions and you're always doing something or thinking about something. And case in point, you took time over the weekend to pull the evidence from those brand new reports, which is great. So I'm curious, always curious about what other leaders are reading, doing to sharpen their skills and to nourish their souls and their minds because you have to have some work-life harmony too, while still spurring thousands of nurses and patient care initiatives forward. So what are you reading or learning about these days to sharpen yourself?

Janice:

Personally or professionally? Either? 

Joni: 

Yeah.

Janice:

Well, I'm going to give you a personal answer. So before I transitioned to this particular role, I had a very strong mentor in my life that knew I needed a certain book at that point in my life. And so my previous Chief Operating Officer, John Horter, mails me a book called Kingdom's Purpose. Joni, I've reread that book three times in the last seven months. I can't put it down. And I pick up things every time I read it. And now I'm on to the Kingdom's Woman Purpose that we are called. I truly, truly believe that God called me to this particular work. But what I really didn't come to realize until I started going deeper into this reading, is that this is his kingdom that he's put us on right now, and the work we do here to elevate him through our profession or our personal lives is what matters. That is our purpose here. So I am purposely called to be a transformational leader, and I was lucky enough that when he created me and the DNA scheme of creating me, that he decided it was going to be in nursing.

So I've come back to my grassroots that I'm here to fulfill. I'm exactly where he wants me to be. I read that book while I was contemplating the move. I've reread it since I've moved, and I'm exactly where he wants me to be at this point in time. And I think as clinicians, whether we have faith or not, we are called into this profession. And if we start to become overwhelmed and overburdened that we lose our caring touch, it's time for a different profession in the human caring profession of some of the most scary times of people's lives or their most joyous times of their lives. And we are called for that connection to our purpose. So that's a personal reading that I've taken on. It helps ground me. It helps me be still as I prepare for tomorrow's work or this evening's work. It's really helped me, especially during my transition from the largest healthcare system in Texas to now the third largest healthcare system in the United States. I just have to be grounded on what my work is.

Joni: 

Yeah, I appreciate that. And so I am always intrigued because you said you were pulling in a personal example that has very many professional applications and of all of the professions in the world that can understand that we are holistic beings in nursing, we certainly hear your heart and understand that that's a beautiful recommendation. I haven't read that, but it sounds right up my alley.

Janice: 

You won't be able to put it down, 

Joni: 

Awesome. Thank you, Janice. Well, we've talked about quite a few things today. Ultimately, what would you like to hand off to nurse leaders at all levels and at every setting?

Janice: 

To never quit raising your hand to learn something new. We are professionals. We are highly skilled, we're highly educated. And even though we are going to drive our own profession, nurses can be leaders outside of nursing. We can serve on boards, we can serve on community boards, professional boards. So understand, because you're equipped to be a nurse and the complexity of that profession, you're also equipped to be a leader in other fronts. Now, I'm not going to talk about getting into the details of leading an accounting cost report or something like that, but just to be a transformational leader of taking care of your teammates, it's very, very valuable. So raise your hand to learn something new, whether it's in your scope or maybe stretches you a little out of your scope. Keep that hand raised because nursing is an amazing profession and you're skilled to do this.

Joni: 

Yes. Thank you. Janice, where can people follow or connect with you to find more of your work? Because I know they will after this.

Janice: 

So the best thing I do is leverage my thoughts and celebrations across Advocate through LinkedIn. We tell our story through LinkedIn. Our leaders at Advocate are encouraged to professionally post within LinkedIn and elevate each other. And so when that neighborhood door opens and you have other professional colleagues across the United States, you learn from them. So the things I post are in a sense of sharing with my colleagues for group learning. And then that's the kind of thing I open in my LinkedIn portal when I can learn something new. All from the power of social media used in a positive way. Right, not in a negative way.

Joni:

That's right. Well, everyone, be sure to find Dr. Janice Walker on LinkedIn. Janice, thank you for sharing your time and expertise with us today. Thank you for spurring us to keep raising our hands in pursuit of our beautiful profession of nursing. It's been a delight having you on The Handoff.

Janice: 

Thank you for the invite. Happy to connect.

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