Episode 85: Why every nurse leader needs a leadership manifesto
Joni, welcome to the show.
Thank you, Dan. It is so great to be here. I really have enjoyed the podcast. And of course, anytime I get a chance to serve with you or work with you, I always jump at that opportunity, so I'm excited to be here.
Yeah, this is going to be fun. It's like old times. Before we started recording, we were reminiscing about all the great things that we have done and could have done, which is always fun to chat with fellow innovators. Now, before I jump into some of the questions and things, I want to know, because you read a thousand books a day and you post them on LinkedIn and you pick pictures of them all, and I'm like, I don't think I've picked up a book since I finished my PhD in 2013. What are you reading right now, Joni? And how many books have you completed prior to us recording this morning?
Well, let's see. I do actually track how many books I read each year, just as part of my personal and professional growth I'm on. I have finished, I think, 74 books at the time of our recording today and that's collectively for the year. And of course, those books are differing amounts of time. Some books take me a couple of weeks to finish. Some books I can read in a day. But right now, let's see, I just finished, I just posted on LinkedIn, I gave a five-star recommendation to an audiobook that just came out Friday called Weird Al: Seriously. It is a serious dive into weird Al Yankovic life and his musicology and how he's been able to craft his unique voice and stay different and relevant in the face of a pretty conformist world. That was a great book. I am rereading a book I read last year, it's called In Defense of Troublemakers. Dan, you would really like that book.
Yeah. It sounds like I need to get that one.
Yeah, That's I think an audible or an audio version. It's like a five-hour read, so you could digest that pretty quickly. I'm getting lots of questions right now from leaders who know I read a lot and they're looking to gift a book to their leadership team or people on their teams. And the book I just recommended to today to a large group of leaders is Dr. Tim Elmore's the Eight Paradoxes of Great Leadership. And that's another book I think that you would really love, Dan. It was the first book I read in January of this year. I'm probably going to reread it before the year is over.
I make required reading for my D&P students at Duke, Adam Grant's Think Again. We'll talk a little bit about that book I think throughout the podcast and some of the concepts, but it's a great book. So yeah, follow me on LinkedIn for book recommendations. I'm consistently reading, it's something that I do to grow and learn and I often pull books from lots of different industries and it has helped me throughout my leadership journey.
Yeah, I love that. And one of the things that I really appreciated when we were in the hiring process together that you shared your leadership manifesto. And so I'd love for you to talk about how that came to be and why you think it's so important for a leader to have that and to share it with their teams.
Yeah, for sure. Yeah, I think it's important, not solely for nurse leaders, but really for any leader, I've had a leadership manifesto for over a decade now. I share the concepts every chance I get because it's helped me throughout my leadership journey. I really crafted it at the impetus of one of my leaders when I was an early manager. I had a fabulous leader. And I can't even remember the conversation that we were having, but she asked me point blank, "Well, what do you really believe? And what is influencing your decision making?" And so, that night, I went home and I actually wrote down what I believed as a leader that was shaping my decision-making and I blogged about it over a decade ago on my blog nursetopia.net, but it's something that I've kept and tweaked almost 12 years now.
Simply put, it's your leadership philosophy written down and it sounds really simple because it is really simple, but it's what you believe as a leader that ultimately guides your own decision-making. And as leaders, we often know our values mostly, but the activity of writing those values and beliefs down is beneficial. So, asking yourself, "What are my values? Who am I? What do I believe? What do I want in life? What legacy do I want to leave through my decisions and actions?"
And knowing yourself and really going through this process, it takes time and effort. You have to be introspective and assess what you believe without external filters, which can be both liberating and terrifying. You have to review your decisions and your actions and analyze really why you make your decisions, and how you feel during decision making and if you would change any of your previous decisions and why. And so, with all of your values visible on paper, you can clearly see if your actions align with your values. And for better or worse, so can everyone else who has the privilege of reading your leadership manifesto because it's meant to be shared.
The entire purpose of crafting your leadership manifesto or philosophy is so you and others know what drives your decisions, your service, and your care. And it's meant to be read by your own leaders, your teammates, your subordinates. And even really your family and community members you do life with each and every day, but most of all, it's meant to be read often by you, the author, as a reminder to yourself of who you are and to help guide your future decision-making in alignment with your true and authentic and best self.
And I keep mine literally printed by my computer. It sounds cliché, but I really do look at it daily. If I'm making multiple decisions in a day, I'm probably looking at it all throughout the day, literally. It has helped me make some tough decisions. When I made decisions that really didn't align with my leadership manifesto, it also helps me reflect on where my moral distress was stemming from. It made leaving a previous team much easier as well because I knew I wasn't going to be able to lead and work in the ways that were my true and best self.
And I share my leadership manifesto, like you said, if ever I'm interviewing for a new role or I share it with the people that I'm privileged to lead because it is a privilege to lead them and they should know those pieces about me. I share it with the full teams, so if I have had teams of 300, 400 people, every person on that team receives my leadership manifesto. I really think it has sped up relationship building. It has opened up some beautiful conversations with those around me, empowering them to be their best and authentic self as well.
It's one page. I have about 20 beliefs on my leadership manifesto. In about 12 years. I think I've added one or two beliefs in there. It's important to know that this is not written in stone. You do have autonomy to tweak your leadership philosophy as you learn and you grow. So yeah, leadership manifesto, it's one of the things that I love.
I respect that, and it did help me when I was interviewing with you to understand your approach and again, align values. Because like you have, you've worked for leaders who you realize you're out of alignment and it's hard to do that over the long term, so I think being explicit about those. Have you had anyone react negatively to the leadership manifesto? Like, "Oh, Joni, what the heck is number eight? That's the dumbest thing I've ever heard."
Yes. And I think this is part of something that we'll talk about a little bit later on is that I've had groups of people really challenge me on some of my beliefs. And a great example that I'll use, it can be seen as risqué, I guess. But the very first thing on my leadership manifesto, I'll read it verbatim, it says, "I believe in the triune God and the God-brave word, which guides my life and work." My beliefs may be divergent from others, which should not change the way I provide care, meaning equity, yet my work and actions should be different in many ways, reflecting foundational Christian principles that undergird my life.
And the Leadership Manifesto is an activity that I've done with lots of students because I believe knowing your values and knowing yourself is important as you are deciding major decisions for an organization and for people's lives. And so, just a couple of months ago, I was with a group of students who are all just, they're already in executive positions, they are strong thinkers. And they asked me, a couple of students in the group asked me about this. I would never put my faith or my absence of a formalized religion out in front, especially if I'm giving this along with my CV. And it really paused me to rethink like, "Should I take it off?" But as I went through conversations with those students, it was really empowering to hear the diversity of thought in the group. And it allowed me the opportunity to say, "When I am my best self, when I am leading my best and I feel like I am hitting on all cylinders in a team, in an organization, I know that I'm living in accordance with the principles of my faith as well." And so, it is a huge part of me.
And I have worked in places that have forced me to segment who I am. It's really interesting because in healthcare and particularly in nursing, we talk about holistic beings and holistic care all the time. And yet when we come to work, we expect people to segment who they are. And that in it of itself causes the moral distress. Now, I'm not going to go around and lay hands on people and pray for them, but you know what? When you step into my office, you probably are going to see scripture references of the Bible. I may tell a story or two that I learned growing up that may relate to a business principle. When I make my decisions, I'm definitely going to make them in accordance with my faith as well because it's my best self.
And so, what was interesting is we started to go around the room and other leaders in this student group began to share their newly created manifestos, several of them put in references to their faiths, which were all different faiths and were beautiful. And it was them saying, "Only because you did that, did you create a space to let me know that it was okay for me to do that, too." And oh, my goodness, if I can do that and create an inclusive environment, so that people can bring their best and authentic selves to their organizations, I am here for it all day long.
That's great. I think what you mentioned is really important is where are you at your best? And for me, it's not necessarily faith, but it's being on that edge of trouble, like the edge of chaos or whatever. And that's guided a lot of, as I've grown as a leader like you have. You say yes to a lot of things early on and you go through, you don't have that frame of reference to go through and make the intentional decisions, so you throw yourself out there, which has its pros and cons. But as you get more experience and work for different organizations and leaders, you hone in on what you enjoy.
And I think that the manifesto leads to finding that joy in your next role or with the people you work with and I think it takes a lot of strength to have to call that out and own it. And sometimes, it frustrates people and sometimes it rubs people the wrong way and that's okay, but it's you and it's how you can be your best.
Right. Another example, Dan, is one of my statements is I believe in radical transparency. When team members know the vision, objectives, barriers, and all data, they can ask meaningful questions, strengthen accountability, generate worthy ideas, and affect change. And I put that word radical in there for a reason because I've worked for organizations who say that they're transparent but really weren't.
Another one of my foundational beliefs is that I believe frontline team members are the largest source of solutions to current problems. And so, if I believe that, then those people need to have all of the information. If I'm not over communicating, I am failing the team already. Radical transparency, when it comes to everything, every data source, all the financial information, where are we in regards to our strategy development or our implementation? Where are we going? Radical transparency is a big deal to me. I've worked for leaders who start to intentionally or unintentionally hide information or just don't share information. I start to have a cue like, "Hey, this is an opportunity for me to have a conversation with my leaders or my team to talk more."
And what's really awesome is that when people have my leadership manifesto, they bring it to me and they hold me accountable. If I believe in radical transparency, team members can say, "Hey, Joni, you're not working or in alignment with your leadership manifesto, this feels really secretive." And so, that brings up opportunities to have great conversations. It's a great accountability method for me as well, because I do want to leave a legacy. I want it to be absolutely fantastic and amazing. And these are the beliefs that I feel like will help me leave the legacy that I want.
One of the other tactics that you have talked about, too, is the challenge network. And so, I'd love to hear how that comes into play to help guide your leadership as well.
Yeah. I didn't have the language of "a challenge network" until Adam Grant's book, Think Again. It is one of my favorite books. It is required reading for my doctoral students at Duke. Before that book, I'd simply talk about the protected diversity of the team. And straight from my leadership manifesto is another belief I believe that, while difficult to develop and maintain, diversity is vital to the health of a team, an organization, and the final service or product.
As a leader, I am often building teams. I am pulling people. I am trying to figure out where to leverage their strengths, but I am always curating the environment whether I realize it or not. And I often end up with a team of people around me that many people would call misfits. Dan, you've been a part of that.
Yeah, I'm a huge misfit.
You even said that you live on the fringes, on the edges. There's a reason that we've worked together because I like the way you think, Dan. And the people that I pull into teams, they are usually people who think pretty differently from one another. They usually think differently than me. They might be seen as industry black sheep, so to speak. They might be perceived as disagreeable or to use a word that you often use to describe yourself, Dan, they might be seen as provocateurs.
Positive deviant, provocateurs, troublemaker.
Yes. Right. Rebellious.
Ambitious people. And so, usually, when I am listening to people in conversation or on social media networks, for example, I usually have found that when I have this cue of, "Wow, they think differently, that's usually my cue to grab them and collect them into my life and work or follow them, so that I can have their voice either formally or informally as an influence. What's important is in a challenge network, I find people that I have a strong relational affinity to, but that they think differently than me on certain topics and things.
And Adam Grant would call this, you have low relational conflict, but strong task conflict. And this yin and yang of agreeableness and disagreeableness is important. The healthcare and behavioral science and business literature support it. Diversity is like lightning in a bottle for businesses and teams. Before healthcare even really started to broach the topics of DEI and belongingness, business has been in this space forever because it really is something special to business. It is lightning in a bottle, but it has to be protected. Otherwise, you're going to knock the bottle over, you're going to pop off the lid, you're going to let the lightning escape.
And leaders work so hard to build diverse teams, but often, we go awry when we don't protect the team environment. And study after study after study confirms that in order to get the benefit of diverse teams, that is the diverse thinking, the divergent thinking of a group, we must have relational trust and psychological safety for individual team members to share their authentic perspectives. Without that safety, you will get silencing of divergent views, which will lead to group think, which leaders might mistaken for consensus.
And so, often, in healthcare and really many other industries, divergent viewpoints and perspectives are seen as "troublesome" or "work" for the leader. It creates a tension there. There's a little bit of conflict, but that's task conflict usually. It's not usually relational conflict. And that tension isn't appreciated as it should be. And as a result, those divergent voices are often pushed to the margins of an organization and silenced and cut off.
And that challenge network is what questions, what's happening. That network gives feedback that might honestly be a little difficult to hear. They point out our blind spots and they prompt our rethinking on things. And what's really important is that the challenge network doesn't do this because they are passive-aggressive. They don't do this because they want to see you fail or the organization falter. They do it because they care and they see a different perspective.
Strong leaders really protect the challenge network while weak leaders work to silence divergent voices. And so, if you want to learn more about a challenge network, I highly recommend Think Again by Adam Grant again, exceptional book. The other book that I'll recommend in this space, I'm actually rereading it right now, I mentioned it earlier, In Defense of Troublemakers by Charlan Nemeth. It is good stuff.
Yeah, you bring up a good point there, which is I think that the main difference between a successful leader and one who will live in an echo chamber and not have lasting change and that's one that's willing to hear divergent thinking, even if it challenges the core of what that person has experienced in their life or done in previous organizations. And you and I both, even recently, have experienced some of this. And it's really frustrating to see people go insular, to remove the voices of dissent, to create an echo chamber. And to not even look at the data points, whether they're people bringing up things or actual data and just ignoring it to build their own narrative. And I think that if you don't have a group of people around you that can call out your BS, you're going to build that.
We're seeing it all over the world at the moment. There's people building echo chambers. It's happening in politics, it's happening in organizations. And that's the worst way to lead in my opinion, because like you said, there has to be this diversity and it's diversity at its core. It's the stuff on top of the iceberg and under the iceberg that allows for novel thinking to occur, which is what innovation is. If you don't have that ability to disrupt your routine, your routines in thinking, your routines in meetings, your whatever, then you are going to do the same thing every single day. And the longer that goes on, the bigger of an event it will take to disrupt that behavior. And so, you just got to be open to it as leader.
Absolutely. I mean it is human that we all want to be right. I mean, we do. And especially the further up you go in the leadership chain, we often fall victims of even what's called the HIPPO principle that the highest paid employee's opinion in an organization. But truth be told, it takes hard work to curate and maintain diversity in a team. It is the far easier path for a leader to build an echo chamber, as you've pointed out, and really just do all of the things that leader would like. That is super easy.
Unfortunately, that is not usually the best route and so, the hard work is going to pay off. And when I get burdened or what I feel like is burdened because it is, it's emotional and relational labor to have a diverse team. It is one of the hardest things to build and one of the hardest things to maintain because again, we shouldn't have a whole lot of high-relational tension, but that happens in diverse teams. We're different.
We're going to see things from different perspectives and it still takes a lot of emotional and relational labor for a leader to help facilitate that in a strong team, so that you're not squelching it, but that you're still managing it. So that relational tension doesn't supersede the task tension and we become so overwhelmed with, "I just can't stand working with Joni. She's always disagreeable." We have to be able to have some trust with one another in order to disagree, but it's the best way to move an organization and industry forward, for sure. But it is not the path of least resistance.
Yeah. No, agreed. And that's the hard work of leadership, I think. It's not just sitting in your office and have an open door policy. You have to curate these relationships every day and it's those micro interactions that lead to it.
We've talked about your leadership manifesto and the ability to build challenging and diverse teams. And so, I'm curious, as you sort look to the future of nursing, what do you see there? And what are some of the barriers that our profession has to overcome in order to realize our desired future?
I tend to think in terms of futures, plural, rather than one singular future. There are so many opportunities and potentials. Nursing is an incredible profession that just continues to grow stronger in evidence, in implementation, in leadership. There are nursing roles and nursing care and work advancements that we haven't even yet thought of. And Dan, your brain is powerful. I'm a creative being. There are thousands of creative and industrious brains thinking about the nursing of the future, but really in a transformative moment. And that sounds cliché because I've heard that my whole nursing career.
I've been a nurse almost 20 years now, which is a little crazy to think about, but it really is, this is a transformative moment. And we could talk about the specific people and process and technology that will change or the sites of care or specific roles. There's so much in this question, but really, truly overall, I envision the futures of nursing as bright and bold. And with the risk of sounding to Pollyanna, that doesn't mean that it's not without its challenges because we will always have crises, for sure, that I believe nursing is becoming more well prepared for, honestly. What I mean by bright and bold is that we're leveraging the over 4 million strong voices in our profession to make life better for the communities we're in.
You cannot turn to any community, these days without a nurse being there. That's how beautifully diverse we are as a profession. And nurses are some of the most brilliant creators I have met in my life. And of course, that is a known bias to me because I've been surrounded by nurses and brilliant nurses and thinkers my whole career. But when I think about the National Academy of Medicine's future of nursing report, particularly around things like social determinants of health, which are really political determinants of health, I am again encouraged that nurses are in all of the places that we live, learn, work, and play.
Gen Z, those who are aged 25 and younger right now are just now entering into the nursing profession. And man, I am here for it. Talk about a challenge network. I mean, this generation is already talking about things like wage transparency and parity and the carbon footprint of your hospital.
And challenging seniority and working nights for 10 years to earn your dues. They're not putting up with that stuff, which I love.
Yes, absolutely. And so, the oldest of these young professionals started their careers during the COVID pandemic, and they are built differently in fabulous ways. And their younger counterparts in Gen Z and the oldest from Gen Alpha, Gen Alpha, the oldest ones, they're all around 12 years old right now. It's interesting because you and I were like geriatric millennials right now, Dan. But to think about Gen Alpha, the oldest of whom is about 12 years old, these generations have had a level of unrivaled native and ubiquitous tech that is going to just continue to propel all associate and consumer experiences forward.
Things like, of course, automation and big data and predictive analytics, machine learning, individualized, holistic care, the internet of things and all the connectivity, all of that, of course, in the future of nursing. And the other thing that I think about in regards to the futures of nursing is the value of nursing is also changing or the conversations around the value of nursing. And that will continue to change as we think about things like the total cost of care and the opportunity cost associated with misaligned care models and staffing solutions and lagging leadership.
In regards to barriers, yes, we have some edge running healthcare organizations in the US, overall, as fast as we feel like we're moving in healthcare, we're like turtles and molasses. I mean, we tout agility. It's our thing in healthcare.
We're the worst.
Man, we are bound in invisible red tape hierarchies and structures and sacred cows that we have often made up ourselves in healthcare. And we've got to speed up our work. We have got to get rid of those invisible rules, so to speak. We have a highly regulated, risk averse industry. And while yes, absolutely, we must keep people safe, do no harm above all, we need to leverage the power of the people doing the work who know the problems inside and out. And often have incredible ideas to fix those problems and then implement and fail like crazy, and then get over the failure and onto the next idea until we reach a scalable, successful version.
Other barriers, we have a lot of tensions in healthcare that we don't talk about. There are dichotomies that we should expect to have, but we just don't talk about them and we try to make them invisible when really, we need to call them out. We throw up our hands as if we cannot do anything about them, when really we need to call the dichotomies out and live in the tension because that's where the innovation and the transformation happen. A great example is standardization versus variation. We need variation to innovate. Well, we need to reduce variation to reach operational efficiencies.
Variation is a tension that often causes a lot of conflict in organizations, other tensions like individualistic versus collective or ownership and accountability versus employee and widget work, short term versus long term. All of these tensions are in healthcare, and we often just navigate them invisibly without calling them out and talking about them with our diverse and beautiful groups, so that we can move forward.
Two other things, Dan, another large barrier that we're really just now starting to broach is diversity, equity, inclusion, and belongingness. Again, it pervades everything in healthcare, our people, policies, processes, technology, you name it. We have some of the most beautiful, weird, and divergent teams on the planet in healthcare. By the way, weird, if you haven't noticed, is a compliment to me. But goodness, the amount of expertise among us is just staggering when you include every member of the healthcare team, but we've let the lightning out of the bottle because we haven't appreciated it, nor protected it. And these are more than buzz words. They truly lead to transformation and often with a strong financial bottom line. And so, we must make space for the voices to be heard and the ideas to shatter the norms.
And lastly, I think looking introspectively within ourselves, nursing has a tendency to want stability. And I get that. I, too, enjoy stability. It's hard to move to the next stair if the one beneath you is crumbling. However, the status quo is gone here. We need to let go of the past and look forward to new and different methods of work and care. And too often, we focus nursing as a victim, like something is being done to us. And for a long time that has been the case, and sometimes in organizations, it may still be the case when you don't have nursing at the table or nursing voices or nursing allies. But again, this is a transformative time. And healthcare organizations that change without the input and championing of their largest single workforce will have difficulty being successful because nurses are flipping the script, moving from bystander to creator.
Yeah, no, I think that's a great perspective and we have to push forward. And the history of nursing has been a no oppressed group syndrome, and we continue to of blame others. And even within our profession, you can see the divide between direct care nurses and management and that comes up all the time. And we got to get over that and respect the traditions that make our profession awesome and let go of some of the stuff that has held us back.
And we can do that by all the ways you talked about, having clear leadership philosophy that is founded in evidence, creating a challenge network. And pushing the buttons in the right way to challenge some of those assumptions and traditions, so that we can build a better future because what we know for sure is going back is not an option. And so we have to fail forward if nothing else. I think that's really important.
We're coming up to the end of the time here. And one of the things we do is hand off that nugget of information to the audience at one piece that you want to share with them as we wrap up the show. Joni, what would you like to hand off?
Goodness. This feels like such a weighty question. Well, considering what we've talked about today, Dan, I want each listener to know that you are the creators of the future. Not just of nursing, but of healthcare and education and commerce and communities. Your voice is powerful and different and all the things you love that make up who you are, are unique and purposeful, and nursing and healthcare, need it. Bring it all as your best self, like don't be a jerk to work and care.
Take some time to develop your leadership manifesto and think about what truly drives you and what you believe as your authentic and best self, and write it down. And then find the places and the people that align with letting you work and live as your best self, a place and a team that listens to your voice, especially if it is within a psychologically safe challenge network. You are the catalyst. You are the change agent. Go forth and create the future.
For the formal leader listening today, I want to encourage you to wildly protect the diversity of your team. Rethink how you are developing relationships with and among the team, and how you foster a psychologically safe environment so that all the divergent voices can speak up. And if you haven't done that to date, you can change the future.
If you have someone on the fringes who you are pushing away from you because they think differently and you always think that they are disagreeable, I would encourage you spend time with that person to build some relational capital. Because that person is probably not disagreeable because they dislike you, they probably have a different perspective that is valid and valuable that you need on your team. And so, I would encourage you that you create the team, you curate the space and the environment. So, create it with all the beautifully weird and wonderful people that you are privileged to lead.
Yeah, great message, Joni. And just so great to hear your philosophy on leadership. I think nurses and healthcare workers in all levels can really learn from the principles we talked about today. If people want to find out more, I know you mentioned LinkedIn, where else can they find you? Are you making TikTok videos about all this stuff? Where do you live online, Joni?
Yeah, LinkedIn is the best place to find me. Although, I do have a 16-year-old daughter who has highly encouraged me to get into book talk, so I'm not quite there yet, but who knows. Maybe for Christmas, Dan, I'll send you my first TikTok video.
That'd be awesome. You got something there. And so, check out Joni on LinkedIn, even for nothing else, the book reviews are amazing. But you can tell she thinks a lot about leadership, teaches leadership, and practices it. And so, just another great nurse co-conspirator to add to our list because we have to build our future together.
Joni, thank you so much for being on the show and look forward to working and chatting with you soon.
Definitely. It's been a privilege, Dan. Thanks so much.