Joni: 

Hi, this is Dr. Joni Watson. Welcome to The Handoff, the podcast for nurse leaders brought to you by Works, healthcare's flexible staffing platform. I'm thrilled to introduce our episode guest. Joining us today is Dr. Jennifer Shull, System Chief Nursing Executive for Kettering Health. With over 18 years of senior leadership experience at Kettering Health and Advent Health, Dr. Shull is known for her deep commitment to her teams and her passion for delivering exceptional patient care and outcomes. She began her clinical journey as a cardiovascular ICU nurse at CHI Memorial Hospital in Chattanooga, Tennessee, and has since made significant contributions in various ICU settings, quality and risk management, and even in the training of new physicians with a family practice residency program, Dr. Shull holds a doctoral degree in executive leadership from Northern Kentucky University, a master's in Healthcare administration, and a bachelor's in nursing from Southern Adventist University. Her role at Kettering Health allows her to partner with nurses, physicians, and leaders across the network to make care easier for clinicians, a mission she pursues by collaborating closely with those on the front lines of care. In today's episode, we'll be discussing some critical topics with Dr. Shull, including her approach to workforce development and flexibility, Kettering Health's guiding principles, helping clinicians find meaning and joy in their work, and how Dr. Shull stays engaged with frontline nurse leaders. Dr. Shull, welcome to The Handoff.

Jennifer:

Well, gosh, after that intro, I'm feeling a little intimidated now. I don't know if I can, Joni. It is a pleasure to be here. I'm looking forward to just having a conversation around topics that are near and dear to me. 

Joni: 

Yes, excellent. You've done quite the work in your career, so I'm excited for our conversation today. And so Jen, we are focusing on workforce development and all things retention and people and processes this season, which are top priorities for really every CNE across the US right now. How is Kettering Health addressing some of these challenges?

Jennifer:

So I think first and foremost, it is really just taking a step back to really ensure that everything that we do is creating an opportunity for our team members to come and do what they do best and in an environment where they truly, as you said earlier, find meaning and joy in their work in order to do that. As leaders, I work with an incredible team of clinical leaders and frontline team members that really help us think through what are those barriers that prevent our nurses from really connecting with their patients because that's where they find joy in their work. I mean, that's why we all went into nursing. It was because we wanted to help people. And so as a healthcare organization and as nursing leaders, I believe our number one priority is to create that environment where our team members feel safe, they feel valued, and they're able to do what they love doing and that's caring for patients.

Joni: 

That's incredible, Jen, and it sounds so simple, but it's certainly not easy. It's not easy to do. And so since Kettering Health starts with guiding principles focused on creating an environment where clinicians can find meaning and joy, can you elaborate more on that and how that work shapes your initiatives and what you do?

Jennifer:

So first of all, trying to define that from an office or a boardroom makes no sense. And so we are very mindful of listening to the voice of the folk closest to the work and partnering with them to help us define what that needs to look like. So one of our fundamental approaches is we don't design anything without having a frontline member help us and give feedback to it. So I think that needs to stay at the forefront of everything that we do. And so we have different forums for that. I believe that the value that we bring as nursing leaders is in our time and attention. And so visibility, accessibility, being in the space with our frontline team members to listen, observe, and really hear them is where we've got to start. And so I work with a group of CNOs and nursing leaders who also believe that. And so it is about how we spend time rounding, how we create conversations, whether that's through town halls, shared governance, different opportunities where we are always asking and never assuming that we've got the answer.

Joni: 

I love that, always asking, never assuming, because it's so easy to assume as a nurse leader, it really is. That's beautiful, Jen. And so I feel like there are so many plates spinning. There are so many balls in the air. We have so much happening in healthcare these days and we really need the voice of nurses in all of it. To your point, asking, never assuming. And so again, these things sound really easy, staying engaged, rounding, asking questions, but it does not mean that it's simple because there is so much going on. How do you ensure as a nurse leader, as a nurse executive that you really stay engaged with the frontline direct care leaders to understand their needs and address their concerns effectively? What does that practically look like?

Jennifer: 

Yeah, so I will just share that how my cup gets filled is really just spending time out on the campuses, talking with teams and finding a balance to that because there is work and strategy and things that we need to be thinking of as leaders, but what I have built into just my process and how I stay connected is I have regular scheduled time where I am out rounding at each of our campuses with an intentional focus. So rounding for the sake of rounding, it's nice, but it's really being focused on what is the important topic that we are hearing from the teams? What is the process that we want to get their feedback on? And if we've put something in place, is it really achieving what we desired? And so it's really having those scheduled opportunities to round. And so you've got to schedule it in because to your point, there are so many things that can fill your day as a leader, but I believe one of the most important things is hearing that voice.

So rounding, scheduled rounding. I also have the opportunity to meet with nursing leaders across the system on a quarterly basis. And those are conversations that we have again to ensure that what we've designed is meeting the needs of our teams and our patients. Probably the most fun forum that I have is our Nursing Advisory Council. So this is a council that started, we've been in about a year. We've been together for about a year, and it initially started as a focus group. So I invited nurses, representatives from each of our campuses to just come and spend time with me and we vision together what we would see nursing at Kettering Health looking like. And so it started out as a focus group. What it has evolved to is now a core group of individuals who meet on a regular basis to help us define that roadmap. This is also the group that we bring policies, practices, and they help us vet it. So let me give you an example. So we recently did a transition from our risk management reporting tool to a new process platform. And our patient safety team spent hours developing it with the thought of, let's make it easy so we get more reporting.

So right before we launched it, I said, this really needs to get frontline input because they're the ones that we want to fill it out. So our patient safety manager came to this group of individuals, nurses did the presentation, and they were able to give us last minute tweaks that really then made sense. So things like put the link upfront at the top so we can see it. I mean simple things, but things that make such a difference. And so this group has really become one of my favorites, and I co-chair it with one of our frontline charge nurses. And I'm telling you, it is powerful. She drafts the agenda, we talk about it, and people come to, we even gave them the option of, do you guys want to do this in Teams or in person? Everybody wanted to meet in person. And so two hours every other month, this group is coming together to give their time and attention to asking how we make nursing better. And there's not one size fits all. I mean, and I know there are other things that I need to be considering to stay connected, but today it's just really that intentionality of in the forums that you have, to be listening and be talking about those things that are important to your teams at the bedside.

Joni:

Yes. Jen, you said a couple of things in there that grabbed my attention. So the first is just the intentionality. I mean because so many times, again, it's easy to round for the sake of rounding, like, oh, I need to be visible. And of course you're gleaning information and having conversations, but to be intentional with your rounds and to know why you're rounding and what you're going to ask about and those sorts of things, that's gold. Jen, thank you for that. The second thing that I love is that you co-chair that committee with a direct care nurse leader. Because Jen, we hear often, I mean, having an executive sponsor that's like a norm, honestly. But I can't say not too many times have I seen a CNE co-chair, a group with a frontline nurse leader. So I love that model to really co-create that space and that meeting to make it meaningful for everyone. That's great leadership. The last thing that you said that really stood out to me, and I'm so glad to hear you say this, is transforming the adverse event management system. Because when we think about transforming nursing technology and processes, we often go to those big buckets like the EHR, which is absolutely important. We can easily forget the amount of time that nurses spend on broken tools like our adverse event management system. So it warms my heart to know that you have focused on that.

Jennifer: 

Well, so that's kind of ironic that we've got a system that was clunky. We still need to improve it, a broken process that we're reporting broken processes in. So that's kind of ironic. And it's everywhere, right? And so we've got to just make it easy. And so what I was really pleased to see is based on some of the feedback from what we call “SNAC” (our System Nursing Advisory Council) is that we were able to bring that down to five minutes at the most. And our reporting has gone up. 

Joni: 

What a great way to take care of patients by taking care of nurses and the technology that they use every day. I love that. I can't even tell you how happy that makes me, honestly. So Jen, we are talking a lot right now about the unique needs of today's workforce. And certainly our workforce today does have unique needs, but let's be real, every nursing workforce before them has had unique needs. Every nursing workforce after them will have unique needs. I'm curious, how are you supporting professional growth and development for, especially maybe for some of our newer nurses who are seeking earlier career pathways. I mean, they may have known they've wanted to be a nurse since middle school or high school and have had programs that have put them out in healthcare, and so it's only natural that they are seeking earlier and earlier career pathways and movements. How are you focusing on that?

Jennifer:

So that's a great question because before I answer that, I think I need to speak a little bit to just another principle that as nursing leaders here at Kettering Health, we have really challenged ourselves with, and that is challenging every paradigm because when you think about professional development being a seasoned nurse in the day, you had to earn your stripes before you even were considered for that next move in your professional career. And so to your point, our nurses coming out are looking for ways to contribute sooner and faster.

And so we as nursing leaders need to really be thinking about how we, number one, have those conversations earlier. So as a nurse coming into Kettering Health as a new grad going into the residency program, we're already going to be talking to you about as we partner with you, as you transition to nursing practice, do you have any other thoughts, any other aspirations? Because we want to start building that into your professional growth and development from the very beginning. And then for those team members that have had several more years of experience, we are always bringing to the forefront what can we be doing to fill your cup professionally. So one of the things that we do here is we have regular touch bases. So leaders on every unit have a one-to-one with each of their team members on at least a monthly basis.

And one of the things we have built into that conversation is really to focus on asking if there is anything we can be doing to help support their professional growth. And sometimes the answer is “yes,” sometimes the answer is “not now.” But we have to always be constantly asking and then have a pathway to put them into. And so I think our past experience of thinking that a nurse needs to have three to five years under their belt before making a transition, that's not the case today. And so we've got to figure out how to grow them quickly and provide them pathways, and we start the conversation from day one.

Joni:

I love that. Jen, you reframed something as you first responded. That caught my attention because I think when we talk about the workforce, particularly when we lean into generational differences, it can get awkward really fast and gross really fast, honestly. But you mentioned that our younger nurses want to contribute more quickly and more often and faster. And that is a great way to reframe it because I think so many times our novice nurses get the bad rap of being takers when really they are tremendous givers and want to contribute to the profession. So I really appreciate that perspective because they have a lot to offer nursing and healthcare and patient care.

Jennifer:

Beautiful. And what I would just add to that is I have observed and have appreciated that our newer nurses, they want to understand why. And frankly, as leaders, we need to be really clearly articulating why we are doing something. And if we can't, then I might suggest we need to take a pause to determine why we're asking teams to do what they're doing. So I have appreciated just really working more closely with our newer nurses because they bring a new and fresh perspective that frankly, as nursing leaders, we need to be able to embrace. And like I said, we have to challenge every paradigm, every single one.

Joni: 

Absolutely. Yeah, which is challenging. It is. But it's good for us. It's good for us and for patient care. So, flexibility in the workforce, that is also kind of stepping into its own right now these days as we talk about workforce, how are you addressing the varied scheduling needs of your team members at Kettering Health?

Jennifer: 

So, not as well as I'd like to, but I believe we're on a pathway. So let me start with students. So we've got several nursing students that are working as NAs and techs, and we have committed to really being flexible and allowing them to have that experience while going to school. So we do pretty good with that. Our teams are very creative in helping meet that need, where I think our opportunity is in really challenging the 12-hour shift. So there's a segment of our colleagues that like it, and there's a segment that are saying, “wow, that's too much.” And so we are really taking a look at how do we create an approach where we can have a combination of eight and twelves? 

And I say that it's easy, it's not, and I'll tell you, our nursing leaders, although they absolutely agree that we need flexibility, it's really just working through how we do that in a systematic way. So we are starting the conversations of are there certain units that eight hour shifts make more sense? Are there certain roles that can job share? And so we're looking at all of those options that we can still provide that 24/7 care needed, but in a way that we're able to customize shifts and opportunities to meet the various needs of our nursing colleagues. 

One of my future visions in flexibility really addresses not only scheduling preferences, but also how do we address potential burnout? And by that I mean when I think about the intensity of work that is at the bedside today, people aren't necessarily wanting to come to the bedside. I mean, today we've got nurses who are looking for ambulatory settings, we've got nurses in the insurance field care management, and although I am grateful that we've got nurses who are supporting those functions, we've got to figure out how do we keep nurses at the bedside? And so one of the concepts we are fleshing out today, is there an opportunity that we can build in an intentional job share, for lack of a better term. But what I would love to see as we develop this is we have positions. So you come to work at Kettering Health and we're asking you to name two, maybe three places that you would be interested in learning about and becoming a part of the team. And so let's just say I want to work on a med-surg and also interested in an infusion center.

And so does that look like your schedule: two weeks, you're on a med-surg unit, two weeks, you're on an infusion unit or whatever that rotation is. But I think that can help with some of what today is pretty intense work. So flexibility has a lot of different meanings to it, but we're exploring all of it. And again, listening to what our frontline needs, again, we can think these are great ideas, but as we listen to feedback, I mean you've got some that say eight hours would be great. We're hearing positive feedback on a job shadowing or job sharing concept. So I'll let you know, we haven't arrived yet, but these are things we are working through with our frontline.

Joni: 

I appreciate that authenticity, Jen, because I think you're at the same spot that so many CNEs and CNOs are in as well, trying to figure out how we make this work. We know we have to make it work because it's not one size fits all. Just for myself, for example, I grew up as a nurse working eight hour shifts. I did some twelves as well. I've done acute care and ambulatory care, and as I've grown as a nurse executive and have kind of transitioned into some consulting roles and things like that, I am thinking about, man, it would be great to be able to go back to the bedside for a shift here and there because I do tend to miss some of that acute care, direct patient care pieces. But let's be real, Jen, if you haven't been at the bedside in a while, it is tough. It is hard work. Our direct care nurse leaders are rock stars. I mean, it is taxing mentally and physically and emotionally. I mean, just the amount of work that nurses and really all the entire interprofessional care team are doing. It's a lot. And so maybe a six hour shift, maybe a four hour shift when I could come in and resource and things like that. But you're right, it's more of how the operations work that I think tends to snag up some of our legacy systems and legacy thinking. So kudos to you for questioning and probing and trying. And, definitely keep me posted because I want to hear all about it, the good, the bad, the ugly, all of the things.

Jennifer:

And again, I think we're just going to continue to iterate as we take a couple steps forward, we might take a step back. But as long as we're moving forward in really creating not only the flexibility piece and allowing colleagues to come six hours, four hours, eight hours. That’s also going to require us to think differently of our care models. So we're going to need to think, because today it's the traditional RN, NA, or PCT, and I'm going to tell you that's not going to carry us into the future. And so as we look at flexibility and shifts, flexibility in roles, we also have to be looking at flexibility in care models.

Joni:

Yes, 100%. Jen, I totally agree. And so as you're thinking about all of these pieces, often the way we prepare our team members needs to shift in the midst of all of that, which just adds a whole additional layer. And so academic practice partnerships are kind of coming into focus for many healthcare organizations and rightly so. It's about time that we focused on this piece. I'm curious, can you discuss your academic practice partnerships and how they help create a pipeline for future healthcare professionals at Kettering?

Jennifer:

So I see one of the key functions of my role is to stay very connected with my academic faculty partners because what I have seen in the past is that there tends to be a silo of what is being done in nursing school and then what is happening in operations. And so what I have been so excited to see here in our region, so I partner with two other CNEs of other systems here and together we have regular meetings with all of the academic schools, all the nursing schools on a regular basis. And partly to build relationship, which is so important, but also to be able to share with them this is what's happening, this is the shift in care models, this is the shift in need, and this is what we are seeing from our new nurses coming out, that we are going to need a different approach in how they're being taught in nursing schools.

So here's an example. As we are moving to a different model of care, it is really requiring our nurses to really get comfortable with delegating. So nurses aren't good at delegating because we've been in this primary model of care. And so we're having to do some work with what delegating means within our own team. And so in recent conversations with our nursing faculty, we talked about models of care shifting. Delegation is going to be key in helping to drive care of the patient. And so they're going to start building that into their curriculum, building it into simulation. And so as we really move models of care, it needs to be in lockstep with our nursing faculty partners because the earlier they can start that conversation and as nurses transition into practice, it's not going to be the first time they hear it.

And so it's really that open dialogue and sharing that is so important. The other piece that we are trying to really figure out how to best support them is faculty needs. So when you talk with our schools, one of the prohibiting factors is they don't have enough clinical faculty to do clinical rotations. And so we are offering a hybrid role where nurses are able to serve as clinical faculty when needed, and then also pick up shifts when school's not in session so that they stay whole as a full-time team member. And I will tell you, the response from our nursing schools has been phenomenal because they are saying, we want to send you nursing students to experience your facilities, your culture, and to give them an opportunity to decide who do I want to be with when I'm done? And so we've got to figure out how do we share information more transparently, more intentionally, and how do we support their needs at the hospital level so that we can bring more students in. So more to come on that as far as how we develop a deeper partnership. But that is something we have got to figure out as nursing leaders on the hospital side because we can't do it without them.

Joni:

Absolutely. And really that's how those partnerships should be. It really should be a symbiotic type of relationship. It's interesting. I don't know how we got so siloed in both of those systems, but we did. And so now it's up to us to bridge them. I love that. Jen, we have talked about so many pieces today, Jen and I really appreciate the way that you frame things and the way that you're thinking about the workforce and the future. And so as I find leaders that I enjoy the way that they think, I'm always curious about what has shaped those leaders, what is continuing to shape them? So what are you reading or learning or even just doing these days to sharpen your skills or to nourish yourself or your soul?

Jennifer:

So I would say for my fellow nursing leaders, it is so important that you take care of yourself. And I know that's easy to say, and I am going to tell you I am a nursing leader that struggles with it. But we have to find intentional time to feed our soul, to feed our minds because we can only be as good to our teams and our families as we are good to ourselves. And so I'm very intentional about when I am off with family trying to be present. And although that sounds like a very simple concept, it is one that I continue to just be mindful of. And so I really find my cup being filled when I am really spending that intentional, purposeful time with family, friends, those who really fill my soul, things that I am really looking to learn more about. So you ask, what am I reading?

So I am reading a book called The Art of Gathering, and it's written by Priya Parker. So she is a facilitator, but in this book, she really talks about thinking about why you are gathering people and what are you really wanting to achieve, and how do you find meaning in that? So as nursing leaders, we're always bringing people together for meetings and conferences. And so I started by saying one of our most valuable things we can contribute as a nursing leader is our time and attention. And so I am trying to be really mindful of when I bring a group together, when I'm having a conversation, and I will say both professionally and personally, is it meaningful? Am I clear on what I am wanting to achieve in this interaction? So this book has really been interesting and very helpful, and just getting me to think about how I can ensure that when I do bring teams together, that there is purpose, there is meaning, and we are really ensuring that we're achieving what we need to achieve. And again, sounds like a simple concept, but sometimes, I mean, you've been in those meetings when you're like, oh, this could have been an email.

Joni:

Absolutely. 

Jennifer: 

Why are we here? Why am I here? And so I don't want to be that person that has called that type of meeting. And so it's just, I think for me, it has been really just a nice opportunity just to rethink about how do I bring folk together? How do I show up? How do I really guide a meaningful conversation and ask the right questions to engage those, engage those that I interact with?

Joni: 

That's great, Jen. And I feel like this theme of intentionality, you've really threaded this throughout your work and the way that you're thinking, which I appreciate because you're right. So many times, at least I have fallen into this, is that I get in my routines and it's just a pattern of, oh, I've got this meeting on this day and this meeting on this day, and we have this meeting every third week. And then we just keep up some of these patterns and routines without really pausing to ask ourselves, is this meaningful or is this bringing value to what we're doing? So The Art of Gathering, that's a fabulous recommendation. Thank you for that. And so Jen, again, we've talked about lots of things. Ultimately, what do you want to hand off to nurse leaders at all levels and at every setting today?

Jennifer:

I would say be curious, stay curious. Don't assume that we have the answers because the answers come from the bedside and those closest to the work. And so I would say continue asking those questions to seek, to understand how you can support and validate the solution with the frontline, because it's really about, it's about them, to ensure that we can care for our patients. So I would just encourage nursing leaders and colleagues to just find those opportunities to connect in ways that are meaningful, ask questions that bring out the real issues and involve the frontline in the solution.

Joni: 

Jen, where can people find you if they want to connect with you or talk more after this?

Jennifer: 

So I'm on LinkedIn. You can reach out to me on LinkedIn and I'm happy to connect and just find colleagues that I can network and learn from. So please reach out, and I have just really enjoyed being here with you this morning, Joni. Thank you.

Joni: 

Excellent. Well everyone be sure to find Dr. Jennifer Shull on LinkedIn. Jen, thank you for sharing your time, energy, expertise, your passion for nursing and patient care today. It has been a joy having you on The Handoff. Thank you.

Jennifer:

Thank you.