Dan:

Nichole, welcome to the show.

Nichole:

Thank you. Thank you for having me.

Dan:

So let's rewind and have the traumatic memories of COVID and just start there.

Nichole:

Sure, let's do it.

Dan:

So you were a brand-new nurse leader when the pandemic started and had to quickly take on a lot of stuff and we were chatting before we started that you were running two stepdown units, COVID units. What was that experience like, if you could sum it up in a few words? What was that like and what changed in you?

Nichole:

So since you mentioned I am an Ironman, so it was like Ironman on steroids. I definitely had to pull a lot of my knowledge and mental strength that I have gained through doing endurance races and endurance training like Ironman to get me through this.

I entered the leader role, like you said, taking care of two stepdown units that quickly pivoted into COVID units needing to care for ICU level patients. In addition, I had a staff COVID outbreak. So that was week one of my newly appointed leadership role and I was down 12 nurses.

And then about week three into that, I was told we had to open additional beds and I had to open an additional 12 beds. So I already had over 50 beds that I was responsible for and then I had to open up an additional 12 beds to help offload the ICU further. And this unit was a overflow mom-baby unit. So we did not have the equipment initially to care for ICU level adult patients, let alone COVID and that acuity.

So we literally had 24 hours to transform this. And I mean it took so much manpower between myself, my team, senior leadership, our supply chain. Everybody came to the table in a very quick way and transformed this unit so we could care for our patient population.

Not only that, but I had brand-new nurses on my COVID unit that were literally just coming off orientation. So I tapped into a little bit of their knowledge and a little bit of their fear too, but their creativity. And we had a very quick staff meeting and we came together and was like, "Okay, how are we going to do this?" So that's where the beginning of team nursing came into play for us.

Dan:

That's awesome. And I love the fact that you tapped into the team to figure out the problems. And you're leading through the unknown. We didn't have the answers, we didn't know a ton about the virus initially. We didn't have the right PPE, but nurses come together and figure this stuff out in real time.

What was some of your background in leadership development and mentorship where you went directly to your staff to start problem-solving when in other systems they went directly to command and control, take the decision-making off the nurses, really push down those things? Where did you develop those skills of teaming rather than the command and control?

Nichole:

They're frontline. These are my frontline staff. These are the people that are going to mean the most to us in how we care for our patients and what better resource than tapping into them and their new knowledge. They're coming into this with fresh eyes and they may have a different scenario than I'm thinking in my head.

And I like to challenge thinking outside the box and doing things a little bit differently than the standard path. Sometimes that's usually the most difficult path, but I like that challenge.

And I think just from being ... at a younger age, I played team sports and I knew I could not do this alone by any means. I knew none of the situations I was going to say or none of the scenarios, none of the ideas were going to work unless I had the support of the team.

Dan:

You know that team nursing has sort of gone in and out of fashion too, that solution, right? And when I was an ER nurse, we did team nursing. We had, I don't know, four nurses per pod. We had our primary patient, but we all just did the work and got it done and picked up for each other and it worked out well and we had the physicians assigned to us too. And I feel like in the ER space, it just is this natural sort of teamwork piece.

But what made you go that direction, and how was it received by the nurses? Because definitely, again, it's one of those things, it's like, well, that's my patient, don't touch my patient, especially in the ICU.

Nichole:

Oh yeah.

Dan:

I'm going to tuck them in. Get away. I'll tell you what you can do. How is that received, and how did you develop that? I mean it was definitely a necessity because you don't have staff, you have staff with COVID, all those type of things, you have no other option. But even despite those things, sometimes we resist that change. So I'd love to hear how you got that across the finish line.

Nichole:

So not only did I have a lot of staff, like I said, my staff were really, really brand-new nurses and maybe that was to my advantage. They didn't really know any differently or any better and they were looking to me for answers as well.

So what I knew was we were going to have to take care of ICU level patients, patients that normally would've been in the ICU. So my nurses hadn't seen this level of acuity, let alone our float pool, which was mostly medical surgical nurses because our ICU float nurses were already locked into our ICUs.

So I had to work with our respiratory department and get a crash course on how to take care of patients on high flow oxygen, which we call Optiflow. And that's the type of patient population we were going to get, and these patients were going to be on max settings. They were one step away from intubation. I utilized those resources and the resources from the hospital in our med surg float pool and I paired them together.

So we paired a progressive care nurse or an ICU level nurse with a med surg nurse, and together they took care of a larger patient assignment, but they divided up the responsibilities. So our progressive care, our critical care nurse took care of the assessment documentation, the titration of the Optiflow, and communicating with the provider. Whereas the med surg nurse or a secondary nurse on the team did all the medication passes.

And then together, they were proning patients outside the ICU so we could attempt to reduce the risk for intubation for these patients. They were repositioning patients. They always had a partner. They were relieving each other for breaks so they could take that break from PPE. And it actually organically transformed into this mentorship and support system for our staff.

Now initially it was like, you want us to do what? And it wasn't super well received. However, we also knew that our primary care model wasn't going to work either. So we really didn't have anything to lose by trying it. And I think what has made it so successful is our staff, like my team, really took ownership of it.

And then I really checked in and listened to what they were saying, what was working, what wasn't working. I went back to frontline staffing at the time and because we were so short staffed, I was working alongside with them and I wanted to see.

My background's critical care, I am that ICU nurse who wants control over her patients and I wanted to see how it worked. And I could see what worked, what didn't work, and I listened to them. And we tweaked it along the way and before we knew it, we had something more substantial than just a crisis intervention.

Dan:

I love that. It's this natural evolution based on the constraints that you had. So now let's fast forward. So now we're coming out of COVID in theory. So what are you not going back to? Are you going to go back to primary nursing or have you gone back to that? Have you reinstituted all the Monday meetings and all the stuff that's in health systems that just dropped off the radar because we were solving problems and taking care of patients? I'm curious to hear what stuck from the pandemic that's actually a really good thing.

Nichole:

So team nursing actually has stuck and it has gone network wide, very excitingly. We, about a year ago, brought back our LPNs into the acute care setting and we are putting them in team models. And they have been working in our adult acute care areas and medical surgical areas across the board.

And that's been very exciting to grow and transform that and see, wow, something that actually started between myself and my nurse residents as part of our nurse residency evidence-based project and it really developed into something pretty significant. And it's definitely something I think we're all very proud of.

Now we don't do it 100% across the board. Like you mentioned, I'm in a new role. I just opened a new ICU, a 20 bed ICU and we're still doing the primary care model there. However, some of the staff had transferred to that unit that had team nursed on my previous units and it's not something that's off the table.

I think what this has taught us, yes we're doing meetings, but we're doing it differently. We're listening to each other. We're exploring those out of the box ideas, like what can we do next that's going to elevate us and elevate our patient care and bring us back to how we cared for patients pre-pandemic, that holistic approach.

Dan:

I think that's such a great example of just teaming and coming together and solving problems and then carrying it through, like maybe we don't need to go back and maybe we can evolve into new ways of working. And that's one, I think benefit of a crisis is it makes you challenge your assumptions, those normal routines that were happening every day.

And you can bring the evidence to it, you had your new grads who have great ideas that don't have all the cultural baggage from the organization and they can really push against and say, "Hey, let's try these new things." That's such a cool thing.

The other thing that is so important is taking care of our staff. So how did Lehigh Health support the nurses as they went through the pandemic and even post pandemic? What are some of the programs that you have for nurses' mental health and wellness? We know that's such a huge issue at the moment.

Nichole:

So I'll say, Lehigh Valley has done an excellent job of maintaining our health and wellness, our mental health throughout this whole thing. I feel like it was always a priority.

So we have a nurse who's a director of compassion and caring and she is somebody who comes around during a crisis time. It could be like she had visited our units when we were hitting this last surge, last winter time and we were losing patients, multiple patients at a time. And she would just be there to support our staff just going through and processing these traumatic events. She had come to some of our meetings, our team meetings.

And then we have our employee assistance program, which is EAP and they have a lot of trained counselors and psychologists on our team. And that assistance program is available to all Lehigh Valley Health Network staff members. You get five free sessions. So it's a great way to start to open up that communication line with all the things that we have dealt with.

I'll share a little bit about myself. I think when going through the last couple years as a new leader and a nurse, I didn't quite realize the weight that was on my shoulders because you're just in this go mode and you're just thinking about the next step in front of you, and how do I take care of my staff? How do I take care of the patients? And you compartmentalize that, what's actually happening around you.

And this hit me post pandemic, so we're coming out of our surge time, because I think I really function well in high adrenaline, high stress environment. So over the summer when we're coming out of this ... And I think this is what's so important now, is to take care of our staff now who are now starting to process what they've gone through.

I'm this mentally strong person, I've done two Ironmans. I thought going into this pandemic, this is not going to break me by no means. I've been there. I've been through tough, tough times mentally and gone through it, but this was two years of sustaining at that type of mental strength. And I finally had enough and I had a complete breakdown, complete. And it came out very primal. I just was crying and screaming and I didn't know what was happening.

And really what was happening was just I was starting to let go and acknowledge all the trauma that I had gone through and just starting to reach out to my staff and my teams and acknowledging that, like how are you doing? Let me tell you, I'm not doing okay. And people look at me like, oh you're so tough, but I felt very broken. So seeking help and feeling supported by the network has helped me regain that strength.

Dan:

That's such an important story, that you may not realize that it's hurting and then it all comes out after the event or after you have time to let down your guard because I used to feel that way as an ER nurse too. My wife's like, "How do you see blood and guts and death and all this stuff?" And you're like, "I don't know, you just switch in a new mode. You're just in a different mode at work." If my kid throws up on me at home, it's not the same. But at work it's different and you compartmentalize it. And I feel like a lot of nurses do that.

And one of the things that Trusted Health did in the pandemic is we set up a crisis line staffed by mental health nurse practitioners. And we were really excited about the opportunity for nurses to be able to call in and in the moment get some debriefing. And we quickly found that nurses didn't want to call in, they were scared to call in. They were afraid to let down their guard and be seen as weak or even have that tough conversation.

So I would love to hear your advice. How did you encourage your teams to process? And then how did you move forward when you realized I'm not okay?

Nichole:

So it was really hard for me to acknowledge that I was not okay, but there were so many signs there that I wasn't okay before I wasn't okay. And I just want to share my story. I had those really real conversations with my staff, not just the everyday mundane things, but like, how is your life, how are you doing? How are you processing this and how can I help you or point you in the direction to help you out get through what you're going through?

Because we're all going to get hit at different times and certain things are going to trigger us. And just to acknowledge that and be present with my staff. It happens to the best of us and it doesn't make us weak. Actually seeking help and getting better makes us stronger. That's strength. Acknowledging that, acknowledging that true vulnerability, that's strength.

Dan:

I think that's great advice. And for the nurses listening, it's okay to not be okay. I think that's the crux here. And it's not a sign of weakness at all. It's a sign of strength like you mentioned. And so if you're feeling that way, make sure that you reach out, get help. There's lots of resources both free and otherwise outside, specifically for healthcare workers. So please reach out and do that.

So recently the Magnet Conference happened and you got to have a podium presentation, which for those of you that haven't been to Magnet or don't understand the whole conference scene, a podium presentation is like next level awesome, and it's really hard to get. Usually you get a little poster over in the corner and you get to stand by it for an hour and people walk by and they're waving to you and they're on their way to get coffee or something else, but a podium, that fills the room.

And this was your first Magnet Conference, which is really cool. So I would love to hear about your Magnet experience and what you presented on, and then how was that.

Nichole:

So Magnet was just awesome. It was like next level awesome to be able to just share knowledge with nurses and in the same room too again, and just be there with one another was just an amazing experience. I was able, I was so fortunate to present our team nursing model on a podium presentation with one of my nurse residents at the time.

So she had only been a nurse for two years actually when she presented at Magnet. She was extremely nervous, but she rocked it and it was just such a great experience to be with a new nurse who I've watched just really evolve and grow.

I mean she came into this as a very new nurse resident and very green and very nervous about everything to just this confident woman who knew her stuff in two years. And being able to share that stage and that platform with her was just incredible. I think she was such a pivotal part of the transformation of team nursing.

And just the fact that we were able to share that and people came up to us afterwards and they're like, "Oh, our institution wants to do this. Can we talk to you more about this? How did you do this? We're trying to figure this out too." Because I think people are looking at alternative staffing models to help get us through and rebuild our profession really.

Dan:

Yeah. Well, a couple things there. One, congratulations on a podium at Magnet. Two, it's so cool that you brought a new nurse or a newer nurse in which I think we need to do more of that. Sometimes we're like, "Well you haven't been a nurse for enough years, you can't go." But I had similar experiences because of my mentors presenting at different conferences really close after graduating and it changes your whole perception of your profession and your professional life. And so that's such an awesome opportunity.

And then I think the thing I love about conferences and presenting there is the conversations afterwards, the excitement of people, it's like, I've been looking for something like this forever and finally someone presented on it. Let's learn, let's teach each other. And that's just such a great way to share knowledge and it's so exciting. And then of course you've got the Magnet party, and so that's not bad either.

Nichole:

No, that wasn't bad at all, actually. That was a lot of fun.

Dan:

That was the best part of it. Yeah, that's cool. Nurses can party, that's for sure.

Nichole:

Mm-hmm.

Dan:

It's always, always fun. Well, so going into the track of the newer nurses, Lehigh recently launched a year-long residency program for new nurses in a time where staffing and investment in nursing is in question in a lot of hospitals as they lose lots of dollars and are starting to come back online and generate revenue again. What was the decision to invest in your new nurses, and what does that program look like? What's one of the special sauce pieces of it?

Nichole:

So it actually was established in 2013, our nurse residency program. But I feel like it has really evolved over the last year to two years. The main focus really is to grow and develop our next generation of nursing. And how we do that is they have a year-long residency where they get to develop their own evidence-based project, which can go network wide. I mean they have the influence of the entire network, which is what my nurses did, which is amazing.

And not only that, but then they also get what's called Tales of the Bedside. So I as a nurse leader participate in Tales of the Bedside and I get assigned a group of nurse residents and we're put in a room and this is their safe space. I tell them it's Vegas and they're allowed to just vent, talk about what's going on, the good, the bad, the ugly. And it gives them that safe space to realize, oh, I'm not alone. I'm not alone in this right now.

And for me, I love participating in it because I gain the knowledge of what they're looking for, like what is the new generation of nursing looking for, what's important to them? And then I can take that back to my team and as I grow and develop that.

Dan:

I think that's such a key is to give them a space because they're processing lots of ... It's super stressful being a new nurse.

Nichole:

It's super stressful and now more than ever it's so stressful. And I want them to feel, and we as a network want them to feel supported and that they want to continue this profession. I think it's been so hard to watch some newer nurses be burnt out so quickly and want to just throw in the towel when you see so much potential in them.

Dan:

I'm curious how you're thinking about staffing as you're coming out of the pandemic too. So you have new grads which are going to require a lot of preceptors, you have team nursing. Did you guys shift your staffing models or did you think about flexible shifts or all of the buzzwords that are happening around the gig economy and nurses not working twelves but picking up four here and six there and eight? I'm just curious if you guys have gone down that road at all as part of that post pandemic, how do we help our nurses think differently about work?

Nichole:

So we are starting to do that and one thing that I have started, we do self-scheduling, which is also great. I actually have converted a couple travel nurses into LVHN employees and one of them has now come to work in the ICU. And part of that was also tapping into what they're looking for too like how do we convert them to stay. They're doing these long stints with us, what can we do to make this appealing to them?

So we do the self-scheduling. It's online, they have to work X amount of weekends, but it doesn't have to be every other. And what I've gained from that and what they've gained from that is just ownership of their unit. And they communicate and really they're able to work their schedule out and there's not a whole lot for me to do once it's set. I don't really have to balance it too much because they've already talked it out.

They know they have to do holidays, but they work with one another to do it. And I think that's the key to it, giving them that autonomy and ownership of it. I know some floors are looking at eight-hour shifts and staffing that way. We do have a position on some of our medical surgical floors called a churn, which they come in midday and they help with lunches and help with admissions and stuff like that. So there's flexibility in that, but I try and keep it as fluid as possible. And we have a scheduling committee and I really value their input.

Dan:

I think that's great. I love self-scheduling, I think it does provide that ownership of staffing the unit and allows some of that flexibility, which is a good transition into some of the more, I guess innovative or disruptive models of staffing where the 12-hour, eight hour thing is of out the window.

And I keep wondering, how do you decrease the stress of ICU nurses or really any specialty, but you work three, four days in ICU, that's a lot. That's a heavy work. What if you work two days in ICU and then the next day you work in the outpatient clinic taking blood pressures or something?

How do you systemize nursing knowledge and clinical talent rather than just throwing them up in a unit and saying that's where you're going to work every single day for the rest of your time here? But really thinking of that talent as a system and deploying it in different ways to give people variety and new experiences. And hopefully one day we get to that system-based staffing rather than the service line based staffing, but we've got a long way to go on that one.

Nichole:

Yeah, but it's definitely a great idea and I mean what do we have to lose really?

Dan:

Right.

Nichole:

I think-

Dan:

We're already short, right?

Nichole:

We are. Honestly though, I think this is a very exciting time for nursing because we're kind of like at ground zero and we can rebuild it now and it's like no idea is too big.

Dan:

I recently gave a talk at Cleveland Clinic's Innovation conference and the topic was it's nursing's Blockbuster moment and we can choose to double down on the past and go the way of Blockbuster and have one left in Bend, Oregon, or we can take on the growth mindset of Netflix and Redbox and Amazon Prime and Hulu and really build our desired future and invest in it and change and challenge some of those assumptions. Like late fees in Blockbuster, maybe there's stuff in nursing we don't need to do anymore that we've just hung onto for so long and it just isn't as value added. I know there's a lot of that.

So I do agree with you, it's time for nursing to step up and build our desired future because there's no going back. And backwards wasn't great either. It's not like we had it all optimized, right?

Nichole:

No, and that's what the pandemic showed us. And now it's really time to be innovative and creative and I think it's exciting.

Dan:

Lehigh also did a documentary, so I would love to hear what spurred that documentary. What was some of the subject of that and where can people check it out?

Nichole:

Oh yeah. So that documentary, I was one of the four nurses selected to participate in it. So it was myself. It was a nurse who worked in the outpatient setting but volunteered to come back into the ICU setting during our COVID surge. And then it was a bedside nurse, she was a float pool nurse who worked on our COVID units a lot. And a flight nurse.

So we came to the table with a lot of different perspectives and experience and our network asked if we would participate in it and tell our story so the rest of us could heal. So as part of a stepping stone towards healing our profession, our network, each other. And it was supposed to be inspirational.

We did talk about the really hard times through COVID and the things we overcame through it, but I think what it really showed us was it really was impactful. It was aired live on television and at our Friends of Nursing event in September, and it really was impactful, a positive impact. And now I know you can view it on YouTube. It is called The Strength to Heal and it's by Lehigh Valley Health Network.

Dan:

Awesome. Well congratulations on being featured on that as well.

Nichole:

Thank you.

Dan:

You're such an awesome nurse leader. I want to just spend more time with you.

Nichole:

Aw, thank you.

Dan:

But I think you've hit on some really good things today. It's about engaging your team, bringing them in as part of the solution, not moving to command and control in times of stress, which is really hard for leaders to do, to fall back on your training. We know as fellow Ironman, there's times in that race where you want to give up where everything just feels like it's breaking down and you got to move through it. And when you get through those things, you can prime your brain to be different.

And so I think in nursing, it's the same way, we were trained to do things. In times of stress, how do we fall back onto that training? And then supporting nurses just in different ways from giving opportunities to our colleagues to come with us to present, if that's a piece of it, or supporting our new nurses in different ways, or providing mental health and wellness support to the nurses that are doing the hard work every day. It's just such a great example of where we need to be post pandemic.

And investing in nursing, because the year of the nurse was 2020 and it was the year of the nurse, but now we need the decade following and we need to build it back. So I just really appreciate you sharing.

One of the things that we like to do at the end of the show is talk about that one thing you want to hand off to the audience. So what would you like to hand off to our listeners?

Nichole:

What I would like to hand off is to always listen to your team. They are the key to your success and the success of your patients and each other and the unit.

Dan:

I couldn't end on a better note than that. It is all about the team. I 100% believe that. That's how organizations evolve and thrive. So Nichole, thank you so much for being on the show. If people want to find out more about you and your work, where can they find you?

Nichole:

So I am on LinkedIn under my name, Nichole Persing. I am on Instagram as Namaste Nurse because I like to do yoga too.

Dan:

Love it.

Nichole:

And I am also on TikTok, but not as active on TikTok, as Unicorn Nurse 22 because unicorns are my spirit animal.

Dan:

I love it. MacGyver is my spirit animal, so I love that you have unicorns. And so check Nichole out on the different platforms, engage with her. She has some awesome ideas. And we might need to make an Ironman nurse club or something at some point.

Nichole:

Yes, yes.

Dan:

Maybe I'll go down and run a race together in scrubs or something.

Nichole:

Oh, that would be so awesome. I would love to do that.

Dan:

Well Nichole, thanks so much for being on the show. I really appreciate it.

Nichole:

Thank you for having me.

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