Joni: 

Hi, this is Dr. Joni Watson. Welcome to the Handoff, the podcast for nurse leaders brought to you by Works. I'm thrilled to introduce our episode guest, Dr. Tracy Gosselin. 

In today's episode, we're honored to be joined by Dr. Tracy Gosselin, a true luminary in the field of nursing. Dr. Gosselin brings with her a wealth of experience, serving as the Senior Vice President, Chief Nurse Executive, and Enid A. Haupt Chair of Nursing at Memorial Sloan Kettering Cancer Center in New York. With a career spanning over three decades, Dr. Gosselin's journey began as an oncology nurse at Duke University Hospital. Her academic credentials are equally impressive, holding A BSN from Northeastern University, an MSN from Duke University, and a PhD from the University of Utah. Dr. Gosselin's dedication to advancing nursing knowledge is evident through her extensive publications and presentations, including her ongoing research on incivility and bullying in healthcare settings.

Beyond her academic and clinical roles, Dr. Gosselin is deeply involved in professional organizations including the American Academy of Ambulatory Care Nursing, the American Organization of Nursing Leadership, and the Oncology Nursing Society, among others. She's also a fellow in the American Academy of Nursing and the New York Academy of Medicine demonstrating her commitment to excellence and leadership in the nursing profession. Join us as we delve into Dr. Gosselin's insights on healthcare leadership, her experiences in nursing and her vision for the future of nursing education and practice. Stay tuned for an enlightened conversation with one of the leading voices in healthcare today. Tracy, it is so great to spend time with you and to share space with you today. Thanks for being here.

Tracy: 

Thank you. This is a wonderful opportunity. Thank you for the invitation to share. I appreciate the time we get to spend together.

Joni: 

Absolutely. I always love spending time with you. You have keen insights into our profession, and so I'm just going to jump right into some conversation no holds bar here. In 2022, Nundy and colleagues shared a perspective that moved us from the Quadruple Aim to the Quintuple Aim, which focuses on care, quality, cost, patient experience, clinician experience, and now rightly so, equity. So you are in an incredibly diverse area, providing care to a lot of populations. Can you share your insights on how the Quintuple Aim framework guides your approach to healthcare leadership, particularly balancing quality and safety with the other aims?

Tracy: 

I think it's a great question. When we think about what is the work that has been done so far when we went from the triple to the quad to now the quin, and how are we building, how are we layering on the work that really serves our people across the lifespan, across their journey? And so to me, when I think about some of this, I think it's really this important piece of looking at populations, whether we do that by geocoding, state level databases, national databases, understanding what does our data tell us? Let's start there. And I think there's this piece when we start to talk about it all, sometimes understanding what those social determinants of health look like. There's different ways to look at them, identify them. The Center for Medicaid, Medicare Services has now said, you've got to do these certain things at certain points in time, which helps us have an understanding, right?

And moving forward, there's the STEEEP Protocol where when we talked about that from the Institute of Medicine years ago, we still have opportunities there when you think about safety, timeliness, effectiveness, and all the other pieces that go with that. And so when I think about the Quintuple Aim and I think about STEEEP, I think it's about how do we provide whole person health? I'm a little biased. I think everybody deserves a nurse, right? And it is Women's History Month. So maternal health needs, look at the problems we have in this country for a country that spends the most on healthcare.

Such an important point when you look at some of our outcomes related to access financing, and it's where we are really saving money? Is it long-term, midterm, early? And then when we start to think about drilling into that geocoding geomapping, when we talk about asthma rates in children, obesity epidemic, all these things that are changing… cancer in younger populations, now we're seeing this shift with certain cancers being what was thought a disease of older people. I mean, not that children haven't had cancer all along either, but we're starting to see changes. So environmentally, socially, politically, culturally, all those factors. And I think the other piece is when we talk about equality and equity, they're not the same. And it's really this important piece where I at least believe when we start to think about food deserts and air quality. There are nights I wouldn't mind walking into a fast food restaurant, walking home from work.

It's cheaper. Typically. It's easier and it's faster for me to go home and make a meal. It costs more and it's time. And when we start to think about our workforce. Nursing, the broader workforce and humanity and people, it's tough. And I think it's really this important piece of what does our data tell us? Right? We can pull from our Press Ganey surveys, we can start to look at race and ethnicity, gender.

All of it. When people bring up the word well, it's their perception. I'm like, well, it's sort of like when we talk about feelings, those are people's feelings. I can't change how people feel. And I think it is their perception of care that's rooted in that culture that they live in what they've known over time. So, I think it's the right place to go when we think about adding in the health equity lens, improving the health of populations, addressing disparities, and better outcomes for all.

Yet, I think we have to start with our data. I think we have to have true understanding, and we also have to meet people where they are to understand what those barriers are. I think hypertension is another good example of we're really going to make somebody take a couple buses to get a monthly blood pressure check? Why don't we figure out philanthropically… grants, foundations, other things? Can we get people home blood pressure monitoring cuffs and they can do it at home versus my benefits may not look like someone else's benefits and what that means to take two hours off from work. So I think really being cognizant of understanding. And sometimes it's hard because going back to the days of being a frontliner nurse and doing discharge plans, they're no different than they are today. Truly understanding what “home” means to someone sometimes looks pretty different depending whether you're urban, rural, big city, right? 

Joni:

Yeah. 

Tracy: 

There's different issues that we do need to think about. And do you have a caregiver? Some people are lonely.

Joni: 

Yeah, definitely. You said so many things in there, Tracy, that I really love. And I think this is why nurses make such great executive leaders and board members as well, honestly, because you ask questions, where are we really saving money? Because so often in healthcare we can take a short-term view rather than a long-term view to our detriment and to the detriment of the people that we serve and the people that we care for, whether that's our population or our healthcare team that we're serving. And then you mentioned whole person health, which I know I'm biased because I'm a nurse, but I feel like that's a uniquely nursing perspective and that we're really looking at everything at the same time. So it's absolutely beautiful. And then the other thing that I took note of is everyone deserves a nurse. That's really incredible. Tracy, lean into that a little bit more. Tell me more about that thought.

Tracy: 

So having a background as an oncology nurse, you see the truly great successes and the cures, right? Yeah. You also see the other side when death is imminent.

And I think midwives and FNPs have really great opportunities in our profession to welcome that new life, right? As we do as registered nurses and maternity units. Yet as people move through life, I think nobody wants to think about their death. Nobody wants to talk about that or get their affairs in order, but it's an important thing. So families aren't left struggling and all those other decisions. Yet as nurses, our presence and shepherding something that may be taboo in some cultures, we don't share diagnoses with family members. We ourselves may not want to appreciate it. It's a privilege throughout the continuum of the lifecycle to help people on that journey and ensure they have the right resources when we're dealing with social determinants and other pieces. And I think as nurses, we're often the glue, we're the glue of, oh, okay, I'm going to call you a little later and check in.

I'm going to make sure about this food bank recognizing you live in a rural county, but you can get groceries there. Okay, let's figure out how we get you financial resources to get your electricity on. And those may sound basic, but they're real issues for many Americans. So I think as in nurses, everybody deserves a nurse. And I think the good thing about the profession is we need to advocate for what we do and how we do it across our care continuum, right? Inpatient, outpatient per birth to death. And that ability to holistically support patients and families and help and “help” sounds like a very little word, but I think for all of us who have read the letters when either they were about us on the frontline or I have the privilege of reading now, it's about kindness, it's about compassion, it's about skill, knowledge. They knew how to manage my symptoms, they helped me navigate. Those are sometimes things we can't quantify. And so it is this perfect blend of art and the science and how they come together.

Joni: 

Yes, I am emphatically nodding my head. Absolutely, Tracy. That's great. So you've mentioned social determinants of health and leaning into what does our data show? You even mentioned geospatial locations and those sorts of things. I live in a border state in Texas. I see a demographic shift that's happening pretty rapidly over the span of my lifetime. I'm sure being in New York, you're at the epicenter of the melting pot in so many beautiful ways. We're seeing a demographic shift in America, and you talked about equity and equality are not the same thing. So how can healthcare leadership ensure that if we rise, we all rise together, particularly in terms of equity in healthcare?

Tracy: 

So I think first we need to be at the table. And we also need to be willing to listen. So I think those are two fundamental things, one to advocate and two, to help move forward. Sometimes we get rooted in our past and the only way is to be together. We still have a lot of fractures that I don't know if they're going to be fixed in my lifetime, within the profession, within our country, I mean in so many different ways. Yet when we go back to the social determinants and how we think about this one, it's about coming together, whatever that table is. So when nurses ask about advocacy, I'm like, you don't need to be on a board. You get involved in your town committees and councils and you will learn a lot about your town having done that work where we did community grants and you're like, I didn't know this happened. 

Joni:

This is amazing.

Tracy: 

And it teaches you the process. And that is so critically important about what is happening. And I also understand it's not for everyone. So I do think we got to meet people where they are and we've got to understand their story because there is always the concern about evidence-based practice and the cookie cutter. And when we start to look at some of the hypertension studies, who are the studies done on male versus female? And we get into race and ethnicity in so many different ways of knowing. So I think first we have to be at the table. We have to understand our data, have the discussions here, and listen to what we may not want to and acknowledge it. We need to think about what access looks like. Critical, fundamental. I'm like we have all these different things in the world of oncology, we have lots of “services on wheels,: as I call it, right?

We can do different screenings, different intakes, but what about maternal health? What about other populations of care? Especially when we start to think about diabetes, heart disease and kidney disease and how those impact different people. I think the other piece, and I said this before, we really need to be able to meet people where they are not having our lens or our perceptions of what we always think. And it's hard. I think it's really hard. I remember being a brand new nurse moving from the northeast down to North Carolina and then back to New York now, and those ways of knowing are subtle, but they do shift and change in our lifetime. And I think that's important because the lens of how we see the world sometimes may not always be the best way. So we have to be open to meeting people where they are and seeking understanding.

Joni: 

Meeting people where they are. Sometimes that sounds really easy, but it can be really difficult in some of our organizations. I mean, you mentioned cookie cutter medicine, meeting people where they are means sometimes that we give different things to different people to get them to the same outcome. And that can be challenging in our healthcare systems today. It really can.

Tracy: 

I think it is really hard, and I think part of it has to do with the pace. When we think about who pays, right? You take a day off, you have copays, maybe you have an HSA account or whatever. So I'm paying out of pocket. Okay, the provider's going to bill, the insurer has to pay, the provider has to ensure they can pay the workforce. Right? It's the perfect triangle of everybody wanting the best in a certain amount of time, but nobody wants to pay more. And it's this unique paradigm I think we all find ourselves in when you try and think about care and care models and care delivery. And not everybody starts at the same place. And I can easily walk around on a Sunday in New York City and cover six to eight miles, and I can tell you not everybody's starting at the same place. 

So when we talk about, or when people say “all boats rise,” well, some boats might need a little more than the others. I don't live in a food desert. I can appreciate why we have food banks. I can appreciate that. I can appreciate children in the town where I live who need a school lunch program who maybe need a breakfast program and it's not the same. And so we have to think about that and then plan for that.

Joni: 

Yeah, great perspective, Tracy. So as we've talked about patients and the people that we serve, I want to shift our focus to the people that we serve and our workforce. There's a lot to talk about in the workforce, and I want to try to get to as many pieces as possible. The American Nurses Association indicates that there are over 4.3 million nurses, registered nurses, that's not including LPNs in the United States. And we are experiencing record numbers of burnout, violence and harassment in our care settings, a widening practice readiness gap, a shift in our nursing demographics very similarly to what the public is experiencing as our retirements are outpacing new entrants into the profession. And then there's so much more. And so as a nurse executive, I can only imagine, I know what it has felt like for me in my past, but thinking about the workforce all the time, all the time, and at times it can seem overwhelming. And so as we think about, maybe let's start with workforce mismatches in expectations, new graduate nurses coming out with mismatched expectations of what the work is really like in care. What steps do you think are essential in correcting that, rectifying that maybe working with academic partnerships? What are your thoughts on this mismatch?

Tracy: 

Well, I think you and I probably both know, it's not like when we finished, we didn't have that thing called the electronic medical record or electronic health record. So there is technology and we'll put that over there and we'll mention that in a minute. I think first, academic practice partnerships need to innovate to the next level. Meaning is we think about curriculum competencies, training, how do deans and chief nurses come together in a very different form to understand not all health systems hospitals have a school, college of nursing or a university, and how are we having the shared discussion of what the reality is? Because the acuity today is not the acuity I started with.

And so when I think about that, if our clinical rotations are still the same of here's your one patient, you are never going to be prepared on the day, you actually start on the floor with a preceptor having 3, 4, 5, 6 patients, whatever that looks like within an institution or in a clinic or a Federally Qualified Health Center. So that experience, I think, is really important. When do you do your community health piece? How do we get those basic communication skills? Because for many, this might be their first job out of school. For some they might have worked as a nursing assistant, patient care tech, EMT. You never know where our nurses are coming from these days. So they might've had some of those skills. I think the pandemic, this is probably controversial, but I think we failed. As a nurse, I think we failed students. Our systems of how we trained, the simulation labs, we know NCLEX passing rates have decreased the past few years.  

So, I think, thinking deeply about how we all have the understanding, and this ties right back to the Quintuple Aim. If we don't have our workforce prepared to take care of the evolving needs of the country and the people, then we failed, right? We are the largest group of healthcare workers, and I think we care deeply about making a difference. And that ties back into workforce wellbeing. The piece of the technology. I'll say, we have to be able to say, what are we willing to give up? What are we willing to keep, change, and modify, and stop doing? There is that value using LEAN methodologies, high reliability, but where can technology and innovation help us work smarter?

Joni: 

Yeah, that's a great point. I too entered the workforce. I've been a nurse for 21 years. I entered the workforce with paper charts and I was a part of the nursing demographic that had moved from paper charts to electronic charts wherever I was. So I've gone through 17 billion go lives over the course of my career, which is great. It's wonderful. It really is. But as we have, while technology is such this interesting space in healthcare and nursing, as we start to see a generational shift in nursing, we have a lot of millennials and Gen Zers who are adept at technology and they also expect a lot from technology, let's just say that too, where many of our EHRs are lacking in some of the tools and resources that we would expect. But how do you view this generational change in our nursing workforce, especially regarding some of maybe conversations or even controversies honestly, about work-life balance, because we know that different groups of people, different generations expect different things. And what impact might this have on the future of healthcare?

Tracy: 

That's a great question. I recently had one of our nurses in our pediatric intensive care unit ask me to do a generational talk with her, and I have to thank Grace for that. I had a nice discussion with her. We're at the magnet meeting. We were talking about different generational things, and clearly, I know we're in different generations, so I knew which part of the spectrum I was talking about, and I knew which part she was talking about. But it's great because as a generation, as much as I'm not about labels, they keep me on my toes.

Joni: 

Absolutely.

Tracy: 

There's this piece where we are putting our slides together and she's like, oh yeah, we'll use this QR code, do a survey, launch it back. And I'm like, “you're doing those slides right?” I'm like, oh boy, right. I found out that I'm going to learn this trick. So when I think about it, I think part of it is our training. It goes back to the prior question around how do we get people ready? So I think that would help them. Simulation is nothing like the real world. And so how do we think about academic practice, partnership and preparation of all the next generations of nurses that we're going to need? And I'm quite certain somebody said something about me and my generation when I was starting out, but I do think it's a group that cares about causes, they care about, causes climate change, social equality, a sense of belonging. And I think there are some very good things there because they care deeply, and I can't teach people that. You have to bring that.

And I also think one of the unique places they are at is based upon what's happened in their life, what have been the world events, national events, and watching leaders fight during COVID. I was watching the news this morning. This kid's like, I don't know who I'm going to vote for. Adults fighting during Covid presidential election. And if you're 22, 23 and you're like, what does the world hold for me? These are adults who are supposed to care deeply, right? Yeah. So I think the good thing with them is my own bias is they do focus on wellbeing. I love it when I round and I see it and grab it and they're like, oh, I just started. And I can tell because they have the clinical nurse one, and I'm like, what do you do for fun when you're not here? Because the work's hard. The work has always been hard.

Joni: 

Totally.

Tracy: 

And it's like, well, I play soccer two, three times a week. I'm like, good for you, right? Fight for, I meet these people and we talk about certain things, and I'm like, oh, I never would've told anybody that if I was a new grad. But I think they're also in a different place from a mental health standpoint. And it's hard. This isn't right. Things have changed a lot of different things. And so I think it's really about how do we mentor them? How do we coach them? How do we create that? How do we look at our orientations differently? How do we think about nurse residency? Where do we get people, especially those who graduated the past few years, who spent a lot of time in sim to a place where they are comfortable and the work is meaningful to them because meaningful is critical to that whole, Maslow’s Hierarchy of Needs, right? Yes. This is great, right? It's hard. Oh, yes. But I made a difference.

Joni: 

Yeah, that's a great perspective, Tracy. It's funny because anytime I feel like I have given a talk on generations, everybody starts to like, oh my goodness, get really nervous. But I think you hit the nail on the head because across all generations in nursing hold the same deep seated desire to care for people holistically. And it sounds like Grace is giving you some reciprocal mentoring opportunities to teach you QR codes and all of that kind of fun stuff too. And so across our entire profession, that diversity really just makes us beautiful and stronger in so many ways. I mean, it's really our younger nurses, like you said, that are stretching us in wellbeing and mental health in all of those large spaces. For sure. I love that. You mentioned about the work always being hard, it seems like, and it's probably just recency bias, honestly, although I will say I have never seen so much workplace violence in nursing as there is today. It is astounding to see. How do you view workplace violence for the workforce? How do you think healthcare institutions can better address workplace violence to protect both staff and patients?

Tracy: 

Workplace violence? I think it is one of those things coming out of the pandemic. We've seen the need for more mental health services across many. And we're not just saying healthcare, we're saying everywhere. I also think it's something that we maybe chose not to acknowledge, sometimes in healthcare, with the patient's always right? The patient always gets what they need. Well, not when you have a nurse with a broken nose, not when you have a physician colleague who's scared to walk out to their car, not when somebody makes racist comments. And I think as an organization, we have to go back to looking at our values because our values serve us.

And when we talk about a patient's bill of rights, it clearly outlines certain behaviors. There is this piece around being able to have the conversation. I think we can all relate that there are some things that are really tough that the patients and families go through. And is it a one time or is it recurring? So as organizations, there's a variety of resources. Healthy Workforce Institute, a variety that I've used before, work in my prior role, current role on how do we still have empathy, still have empathy and kindness, yet really ensure that the behavior is unacceptable. Because as soon as the unfair treatment behavior happens, for me, I worry about quality and safety because I'm not going to want to go in the room. Am I going to get yelled at again? Do I bring somebody else with me? How do I manage this? And places have used behavioral contracts, signage, tiered escalation processes, and I think it's really important having done this work before and doing it again, but also knowing that you're not alone as a single individual or a single discipline.

It's about, again, how do we come together? How do we use our data to make good decisions? So whether that's your patient rep, department security, threat management, legal risk, other clinical quality, clinical colleagues coming together, I think it provides a good perspective. And if you have a patient family advisory council, because in my update to the board, I have an update next week. This is one of my agenda items just to touch on where we are, just because it's from the frontline to the board. And I think it's really important for people to understand that. So there's that side, and then there's the colleague to colleague and my own research in that area, whether it's from your horizontal, vertical, other clinical colleagues, your leader, and I think some of it's the same. 

I remember what my first incident felt like, and I was very grateful to have a trusted colleague because after I was in tears, I was so angry. It took me a few days, but somebody who could coach me through that, and I did something and was able to follow up in a way that was meaningful to me to say. So I think being able to name it, but I think as leaders, if we permit it, then we're promoting it and we're saying it's okay. And so there has to be the discussion around, did it just happen once because this diagnosis was bad, or is it a continuous baseline?

Joni:

That's great. Tracy, I'm just writing down your phrase, if we permit it, we promote it. That's gold right there. So I want to wrap up with two final concepts because you are talking about how nurses do hard things every single day. And nursing, to me, I feel like nursing is always hard. I've never had an easy nursing job. And you've mentioned naming things and calling things out and acknowledging the hardships that we have, but then you are also talking about for patients, but I want to flip it to nurses about one time versus this pattern sort of thing. And when we've talked before, you've mentioned this concept of nurses either in a state or nurses having a trait. So talk to me a little bit about your perspective about acknowledging hardships and then working with nurses and healthcare team members for a more supportive work environment.

Tracy:

So I think for me specifically, I don't think I understood this as the frontline nurse. I think I grew to understand it more as a leader, specifically in leadership roles, because nurses are always leaders. They're always advocating. So we'll take the nurse driving to work, they get a flat tire, they're late. I come flying in, I yell at you, blah, blah, blah, blah, blah, blah, blah. And you're like, oh my gosh, Tracy, I've had enough of you. But it only happens that once the leader knows, leader comes to say, “Tracy, what happened here?” And I'm like, oh, my flat tire. And then my lunch is all over the car. I don't know. Versus every time I'm a charge nurse, I treat people, maybe I roll my eyes. There's the very overt things that happen. And then there's the covert, and that's more of a trait.

So the state is the one time situation of what maybe happened, but my trait doesn't flare. That's not normally me. But sometimes people who have this, we know there's not a gene, at least that I've found in the research yet about bullying, the bullying gene, yet every time, right? We'd all be dealing with something very different. But it is this piece around and we know it. It's like, well, they're the best nurse or they're the best supervisor, they're the best home health aide or whoever they are. Well, maybe they're not the best to us. And what does that say to the rest of the workforce? And do they develop? They coach people who want to be there. Sometimes we're our own worst enemy. So either feed your garden or weed it, but figure out which one you're going to do. You can't do both.

Joni:

That's good. It took me a long time to learn this in leadership that people with those traits, but we still call them the rockstar clinical person. It took me a long time to learn that they're actually a low performer. And that was hard to learn, honestly. It was pretty painful. 

Tracy: 

Well, that's true. 

Joni: 

Yeah, absolutely. So Tracy, I am always curious what leaders are doing to sharpen themselves. I know that in New York, you are not short of incredible experiences to pour into your soul, to nourish your mind and your body and your spirit. And so I'm curious, what are you reading? What are you doing these days to sharpen your skills? Tell us about it.

Tracy: 

Yes. One always has to find those moments to read. Well, one, like everybody, I have all my journals that come in that keep me very professionally aware and engaged. So that's always good. I joined a book club, so I love book clubs, but I've never really done one. So it's this strange piece. I'm like, oh, well, how's that going to work? And logistically, I had done my first online book club, and it was done by the DNPs of Color. And I read the book, the Black Angels, the untold story of the nurse who helped, well, the nurses who helped cure tuberculosis. And I read the book pretty quick. We're still doing the book club. We have a few sessions left, and it's been great. But it centers in New York. So I got to learn New York history at a tumultuous time.

The twenties, the thirties, the forties, the fifties. This hospital in Staten Island, black nurses could not necessarily work in the south. And if you wanted to be a nurse, you had to come north. And we still had racism issues, but it was an amazing book. So I love that. And then one that took me a little longer to get through was by an author called Doug Silsbee, and it's called Presence-Based Leadership. And I really had to think about it. So there's the books we read where you're like, this is great. And then there's the ones where you have to stop and pause, because this really gets into who you are as a leader when you think about your context, your identity, your soma, which is your body in certain situations. And then the sensing, the being, and the acting. And I did, I had to think deeply. I had to pause, and there's certain exercises in the book. So it took me a little longer to read that one I just finished, and now I have a mix of books. I haven't decided quite yet on my nightstand of what I'm going to pick yet. So we'll see.

Joni: 

Nice. Very great. Tracy, what was the name of that last book you mentioned?

Tracy: 

It's called Presence-Based Leadership.

Joni: 

I'm going to have to check that out. So Tracy, we've talked about a lot of different things today. We've talked about the quintuple aim and everything that's rolled up within that Whole Person Health. You've mentioned everyone deserves a nurse equity and equality, and then we shifted over to the workforce and you've just dropped jewels for us. So out of everything that we've talked about today, what do you want to hand off to the listeners?

Tracy: 

Wonderful question. So I think there's a couple things, right? What are you willing to hear? And listen, those are critical things and they're different. How do you use your data? And I think this is so critical with the workforce of today. I go to them to learn. I can't solve your problem in my office. That's the worst thing that could happen for anybody. But it is to help me, show me, teach me. And so I think those are critical pieces. When we talk about the Quintuple Aim, when we talk about equity, really being able to do that work and stepping back. And you don't always have to like it, right? You don't always have to like it, but it is being able to gain the perspective you need as a nursing leader, from the frontline to the boardroom, to your organizations that we lead, right? Because at the end of the day, it's about making a difference.

And I think that's the critical piece to draw back on because I think when you know that it helps your wellbeing. One of the things I started doing, Brian Sexton was a colleague I had back at Duke, and he did this study called Three Good Things. And I thought, okay, I'm going to try this. Right? Alright. So at first I was like, at the end of the day for three weeks, I had to write these things down. I was like, oh my gosh, three good things. I can't even come up with it. And this was well before COVID. Well, then I got on a roll. So I kept doing it for a while and I stopped and I would do it walking out of work. Well, during COVID, you're a chief nurse and you're like, I got to find the good things. So every day, and I started it again this year, and so I'm like, this is great.

At the end of the day, and some days I have more than three good things, but I think sometimes we feel the setbacks and that's what we remember. We don't always remember the good things that happen. And maybe it's not three things every day, but maybe it might be one. And I think trying to remember the positive and the joy we bring to people, I think that is the most critical thing when I think about as we go forward and what we've talked about. Because as nurses, we have so much to offer people, and that to me is the critical piece of why we do make a difference and why everybody needs a nurse.

Joni: 

Yes, absolutely. Tracy. Tracy, where can people follow or connect with you if they want to find out more of your work or just be like me and just keep you in their lives to learn from you?

Tracy:

Oh, you're too kind, Joni. Well, I am on LinkedIn. You can, I have publications. You can go read them. They might put you to sleep. I don't know.

But always feel free to reach out on LinkedIn. I've met a lot of great people that way. Different people I've mentored who I haven't really known before. And I think it's the opportunity to connect and learn from people. We're always learning from people, and that's the key part.

Joni:

Excellent, excellent. Everyone please after this, yes, go find Dr. Tracy Gosselin’s publications. They are exceptional. She's an expert in several areas, so you'd get the benefit of her continuing to speak into your life directly through her publications. And everyone, please find Dr. Tracy Gosselin on LinkedIn to follow her work and continue conversations. Tracy, I love your blend of expertise and questioning and sharpening. It is a delight. Thank you so much for handing off such spurring leadership guidance with us today.

Tracy: 

Thank you, Joni. I appreciate the opportunity.

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