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 today. We have the privilege of speaking with Dr. Brooke Baldwin. Brooke serves as the Senior Vice President and Chief Nursing Executive at Oregon Health and Science University Healthcare or OHSU Healthcare, where she also holds the role of Associate Dean, Clinical Affairs at OHSU School of Nursing. Prior to joining OHSU Healthcare in January, 2023, Brooke served as the Chief Nursing Executive at UCI Health, and she's been instrumental in driving transformational change within OHSU Healthcare. 

As Chief Nursing Executive, she has a pivotal role in shaping strategic goals and envisioning the future of patient care, ensuring that nursing standards remain exemplary across the entire healthcare system. Her leadership extends to overseeing nursing and patient care initiatives in both acute and ambulatory care settings, ensuring that every aspect of the patient experience is of the highest quality. But Brooke's impact reaches far beyond the administrative realm. She's deeply committed to empowering nurses to thrive in their roles, advocating for their professional growth and development. Brooke is passionate about helping nurses navigate the complexities of healthcare, including translating the emotional aspects of their work into language that resonates with nonclinical groups. Join us as we delve into Dr. Brooke Baldwin's inspiring journey and learn how she is spearheading efforts to transform nursing and elevate the voices of nurses everywhere. Dr. Baldwin, thank you so much for joining us today on The Handoff.

Brooke:

Alright, thank you for having me. Glad to be here.

Joni:

Absolutely. I've been looking forward to this because the last time that you and I shared a conversation, you shared a couple of phrases that I have really just been thinking about quite a lot recently. You said that you're working at OHSU to reimagine nursing, so we thrive, which is a pretty astounding and exciting statement from my perspective. So I would love to hear, where did this originate? What were you working on? What are you working on? And what does thriving in the nursing profession look like to you?

Brooke:

I think my thinking started on this probably most recently relative to both leading pre-pandemic, during the pandemic, and now post pandemic. And when I thought for myself, how I led pre-pandemic, and then the impacts that came with the pandemic, and learning through that what leadership looked like during that time, and then how multiple things had changed. Not only did we have the pandemic, but we also had the racial reckoning with George Floyd’s murder. We also had examples for me of the trial of RaDonda Vaught and what that meant for nursing professional practice and the obligations we have and the impacts that our practice has on patients and the impact that patient care and following our professional practice and practice that is needed, how that can be disrupted for a variety of reasons. And thinking about that, how I wanted to be a different leader in terms of incorporating new things into my practice and taking on this new chief nurse executive role at OHSU at the beginning of 2023 and understanding the context of what had happened here through the pandemic.

The organization was also in their nursing contract negotiations with the Oregon Nurses Association and hearing what the impact of the pandemic and on nursing practice that was coming through in those bargaining sessions, it felt really necessary to say, who do we want to be as nurses moving forward in the present and in the future? What does that look like and what should it encapsulate and encompass? And that really set me to have a conversation with the nurse executive team here at OHSU to talk about those individual perspectives, me being a new leader and setting a new vision and strategy, but also understanding the deep context and the historical excellence of nursing here at OHSU and how can we look towards the future and what does that look like? And that's really where it all started.

Joni:

Oh my goodness. There's so much wrapped up in that. I love that you sort of pause with your leadership team to kind of rethink. Obviously we're doing a lot of things right now globally in our profession and in healthcare that we've done for a long time that really just haven't been working and we're kind of perpetuating some things. And so I love that you took the time to kind of pause and think about who we do we want to be? And so from your perspective, how do you move OHSU forward in re-imagining nursing so that nursing is thriving at OHSU?

Brooke: 

I think it started with an acknowledgement of where people were at, where nurses were at…the talk about moral distress, the discussions about burnout, the discussions about mental health, and then pausing and saying, what exactly do we think about these things? What is our awareness of what's really going on in the root causes? And then how do we plan for what to do next and what to do next? There are certain things that seemed clear. We knew that people had left the organization, we had to spend time on the workforce, but what was important? What did we really want to focus on? How did we want to approach it? And so that was some of the starting points and really building out some guiding principles. What was our new vision for nursing for the future from the nurse executive team vantage point? What were our guiding principles that we could all align around as we talked about this amongst our executive team, but also throughout all levels of nursing and nurses in different roles and in different care settings? What was that common shared mental model that we could align around in order to define that future? And that's really where it started and how we kind of came together to say what's going to guide us into the future so we can develop clear tactics and metrics and outcomes associated with driving that strategic roadmap.

Joni:

Yeah, that's so good. I think too, you mentioned pausing and rethinking some of our biases, our long held beliefs. It's hard to do. It takes time to do that and to also look at the evidence, but then to create guiding principles for a large workforce that can be challenging in and of itself. So there's a lot of upfront kind of work. Then once you get the work done, those guiding principles kind of let you move a little bit faster, honestly. So as you developed these guiding principles, did you actually put them on paper or what does that look like pragmatically for OHSU?

Brooke: 

Yeah. I should also mention that some of many of the guiding principles came out as a new leader into an organization, having focus groups with all different roles in nursing and hearing themes over and over again, and taking those themes to help build the guiding principles. And then, yes, we absolutely created a document and PowerPoint slides so that we could utilize those in different settings and in different ways. And it really was an outline of what we called the “Fiscal Year 2024 Nursing Operational Plan.” And in theory, it was really a strategic roadmap, but we really wanted to get pragmatic. And yes, we have guiding principles. Yes, we have a vision. Yes, we have six different work streams that are operational in nature, strategic in nature, but we need to have clearly outlined tactics that everyone can connect to and cascade throughout the different units and departments, whether that be ambulatory setting, perioperative setting, inpatient setting, pediatric settings, wanting each individual department and unit to have a document from which they could connect the daily work happening in those work units in order to express in everyday work that strategic roadmap.

And that's what that looks like. And often those slides are used in various presentations to keep us connected. And in my presentations, I often use the visual of a map of the stars or just stars in the sky and with a second slide that has a constellation. And using that to represent at OHSU, we had so many examples of shining excellence that were happening, but often in silos and not connected to one another. And so part of our journey was to build the constellation and what I refer to as “the narrative of nursing and patient care services” that connects us all and keeps us connected to those guiding principles, those concepts, and being able to execute on a strategic roadmap that we can identify each of ourselves as an individual and our individual teams and groups in that roadmap and operational plan.

Joni:

Wow, Brooke, that is a powerful metaphor, and you're explaining so many pieces of complex systems right now within your metaphor. And so it's no wonder that you have such a balanced operational roadmap that you've developed to kind of balance the individual but also the team as well, so that everybody sort of has those minimum specifications, those very specific guidelines, so that they can see that they can take their own individual talents and move OHSCU forward in their departments and teams. That's powerful. Thank you for sharing that. I may replicate that in my work in the future. I'll be sure to credit you, Brooke, I promise. But I also love the language that you shared creating the narrative of nursing that connects us all. That's powerful and beautiful. At the same time, you mentioned in your roadmap there are six different work streams or pillars to help ensure leaders and patients thrive. Can you walk us through what are those six different pillars or streams on the roadmap?

Brooke:

Absolutely. There are six in total. The first outline, and these are in no particular priority or order, is workforce. We knew that we had a high number of contract labor and we needed to continue to build our career pathways for bringing nurses in. And so there is a work stream really focused on workforce. We are also adopting here at OHSU, Human-Centered Leadership in Healthcare, which is a recent book published, I think in 2022. Kay Kennedy, Lucy Leclerc, and Susan Campis are the authors and researchers, and we have had them out here to help us implement and use their program to help us ingrain those principles within our leadership teams and really teach and learn and have peer learning groups in order to facilitate integration of that work here at OHSU. The next one is Safe and Appropriate Staffing and Innovative Staffing. And in Oregon, we recently passed in September of 2023 legislation for staffing ratios. And what we also wanted to do is ensure that we had clear professional governance around safe and appropriate staffing and building what that looks like and addressing ongoing issues around appropriate staffing and safe staffing in the organization.

We also have a work stream on clinical excellence and reducing preventable harm. One of the empirical outcomes of nursing work is really around our nurse sensitive indicators and other quality and safety metrics that we work on with our interprofessional teams. And so that needed to become a clear focus for us as things had changed throughout the last few years in a way where we needed to recenter and regather around working towards that level of clinical excellence. And then we also built a work stream around diversity, equity, inclusion, and belonging. And while generally we want those elements to be in every one of the work streams, we specifically called it out to make sure it was visible that we were actively as a nursing services and patient care services team actively embarking and working on how to be inclusive and look at areas of diversity, equity, inclusion, and belonging in the daily work and let that be shown through our presentations.

Joni: 

Wow, that's great. So you mentioned Brooke, workforce, human-centered leadership, safe and appropriate, innovative staffing, clinical excellence and reducing preventable Harm. And then DEIB. And so there's one more. What's the sixth piller?

Brooke:

And the sixth one is re-imagining our professional governance structure. And within the last year or two, there's been a lot of discussion within nursing circles about what does shared governance versus professional governance, the work of  Tim Porter O'Grady and colleagues that work with Tim Porter O'Grady really putting out a new book very recently in the last couple months and some articles. And so we are re-looking at our structure and shifting from what we were calling it OHSU, a shared governance model to the professional governance model and making sure that is strong in robust in both structure and processes, again, to support those empirical outcomes for nursing and make sure they're disseminated throughout the entire nursing services at all levels to each work department. And there's a connection back with bi-directional communication.

Joni:

Wow. Brooke, I mean you make no small plans at OHSU, I mean just one of these is enough, but all six of them together and definitely re-imagining and kind of shifting from shared governance to professional governance structure. That in and of itself is a big shift. So kudos to you and the OHSU team for truly re-imagining nursing. I mean, you really are working on what you said you wanted to do. And so as we think about nursing, there are a lot of conversations these days about the value of nursing. I'm curious from your perspective, how can nurses better demonstrate their value within healthcare systems and ensure every voice is heard and that every nurse is empowered to speak up?

Brooke:

Yeah, I think the value of nursing is something we talk about a lot here at OHSU and I think of it from two different pathways. The first is within nursing itself, how do nurses value nursing? How do we value one? The other is how do we demonstrate nursing's value throughout our entire enterprise, our organization locally and regionally and nationally? And this is so important because sometimes it is apparent to me that some of the work of nursing can be hidden from others and is not visible.

And one of the ways that I think making the value of nursing really comes through in our creation of the strategic roadmap in this operational plan and building presentations that I can infuse and others can infuse either at the unit level or anywhere within the organization, that we utilize our work streams to continue to demonstrate that value and that work being done. And we have consistent messaging and branding around that. And so that we're using both internally and also building a strategy for external, how we communicate that externally, whether that's via social media or other platforms, to really understand not only how nurses view their own value, because we can have our own perspective and vantage point of that sometimes or often we need to translate the work of nursing to others who are in our organizations, in our enterprises, and what does that look like to them in a language that they understand because it is not always received with the same intent that we're trying to communicate the value of nursing. And so we talk a lot within our leadership teams and within our teams at OHSU about what voice, what messaging, what words, what is the methodology for us to communicate nursing's value at all levels in the organization so that it is heard and received in the way that we intend our language matters, our words matter, and how we present it does matter.

Joni:

Yeah, that's gold. Brooke. I think at least in my experience, nursing, even though we are such collaborative colleagues, we often silo our communication and use our own jargon. We can tend to have some emotional language as well that doesn't translate very well in board rooms and with our financial colleagues and operational colleagues. And so again, you're doing some strong work to really pause and help people rethink and be intentional, which is strong leadership for your entire team. And so in addition to helping people kind of pause and think about language and tone and who we're talking to, how do you encourage agency in nurses so that nurses all throughout OHSU feel empowered to speak up? And how do you encourage them to translate some of that emotionality in nursing into other language for other colleagues to understand?

Brooke:

When I approach this conversation, I start with leaders, right? Because leaders at every level need to understand this because they're working with interprofessional partners on a daily basis and then making sure our leaders can then translate that to the direct care staff. And one of the things that I start with describing nursing leaders are clinical operators, which has two components. We are active and participative in operations, the generic use of the word operations. We are also clinically oriented as well, and we have a clinical specialty and knowledge. And when we put the two together, that is a very strong combination to be able to have that clinical expertise that informs operations, operational expertise that can help inform clinical. However, when we think about caring for patients, we feel the emotions of that and we should never not acknowledge that. We need to acknowledge we have emotions and we need to start talking amongst ourselves and within our individual selves to say, I have these emotions. How does it translate into language of operations? And it's almost being our own translators, because I described it this way to a nurse leader.

There are very few finance people who will know what it feels like to be at the side of a neonatal bassinet when there's an urgency. The parents and family are in distress. And we feel that. And sometimes when we talk, we assume people can empathize with that emotion and feeling that's coming across. However, others who have not been at that bassinet side or that bedside have no way to translate the emotionality of wards of how that feels and that maybe distress that comes or the intense kind of cognitive load or emotional load that has no context of understanding and translating that into their own understanding. They have not necessarily experienced it in the same way. And so taking the time to understand the emotionality and to start translating that into clear language of operations and finances, I'm not saying that's easy, but it is our responsibility to make that shift because as we as humans, we have that need to be heard and understood. And in order to do that when we're talking to those who don't have the same lived experiences as us, we need to find the language to translate so that they can understand. And certainly that is something that I work on every day, and it is not always easy to figure out what that language is, but practice, practice, practicing how to do that is critically important.

Joni: 

Wow. Brooke, I took some notes as you were talking and I love how you phrased that. It's our responsibility to help make that language shift. And just recently, I've been rereading our code of ethics as I'm working on another project, and it sounds so simple, but it's easy to forget that our ultimate responsibility is to the patient and our responsibility to the patient includes helping translate the right information to the right stakeholders at the right time. That's really powerful, Brooke. And I'm curious, how has your team received this? Because again, it kind of seems simple, but simple doesn't always translate into easy. These are some hard pieces, and again, communication, the evidence shows us it does not get better with experience. We have to be intentional and practice it. It's a skill. So how has your team received this overarching reimagining and your request for them to pause and think through some of these things. 

Brooke:

Knowing that any leadership transition is always a transition and a journey and an iterative process, I think overall it has been received well. But that doesn't mean that we haven't had to recircle back to conversations that we haven't had to take a pause when it appears we're all moving in the same direction and aligned, but then something happens and it's like, oh, let's pause for a second. Let's go back to these principles. And I think when I am talking to leaders and we are talking to other nurses and connecting vision and connecting that shared mental model, it is always fraught and rife with bumps in the road. But it is our responsibility to pause and reflect on that because it's not always easy. The transitions of change, transitions of leadership, transition of one way of a framework for nursing and shifting to another can be rattling to some people and it can take everything that they thought they knew and make it…I'm not sure where I am in this journey. I'm not sure if I'm connecting to this vision. I'm not sure if I'm seeing and feeling those things and being ready to have the conversations, asking those who are having those emotions and thoughts to be open and to seek out more clarity and understanding, helping each other to find where we're passionate about and sometimes not. All of the six work streams that I described to you would make sense for everyone, but there is usually something that each of us can connect to and start building from there. So it's an ongoing iterative process. There's not a magic wand that everything changes from one day to the next. And even looking at what we've designed as the roadmap and the operational plan, knowing that it will change, that this is never done, right? I love that we will continue. I love that even something we put down on paper last week or in a slide presentation may have, may not be the same today. And acknowledging that agility and there's a bit of uncertainty that happens as well, but being able to pivot and be agile when we need to and acknowledge this is no longer serving us in a way that we thought or intended it to be. And being open to that.

Joni: 

Brooke, that is so good. And really that's what we need to be able to unlearn and to learn new things, especially with a vision as big as re-imagining nursing so that the nursing profession can thrive. That's good stuff, Brooke. Just good stuff. And so obviously I've been enthralled with the work that you're doing, and I ask all of our guests this because I'm always curious with what makes a leader, how do they form and how do they stay sharp and get the ideas that they have? I know what I do, but I'm curious, what are you reading or doing to sharpen your skills or to nourish your soul so that you can reimagine nursing? 

Brooke:

Try to stay connected to colleagues throughout the nation, even regionally, locally. I'm always reading something and I do confess that I might not always read books or articles from front to back. Sure. I may open a book and read a chapter and see where that takes me. And what I think that helps me do is see trends that are going on, really stay connected to what's important to me. One of the books that I read this year that has been highly impactful is called Taking Care, the Story of Nursing and Its Power to Change Our World from Sarah DiGregorio, who is a journalist. But it really connected me to the history of nursing in a way that I had never seen it written before. But certainly I will say that the book made me angry in a way. Not that I was angry at the book, but I realized how much there are things in the history of nursing that I may have never acknowledged before and need to start wrapping into my practice and bringing into my practice that I need to think about differently about the agency of nursing, how nurses can be empowered to lead in healthcare, where there may have been historical efforts to squash that voice for a whole host of reasons. 

And then looking at the things that resonated with me in that book, thinking about what I read in nursing journals and thinking about what I hear at conferences and what's being written about on blogs or listservs or on websites. And really trying to take all of that, understand what I think about it and how I should put it into my frameworks and practice as the chief nurse executive at OHSU and what that may feel or look like to others. And while I constantly am reading, I know that not everyone has that space to do so. So I try to share tidbits of information in small bites. I encourage others to do the same, but really staying relevant into the current topics that are happening. Things that I read 10 years ago that were really impactful to me and I really tried to put into practice have shifted somewhat and really haven't remained stagnant. And so I want to make sure that I am staying current and having those open conversations about how important it is to understand the current legislative landscape regulations and what's important to people, what's important to patients, what's important to nurses, what's important to the entire interprofessional team. Having conversations can be very meaningful and help to design my own thinking and continue to evolve my thinking and really stay in a space of learning every single moment.

Joni:

Yeah, that sounds great, Brooke. I mean, you really have had this thread of rethinking and relearning throughout our entire conversation, which I appreciate as well, because our work in our world has changed and it will continue to change. And so often I have fallen into the trap and sometimes still do that. Something's written in pen, it's like indelible. I can't take it away, but it has taken me years of kind of thinking, why do I think that way? And undoing that to think very similar to what you're saying is that this is kind of written in pencil right now. We can shift it based on new evidence or changes that are happening. That's great. So we've talked about quite a bit of work and goodness today, Brooke. I'm curious, what would you ultimately like to handoff to nurse leaders at every level of leadership and in every setting today?

Brooke:

The thing that I always think about is I feel a great privilege to be a nurse, to be licensed as a nurse, to be part of this profession. It is definitely not the easiest career to have, and we are highly regulated. The reasons why each of us went into nursing may not always be readily apparent to us in the daily grind of work. However, our profession can help shape the health of our communities and our nation. And for me, that's a privilege. And connecting to meaning and purpose is something that I continuously have to do. And I always want leaders and other nurses to know that that journey is never ending. What you're passionate about today does not have to be the same thing that drives you and you're passionate about. And where you head in your career can be different tomorrow. And to acknowledge that it's a journey and that you can always adjust and adapt, but being in a place where you're frustrated, being in a place where you feel that I'm at the cusp of leaving the profession to take the time to think about what other perspective, what other possibilities exist, and using your mentors and using your network to help you see possibilities that at any point in your career may not seem present or available.

Joni:

That's powerful encouragement, Brooke. Thank you for that. Brooke, where can people follow you or connect with you if they want to find more about your work? Your work really does feel very edge-running, and so I have no doubt that there are people that are going to want to learn from you.

Brooke:

I would say the easiest connector for me is on LinkedIn. That's where I do all my professional connecting. I'm also on Instagram, but that's more of a personal account. If you like sunsets and pictures of sunsets and sunrises and nature, that's probably where you would want to go. But LinkedIn is probably definitely where to go. And then of course via email, which I believe is probably online somewhere at OHSU in a directory somewhere that people can access for OHSU as well.

Joni:

Absolutely. Absolutely. Well, excellent, everyone, be sure to find Dr. Brooke Baldwin on LinkedIn to continue conversations. Brooke, I love your blend of passions, your perspective on rethinking, unlearning, relearning, and the evidence-based hope, which you are using to propel it, propel our profession. So thank you so much for sharing your spurring leadership expertise with us today on The Handoff. 

Brooke:

Thank you. This has been so much fun.